Today is World Contraception Day under the theme “A choice for all – agency, intention, access.” UNFPA emphasizes that “everyone deserves accurate, unbiased information about and access to contraception, tailored to individual needs and circumstances.” Millions of people across Africa are still underserved, and still a long way to realize their reproductive agency. We are far from guaranteeing that every pregnancy is wanted. Our advocacy remains rooted in rights and informed choices about sexual and reproductive health, even as the systemic failures and current anti-gender rights threaten the gains made so far. Today however, I urge us to reflect on forced sterilization as an assault on reproductive rights.
In 2023, four Kenyan women living with HIV were each awarded $20,000 in damages after being sterilised without their informed consent, after a nine-year legal battle. One of them, “Penda,” described how the bilateral tubal ligation surgery she underwent after giving birth to twins at Pumwani Maternity Hospital in Nairobi devastated her life and prospects for motherhood. Abandoned by her children’s father, she was left to navigate the intense stigma of being HIV-positive and living with infertility.
In 2023, FIDA-Uganda supported a 35-year-old Ugandan woman to file a civil lawsuit against the local government in the western district of Masindi and the Attorney General, alleging involuntary and forced sterilisation at a government health facility. The case is still ongoing. These two cases from two neighbouring countries speak to the same violent reality women face with the use of forced sterilization as a tool to police and punish women’s reproductive choices, particularly those already living at the margins.
For example, a landmark case, a first in Africa, in 2012, HIV-positive women challenged the government of Namibia, over sterilized without proper informed consent, a pattern documented by NGOs and confirmed by the courts. The High Court ruled in favour of the women on the issue of informed consent, finding that the government failed to prove they had been properly informed or that their consent was freely given, especially as many were asked to sign forms while in labour and in pain. In South Africa, the Commission for Gender Equality in 2020 found that several women living with HIV were sterilized in public hospitals, often told it was a condition for accessing C-sections or maternal care. In Kenya, the 2014 report Robbed of Choice by the African Gender and Media Initiative (GEM) documented testimonies of women who were sterilized under coercion, some only discovering the procedure had been performed years later when they sought fertility assistance. Forced sterilization, thus, is not just a singular violation; it is a multi-layered assault on autonomy, dignity, and justice.
Sterilization is defined as “a process or act that renders an individual incapable of sexual reproduction.”
Forced sterilization occurs when a person is sterilized after expressly refusing the procedure, without her knowledge or is not given an opportunity to provide consent. Coerced sterilization occurs when financial or other incentives, misinformation, or intimidation tactics are used to compel an individual to undergo the procedure.
Sterilisation, when chosen freely and with full, informed consent, is a legitimate and often empowering contraceptive option for individuals and couples seeking to control their fertility. It is one of the most widely used forms of contraception globally, with procedures like tubal ligation and vasectomy offering safe, effective, and permanent solutions to those who desire them. However, when such procedures are conducted without consent or under coercion, the same medical practice becomes a profound violation of bodily autonomy, dignity, and reproductive justice.
Historic assault on reproductive autonomy
Forced or coerced sterilisation is not merely a medical malpractice; it is a gendered and often racialized form of violence rooted in eugenics, patriarchy, and systems of control over marginalised bodies. This is usually rooted in systemic inequalities and a belief that certain bodies are “unfit” to reproduce, for instance, those belonging to differently abled people, poor communities, people living with HIV, racialised minorities, and gender-diverse individuals. Historically framed as a women’s rights issue, forced sterilisation is inherently discriminatory across multiple axes of identity, weaponised to control the reproductive autonomy of those deemed “undesirable” by dominant social, medical, or political norms. Throughout history and across the world, women and gender diverse individuals, particularly poor women, Indigenous women, women with disabilities, intersex and women living with HIV, have been disproportionately targeted by state and medical systems that have viewed their reproduction as dangerous, irresponsible, or unworthy. This pattern continues today under new guises of “public health” and “population control.”
Forced, coercive, and involuntary sterilization is also a grave violation of women’s fundamental human rights and bodily autonomy. It is a brutal manifestation of intersecting systems of oppression, patriarchy, racism, ableism, and colonialism. In 1997, scholar and social justice activist Prof. Dorothy Roberts authored Killing the Black Body: Race, Reproduction, and the Meaning of Liberty”, chronicling the war against black reproduction, from slavery to the present day. The more children an enslaved woman produced, to be owned and sold at her master’s discretion, the more valuable she was, which Roberts says “led to a regime of practices, laws, and ways of thinking about Black women’s bodies that permitted coercion of their reproduction.” She insists it is impossible, therefore, to view forced sterilisation as anything less than a deliberate, structural act of colonial and racialised gender violence and a reflection of ongoing systems that continue to devalue certain lives as less worthy of reproductive autonomy.
Often cloaked in medical language or disguised as “voluntary” procedures, forced sterilization is coerced through pressure, misinformation, the strategic withholding of critical information, or outright manipulation, especially within healthcare settings where power imbalances between medical providers and patients are acute.. In many cases, consent is obtained under distressing conditions, during childbirth, surgery, or when women are misled to believe that sterilization is a prerequisite for continued medical care or access to antiretroviral treatment.
Beyond the physical and psychological consequences, this practice also results in deeper, often unspoken violations: the erosion of legal agency, the denial of access to remedies, and the silencing of women’s experiences through stigma or institutional gaslighting.
Actions towards addressing this violation
Over the past three decades, international feminist and human rights movements have tirelessly worked to reframe global population policies and health frameworks around respect for women’s autonomy and reproductive rights. The 1994 International Conference on Population and Development (ICPD) marked a pivotal shift away from coercive population control policies, such as sterilization targets and contraceptive quotas, toward recognizing SRHR as fundamental human rights. It emphasized voluntary, informed decision-making and placed reproductive autonomy and gender equality at the center of development. Today, 179 countries have adopted the ICPD Programme of Action, and its language on rights-based family planning and informed consent has been integrated into UN declarations, WHO guidelines, and national laws. Similarly, the Beijing Platform for Action, adopted in 1995, unequivocally called for the elimination of coercive sterilization practices and reaffirmed women’s right to make decisions about their reproductive health free from violence and discrimination. The World Health Organization (WHO) has also issued clear guidelines condemning forced sterilization, underscoring that respect for informed consent and dignity must guide all healthcare interactions.
The African Commission on Human and Peoples’ Rights passed a Resolution on Involuntary Sterilisation and the Protection of Human Rights in Access to HIV Services, prohibiting the practice. The commission asserted that forced sterilisation is an act of sexual or gender-based violence that may amount to torture or inhuman treatment.
The Maputo Protocol, an authoritative legal instrument on women’s rights in Africa, explicitly guarantees women the right to control their fertility and access reproductive healthcare without coercion, reinforcing that forced sterilization violates both human dignity and bodily integrity.
In Uganda, the Constitution guarantees the right to health care, freedom from degrading treatment, gender equality, and the state’s duty to protect women’s reproductive autonomy. Under the Persons with Disabilities Act, forced sterilization is explicitly prohibited, affirming that persons with disabilities must not be subject to medical procedures without their agreement. Uganda’s law prohibits harmful practices against marginalized groups and mandates the provision of inclusive and dignified healthcare services. These national commitments affirm that forced sterilization is not only a violation of international human rights obligations but also contravenes Uganda’s constitutional and statutory protections.
Feminist demands for reproductive justice
At the heart of feminist resistance to forced/ coerced sterilization lies a powerful, unwavering demand: reproductive justice. More than the narrow right to access contraception or abortion, reproductive justice envisions a world where everyone, regardless of their identity or status, can access reproductive health care. Feminist, disability, and human rights movements have fought back, not only through grassroots mobilisation, survivor-led advocacy, and litigation, but also by strategically engaging with international and regional legal frameworks to hold governments accountable.
Feminist advocates have utilised shadow reports, strategic litigation, and sustained pressure on treaty bodies to advocate for stronger protections and greater accountability. This engagement has led to international rulings, state-level legal reforms, and a growing global consensus that reproductive control through sterilization without consent cannot be tolerated under any circumstances.
Still, the work is far from over
What these movements show is that addressing reproductive injustice takes more than legal reform. We must dismantle systems of substitute decision-making, where others, like doctors or guardians, make choices for women without full and informed consent. This is especially harmful for women with disabilities, who are wrongly seen as incapable. Deeply personal decisions, like sterilization, are too often made about them, not by them, even when they could decide with proper support. Replacing these systems with supported decision-making ensures that every woman can understand her options and make decisions about her body, with support, but never stripped of that right. Governments have a duty to protect these rights universally, not selectively. This means outlawing forced sterilization, ensuring access to justice for survivors, and providing meaningful reparations, medical, psychological, and symbolic.
Elizabeth Kemigisha is a Feminist Lawyer and Organiser at the Uganda Association of Women Lawyers (FIDA Uganda)