The following is a guest post by Professor Sofia Gruskin and Sarah MacCarthy. Gruskin is director of the Program on International Health and Human Rights (PIHHR) at the Harvard School of Public Health, and Faculty Chair of the Group on Reproductive Health and Rights (GRHR). MacCarthy is a doctoral candidate working at PIHHR and coordinating the GRHR.
In early September, the case of three HIV-positive women who filed suit saying they were sterilized at public health facilities without their consent resumed in the High Court of Namibia, garnering substantial international attention. In partnership with the International Community of Women Living with HIV/AIDS, women’s groups in Namibia have been at the forefront of a global movement to document and raise awareness of the alarming levels of forced sterilization occurring among HIV-positive women around the globe.
Jennifer Gatsi-Mallet, an HIV-positive Namibian woman, has worked tirelessly to bring international attention to this issue since her realization in 2008 of the numbers of HIV-positive women in Namibia who were sterilized against their consent. Similar stories have been documented in Zambia and in the Democratic Republic of Congo. In Latin America, while the extent of the practice is not yet known, an HIV-positive Chilean woman with legal support from The Center for Reproductive Rights and Vivo Positivo, has filed a complaint against the Chilean government in the Inter American Court of Human Rights claiming she was sterilized without her knowledge or consent immediately after delivery. Most recently a report from Indonesia described how a 25 year-old HIV-positive woman was sterilized after the birth of her second child. Feeling as though she had no choice but to follow her doctor’s recommendation, she is now bringing international attention to the issue.
These stories bring to light the forced sterilization of HIV-positive women as it occurs around the globe. The report from a three-day conference convened earlier in the year at the Harvard School of Public Health (Report: The Pregnancy Intentions of HIV-Positive Women: Forwarding the Research Agenda) highlights the critical need to promote and protect HIV-positive women’s reproductive and sexual rights, in order to stop forced sterilizations from happening, but also in relation to desired pregnancy, childbearing and abortion.
For HIV-positive women, the risk of forced sterilization brings attention to the actions of health services. One study of women in Brazil found that providers played a significant role in determining whether HIV-positive women were sterilized after delivery. Other studies show that forced sterilization occurs at the time women, especially those who are poor, seek other services such as abortion, Caesarean deliveries, PMTCT or cervical cancer screening, all of which are then provided only on condition that the woman be sterilized. Forced sterilization has not surprisingly been recognized as driving women away from needed services, both for fear of it occurring and once it has occurred. Despite important recent efforts by non-governmental organizations to document the extent of forced sterilizations, there has been limited research to understand and untangle the roles that health care policy, providers and related-services play in these abuses.
The need to understand and address the extent of these practices for the health, rights and lives of HIV-positive women in all settings is of critical importance. The Harvard conference proposed a number of targeted recommendations for further research relevant to women’s communities, health systems, and the broader policy and legal and policy frameworks where they live.