When she went to hospital to give birth Amani had a lot on her mind. Not only are maternal mortality rates in Kenya worryingly high but during an ante-natal check-up Amani had been told that she was HIV positive. The expectant mother was reassured that delivering the baby by caesarean section was the safest way to avoid transmission of the virus to her child. So as she was wheeled in to the operating theatre she could be forgiven for thinking she was in safe hands. But her trust was misplaced. During the procedure, and without her knowledge or authorisation, Amani was sterilised.
She only ever found out what had happened by chance. ‘I discovered that tubal ligation had been done when I took my baby to the clinic after delivery,’ Amani said. ‘The nurse requested me to allow her to examine my wound, and in the process a colleague passed by and asked how the tubal ligation scar was healing. I did not know about it and only thought they had cut me because I was having a baby.’
Amani’s is not an isolated case. A new report by NGO African Gender and Media Initiative details 40 case studies of Kenyan women who have undergone forced or coerced sterilisation because they were HIV positive.
The report makes shocking reading, some women find their husbands signing the medical papers, allowing doctors to perform the irreversible procedure to tie their fallopian tubes. Others unwittingly sign documents thrust in front of them during the chaos of labour, only to later discover what they had signed up to.
Several of the women interviewed reported being mistreated by the health care workers trained to support them. Nekeska gave birth in 2008 at Kakamega General Hospital. There she faced a barrage of abuse. According to Nekeska the doctor told her ‘It is an offence for women who are HIV positive to have children’ and said she was told she could only have the baby she was due to deliver if she agreed to be sterilized. Nekeska put up a fight and refused to sign the consent papers, but was sterilised anyway.
Many of the women coerced or forced into sterilisation report finding themselves ostracized, cast out from their martial homes with the double burden of infertility and their HIV status. Amani’s husband died of Aids in 2004 leaving her and her daughter. ‘In the last few years I have had three suitors but I had to stop the relationships because if I get married to them, then I will be abandoned when they discover I cannot have children’, she said.
According to the 2007 Kenya AIDS Indicator Survey nearly one out of every ten pregnant women in Kenya is infected with HIV. Children less than 15 years of age account for 16 percent of all HIV infections; most of these infections were acquired through mother-to-child transmission. However, the chances of HIV transmission from mother to baby can be virtually eliminated through use of anti-retroviral drugs during pregnancy and labour, and by delivering the baby via Caesarian section.
The report follows a Kenyan television news report in January which claimed that a US-based organisation Project Preventionwas paying women living with HIV to have intrauterine birth control devices implanted. The Kenyan government reacted angrily to the news with the minister for medical services, Peter Anyang’ Nyong’o, announcing ‘It is important to stress that even HIV-positive women have the right to have children if and when they desire. HIV doesn’t take that right away, not at all.’
However it is both local health care workers and international NGOs that are implicated in this new report. Provision from Medicin Sans Frontier and Marie Stopes is mentioned in some of the women’s testimony.
Betty discovered she was HIV positive in 1993. She had just given birth to her fourth baby when community health workers visited her home and she claims she was then asked to accompany them to meet Marie Stopes doctors. Hoping she might receive financial assistance from the NGO she went along to the mobile clinic. Betty reports that there she was given forms to sign but she says ‘No one told me what I was signing for. I thought it was part of the registration.’ She was then operated on. After the procedure she was told community health workers had earmarked her as someone who should be sterilised because she was HIV positive and had no husband or income.
Marie Stopes responded to the report stating that ‘The process described by Betty is absolutely contrary to Marie Stopes International’s values, policy and practice on informed consent. We take any non-compliance on this issue extremely seriously.’ The NGO goes on to state that some of the case studies highlight that the sexual health body can ‘work with organisations who refer clients to Marie Stopes Kenya to strengthen their policies and practices around informed consent, and this is something we will seek to do immediately.’
A growing trend?
This is not the first time the issue of forced sterilisation has made the news. In June The Lancetreported on a government led sterilisation drive is Uzbekistan designed to control population growth. According to the report doctors received monthly sterilisation quotas and admited to tricking or pressuring women into the decision, or performing the operation without their consent, during caesarian sections.
The Uzbeki government firmly denied the reports.
Read Robbed of Choice: Forced and Coerced Sterilization Experiences of Women Living with HIV in Kenya here.
First published on www.bureauinvestigates.com September 7th 2012.