After having her second child at 27, Celine* decided that would be her last. She asked doctors at the Catholic Mission Hospital in Rongai where she had given birth for a tubal ligation procedure. The contraception method is permanent and Celine felt it would be a massive step in taking control of her womanhood.
The hospital’s response stunned her. The gynaecologist told Celine the consent of her partner was needed. The doctor argued that Celine could change her mind along the way about wanting a third child, maybe a fourth. The “man of the house” had to provide consent to prove that the decision was made by both parties.
Nothing made sense. She was making a choice she felt was best for her reproductive health. When her partner did not consent, Celine put her plans on hold.
Eight years down the line, Celine was ready to have the procedure once more. This time, she went to a government hospital in Nairobi hoping that at 35, things would be different. To her dismay, her request was met with the same dismissiveness. Single at the time, she was advised to seek consent from a male member of her family who was of sound mind.
“Imagine asking my dad for permission to tie my tubes,” says Celine. “How insane is that?” She opted not to go through a process that she deemed dehumanising.
Celine is one among many Kenyan women who have been denied tubal ligation. Her case would be no different in 2021. Not even the medical practice is spared from the claws of patriarchy and misogyny. Online conversations have in the past revealed, at least anecdotally, that the obstruction of tubal ligation is far too common, even in urban places. Every waking day, patriarchy seems to take charge of policing women’s bodies. It is so ingrained into our culture and systems, that even women perpetuate it.
Reproductive health rights for women have become so intertwined with patriarchal demands that they can barely be separated.
The contraception conversation is a continuous contentious debate. It can be exemplified by the Reproductive Health Bill which provides a framework governing access to family planning, safe motherhood, termination of pregnancy, reproductive health of adolescents and assisted reproduction. The bill which was first proposed in 2014 by then-Nominated Senator Judith Sijeny failed due to misinformation around abortion and access to contraception for adolescents propagated by religious leaders and civil society lobby groups such as Citizen GO.
The bill was revived by Senator Susan Kihika in 2019 and is currently before the Senate. Still, the same patriarchal prohibitive thought patterns seem to be hindering its progress.
Data has proven that low contraceptive use is inversely proportional to a country’s maternal and child mortality rates. This is evident in countries with deeply ingrained customary and religious laws.
Tabitha Saoyo, a Kenyan health and human rights lawyer says there is no law in Kenya that proposes male consent as a prerequisite to offering tubal ligation.
“If you are seeking your man’s approval, it is because of culture, patriarchy and probably the fear of domestic violence, not because the law demands your husband’s input,” says Saoyo.
She adds, “Consent mostly applies to persons of unsound mind, minors and persons with disabilities because the law deems them incapable of making sound decisions, either due to age or due to mental incapacitation.”
Society has for a long time relegated the duty of contraception to women, often overlooking what a huge burden it is to bear. The majority of the procedures such as implants, injectables and intrauterine devices are highly intrusive. Besides the pain experienced during these procedures, contraceptive methods such as implants lead to increased risk of ovarian cysts, and may cause mood swings and depression.
An easy birth control method for men is the use of condoms, which many couples in marriages dismiss. The male equivalent of tubal ligation is vasectomy, a procedure that blocks sperm from reaching the semen, making it impossible to get a woman pregnant. Vasectomy is a fairly affordable and accessible procedure whose intentions are hardly ever questioned.
Vasectomy is reversible, although Kenyan hospitals are not equipped to reverse the procedure. While the reversal option is available unlike for tubal ligation, this fact should not be used to take away a woman’s agency over her body.
There’s another side of the coin. There are groups of people who are coerced to undergo tubal ligation; women and girls suffering from disabilities, HIV/AIDS patients, and intersex persons. According to Human Rights Watch (HRW), coerced sterilisation usually occurs when financial or other incentives, misinformation, or intimidation tactics are used to compel an individual to undergo the procedure.
Women with disabilities may have difficulties understanding or expressing what was done to them, increasing their vulnerability to forced sterilisation. These decisions are often made by family members, guardians and spouses who often justify their choices as being in the best interests of the victims.
The HRW report indicates that these arguments for their “best interests” often have little to do with the rights of women and girls with disabilities and more to do with social factors, such as avoiding inconvenience to caregivers, difficulties in protecting against the sexual abuse and exploitation of women and girls with disabilities and the lack of adequate and appropriate services to support women with disabilities in their decision to become parents.
“Perceived mental incapacity does not invalidate the requirement of free and informed consent of the woman herself,” says Saoyo.
Coerced sterilisation is a violation of constitutional rights. Organisations such as the Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN) are fighting for justice for these marginalised women. KELIN is challenging in court the sterilisation of four women living with HIV. Medicin San Frontiers (MSF), Pumwani Maternity Hospital and Marie Stopes International are the respondents in the case. The matter has been ongoing since 2014. KELIN has also documented the stories of HIV positive women who have suffered forced sterilisation.
Any woman who has undergone tubal ligation without their informed consent can seek legal recourse. Similarly, any woman who has been denied the procedure can sue the healthcare facility. “You have a right to accurate and most scientifically advanced information and choice in terms of your body,” says Saoyo.
Medical health professionals have an obligation to give their patients options and to advise them on what would be most suitable for their bodies. Medics have no right to deny people their preferred methods of contraception.
The broader pattern drawn from family planning choices, whether consented or not, is that there are systemic issues – legal, medical and cultural.
According to Saoyo, the fight for women’s reproductive rights has been largely hindered by religion. “They have demonised reproductive rights and equated them to immorality, coupled with misinformation, fear, threatening lawmakers, refusing to give services in their own hospitals and inciting the general population with a lot of myths and falsehoods,” she says.
These patriarchal structures within the church are often disguised as church values.
Reproductive healthcare has improved by leaps and bounds with each decade. It is about time society emancipates itself from the shackles of outmoded cultural and religious beliefs that seek to oppress women’s rights. The feminist movement is fighting the good fight in ensuring gender equality. Picking up the pieces of the tossed out Reproductive Healthcare Bill and bringing it back to the Senate is a step in the right direction.
One of the goals within Sustainable Development Goal 3 (Health) is to ensure universal access to sexual and reproductive health-care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes by 2030. The Ministry of Health and related agencies should not only build proper laws on sexual and reproductive health but also be keen on implementing prevailing policies such as the National Adolescent Sexual and Reproductive Health Policy.
The current constitution is the first to guarantee the right to health care services, including reproductive health care. It does not give any caveat to offering this service. Therefore, denying a woman access to a contraceptive method of her choice is a violation of her sexual and reproductive health rights, and by extension, human rights.
Any woman who has attained the legal age and is of sound mind should have the opportunity to undergo tubal ligation without the consent of a man. Adulthood affords one the right to their bodies and the agency to choose when and if to bear children.
No woman should have to go through the indignity of pleading with their fathers to offer them consent to care for their reproductive health however they deem fit. It is demeaning, carries away a woman’s self-esteem, and shows little to no thought about what the woman would like to do with her body. It implies that their bodies are men’s properties and shames single women. Women should no longer grovel to have gender equality.
Medical facilities such as Marie Stopes who offer tubal ligation procedure for Sh20,000, and without any prejudices, have been a welcome relief. Some private facilities charge from Sh50,000 upwards for the procedure.
“For you to have agency, you have to be a woman of means,” Celine remarks. She was advised that it was best to try tubal ligation at the age of 40. She recently turned 41, but Celine is sceptical about trying it a third time.
Attitudes towards permanent birth control methods for women are still skewed towards patriarchal demands. “Where’s the money to go to these fancy hospitals?” she asks.
* A different name has been used as the subject asked that her identity be protected.