Last week's revelations that Indian women are being sterilised for as little as $13 (£8.30) to meet targets set by state officials and at risk to their lives has rightly seen a collective, international outcry.
It's reported that women targeted for sterilisation are typically from the very poorest parts of the country are under pressure to comply and offered no other form of contraception. But coerced or forced sterilisation happens in more countries than India and for more reasons than a misguided attempt at controlling a country's population through the most brutal means possible.
In fact, earlier this year, the UN and the World Health Organisation released a statement making clear their opposition to the practice, an acknowledgement of how widespread its use is. It said sterilisation should be, "free from discrimination, coercion and violence", and the procedure based on the "full, free and informed decision-making of the person involved".
Sadly, for many women each year, being sterilised is a less personal choice, and more by order of the state. Coerced or forced sterilisation is better seen as a way of stopping women deemed "unfit mothers" from breeding. And it's part of a broader problem of lawmakers, politicians and medical professionals the world over being too ready to take responsibility for women's reproductive systems for their own economic ends or personal beliefs.
These decisions have a grave impact on people's lives. In Chile, the Dominican Republic and across sub-Saharan Africa, women with HIV are routinely sterilised, despite the fact that – with the correct drugs – the mother-to-child transmission rate is less than 5 percent. These are all countries where a woman's ability to bear large numbers of children is highly prized and the loss of that right can jeopardise their very life.
I spoke to Jody Fredericks from the Women's Legal Centre in Cape Town, South Africa. She's representing three women who all say they were advised by their doctors to be sterilised because of their HIV status, and asked to consent while in labour, a clear breach of national and international law.
"We can't understand why this practice is taking place, there is no justification for it," said Fredericks. "These women are so traumatised, it's difficult to even get a statement out of them." None of the women have told their partners or their families that they've been sterilised, for fear of being ostracised. One of the women's husbands has already had children with other women in light of his wife's inability to conceive.
Up until now, the South African government has settled all cases out of court, admitting to negligence, but not to HIV being the reason for the procedure. This time Fredericks wants the doctors held accountable. It's not the law that needs changing, she says, but the paternalistic attitude of the medical profession.
This attitude is also found in countries that otherwise don't trouble Amnesty too much. Many countries, including France and Belgium, require transgender people to undergo (often unwanted) sterilisation surgeries in order to have their preferred gender recognised. Intersex people are frequently irreversibly operated on as infants to assign them a sex, which doesn't always turn out to be the sex they want to be when they're older. Sterilisation of people with disabilities is still contested. In Australia just last year, a ten-month inquiry concluded that the sterilisation of people with disabilities without their consent should be banned.
The reluctance of countries to look in their own backyards when it comes to invading a person's right to give birth, and piecemeal progress in acknowledging that right, is mirrored in the reluctance to condemn others' practices.
In Uzbekistan, there has been a sustained programme of forced sterilisation since 1999 in a bid to control population growth. A 2013 report by journalist Natalie Antelava for human rights group Open Society Foundations found doctors under pressure to meet government targets, and unable to provide proper medical examinations or sterile environments.
Women say they are often unaware of the nature of the procedure. One woman, "Shahida", a mother of two, was told it was reversible and only discovered the truth when those children died in a car crash and she was unsuccessful in conceiving more. Her husband left her.
Other women aren't asked at all. Uzbekistan women's rights organisation Ozod Ayol (Free Woman) has recorded cases of involuntary hysterectomies. Khulkaroi Abdullaeva told them what happened when she went into hospital to deliver her third child:
"They tied a sheet around my stomach and started pulling on it until it tore. They tormented me and I lost consciousness." The baby was stillborn, and afterwards doctors performed a hysterectomy. She also only discovered the extent of the operation later, when she realised she had not been fitted with the standard IUD.
But despite persistent reports of these abuses, the international community has stayed silent on the matter. In fact, Uzbekistan has received praise for its meeting of Millennium Development Goals on reducing infant and maternal mortality rates, despite its disregard for all other human rights treaties.
Steve Swerdlow works for Human Rights Watch, investigating and advocating for a wide range of issues in Uzbekistan. He described the use of forced sterilisation as a "sick and twisted way of improving their statistics". But also says that the strategic importance of the country now prevents countries from condemning its policies.
"The west – and the UK and the US in particular – have gone very soft on human rights abuses in Uzbekistan. They seem very concerned about Uzbekistan not cutting off cooperation in Afghanistan, namely the use of its territory to transit military supplies in and out of the country".
Swerdlow told me that, rather than the country being positively affected by its cosier relationships to Europe and the United States, reports of torture have increased in recent years, including instances of people being sterilised against their will. And when it comes to some of the worst offenders for tampering with women's reproductive rights, it would be remiss to not mention the record of America, which, along with the UK, helped fund India's sterilisation programme.
Just last year it was revealed that, as recently as 2010, women in Californian prisons were being coerced into sterilisation by doctors who believed it was their duty to save the state money and prevent women in the criminal justice system from having more children. In September this year, senior Arizona lawmaker Russell Pearce had to resign his position in the Republican Party after making comments about sterilising poor women who claimed welfare payments, while Project Prevention continues to pay substance misusers to be sterilised.
On the flip side, women are routinely denied access to contraceptive choices and forced to carry to term unwanted or unsafe pregnancies. Professor Alexandra Stern of Michigan University is an expert in the history of eugenics in the United States. "Women's reproductive health is as contested now as it's ever been in the US," she told me.
One of her biggest worries was the growing criminalisation of pregnant women, in particular by the use of "fetal harm" laws. In Montana, 21-year-old Casey Gloria Allen was charged with criminally endangering a child, after testing positive for illegal drugs while three months pregnant. In Iowa a pregnant woman was arrested after falling down the stairs and accessing medical treatment.
Professor Stern said these instances are likely to become more regular as Republican governors, emboldened by success at the midterms, seek to advance the anti-abortion movement, state-by-state. The next step was to grant "personhood" to embryos from the moment of conception.
These reproductive horror stories give a grave picture of women's rights internationally, but vibrant campaigns for justice are being fought in countries as varied as Slovakia and the Czech Republic, where Roma women were sterilised as late as 2001, and Peru, where 300,000 indigenous women, mainly poor and illiterate, were coercively sterilised between 1995 and 2000. In October this year, North Carolina began sending out compensation payments to victims of its eugenics policy that saw thousands of men and women sterilised between 1929 and the late 1970s.
The decision on whether to have children is one of the most personal someone can make, not something to be forced or prevented by those with their own motives. The shocked coverage generated by the deaths of those 13 women in India last week is a positive sign that people don't want to live in a world where that choice is removed.
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