This means having access to reliable, nonjudgmental sexual health information, affordable contraception, and prenatal and neonatal health care.
It means opposing any state or religious interference with people's private reproductive decisions.
And it means shining a light on a persistent, pernicious problem: sterilization abuse.
Today's Globe and Mail has a feature about sterilization abuse in several African countries - and about courageous women who are speaking up and fighting back.
A few weeks after giving birth to a baby boy by Caesarian section, Hilma Nendongo went back to hospital to have the stitches removed. A nurse glanced at her medical record and casually asked her a horrifying question.
“Oh,” the nurse said, “did they tell you that you had been sterilized?”
Ms. Nendongo, a 30-year-old villager from northern Namibia who barely spoke English, tore through her personal health card, looking for a clue to what had been done to her in the state hospital.
She couldn't read any of the doctor's scrawled handwriting, except for the word “stop” and the word “closed.” She later discovered the sickening truth: this was a common code for a tubal ligation, the most frequent form of sterilization in Namibia.
She suddenly remembered that the hospital staff had told her to sign some papers as she entered the operating room for her C-section. Nobody had explained the papers.
“It was a very big shock,” she said, brushing back tears. “I was very emotional. I cried a lot. I wanted a sister for my three boys, and now I can't have one.”
She returned to the hospital to search for the doctor who had sterilized her. She hoped that somehow he could reverse the operation. But every time she went to the hospital, the staff said the doctor was busy or away.
Ms. Nendongo didn't know it at the time, but she was one of dozens of African women – perhaps hundreds – who have been sterilized without their knowledge or consent in recent years because they were HIV-positive. At least 20 such cases have been documented in Namibia, some occurring as recently as six months ago, and similar cases are believed to have occurred in Zambia, South Africa and Congo.
Women's groups say the coerced sterilizations are examples of the continuing stigma and discrimination suffered by African women who have the AIDS virus. Governments and doctors still sometimes see HIV-positive women as irresponsible dangers to society who must be restricted or even criminalized. Despite new medicine that allows them to live normally and have healthy children, many women are told they must not get pregnant. Two countries, Sierra Leone and Tanzania, even passed laws that criminalize the mother-to-child transmission of HIV.
I chose not to have children. It's a choice I was able to make because of the place and time I live in, and because I have enough education and resources to be a free human being. Women who are unable to control their reproduction are slaves.
Although I chose not to have children, I can think of few things worse than a government and a medical establishment taking that choice away from me without my knowledge or consent. I can only imagine the rage and the sorrow these women feel.
And although I won't pretend to know what they are experiencing, I do know from my own experience with sexual assault that becoming an activist - educating the public, reaching out to survivors - can be enormously therapeutic and empowering. I hope these women are finding comfort and strength in their cause.
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Lest anyone believe this to be an African problem, consider that forced sterilization of impoverished black Americans was once known as a "Mississippi appendectomy". Between 1928 and 1972, nearly 3,000 people in Alberta were victims of forced or coerced sterilizations.
Sterilization abuse of mentally ill and developmentally disabled people, of aboriginal people, and of Roma (Gypsies) has all been well documented.
As a sidebar to the story, above, the G&M has a summary of some 20th Century forced sterilization policies from the US, Canada, Japan, Germany and elsewhere, but of course they use very conservative estimates, and they seem to have omitted the medical abuse of aboriginal people.
The Wikipedia entry on compulsory sterilization is extensive, although largely unsourced.
This article from the Our Bodies, Ourselves website is about sterilization abuse in the US.
The blog Mississippi Appendectomy (which seems to be defunct) has a post on the forced sterilization of Romani women.
The 1996 documentary "The Sterliization of Leilani Muir" is about the eugenics policies of the province of Alberta. From the National Film Board site:
Twenty-five years ago Leilani Muir was informed she would never be able to conceive a child. Unbeknownst to her, at the age of fourteen, she had already been sexually sterilized, by an Act of the Alberta government. The film entwines her personal search for justice with the background story of eugenics, a respected "science" during the early decades of the twentieth century. In 1928, the Alberta government, supported by some of society's most prominent members, passed the Sterilization Act. By the time the Act was repealed in 1972, the lives of nearly 3,000 individuals were irreparably changed. Included in the wide net of people considered "unfit" to bear children were new immigrants, alcoholics, epileptics, unwed mothers, the poor and native people. The film opens as Leilani concludes years of emotional and legal preparation and steps into court to sue the Alberta government.
British Columbia had a similar policy, although less extensive.
The Globe and Mail story is worth reading. The women profiled - using their own horrific experiences to expose these human rights abuses - are inspiring.