Ruth Achieng, one of 40 HIV-positive women planning to sue the Kenyan government for forced or coerced sterilisation, knew nothing about her operation until it was too late.

Achieng’s neighbours carried her to Nairobi’s Kenyatta National Hospital after she started bleeding profusely. She was having a miscarriage.

“I bled until I didn’t know where I was. I lost my mind,” she said.

A week later, a doctor touring the ward told her that they had sterilised her. She was 22 years old.

“He said: ‘It’s because of your situation and your HIV status that they sterilised you,’” Achieng told TrustLaw. “I was not supposed to give birth because the children would be (HIV) positive… They said: ‘Sterilisation is good for someone like you.’”

For other women, the threat to stop supplying antiretroviral drugs for their HIV infection or formula milk for their babies convinced them to submit to the knife.

“I was a single mother and did not have a job or anyone to depend on at the time,” said Pamela Adeka, who attended Blue House clinic, run by aid group Medecins Sans Frontieres (MSF), in Nairobi’s Mathare slum.

When Adeka visited the clinic expecting to be given formula, the nurse started pressurising her to get sterilised. She left empty handed.

“I asked myself what were my twins going to eat if they did not get their formula? They were not yet six months old so they could not even take porridge,” Adeka told TrustLaw.

She later consented to sterilisation, which she said has left her weak and unable to work. She experiences bouts of heavy bleeding from her womb.

FEAR AND CONFUSION

Doctors told Teresia Njoki she would die if she kept giving birth because she was HIV positive.

“If the doctor tells you (that) you are going to die, it makes you so vulnerable,” she said. “I was in labour and I was going for a c-section. There was that mixed fear and confusion. So that is what made me sign.”

The women’s experiences are documented in Robbed of Choice, a recent study by the African Gender and Media Initiative.

Its author, Faith Kasiva, maintains that forcible and coerced sterilisation of poor, HIV-positive women is “systemic in public health facilities”.

Lawyers from the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) are helping the 40 women interviewed by Kasiva to sue the government.

“We are currently still analysing the evidence. So far we have about five solid cases,” said Allan Maleche who heads KELIN.

“By solid, I mean they have documentation to show they were admitted in the hospital and the process of sterilisation undertaken.”

MSF has said it will investigate cases at its clinic featured in the report.

‘UNWORTHY’ OF REPRODUCTION

Illegal sterilisation of poor, stigmatised women, deemed “unworthy” of reproduction, is a global problem, according to the Open Society Foundation, resulting in social isolation, family conflict, abandonment and grief.

It has documented the sterilisation of HIV-positive women using coercion – when incentives, misinformation or intimidation are used to compel a woman to undergo the procedure – as well as force – when a woman is sterilised without her knowledge or informed consent – in Namibia, South Africa, Venezuela, Chile, Mexico and Dominican Republic.

Hopes for justice have been raised by a Namibian court ruling in July, which found that state hospitals illegally sterilised three HIV-positive women. The women had not given informed consent as they were presented with sterilisation forms just before or after giving birth, without being told what they were signing, the ruling said.

However, the judge did not feel there was sufficient evident to prove that it was a discriminatory practice against women living with HIV.

“We will try our best to prove the link (in the Kenyan case) because out of all the women that we have so far, none of them is HIV negative,” said Maleche.

Comments made by health workers, included in the African Gender and Media Initiative report – such as “Woman, you are still giving birth and you are HIV-positive?” – seem to suggest that the women were sterilised because of their HIV status.

One woman was even taken to a ward occupied by children with AIDS-related infections to deter her from having a child.

‘THE CHOICE IS YOURS’

The Ministry of Public Health and Sanitation has asked the regulatory Medical Practitioners and Dentists Board to investigate and discipline the institutions and professionals involved in such abuses. This may include pressing criminal charges against them.

“The government’s position is very clear. Whether you are HIV-positive or not, the choice is yours,” said Shanaz Sharif, the director of medical services.

“The government does not say that, if you are HIV-positive, you should not get children.”

Thanks to an aggressive antenatal testing policy and the provision of antiretroviral drugs to pregnant women and their babies, 90 percent of babies born to HIV-positive women in Kenya are HIV-negative, Sharif said.

But between 7,000 and 10,000 babies still contract the disease in Kenya each year, largely because their mothers do not attend clinics or decline to get tested, he added.

NO CHILD, NO HOPE

The suffering of the sterilised women is particularly acute because of the status attached to motherhood in Kenya.

“We live in an African cultural setting where having a child or motherhood is glorified in a way that probably it’s not in other societies,” said Kasiva, director of the African Gender and Media Initiative.

“A lot of these women, because they cannot give birth, they have been chased away from their homesteads. Others have been disinherited.”

Achieng, now 30, is resigned to living alone with her two daughters after her husband died in an accident. “I have given up on life,” she said.

Although she has had suitors, none will marry her because she has been sterilised.

“If a man marries you, you have to give him a child. You won’t be called a woman if you don’t have a child with him,” she said. “I am not that old… but because of this (sterilisation) I can’t stay in a marriage.”