'No more babies for you!'

Two more forced sterilisations of HIV-positive women - one at a private Gauteng hospital - have been revealed.

Both instances were last year. They have been exposed by the non-profit organisation the Her Rights Initiative, and by the University of KwaZulu-Natal.

They bring to 48 the number of such cases, dating back to 1986, brought to light, according to Ann Strode, an advocate acting for HRI.

The NGO believes there have been many other cases of forced sterilisation but the women involved have been "too ashamed" to come forward.

Strode said she was surprised by the two recent cases. She expected the practice to have ended in 2006, when antiretrovirals were made widely available to South Africans.

Instead, more than half of the 48 cases took place after 2006, even though ARVs prolong the lives of HIV-positive women and prevent mother-to-child transmission.

In all the cases reported to Strode, a nurse or doctor suggested sterilisation to an HIV-positive mother.

Often, women were not told about sterilisation until they were in labour.

In one instance a woman in labour was asked to sign a consent form after she had collapsed onto the floor.

Strode said health workers assumed that signing a consent form equalled consent - but this was not the case if they did not ensure that the woman understood what she was signing.

The husband of the woman sterilised at the Gauteng private hospital had wanted more children and was not told that his wife had been sterilised. Their marriage is now in difficulties. Litigation is under way, said the NGO.

The second case occurred at a state hospital in KwaZulu-Natal. The woman was told that she had "too many children, was young, HIV-positive and unemployed". She was allegedly coerced into signing a consent form while being wheeled in to the operating theatre for a Caesarian section. A challenge to the legality of the sterilisation is being made.

In 10 of the 48 cases, women learned that they had been sterilised only after the procedure, or years later, when they struggled to fall pregnant or were subjected to another medical procedure.

A director of the Her Rights Initiative, Sethembiso Mthembu, said that, in many communities, the stigma of being unable to bear children was worse than being HIV-positive.

One woman who said she underwent a forced sterilisation hid the fact by lying to her boyfriend. She said she would tell him that she had been pregnant but had miscarried.

A case of forced sterilisation was settled out of court last year; the parties would not disclose the terms.