One woman, Doris, claims her husband gave doctors permission to sterilize her while she was in labor, and that she didn't find out about it until three years later, when she tried to get pregnant again. Another woman, Amani, says she was sterilized during a cesarean birth, but wasn't informed about the procedure until she questioned her nurses when she overheard them talking about her internal scars.
A report by the African Gender and Media Initiative (GEM) includes these stories — told by women whose names have been changed to protect their identities — along with 38 other cases of HIV-positive Kenyan women who assert they were forcibly or coercively sterilized.
The report, titled "Robbed of Choice," sparked outrage in Kenya when it was published in 2012. Now, two years later, five women featured in the report have filed a lawsuit against six of the hospitals and organizations accused of participating in the sterilizations, including Médicins Sans Frontières (MSF, or Doctors Without Borders), which allegedly provided facilities where the sterilizations occurred and referred women to hospitals where the procedures were performed.
The lawsuit — supported by GEM and the Kenya Legal and Ethical Issues Network on HIV (KELIN) — was filed December 9 with the High Court of Kenya in Nairobi, the nation's capital. The case marks the first national-level challenge against forced sterilizations of women with HIV in Kenya. Stories by victims in GEM's report date back to the early 1990s, suggesting this practice may have been occurring for more than two decades.
"Kenya has a prophetic legal and judicial framework protecting human rights issues, and prevention of transmission of HIV from women to children is a major medical focus," Allen Maleche, executive director of KELIN and the attorney representing the five women in the lawsuit, told VICE News. "So why these sterilizations are happening, I do not know."
Maleche revealed that additional women have come forward claiming they were forcibly sterilized since the "Robbed of Choice" report was published. Many were reluctant to report their experiences out of fear of being stigmatized by community members and their families. Some women were worried their spouses would abandon them, a common experience described by women in the report.
'Others may still not even know that they have been sterilized.'
"Others may still not even know that they have been sterilized," Maleche said.
The sterilizations occurred via tubal ligation, a surgical procedure that permanently prevents a woman's fallopian tubes from delivering eggs to her uterus. The incidents allegedly took place at six major medical facilities, including the Kenyatta National Hospital. The hospital — accused by multiple women of conducting sterilizations after they gave birth or while they were unconscious — gave GEM access to its hospital records after the report was published in 2012.
According to the World Health Organization (WHO), HIV-positive woman have roughly a 5 percent or less chance of passing the disease onto their child if they take the proper medication in the months before they give birth. HIV transmissions from mother to child decreased globally by 15 percent from 2001 to 2010.
But antiretroviral drug cocktails and prenatal education aren't widely available in most underdeveloped countries, and more than 90 percent of the world's pediatric HIV infections occur in sub-Saharan Africa. In that climate, sterilization may have been seen by some medical personnel as the only surefire way to limit the spread of the disease.
The five Kenyan plaintiffs and their attorney argue that forced sterilization is a human rights violation that runs afoul of both Kenyan and international law. The United Nations Human Rights Committee considers forced sterilization a form of torture. The International Federation of Gynecology and Obstetrics says that the practice is never merited, even in medical emergencies.
Beatrice Debut, a spokeswoman for MSF in Kenya, told VICE News that the organization ran an internal audit after the GEM report was published in 2012 and concluded that only a few women felt pressured to consent to sterilization.
"Between 2008 and 2012, only 21 women were referred by MSF to Kenyan health structures for surgical sterilization procedures," Debut said. "On three occasions, women told MSF's internal auditor that they felt that they needed to choose sterilization to maintain the relationships they had with their healthcare providers."
Debut added that MSF "has never encouraged surgical sterilization as a preferred contraceptive method," and that the organization is removed from the final decision between patient and doctor.
"Counseling and obtaining consent for the procedure is the responsibility of the institution that performs sterilizations, not MSF's," she said.
Asked why MSF — a revered NGO that provides medical aid to areas ravaged by war — is included in the lawsuit when the organization only referred patients to hospitals where sterilizations allegedly occurred, Maleche said he would "leave it to the courts" to decide liability in the case.
"It is a responsibility to make sure the clinics they referred women to were properly taking care of patients' well-being," the attorney said.
In a similar case two years ago, Namibia's Supreme Court granted victory to three HIV-positive women who sued the national government for sterilizing them without proper consent.
All three women in the case signed forms approving the procedures, but they argued doctors did not properly educate them about the risks and long-term effects. The court ruled in their favor, noting that written consent is not the same as informed consent, and that women cannot be asked to consent to sterilization while in labor or pain.
Many of the women featured in "Robbed of Choice" described situations similar to what the plaintiffs in the Namibia case experienced. One woman said doctors had her sign a form without telling her what it was for when she was admitted to Kenyatta National Hospital in 2005 with pregnancy complications. Five years later, she discovered that her signature permitted the doctors to sterilize her.
Inviolata Mmbwavi, national coordinator for the International Community of Women Living with HIV and AIDS (ICW) branch in Kenya, told VICE News that the outcome of the Kenyan lawsuit could change the medical landscape surrounding reproductive rights for HIV-positive women in the country.
"Health workers would have to be very careful to meet basic guidelines for these operations, such as making sure they provide sufficient information, give women enough time to think about their choice, and make sure consent is given when the women are in a sober state," Mmbwavi said.
Globally, ICW reports that HIV-positive women in at least 30 countries have been subjected to forced sterilization.
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