Sterilised without consent: ‘They took away my pride’

Forced sterilisation, an act internationally recognised as a form of torture, could be more prevalent in South Africa than people think.

This emerged after the Commission for Gender Equality released a report on 48 confirmed cases of forced or coerced sterilisation of women living with HIV/AIDS by public health practitioners since 2002.

After the report was made public this week, more women have come forward to share their horror stories of how they were made to sign consent forms to be sterilised, by permanently altering or removing reproductive organs after giving birth.

“ They took away my pride and privilege to be a woman,” said Thandi* a woman who was sterilised without her knowledge in a KZN hospital in 2009, when she was just a teenager.

“ I went to a hospital in Stanger late at night on December 13th. I had been experiencing bad labour pains for hours until the next morning when I eventually had a doctor take me to theatre. On my way to theatre I remember a doctor giving me some papers to sign but because of the amount of pain I was in, I do not remember what it was.”

It was only in 2015 when she was trying to conceive a second child that she experienced excruciating pains which prompted her consulting a gynaecologist. The doctor broke the devastating news to her that her Fallopian tubes had been ‘cut’ incorrectly during a sterilisation procedure, which was why she was in pain.

“I did not know that I was sterile and the most heartbreaking thing was that I  was told it was likely irreversible. It is a pain I still cry about today and it hurts to think that I may never have any more children,” said Thandi*.

“I trusted that doctor with my life and they took away something I can never get back.”

Bongekile Msibi, an activist who experienced a similar ordeal, hoped the report would highlight the underlying issues around informed consent for women, especially during childbirth when many were at their most vulnerable.

Msibi’s own case did not fall under the category dealt with in the report, as she was not HIV positive, though she was part of a support group comprising mostly of women whose uteruses had been removed. When she was just  17 in 2005, Msibi gave birth at Chris Hani Baragwanath Hospital in Soweto. It was only in 2016 that she realised, after trying to conceive and consulting a doctor, that she no longer had a uterus.

“I am part of a support group called the Hopeville Foundation which was formed with an idea to be a support structure to give to people who have suffered from medical negligence. About 70% of our people have had their uterus removed and there really is not much that has been said to them about why they had to lose their uterus. A lot of the doctors claimed to have been saving their lives, that one comes up a lot. But in my case it has been 15 years and to this day I don’t know why my uterus was removed.”

The report listed 15 hospitals, most of which were in KwaZulu-Natal, where acts of gross human rights violations were found, meeting the United Nations and the World Health Organisation (WHO) standards of what could be deemed torture.

Problem? What problem?

KZN’s former MEC for health Sibongile Dhlomo, who was at the helm between 2009 and 2019 was unimpressed with the outcry over the outcomes of the report.

He said he did not believe that there needed to be any changes in policy as a result of the cases highlighted in the report, because at the time when they came to light in 2015, his department condemned the alleged acts.

“This matter was raised when I was the MEC of health in KZN which was the province that was most affected, and we said this matter must be investigated,” Dhlomo pointed out.

“We released a statement and when this thing was opening up we said that it is not government policy to sterilise women who have HIV and Aids. This (report) is the end of the road that we opened up. This report is not based on what happened last month. It was never allowed even at that time, but it is not like it is still happening now, it should have stopped when we made that pronouncement. Anybody who is still deviating from that policy, there must be corrective measures put in place on those individuals.”

In response to this, the CDE Commissioner,  Dr Tlaleng Mofokeng, said a lack of accountability among political leaders in the country’s health system was why such gross human rights violations were being allowed to happen.

“The crux of the problem is that they are still not saying that gross human rights violations took place under their watch. Some of these cases which were part of the investigation date back to 2002, so you cannot say that all of them happened in 2015 and because you condemned it, suddenly it stopped. They didn’t do a prevalence study, they did not institute disciplinary hearings, they did not participate in any meaningful way in our investigation. They did not take any sort of posture to suggest that they understood the gravity of the situation.”

The investigators expressed their suspicion in the report that government’s already dysfunctional filing system in state health facilities was being used to deliberately frustrate the investigation. In most cases, inadequate information regarding individuals involved in the sterilisation were conveniently not available as a result of missing patient files.

Nasreem Solomon, an attorney at the Sexual and Reproductive Health Rights Program said the report pointed to personal bias against HIV positive women as one underlying reason behind the cases investigated.

“According to the report, at page 47, a number of the complainants alleged that they were expressly told by medical staff that ‘they ought to be sterilised because HIV positive women could not be allowed to bear children’”, said Solomon.

“The medical staff seemed to be imposing their personal beliefs on the women who had undergone forced sterilisation, and so it is difficult to ascertain the exact underlying reasons as to why women living with HIV were targeted, but the above quote from the report points to one such reason.”

The report stemmed from a a 2015 complaint lodged by the Women’s Legal Centre on behalf of Her Rights Initiative (HRI), and the International Community of Women Living with HIV (ICW).The complainants 48 women whose cases of forced or coerced sterilisation were documented as a matter of public interest.

What happens next?

The commission made nine recommendations in its report including that South African Nursing Council (SANC)and the Health Professions Council of South Africa South African (HPCSA) to investigate any breaking of their codes of conduct and ethics.

The commission also recommended that the national health department review all aspects of the signing of consent forms for sterilisation, to make sure they protect and properly inform patients’ rights. This included ensuring informed consent using an official South African language the patient can understand.

It also wanted the process to include a counseling session prior to consent and for the patient to be given a reasonable amount of time to consider their options. Forms must be in line with the guidelines of the International Federation of Gyneacology and Obstetrics.

According to the report many of the patients were impoverished and socially vulnerable, which Mofokeng pointed out as one of the reasons it would be difficult for many of them to seek legal justice through the courts or even through mediation.

Msibi said while she could not reveal the details of her mediation process with the Gauteng health department, only saying things “did not go well”. The provincial department recently announced renewed efforts to ease the burden of billions in medico- legal claims against it through mediation.

Mofokeng said it was important for the department to act on the forced sterilisations as a matter of urgency because normally, the patients’ lack of access to resources coupled with the cantankerous filing system of the Department meant it would be virtually impossible for most victims to seek civil claims or any form of legal justice on their own.Simnikiweh@citizen.co.za

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