SA’s forced sterilisation shame

2014-06-08 15:00

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A battle for compensation is on for 22 HIV-positive women who were sterilised without their consent or were pressured into signing consent forms allowing state doctors to render them unable to have children.

The women were sterilised between 1996 and 2011 in KwaZulu-Natal and Gauteng, and now want provincial health departments to compensate them for their trauma. Most of the procedures took place in the late 1990s and early 2000s at the height of the Aids pandemic, a time when antiretroviral drugs were expensive and were only made available to private patients. Aids-related deaths were skyrocketing.

Some of the women City Press spoke to say hospital doctors ordered them to sign consent forms while they were in labour or while being wheeled to theatre for Caesarean sections.

Others say doctors coerced them into accepting sterilisation before they would allow them other treatments, such as Caesareans or abortions.

Four of the 22 women had no idea they were sterilised. They found out years later after trying in vain to conceive, or while receiving treatment for other reproductive health problems.

Now they want justice. But this may be difficult to come by.

Sanja Bornman of the Women’s Legal Centre (WLC) in Cape Town said some of the women were sterilised as far back as 1996 and some as recently as 2011. The WLC, a nonprofit law centre, is working with advocacy group Her Rights Initiative (HRI) to secure compensation for the women.

Bornman said: “In order to claim civil damages, a woman has to launch a case within three years of being sterilised. Due to a lack of knowledge of their rights, of what happened to their bodies in the first place and the trauma of the event, many women do not seek legal advice in time and their [opportunity to sue lapses].”

The WLC represented an HIV-positive woman who was sterilised without giving informed consent at a government hospital in Gauteng. The 28-year-old went to hospital to give birth in 2009 and was asked to sign several forms, including a consent form for a Caesarean section, without knowing she was also agreeing to be sterilised. She was not given any explanation of the risks and consequences of the sterilisation procedure. The Gauteng department of health accepted liability in April and settled out of court, paying the woman R500?000.

Bornman said while it would be difficult for the women to receive compensation, they would do all they could to help them. They were completing investigations into the cases of eight of the women, for whom they were exploring “out-of-court solutions”.

The cases of the remaining 14 would be harder to finalise because many of their hospital files were missing and some were reluctant to proceed, fearing victimisation from state hospitals and clinics, on which they continue to rely for medical care.

“Our aim is to get some relief for women whose constitutional rights are abused in this way. We want to give them a chance to exercise the reproductive choices remaining to them, such as falling pregnant through in vitro fertilisation,” said Bornman.

Sethembiso Mthembu of the HRI agreed, saying: “Some of the women are still within the reproductive age and maybe the sterilisation can be reversed. But the challenge they have is they do not have the necessary resources to do it. This is why we want government to compensate them.”

KwaZulu-Natal health spokesperson Desmond Motha said he was “aware of these allegations through the Commission for Gender Equality, which had a meeting with the MEC for Health, Dr Sibongiseni Dhlomo”.

“The MEC strongly condemns the practice and cited the Sterilisation Act, which talks about the right, among others, of women to reproductive health,” he said.

Gauteng health spokesperson Simon Zwane said they were only aware of the case of the woman with whom they had already settled out of court.

National health spokesperson Joe Maila said they were still investigating. “It is not the department’s policy to sterilise any person without being informed or without being given a choice,” he said.

Mthembu, however, said the national health department’s investigation was taking too long.

“Back in 2012 at a meeting between us and the national department, it was pointed out [by the officials] that these were isolated cases,” she said. “The fact that there was no black-and-white policy stating that HIV-positive women should be sterilised during the peak of the Aids pandemic does not mean it didn’t happen.”

The policy of silence

Research shows that the practise of forced sterilisation has taken place in at least four Southern African countries.

A study titled The Forced and Coerced Sterilization of HIV Positive Women in Namibia, authored by Jenifer Gatsi-Mallet and others, documented 40 cases of women either forced or coerced into undergoing sterilisation because they were HIV-positive.

There have also been anecdotal reports of coerced sterilisation in the Democratic Republic of Congo and Zambia.

It is not known how many HIV-positive women have been coerced or forced in South Africa. But a 2011 study involving University of KwaZulu-Natal academics, titled I Feel Like Half a Woman All the Time, suggests the practise may have been widespread.

However, the study found that the victims either did not know their rights or were too ashamed to report what happened to them.

Study co-author Sethembiso Mthembu, of Her Rights Initiative, says: “There might have been some silent policy in the late 1990’s about sterilising HIV-positive women.”

This, she said, was because of the belief at the time that HIV-positive women would not live for long and could also pass the virus to their babies.

National health spokesperson Joe Maila deni ed the existence of any such silent policy.

“The Sterilisation Act of 1998 clearly states that a patient must provide his or her informed consent,” he said.

Reproductive health experts say forced sterilisation is a violation of patients’ human rights.

Professor Helen Rees, director of the Wits Reproductive Health and HIV Institute said: “HIV is never a reason to sterilise a women because with proper medication and treatment, chances of transmitting the virus to a foetus is minimal.

“Women have the right to choose sterilisation as a contraceptive option and if they do exercise that right they must be properly counselled about the risks, benefits and consequences,” she says.

Dr Hein Odendaal, a leading obstetrician and emeritus professor at Stellenbosch University agrees saying, “sterilisation can only be done after the necessary information has been given to a woman and preferably her companion as well. “It is then up to her to decide.”

Three women tell their stories

No chance of motherhood

Nokuthula Khathi

Nokuthula Khathi was in a hospital bed, recovering from surgery, when her gynaecologist turned her world on its head with a single question.

Why, he asked, had she been sterilised at such a young age? She had no idea that, 14 years earlier, a doctor had tied her Fallopian tubes without telling her or seeking her permission. “I told him I had never been sterilised – the only major operation I had was when I gave birth to my son by Caesarean section.

“He shook his head and said: ‘No, you were sterilised and your tubes were cut and stitched up. Even if you wanted to have a child it would not have been possible because your tubes were stitched together with your uterus in a very clumsy way.”

Khathi (45) spoke to City Press in Durban. She lives in the nurses’ accommodation at King George V Hospital, where she works as an auxiliary nurse in the psychiatric unit. Her other job – as a motivational speaker – sees her lecture others on Aids prevention, treatment and her own journey to health.

It was difficult for her to speak about her ordeal. “I found out I was HIV positive in 1996 when there was no treatment in the public sector and my partner rejected me and my son,” she said.

According to her, the sterilisation must have been performed at Durban’s Addington Hospital where she gave birth to her son. She insists nobody asked her permission.

“My son died of an Aids-related illness a few years later. I mourned him for four years and decided not to get into a relationship. Just when I was ready to start dating, I found out I had early-stage cervical cancer and the only way of preventing it from spreading was to remove my uterus. For months I tried to come to terms with that. Maybe I would have had another child. When I had a hysterectomy, another bombshell was dropped on me: even if I had?...?tried to conceive, it wouldn’t have happened because somebody decided I didn’t deserve to be a mother again.”

Her emotional scars are still fresh. But Khathi says no court action would bring back her reproductive organs. “All I want is for health professionals to stop violating the rights of women living with HIV.”

‘They killed me that day’

Dudu is still angry.

Dudu Mlambo* was in her final stages of labour when an obstetrician handed her a form and told her to sign it. The doctor, she says, did not explain what the form was for, nor why she should sign it.

Then she was wheeled into theatre for a Caesarean section and gave birth to her second child. She was 33 at the time.

Seven years later, the mother from Kwa­Zulu-Natal’s south coast discovered she had given the hospital permission to sterilise her. Now she wants justice: she wants Port Shepstone Hospital to pay for violating her rights.

“The doctors who sterilised me probably don’t even remember me because to them I was just another pregnant, HIV-positive woman. But the tragic reality is that they killed me that day. Today I feel like less of a woman,” she says.

Mlambo has a partner who she says refuses to believe her when she tells him she cannot have any more children. “When I tell him, he laughs at me.”

In 2011, after years of trying to conceive a third child, a private gynaecologist ­examined Mlambo and told her she had been sterilised. He couldn’t give her any more details, and advised her to find out more from Port Shepstone Hospital.

She was devastated, but hoped he had made a ­mistake. He hadn’t. When she confronted staff at the hospital, a ­doctor confirmed what had been done – but said she’d agreed to it. “He showed me a consent form I signed a few minutes before I was wheeled into theatre. He told me there was nothing he could do because I had agreed to the procedure.”

Mlambo, a domestic worker, lives in a one-room house she built for herself and her son and daughter, aged 15 and 10.

“I am still very angry that someone decided that I should no longer have children because I am HIV positive,” she said.

She still has many ­unanswered questions, including which procedure was performed to sterilise her and if it is at all reversible. She had given up until last year, when she was introduced to the advocacy group Her Rights Initiative, which is now helping her and 20 other women who say they were sterilised without their consent or ­without having the procedure properly ­explained to them.

*?Not her real name

A matter of life and death?

Lindiwe bears her secret alone.

Lindiwe Zungu* (46) always wanted to have a big family. She longed for two boys and two girls.

But that dream was shattered 16 years ago when she was told by a doctor at Richards Bay Hospital that, because she was HIV positive, she should no longer have children. At the time, Zungu was five months pregnant with her second child.

She says the doctor told her: “We will sterilise you after delivering your baby because if you have more children you will die.”

Zungu says she agreed without asking questions because she could not argue with somebody who had medical knowledge and experience. She believed the doctor when he said it was a matter of life and death.

“All I wanted was to live longer and be there for my kids. If that meant not having more children, I was prepared to do it.”

What broke her heart most that day was the doctor’s insensitivity.

“The doctor knew I was vulnerable and knew little about HIV, except that there was no treatment available and it could not be cured. Any person who is told to either do something or die, they would do it.”

That day changed her forever.

“I am empty inside. Sometimes I feel like I’m walking in this dark forest, going nowhere slowly.”

Zungu lives in Melmouth, in northern KwaZulu-Natal, with her children, aged 21 and 15, and her parents. She has no partner.

The family lives in a homestead in the rural area, and she supports her parents and children with the salary she earns from her job as an administrator at a local paper mill.

She bears the secret of her sterilisation alone. She has told neither her children nor her parents about it, only the other members of an HIV-positive women’s support group she joined through Her Rights Initiative.

“I gave up on love a long time ago because I know that even if I got into a serious relationship with somebody and he wanted to marry me, it would be useless because I could never bear him children.”

*?Not her real name

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