Last week, the International Community of Women Living with HIV Eastern Africa (ICWEA) launched a campaign following findings from a study that focused on forced/coerced medical sterilisation in women living with HIV in Uganda. The study whose findings were published in June this year is available for download online.
Some of us have heard conversations about sterilisations by health workers. “Oyo bamukomya” [That one was stopped], people say and we do not fully comprehend the violation. We give reasons- she was a danger to herself with all those deliveries; people who give birth by C-section shouldn’t give birth to many children; she is HIV-positive; etc, etc. It is always a decision that must be made for the woman. Even in the way we talk about it, “they stopped her”, the woman has no active say in the matter. It is almost never “she stopped herself”, or stopped her womb or ovaries- whatever it is that we refer to when we speak of stopping. She doesn’t get to do the stopping; they do.
Most of the forced sterilisations occur in the theatre when the woman is giving birth by C-section; about 95% (ICWEA, 2015). The health worker has the instruments and with them, decides what happens to a woman’s fallopian tubes. Many of the women are not even informed. They only find out later when they return to a health facility to ask why they cannot conceive anymore.
Some of this has to do with power dynamics. And the ICWEA report does a good job of pointing this out. The health worker is always assumed to be knowledgeable and in position of power while the woman is illiterate and uninformed. A large percentage of the women still have very low education and little power over their lives, much less their reproduction. (Although according to findings by National Forum of People Living with HIV/AIDS in Uganda, 63% of the HIV-positive women in Uganda decided not to have sex (2013).) With the such power dynamics in the clinic and hospital, the patient asks no questions and the health worker gives no explanations. The patient takes all the barks and reprimands; and does not dare ask why a sterilisation is recommended.
This is violation of the women’s rights on several levels: their right to comprehensive health care (where one explains and the woman can decide), their right to information; their right to their bodies.
“Sexual violence takes multiple forms and includes rape, sexual abuse, forced pregnancy, forced sterilisation, forced abortion, forced prostitution, trafficking, sexual enslavement, forced circumcision, castration and forced nudity.” Sexual and Gender-Based Violence in the Context of Transitional Justice, Office of the High Commissioner for Human Rights, October 2014
It does not matter if whoever has the scalpel thinks this is the best choice. The job of the health worker, and whomever has information, is to give (accurate) information. Explain the rationale for your advice and let the bearer of the fallopian tubes decide. They are not communal property.