Reproductive justice is founded on three principles: the
right not to have children, the right to have children, and the right to parent
children one already has in safe and healthy environments. It understands that
‘choice’ in reproductive decision-making is directly enabled or disenabled by/through
interacting systems of oppression. Owing to these interacting systems of
oppression, people will have different experiences of reproductive freedom and
oppression, something that needs to be well understood in order to ensure reproductive
justice for all.
In February of this year, The Commission for Gender Equality
(CGE) released its report on 48 reported cases of forced sterilisation that took
place between 2002 and 2015 in 15 South African public hospitals in KwaZulu
Natal and Gauteng. At the time of the violations, the 48 womxn, all of whom are
black and most but not all of whom were HIV positive, were pregnant and had
presented at public hospitals for medical assistance. All of the womxn gave
birth at the hospitals via caesarean section and were sterilised whilst in
theatre for the caesarean. Immediately
prior to giving birth and whilst during labour or in severe pain, some of the
womxn had been asked or told to sign consent forms. Of these, while some womxn
reported having been briefly told that by signing the forms they were granting
their consent for sterilisation, others reported they had not been told that
the forms were for sterilisation. Few of
the 48 womxn were not given consent forms nor told that they would be sterilised.
The report details various methods/tactics of coercion used
to ensure that the sterilisations occurred. In addition to capitalising on the
exhaustion, confusion, distress, and/or pain that may characterise giving
birth, and insufficient/a lack of explanations about the sterilisation
procedure (including its consequences), coercion tactics included misinformation,
threats to withhold medical assistance (including the caesarean operation
itself), and/or humiliation.
I wish to focus on the womxn’s accounts of the humiliation
they faced at the hands of healthcare providers. In doing so, I do not mean to
undermine or dismiss the importance of discussing the healthcare providers’ violation
of informed consent principles and procedures- the CGE’s report addresses this aspect.
Rather, focusing on some of the womxn’s accounts of humiliation, and the media
representations of the forced sterilisation cases investigated by the
commission will, I believe, reveal the usefulness and potency of a reproductive
justice approach in our understanding of unjust social practices as well as
feminist efforts to ensure justice for all.
Several womxn who were HIV positive reported being told that
the sterilisation was necessary because womxn living with HIV cannot be
permitted to have children. For example, one womxn reported being told that
“women (sic) with HIV should not have children” (Commission for Gender
Equality, 2020, p.45). Another was told
“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” (Commission for Gender Equality, 2020, p.48). Similar
accounts were reported in a South African study on
the forced sterilisation of womxn living with HIV.
As stated earlier, most but not all of the 48 womxn whose
cases were investigated by the CGE were HIV positive. Indeed, healthcare
providers also humiliated womxn for other reasons. For example, one womxn was
told that the sterilisation was necessary “because she had too many children”
(Commission for Gender Equality, 2020, p.42). In other womxn’s cases,
healthcare providers seemed to justify the sterilisation for other
reasons such as because the womxn had TB, were poor and/or young. We also
need to keep forefront the racialised aspect of this practice: all of the 48 womxn
are black.
A reproductive justice perspective and feminist scholarship
around reproductive politics enable us to see connections across healthcare
providers’ justifications for forced sterilisation. When all of the
justifications are taken together, and it is imperative that they must be, it
is clear that in forcibly sterilising the womxn, healthcare providers were
making judgments and drawing on public health discourses about which womxn are
fit to reproduce. It is no coincidence that within mainstream public health
discourses, parenthood by oppressed groups is constructed as a threat to individual
and public health as well as the economy. Indeed, the healthcare providers’
judgments and use of public health discourses are features of and produced within
systems of oppression which instate white, wealthy, healthy, older womxn as non-threatening,
rightful, desirable legitimate parturient subjects and reproductive citizens,
and in particular as having the (unconditional) right to have children and to parent
them.
Newspaper coverage of the CGE’s investigation has rightfully
framed the forced sterilisations as a humxn
rights’ violation. Worryingly, however, some
of the newspaper coverage of the CGE’s investigation have focused almost
exclusively on those 48 womxn who are HIV positive. This could, perhaps, be
due to the fact that the CGE’s report itself (particularly the analysis section)
highlights the cases of the HIV positive womxn, which is possibly expected
given that one of the two complainant listed in the report is an organisation
that advocates for the interests of womxn living with HIV. Past research has
indeed shown that womxn living with HIV are vulnerable to forced sterilisation
practices. To re-present/frame the forced sterilisation practices documented in
the CGE report as only happening to womxn living with HIV, or to highlight
these cases and neglect others, is to reduce the forced sterilisations
documented in the report to a single issue. This is problematic because doing
so erases and diminishes the suffering of the womxn who were HIV negative, as
well as the suffering of womxn who were HIV positive and black, poor,
young and/or were deemed to have ‘too many children’. There are a number of
implications of understanding this issue as one where it is only womxn
living with HIV whose reproductive rights have been violated. Doing so: 1) implies
that there are forced sterilisation practices that are more egregious, and
therefore less tolerable than others (and vice versa); 2) prevents us in this
instance from fully acknowledging and grappling with white supremacist,
anti-poor and patriarchal systems that mean that in democratic South Africa, black
poor womxn continue to experience population control measures that were a
feature of the design and practices of apartheid; 3) prevents us from asking
and exploring whether (black) people from other oppressed groups, such as poor people
(including of all races), immigrant and undocumented migrant people, queer people,
and people living with disabilities who are womxn, mxn and gender
non-conforming might have similar experiences; 4) prevents us from seeing the
connections across different experiences and practices of forced sterilisation;
and 5) ultimately means that efforts to ensure freedom from forced
sterilisation may rightfully uphold reproductive autonomy for HIV positive
womxn, while leaving behind those who are deemed to be comparatively less
worthy.
Posted by Dr Jabulile Mary-Jane Jace Mavuso
Research Associate, Critical Studies in Sexualities
and Reproduction, Rhodes University, South Africa
Reference(s)
Commission for Gender Equality. (2020). Investigation
report on the forced sterilisation of women living with HIV/AIDS in South
Africa. Accessed from http://www.cge.org.za/wp-content/uploads/2016/12/Forced-Sterilisation-Report.pdf
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