The BBC reported this week that three women in Namibia are suing the state for performing a sterilisation without consent. There appears to be some uncertainty about the degree of force because of difficulties during consultation. A legal representative remarked that procedures are not always discussed clearly and the eleven indigenous languages create, at times, a language barrier. The women have been protesting and carrying placards which state “My body, my womb, my right”.
Now, for the next crucial point: these women were sterilised following a positive diagnosis of HIV. Coming from a society (UK) that promotes individual autonomy and truth-telling to patients to its greatest extent, it is easy to jump on the bandwagon and start pointing the finger at the accused doctors for their wrong-doing. Forced sterilisation has been reported in other countries, particularly post-Communist countries such as Albania and the Czech Republic. It has been difficult to carve out the image of autonomy from a history that denied individuality. But Namibia has a different twist. I can only surmise that the goal for preventing future pregnancies of these women is to halt this method of potential transmission of the HIV virus.
In a country where HIV/ AIDs is the leading cause of death, and the National Demographic Health Survey (2006) estimated close to 17% of children under the age of 18 have been orphaned by at least one parent, the medical community – as well as society – must be close to despair. Does this make a doctor’s action to perform a sterilization on a HIV+ woman who may have not consented with capacity and competence, or not consented at all, any easier to understand?
Is it a utilitarian ethic to prevent the potential future suffering – medical and social – of a family – and is a doctor the right person to instigate such practices? First of all, HIV is a manageable chronic condition in Western countries, but with the lack of accessibility and availability of medication along with other factors specific to a country, HIV is a death-sentence.
Is managing birth a way of managing disease? Truth and trust often go hand-in-hand. What are the implications for Namibian women and the countries medical system? It appears that the sterilization of these three women, forced or not forced, is raising questions about how must medicine respond to dire threats to human life, and moreover, cutting the cord of trust between a doctor and a patient terminates a part of the system of society.