Women recount pain in doctors hands

By Lonah Kibet

Some of the more disturbing claims in the ‘Robbed of Choice’ report involve illegal sterilisations performed without the patient’s knowledge.

For example, Selina, a mother of two claims she was sterilised at the Kenyatta National Hospital in 2000, after her husband signed the forms approving her C-section and tubal ligation. It is not clear if he was aware the sterilisation was to be performed since he later left her when she could not have any more children.

Jane, a mother of four who was allegedly sterilised at the Kakamega General Hospital in 2004, says her husband talked a doctor into performing tubal ligation to punish her “for only giving birth to daughters”.

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However, she admits that she kept her HIV status a secret from him and he only found out when a doctor at the hospital told him.

Other women sterilised at public hospitals say doctors or other health workers either threatened to withhold C-sections or used other forms of pressure to get the men to sign the forms.

Some say the forms were brought to them when they were in advanced stages of labour and could not give informed consent.

The stories told by Pamela Andeka, 42, and Ruth Achieng’, 30, suggest some of the women gave uninformed consent or were sterilised during emergency surgery following pregnancy complications. This puts to question some claims of coercion.

Andeka is a widowed mother of five from Nairobi’s Mathare slum. She had her first three children in 1988, 1992 and 1998 before her husband died of HIV-related complications in 2002.

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The eldest of the three is HIV-positive and, like Andeka, on anti-retroviral medication provided by the Blue House Clinic, a Médecins Sans Frontières (MSF) facility in Mathare.

Two years after her husband’s death, Andeka had unprotected sex with a man she met and got pregnant. She turned for help at Blue House, which specialises in pre-natal care and prevention of mother-to-child transmission.

Nine months later, she delivered a healthy set of twins at the Pumwani Hospital.

She further claims that when she took her children to Blue House, she was told they would not get medical attention or food supplements unless she could prove her tubes were tied.

MSF, the group behind Blue House, says it is investigating claims by Andeka and other women. “Instead of my children suffering and not getting milk (in a free feeding programme) I decided to have the operation done by Marie Stopes International,” she said. Andeka says she regrets having had the procedure.

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“That pain is something I would not want any woman to undergo,” she says. She adds that meeting and talking to other HIV-positive women who have had tubal ligation has been therapeutic. She can now openly speak about her status and encourage others like her to take charge of their reproductive health.

Consequences

“Women living with HIV can have healthy, virus-free children,” she says. “I am proof of that. I have two healthy twins as living proof.” She warns pregnant HIV-positive women not to be pressured into getting their tubes tied. “The doctor or health worker should be clear about the consequences of the operation.”

Achieng’, who lives in Kibera, got to know she was HIV-positive shortly after having her first child at 19.

Her HIV-status was confirmed during pre-natal care and she was put on a seven-month course of antibiotics to prevent infection and raise her CD4 (white blood helper cell) count high enough that she could start taking ARVs.

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Achieng’ conceived in 2004 but did not tell the doctors or seek treatment to prevent HIV transmission to the child.

The pregnancy ended in a miscarriage and she conceived again. This time the pregnancy almost ran the full term. But one day, late in her pregnancy, she passed out and was rushed to KNH.

Achieng’ says she regained consciousness one week later, having lost the baby. Three days after she woke up, a doctor asked her whether she was aware of her HIV status.

“I told him I knew I was positive and he said it was not right for me to give birth given my condition,” she says. “He told me that I would give birth to a HIV positive baby and that is why they had closed my womb.”

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Women sterilization