Debate on the investigation of Commission for Gender Equality (CGE) on the reported matter of forced/coerced sterilisation of women living with HIV/AIDS in South Africa

Hon. NJ Nkwanyana, MPL, IFP KZN spokesperson for Health

24 November 2020
KZN-Legislature, hybrid sitting


Honourable Speaker,

The IFP would like to begin by commending the non-profit organisation, Women’s Legal Centre, which, on behalf of the Her Rights Initiative (HRI) and International Community of Women Living with HIV (ICW) organisations, documented 48 cases in 2015 where women were allegedly either forced or coerced into agreeing to the sterilisation procedure while giving birth. This then prompted an investigation by the Commission for Gender Equality (CGE). We commend the CGE for tackling this matter with the seriousness and urgency it deserves, and for ensuring that, despite the hurdles along the way, the investigation was completed. Such organisations, which are on the forefront of protecting patients and upholding their human rights must be applauded and supported.

The IFP recently learnt of the findings contained in the CGE investigation report into claims about women – as early as 2015 – who were coerced into reproductive sterilisation, meaning that they were coerced or forced into a medical procedure that permanently blocks a woman’s fertility. It is performed either by tubal ligation, where the fallopian tubes are tied, or a hysterectomy — removal of the uterus.

The findings of the investigation revealed that women were not properly informed or counselled prior to being sterilised. Some women were not informed in a language they could comprehend, or they were not given enough time to make their decision. In some cases, it was found that women were sterilised while receiving C-sections. Client files were not found, despite having a record of less than 25 years. Consent forms and procedures differed from the records, and some consent forms were signed when patients were in dire pain. This is a gross violation of the rights of these women, as well as an injustice. This is still happening, despite the fact that in 2016, the United Nations General Assembly committed to ending forced and coerced sterilisation, in particular the sterilisation of women living with HIV, in the Political Declaration on Ending AIDS.

As the IFP, we strongly condemn this inhumane and unethical practice. It is a crime against humanity. Health officials in this country need to stop disregarding people’s rights and treating patients with a poor attitude and rudeness. We have even heard reports that some nurses and doctors swear at women for being pregnant, or if they suffer from various conditions, humiliating them publicly.

This report is not shocking at all.

It is not the government’s policy to carry out forced or coercive sterilisation. The Sterilisation Act is clear that sterilisation should not happen without informed consent. Using force, or any other type of coercion, is prohibited and considered a violation of human rights. It seems that this Department does not care about human rights, and is regularly found to be trampling on and ignoring the South African health legislation, which clearly forbids coerced or forced sterilisation.

We are deeply disappointed that this injustice against women also takes place in our province, when the Tubal Ligation Guidelines of 2014 – set out for the Department of Health in KwaZulu-Natal – clarify the provisions for those who undergo “female sterilisation” for healthcare practitioners. The guidelines stipulate that those who choose sterilisation should have access to it and undergo an appropriate consent procedure, including counselling, information on the advantages and disadvantages of the procedure, and information on other forms of contraception available. It clearly says that obtaining consent should be conducted in the language that the patient understands and witnessed by at least one other health worker.

Therefore, it is appropriate that the IFP seek suitable answers to the following questions from the KZN Health Authorities:

  1. How many doctors and nurses have been found to be involved in this inhumane practice in KZN?
  2. Are these doctors and nurses still working in the same health facilities, if not, where are they now?
  3. How does the Department plan to deal with doctors or nurses found to be responsible for forcing or coercing women into sterilisation?
  4. If the doctors and nurses involved in this scandal are no longer working in the local health facilities, how will the Department make sure they account for their actions?
  5. Does the Department know how many women in KZN have been affected?
  6. Has the Department taken any action to put a stop into this injustice against women living with HIV/Aids?
  7. Are there any complaints or claims to the Department relating to this practice? If yes, how many?
  8. At which public hospitals or clinics did this practice happen?
  9. What plans are in place to prevent this malpractice from happening again here in KZN?

All these questions must be answered.

The IFP has, on numerous occasions, raised serious concerns about medical malpractice in provincial hospitals and healthcare facilities, which has led to the Health Department paying exorbitant amounts of money due to claims lodged by affected patients. People go to hospitals to get treatment for medical problems, yet sadly they receive maltreatment from the very people who are trained to assist them. Medical malpractice continues to be an area of grave concern and is costing the Department millions of Rands. Again, we are on record calling for this Department, especially the KZN MEC for Health, to intervene and find solutions to deal with the incompetence, negligence, abusive behaviour, unprofessionalism, as well as the irresponsible and  bad attitude of health practitioners towards patients, all of which contribute to the injustices committed against patients.

Many more people will lose trust and confidence in our healthcare practitioners because of the mistreatment and forms of abuse from health workers, which amount to the blatant violation of patients’ rights, as well as the Oath they undertook at the beginning of their careers.

These are fundamental human rights guaranteed to all patients – regardless of HIV status, level of education or social status – as per numerous global, national and regional treaties.

What is further of great concern to us is the arrogance and ignorance that was displayed by the Department of Health in relation to this critical investigation.

The CGE indicated that the investigation sampled public hospitals in KwaZulu-Natal (KZN) and Gauteng, the Department of Health (DOH) was informed of the allegations that were reported, and permission was requested to commence an investigation. A team from the Department was also requested, to assist with the investigation. It was indicated that after several meetings had been held between the CGE and DOH to find a joint strategy, the DOH offered very little cooperation and delayed the process, forcing the CGE to go ahead with the investigation, and to release a preliminary report on their findings, without the full cooperation of the DOH.

Is this not a clear indication that the DOH has something to hide, as the findings revealed?

The level of arrogance has already led this Department to spend billions paying medico-legal claims.

Further, if you care about the health of South African citizens, how could you refuse to cooperate with an investigation that seeks to get to the root of malpractice of your Department?

As the IFP, we are not surprised that the CGE received little cooperation from the Department of Health regarding this matter. This Department is well-known for its incompetence. It is therefore not shocking to us that it suddenly created a barrier to the CGE, obstructing it in its task of investigating this gross human rights’ violation. This is how cases such as the ‘Life Esidimeni tragedy’ and the oncology crisis here in KZN happen – due to sheer arrogance and little care for the wellbeing of citizens.

The IFP calls upon the Health Ombudsman, the South African Nursing Council (SANC) and the Health Professions Council of South Africa (HPCSA) to ensure that the medical practitioners responsible for this misconduct are criminally charged and that their licenses are revoked. Further, the IFP demands that those found guilty must be named and shamed, and blacklisted.

The IFP also supports the recommendations made by the Commission that the Department of Health must put concrete steps in place to ensure that the harmful practice of forced sterilisation is eliminated, once and for all.

This report reminds us of the need for reproductive justice for women living with HIV, and that we must constantly be vigilant, and responsive to violations.

Lastly, as the IFP, we will pursue this matter by ensuring that the affected women are heard by the authorities. We will find out which health facilities are still breaking the law and seek the help of relevant agencies, to ensure that proper action is taken against those found responsible for committing this atrocious act against the women of South Africa.