Teresia Otieno July, 2014

1. Improving advocacy for respectful maternity care and the reproductive rights of WLHIV- Forced and Coerced sterilization experiences Teresia Otieno July, 2014

2. Presentation Outline • Experiences of forced and coerced sterilization in Kenya • Opportunities for Advocacy

3. ICW leads the way • 2005 - ICW exposes cases of forced/coerced sterilization of women living with HIV in Namibia. • 2008 – Women who have experienced sterilization file suit to challenge the unlawful sterilization of women living with HIV. • 2010 – ICW identifies cases of forced and coerced sterilization in Kenya and Eastern Africa • ICW Members and partners documented experiences of WLHIV on forced and coerced sterilization in Kenya.

4. Study Findings in Kenya • Forty women were sampled aged between 18 –54 years • 85% of the participants are unemployed without income. • 75% of the cases happened at private health care facilities, while 25% at public health care facilities • 50% of the participants were coerced and 50% were forcefully sterilized.

5. How involuntary sterilization happened? • TL done during an emergency cesarean section • Consent form signature obtained when the woman was in labor • Sterilization was required as a condition for getting support • healthcare providers belief that WLH should not have children or that they had too many children already.

6. How involuntary sterilization happened? • Spouse and/or parents gave consent for sterilization on behalf of the women. • Misinformation by healthcare providers about their family planning choices or the risks of future pregnancies to their health and that of their baby. • Sterilized because of their disability and HIV status

7. Impacts of sterilization experience • Intimate partner violence-Psychological and physical violence e.g partner walks out on disclosure of sterilization status • Dis-inheritance of matrimonial property because she cannot bear children for the family • Frequent abdominal and back pains- Botched procedure? • Reduced sex desire- Gynecological explanation?

8. Study Recommendations • National survey to better understand the scope of the problem • Review of the national family planning guidelines to align to international standards including the FIGO guidelines. • Clear-cut training on procedures around sterilization for all women with emphasis on the counseling and consent obtaining procedures. • Public education on reproductive health rights and choices for women living with HIV targeted to both women and men. • Accessibility to medical records, all patients should have access to their medical records

9. Current Challenges • Lack of recognition amongst women living with HIV and health care workers of what constitute violations of sexual and reproductive rights. • Challenging to find women willing to endure the arduous and difficult process of litigation. • Unfavorable legal environments. • Denial from authorities that this is a systemic pattern, focus on individual instances. • Need to strengthen the institutional capacity of HIV-positive women’s networks to be able to document, monitor and publicize human rights violations experienced by women and girls living with HIV and to use this evidence in policy advocacy.

10. Setting the Agenda • Advocacy Strategies: Litigation, More Research, Advocacy, Mobilization and Media Engagement. • Forced & Coerced Sterilization Working Group in Kenya • Connect women living with HIV and their allies. • Share strategies and knowledge. • Raise awareness at the national and global Level. • National and regional campaigns to end forced and coerced sterilization. • Building a global advocacy campaign- together

11. THANK YOU!