Four women in Kenya have each been awarded $20,000 (£16,000) in damages for being sterilised without their informed consent.
The women fought a nine-year legal battle – and their names have been changed to protect their identities, which were not revealed during the case at the High Court.
“It has ruined my life,” Penda said about the surgery she underwent shortly after having twins at the state-owned Pumwani Maternity Hospital in the capital, Nairobi.
The procedure is called a bilateral tubal ligation (BTL) – when a woman’s fallopian tubes are cut, tied, burned, clipped or partly removed, closing them and preventing future pregnancies.
The father of her twins left before they were born. Her husband had died a few years earlier of HIV-related complications. She is distressed that she will never find another partner: “Who will marry me if they know I can’t give birth?”
Penda knew she was HIV-positive when she became pregnant so had sought medical advice. At the time, pregnant women with HIV were encouraged to give birth by caesarean section and to not breastfeed their babies to prevent mother-to-child transmission of the virus.
These are expensive routes to go down for many from poorer backgrounds. Nowadays most maternity care in Kenya is free. But it has not always been the case.
After giving birth, Penda says she was told to exclusively use formula milk. She says she was assured she was entitled to get free food for herself and the babies, but only if she showed proof that she was using family planning.
“As a single mother, that shocked me. I was already struggling with stigma. I didn’t know what else to do,” she says.
To help Penda obtain this proof, the hospital nutritionist referred her to a community health worker who told her to report to a clinic where personnel from Marie Stopes, Kenya’s largest and most-specialised sexual reproductive health organisation, ran a family planning programme.
Here Penda was given a form, which she signed, to have a BTL. As she cannot read, she says she did not know she had given her consent to be sterilised.