No more babies! Women sterilised illegally for being HIV positive

In 2003, Agnes (name changed to protect her privacy) was diagnosed with HIV. A year earlier, the resident of an informal settlement in Nairobi County, had lost her husband to the disease.

She then had an intimate relationship, which resulted to a pregnancy in 2004. She started attending ante-natal clinics in a local hospital where she says nurses began warning her against having more children due to her status.

“They told me having more children would weaken my immune system. They suggested sterilisation as a safe method for me to live longer. I said I’ll think about it,” she says.

They reminded her over and over again for the next visits until she delivered twins on October 29, 2004.

Breastfeeding

On delivery, she was advised against breastfeeding as they informed her that she would not only infect her sons, but also would die sooner. Worried and troubled, the nurses referred her to another hospital in the nearby slums where she underwent the tubal ligation (TL) procedure.

“I found many other women on the waiting bay and when my time came, I went in and the doctor did the TL without telling me what I should expect after the procedure. He did not even give me painkillers,” says Agnes who was 35 years at the time.

Between 2012 and 2018, Agnes says she experienced irregular heavy bleeding. She would bleed for two months, non-stop, she says.

After thorough check-ups in two hospitals in Kiambu County, she was found to have growths in her uterus arising from an improperly done TL.

With the help of well-wishers, her uterus was finally removed in September, 2018 at Kenyatta National Hospital.

Own money

“I still have pains on my stomach and my back. I can no longer do strenuous jobs. I have turned into a beggar yet I would make my own money from doing laundry work in the neighbourhood,” the distressed woman cries out.

She goes on: “I can’t date anymore though I have the desire for marriage and more children. I keep on dismissing men interested in me and they cannot understand why.”

Similar predicament befell Tessy, who also lives in a Nairobi informal settlement.

The surgical procedure done on the HIV positive woman in September 2006, has caused her too much of physical and psychological trauma.

Just like Agnes, the nurses at the ante-natal clinic in the slum scared her with early death warning should she continue to have kids.

But how the procedure was done was even more invasive and inhumane.

On September 15, 2006, she was checked into theatre for caesarean, unaware that the decision had already been made for her.

Distraught woman

“All I remember was the doctor showing me my child and telling me tumekufunga (referring to TL),” she says.

“It didn’t bother me at the time. I didn’t ask what it meant. I was in pain and not in my normal senses,” explains the distraught woman who was only 20 years when her ability to deliver again was taken away from her without her consent.

Then in September 2007, thugs killed her husband while he was returning home from work. He had known that his wife had been sterilised. Six months after his death, Tessy remarried a man who also had HIV.

They lived a happy life until 2011 when they decided to have a child.

“We tried and tried but nothing was happening. My husband then asked me to go for a check-up. I went to a Mzungu (white) doctor who told me I had been sterilised,” she says.

“He, however, asked me to establish the kind of sterilisation that was done from the hospital where it was done,” she says.

That is when the tumekufunga term hit her. Her request for the file turned out to be a circus. For a year, the hospital management took her in circles until she gave up.

By that time, her husband had become hostile, calling her a “useless woman who cannot bear him children.” He even married another woman whom he immediately impregnated and brought her to the house to co-exist.

She says she persevered since she had nowhere to go being an orphan.

Then, one day, he beat her so badly that he broke her right leg and ran away with his new wife. And that was the last time he saw him.

She still desires to love and be loved.

“I am just 35 years. I want to get married but who is going to marry me?” she asks with tears dancing in her eyes.

Agnes and Tessy are among 40 known women who have suffered from forced and coerced sterilisation, a clear violation of their constitutional right provided in Article 43.1(a).

Healthcare services

This Article states that “Every person has the right to the highest attainable standards of health, which include the right to healthcare services, including reproductive healthcare”.

Furthermore, National Family Planning Guidelines for Service Providers in Kenya (2010) affirms the need for informed and voluntary consent before a woman undergoes surgical sterilisation.

It observes the importance of ensuring special care such that “every client who chooses this method does so voluntarily and is fully informed about the permanence of the method and the availability of alternative, long-acting, highly effective methods”.

Even worse, the two women were treated with multi-layered discrimination, one as giving incorrect and frightening information to wrongly influence their decisions and secondly, as HIV positive women.

For them, their rights to privacy, dignity and information as well as health, life, freedom and security of the person were infringed, thereby lowering the quality of their lives, legal and human rights experts say.

Informed consent

“No one should invade your body without your consent,” states human rights lawyer and executive director of Kenya Legal and Ethical Issues Network on HIV and Aids (Kelin) Allan Maleche.

He says health workers would have saved the women from the lifetime turmoil and pain had they simply sought their informed consent.

“They can no longer have babies. That is reducing their quality of life,” he notes.

He suggests review of existing laws and policies to capture the peculiar circumstances under which the coerced or forced sterilisation is done, especially regarding HIV positive women. The government should at the same time commit to implementing them effectively.

“This country has a demeanour of having good laws but fails to invest time and money to operationalize them,” he says.

Last year, a Reproductive Healthcare Bill sponsored by Nakuru County Senator Susan Kihika and which sought to penalise a health professional sterilising “a woman without obtaining her written consent, counselling and explaining to her implications of the sterilisation procedure,” was heavily contested as being pro-abortion. It never passed second reading.

Crimes committed

Even with the laws, for these women to access justice for the crimes committed against them, they must have some form of evidence such as clinic cards or a health record showing they sought health services in the facility where the procedure was done.

But the process of gathering evidence is itself gruesome, opening wounds that may have healed. It also requires immense financial investment, which for most of the women violated cannot afford, since they come from extremely low-income areas.

Kelin and African Gender and Media Initiative (Gem) are, for instance, helping five of those women reclaim their rights. The women have sued Pumwani and Marura hospitals alongside Médecins Sans Frontières and Marie Stopes International for sterilising them without their consent.

Nairobi County Health Executive Committee member and Health Cabinet Secretary are also enjoined in the suit as respondents.

The five were among 40 HIV positive women from Nairobi County (Kibera, Mathare, Huruma and Kakamega County (Lurambi) whose experiences Gem captured during its 2012 survey on women who had undergone coerced or forced sterilisation.

It is now seven years since the case was filed in the Nairobi High Court. Notwithstanding, the process of collating the evidence was unimaginably traumatic.

Gem Executive Director Gladys Kiio says going to court required the women to prove the claim of sterilisation, a process that had to be done by a qualified doctor. It took a year to get the doctor.

The procedure is itself traumatising. Ms Kiio describes it “as an invasive procedure that involves the women going to theatre and staying in bed for a week or more days.”

She says the women require much psychosocial support to recover from the trauma and the ripple effects of the surgical operation.

Health workers

In their plea in court, the women seek compensation for “physical and psychological suffering occasioned by the unlawful and unconstitutional sterilisation.”

Between 2013 and 2015, the organisation made efforts in sensitising health workers in Nairobi and Kakamega counties against coerced and forced sterilisation, and her hope is that no woman suffers from the same going forward.

As Tessy says, “The doctors should know that having HIV does not mean our dreams for a family life and motherhood are dead. We are human beings with a right to enjoy our lives.”

NB: The women did not approve of their photos to be taken or recorded

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