SANTA MONICA, California — Health care providers in Latin America are pressuring — or in many cases, forcing — HIV-positive women to undergo sterilization due to prejudice and misinformation about the risk of the virus being transferred to a patient’s children. This practice is an avoidable and unnecessary violation of basic human rights.
Forced sterilization means that a woman is operated on without her knowledge, while coerced sterilization means that a woman is made to sign a consent form while under distressing circumstances or without being properly informed. Many victims who undergo the latter are manipulated by doctors and nurses into feeling like there is no other choice.
According to U.N. figures, there are approximately 59,300 women living with HIV in Mexico, El Salvador, Honduras and Nicaragua. And while a survey conducted by Harvard School of Public Health research fellow Tamil Kendall showed that approximately one quarter of these women faced pressure or coercion to undergo sterilization, those who were pregnant were almost eight times more likely to face such pressure.
In effect, health workers are forcing their misguided beliefs onto HIV-positive patients. They are denying their patients reproductive rights—including number and spacing of children and preferred contraceptive method. “It’s really unthinkable that women living with HIV are being pressured and forced into sterilization when treatment almost eliminates the possibility of the mother-to-child transmission,” said Kendall. She added, “Even though our knowledge is growing about how safe conception and pregnancy can be with current HIV treatments. . . this knowledge is still often ignored as a routine part of HIV care.”
Instead, victims give accounts of being intimidated, bullied and misled into sterilization by healthcare providers. Some say that doctors threatened to withhold medical or economic support if they did not comply. One 19-year-old El Salvadorian woman said, “The nurses forced me to sign. They asked me more than three times and threatened not to perform the cesarean. Because of the pressure, I had no option but to sign.”
Other women were sterilized without any form of consent or knowledge of the procedure. In one particularly shocking incident, a Mexican woman was sterilized while under anesthetic for a caesarean section. When she regained consciousness, she found that her thumb had been dipped in ink to be used on a consent form.
The WHO reports that, without treatment, the likelihood of mother-to-child HIV transmission ranges from 15 to 45 percent. With antiretroviral treatment, this number can be reduced to less than five percent. In light of these findings, it is appalling that coerced and forced sterilizations continue to occur. Kendall’s study surveyed rich and poor, rural and urban women. “Yet neither their ethnicity, nor economic or social status were significant in indicating whether they were likely to be pressured to sterilize,” Kendall noted. “That reinforces the idea that what is actually driving this is discrimination around HIV itself.
The news that this violation of reproductive rights is entirely based around prejudice and misinformation is unnerving. Yet it also has its benefits: if culpable health workers are properly educated about the issue, as well as about improved reproductive health care, the problem can be vastly improved or even eliminated.
The findings also hold significance for policymakers and enforcers. “[There is] a great need to evaluate how health care providers are held accountable—in courts, for example—for violating the reproductive rights of women with HIV,” said Kendall. “And it’s important to work with policy makers, because they are the ones who ultimately need to hold institutions accountable.
Although forced and coerced sterilizations are problems that require multifaceted cooperation and global awareness, there is a strong prospect that the prejudice at its root can be addressed and extinguished.
– Mari LeGagnoux
Sources: UNFPA MHTF, Harvard School of Public Health, Trust.org
Photo: Huffington Post