Inter Press Service - June 23, 2009
Servaas van den Bosch

"My rights were violated and someone needs to be held accountable," says 38-year-old Shikongo in her iron corrugated house in Okahandja Park, a poverty-stricken township of Namibia's capital.

On Dec. 29 December, 2008 Shikongo, two weeks overdue, was booked into Katutura State Hospital for a caesarean section.

"That evening a black lady doctor came to me and said: 'When we operate tomorrow we will close you because you have HIV and you have had too many children. Your uterus is tired'. 'Closing' in our Oshiwanbo language means sterilising," Shikongo told IPS.

"I was very afraid, but I didn't know if I could say no to a doctor. When I was rolled into the theatre the next morning, the same doctor rushed in with a green form. She told me to write down what she said; that I consented to sterilisation because I felt I had had enough children.

"After removing the baby, the doctor ordered her white colleague: 'Cut, cut again and now tie tightly!'"

Shikongo is one of a group of twenty women who claim to have been forcibly sterilised by state doctors. All of the women are from impoverished backgrounds, with little or no education. And all are HIV-positive.

Consent

The ministry of health maintains that all procedures were consented to and therefore legal.

"Doctors may recommend a procedure, but consent must be given completely freely and voluntarily and should never be forced," says attorney Linda Dumba from the Legal Assistance Centre (LAC) in Windhoek that represents the women.

One woman's consent form, dated Dec. 8, 2008, states that the nature of 'tubular ligation' needs to be explained to patients and they must be told that "the object of the operation is to render [the patient] sterile and incapable of parenthood."

The signature of the attending physician, although required, is missing on the form that IPS has a copy of.

The practice first came to light in 2008 when three participants at a workshop of the International Community of Women (ICW) in Namibia said they were sterilised against their will.

The LAC organised meetings in low-income Windhoek communities to warn HIV-positive women. Several more victims came forward. Meanwhile in South Africa, the Woman's Legal Centre (WLC) has collected 12 cases of what they're terming coerced sterilisation, all in public health facilities.

"In Namibia 19 out of 20 documented sterilisations took place in two state hospitals in Windhoek and one in Oshakati State Hospital in the North," says Dumba. "The first reported cases happened in 2003 and the last in December 2008. This means that sterilisations went on even after the ministry was informed."

According to the lawyer, several doctors performed the operations. "The medical files testify to at least six different doctors."

No medical grounds

Obstetrician Bernhard Haufiku, a former chair of the Namibian HIV Clinicians Society who is familiar with the case, disputes that sterilisation is necessary for HIV-positive women. "The risk of mother-to-child transmission of HIV can be minimised through early diagnosis and antiretrovirals."

The number of children that a woman has already delivered is also irrelevant. "To say that a uterus is 'tired' is absolute nonsense."

According to Haufiku, rumours around sterilisation have been circulating in the medical profession for years. "Especially in the era before ARVs, it was considered a suitable permanent contraceptive by some doctors."

But some physicians that IPS spoke to, openly question the women's story. "It's a fact that these operations happen, but in my opinion it's highly unlikely the women were 'forced'," says one female specialist who has worked in Katutura hospital.

"Either someone is lying or - and this is quite possible - some serious miscommunication occurred between medical staff and patients."

Bernhard Haufiku also admits that "a lot gets lost in translation" in the state hospitals.

Government attorney Philip Swanepoel, who will defend the ministry in two of the lawsuits, thinks he has a strong case. "We will deny that sterilisations happened without consent and have the medical files and consent forms to prove it. I am very confident we will win this."

But the women maintain they have been deceived.

"They told me to sign where the dots were," says Teresia Nangolo* who was sterilised in 2006, at the age of 33. "They said: 'We are going to close you because of your HIV status.' I didn't get time to think and they didn't explain.

"Six weeks later I went to the clinic for family planning. The nurse looked in my medical passport and asked me: 'What are you doing here? You are sterile.'

"I don't understand why they had to do that. I can control myself and not fall pregnant."

Reversal of the procedure is possible but the success rate is low and it is extremely costly. "Unless it is covered by the ministry, it's highly unlikely these women will be able to afford reversal," says Haufiku.

Like Anna Shikongo, Nangolo learned of her HIV-status in 2002 and gave birth to several sero-negative babies since then.

"None of these women asked for sterilisation," says Linda Dumba. "We will bring in doctors, psychologists and other experts to show that there was no due process of informed consent in the public hospitals."

The LAC has started litigation in eight of the cases. The trial is expected to take place before the end of the year.

*Not her real name

*****

+ UGANDA: Smaller Families, Manlier Men (http://ipsnews.net/africa/nota.asp?idnews=41890)

+ PERU: Forcibly Sterilised Women Gain Voice in Congress - 2006 (http://ipsnews.net/news.asp?idnews=33918)

+ ARGENTINA: Systematic Mistreatment of Low-Income Pregnant Women - 2005 (http://ipsnews.net/africa/interna.asp?idnews=27001)

+ BRAZIL: Women with HIV Defend their Right to Bear Children - 2002 (http://www.aegis.org/news/ips/2002/ip021229.html)

+ International Community of Women Living with HIV/AIDS (http://www.icw.org/node/471)

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