The South African Commission for Gender Equality (CGE) has published a new report this week, the results of an investigation into claims that pregnant women who were HIV positive had been forcibly sterilised while in hospital.

The Commission — a constitutional body established to promote respect for gender equality and the protection, development, and attainment of gender equality — launched its investigation in 2015 and published its findings on Monday. 

The CGE began its investigation after receiving complaints from a feminist social impact organisation called Her Rights Initiative (HRI), and a regional and global network called International Community of Women Living with HIV (ICW) against the National and Provincial Departments of Health. 

The two groups alleged that the sexual and reproductive rights of their clients, who are women living with HIV, had been violated when the women were subjected to forced and/or coerced sterilisation in public hospitals between 2002 and 2005.

The CGE gathered sworn affidavits from the women — which numbered at least 48 — about the procedures they said they had undergone. The women also gave the investigation team legal access to their hospital records. 

According to the report, at that time of the alleged sterilisations, the women were pregnant and were seeking medical assistance at various hospitals in the country.

“Just before giving birth, but either while in labour and/or in extreme pain, they were coerced or forced to sign forms that they later learnt through various means were consent forms allegedly permitting the hospital to sterilise them,” Keketso Maema, chief executive officer of the CGE, said in the report.

Additionally, some of the women said that, because of the extreme pain they were in, they didn’t understand the contents and consequence of the forms they were signing.

Some of the women cited in the report say that hospital staff threatened not to deny them medical attention if they didn’t sign the paperwork. 

Meanwhile other women’s narratives allege that they were also humiliated by the staff, with references to their HIV status; while “a number” of women were told they should be sterilised because women with HIV “could not be allowed to bear children.” 

One woman told the committee that, when she asked what the forms were for, the nurse replied: “You HIV people don’t ask questions when you make babies. Why are you asking questions now? You must be closed up because you HIV people like making babies and it just annoys us. Just sign the forms so you can go to the [operation] theatre.”

In a country where half the population lives below the poverty line of R992 ($65) per month, the women would likely have had no alternative for seeking medical help if they were denied care at a public hospital. 

One woman told investigators that she only found out her fallopian tubes had been cut a few years after the incident, when she went to a private doctor to ask about why she wasn’t able to conceive.

During their investigation, the CGE reports that it met with the National Department of Health (NDH) several times, as well as conducting onsite visits to 15 hospitals across the Gauteng province and the province of KwaZulu-Natal.

This isn’t the first time that forced sterilisation of women living with HIV in South Africa has been a subject of investigation. 

The South Africa National Aids Council’s 2015 stigma index, for example, revealed that, out of just over 6,700 HIV positive women interviewed, an estimated 500 women said they’d been forcibly sterilised. 

The report highlighted that “every woman has the right to bear children”, and that subjecting women “to forced sterilisation because they are HIV positive is a fundamental human rights violation.”

“To deny women the right to have children because of their status amounts to discrimination,” continues Maema, in the report.

The CGE concluded that the women suffered several rights violations and were subjected to undignified care, and also accused medical staff of breaching their duty of care to the patients.

The recommendations from the report included: to investigate the medical staff implicated; to eradicate the practice of forced sterilisation; to amend legislation to make sure consent is obtained properly; and to print consent forms in all official languages, among others. 

The health department has been given three months to respond to the report.