Sterile without consent

Namibia’s ongoing court case involving the alleged sterilisation of three HIV-positive women without their consent has exposed serious human rights violations within the public health system that may be hitting women hardest.

As witnesses take the stand at Windhoek’s High Court in the case against the Namibian government, testimonies are prompting more people living with HIV to come forward with stories of stigma and mistreatment at government hospitals and clinics, according the Mark Nonkes, communications officer for Namibia’s legal aid body, the Legal Assistance Centre (LAC).

“We’re hearing that people who are living positively [with HIV] struggle to get the same treatment,” said Nonkes, who added that many in the court had stories in which health workers publicly disclosed patients’ HIV-positive statuses in waiting rooms and often blamed those living with the virus for “bringing it on themselves.”

“It’s awful, cruel treatment that people living positively are receiving and it’s not fair,” he said.

While it was announced on Friday 4 June that the case will be postponed until 1 September due to difficulties with courtroom translation and a busy court schedule, the LAC’s AIDS Law Project Manager, Amon Ngavetene said he hoped the case would not only be justice to the plaintiffs but to affect change within Namibia’s health sector.

“The government attorney asked one of the [plaintiffs], ‘If you were not in agreement to be sterilised, why didn’t you complain?’ Ngavetene recounted. “She answered, ‘If you are in a hospital where patients’ rights are not taken into consideration, who do you complain to?’”

Ngavetene added, “We’re looking for compensation but more importantly, we hope the case would have an impact on reforming the health system…to adopt a more human rights-based approach.”

If the women win their case, they are seeking 1 million Namibian dollars in compensation from Namibia’s Ministry of Health and Social Services.

The International Community of Women Living with HIV/AIDS (ICW) was the first to highlight the problem of sterilisations occurring at public hospitals without women’s consent in 2007, when it was raised by a number of women during regular ICW forums for HIV-positive women.

Since then, the ICW has conducted fact-finding missions to three of Namibia's 13 administrative regions to document stories from women who have been sterilised, some of whom said they signed consent forms to undergo what was simply listed on their health documents as a "BTL" without fully understanding its implications.

"BTL" is the acronym commonly used for bitubal ligations. Considered a permanent form of sterilisation, the procedure involves sealing a woman's fallopian tubes to prevent pregnancies. Reversals are possible but the procedure is costly and success is uncertain.

What sterilisation really means for women

For many women who have faced stigma about their HIV-positive status, the stigma of not being able to have children within traditional African society is even worse, said Victoria Noa, speaking in 2008. Noa is an HIV-positive activist and who was sterilised in 2001.

“People believe, in traditional society, if you are a woman, who can’t have children, it’s almost like your worthless,” said Veronica Kalambi in a 2008 interview. Kalambi was formerly at ICW before moving to the Namibia Women’s Health Network.

ICW's Saima Moses, who conducted research on the subject in northern Namibia, found some hospitals even had lists for women waiting to undergo the operation. She spoke about what sterilisation has meant for women like these.

“It’s destroyed their marriages and the husband and boyfriend was never told, he doesn’t know,” said Moses, who recounted the experience of sterilised women whose partners had taken on additional girlfriends in the hopes of fathering children or had become physically abusive.

“Some of these women are dependent on these men for money so [when they can’t give them children], these men will tell them they are ‘eating for free.’” This feeling of disempowerment at home carries over to the hospitals and clinics for many women who feel unable to challenge doctor’s orders.

“The majority of these women are illiterate [and] the doctor will come in speaking English, which they don’t understand,” Moses added. “To these women, the doctor is always right.”

Currently, the Namibian public health systems require that all surgical patients, including those undergoing BTL, sign a standard, written consent form. Translation duties largely fall upon nurses. Doctors are required to double-check that patients have consented to surgery when they receive patients in surgery.

Laura Lopez Gonzalez is a freelance journalist based on South Africa. This article is part of the GL Opinion and Commentary Service.

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