Sorry, Those Aren’t Your Rights: HIV-Positive Namibian Women Face Coerced Sterilization

Several of my colleagues from the International
Community of Women Living with HIV/AIDS (ICW)
and I were crammed into an
SUV with our luggage and food driving through the northern regions of
Namibia.  It was a trek familiar to
Jennifer Gatsi-Mallet, ICW Namibia Country Officer, and Veronica Kalambi, an ICW
member.   This was a journey they had made
many times while visiting the many women and girls who come to positive women’s
support group meetings throughout the country. 
For the rest of us, it was our first time to rural Namibia and the
Namibia-Angola border. 

The trip we
were making was in response to a shocking discovery by Jennifer during a
Namibian Young Women’s Dialogue that
several HIV positive women in Namibia had been sterilized against their
consent.  More inquiry into the situation
by ICW Namibia and the Namibian Women’s Health Network determined that there
was a need to do a fact-finding mission to gather data and take steps to demand
justice from those individuals and entities that had violated the sexual and
reproductive rights of women.  These
fundamental rights include the rights of HIV positive women to have a safe,
healthy, and fulfilling sex life and to determine whether and when to have
children.  They also include the right to
access health services free of stigma and discrimination; the right to full
information about health services and conditions; the right to give full
informed consent before any medical procedure; and the right to access to
prevention of mother-to-child transmission services. 

Members of ICW know all too well the terrible and
traumatic experiences faced by HIV-positive women as they attempt to access
care, treatment, and support in general, and with specific regard to sexual and
reproductive health services.  However,
knowledge and awareness is never preparation enough for the traumatic and
extreme rights violations that we were now documenting in Namibia.  

As we asked questions: have you ever been mistreated in a
hospital? Have you been forced to accept a procedure you did not want? Women
raised their hands time and time again, speaking of poor treatment by nurses and
physicians, telling of being kept in separate waiting areas because they were HIV
positive, and being identified as HIV positive in front of other patients.  Alongside stigma and discrimination, women spoke
of being made to feel that because they are HIV positive they should not be
pregnant, and about receiving misinformation about pregnancy and HIV. Positive women
spoke of their rights to information and informed consent being violated: For example, some were encouraged to take birth control
despite desiring more children, others were forced and coerced into sterilization while
in labor or while having a caesarian section.  
We visited hospitals and spoke to staff that admitted the mistrust they
have for women when it comes to caring for their own bodies.  One physician even spoke of the women who
visit his clinic as being unclean and poor and unable to make the best decisions
for themselves, their bodies, and their communities.   

ICW has partnered with several domestic and international
NGOs in order to seek justice for the women who have been sterilized and demand
that necessary changes be made to stop the violations of women’s sexual and
reproductive health and rights.  All are
rights protected by the Namibian Constitution as well as regional and
international human rights agreements. 

For HIV positive women who need to access health services
for their survival, a hospital should be a place of safety, a place where one
recuperates, and where one can fully understand and address the health issues
that affect them. In other words, hospitals and health care facilities are a
place where rights should be realized, not violated.   As
documented by ICW
, health care facilities as sanctuaries of health and human
rights for HIV positive women in Namibia remain far from reality.

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  • progo35

    That is horrible and Needs to stop NOW.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • invalid-0

    Let the whole see what women go through! together we can stop this!

  • invalid-0

    This report from Namibia is horrifying, but unfortunately it is emblematic of both the continued stigma and discrimination towards people living with HIV – particularly as it is perpetuated by health care providers – and of the persistent, archaic notion that women don’t know what is best for themselves. In short, these health care providers are failing to adhere to the fundamentals of quality health care – a key pillar of which is the right to informed choice. This means that women living with HIV who want to have a child have the right to be supported so that they can safely deliver a healthy baby. It also means that women (and men) who do not want children now, yet who enjoy a healthy sex life, have the right to a range of contraceptive options for preventing pregnancy, regardless of their HIV status.

    For millions of individuals around the world who are certain that they do not want children in the future, sterilization is one of many effective methods they should be able to choose from – but it absolutely must be a choice that they make on their own. When abuses arise, such as those in Namibia, one unintended consequence is that some health care professionals become reluctant to offer sterilization services, and clients hesitate to ask for a permanent method even if they believe that is what is best for them. The paradox here is that, ultimately, this limits both individuals’ rights to informed choice and their access to a full range of contraceptive methods. We must be as vigilant in preventing abuses as we are in protecting options.

    At the same time, for quality care to be a reality for everyone, reducing HIV-related stigma and discrimination among health professionals must be a priority. We know it is possible to change harmful attitudes and practices among health care providers, and as this report makes clear, the need to do so is as urgent as ever.

    Dr. Isaiah Ndong,
    Vice President of Programs,

  • jodi-jacobson


    Hope you are well and it has been a long time.

    I am so glad you wrote. You have captured exactly the issue in your comment, the paradox of the ways in which women’s autonomy, rights and ultimately their health are abrogated and compromised whenever they are coerced into choosing any specific option, or coerced indirectly by a lack of options.

    I would, if I may, rephrase your point to say:


    We must be as vigilant in achieving universal access to all options for safe and healthy sex lives, information, education, services and methods–including permanent ones such as sterilization when those are truly chosen–while preventing abuses of individual rights.

    And I could not agree more: We must also be vigilant in ensuring that examples of stigma, discrimination, and coercion are used as an impetus to expand and improve services and not to allow politicians or others to exploit such situations for an agenda that equally undermines women’s rights.
    Thanks so much for writing.

    All best wishes, Jodi Jacobson

  • invalid-0

    This is shocking news! The choice on whether to have a child or not should be a personal decision. Instead of forcing women living with HIV to be sterilised, the Ministry of Health should work with relevant NGOs such as ICW to sensitize women about prevention of mother to child transmission (PMTCT) programs. Scientific evidence has proved that PMTCT programs can drastically reduce mother to child transmission of HIV. Why in this era should HIV positive women be encouraged to stop having children?

    Through personal experience, i know how bitter is the stigma and discrimination against people living with HIV at healthcare settings. At the end of 2007, i accompanied a female relative living with HIV to a local clinic in Zimbabwe and I couldn’t believe the stigmatising attitudes that she had to face at the clinic. She was given harsh treatment despite the fact that she was agonising with pain. Our health workers especially in poor rural areas still believe that people who are ill due to AIDS-related illnesses deserve that kind of suffering.