Francisca, a young Chilean woman, describes the day her only son was born as the worst and the best day of her life. The best—for obvious reasons. The worst—for reasons almost too awful to fathom. While a doctor at Curicó Hospital was delivering Francisca’s baby via cesarean, he also sterilized her without her knowledge or consent—because she was HIV-positive.
“I was floored by this news. I couldn’t understand why they had done this and especially without asking me,” remembers Francisca. “A few days later, I went home from the hospital filled with joy for the birth of my new beautiful son, but also a profound loss of security and self.”
Although she has never fully recovered from this violation, Francisca has thrown herself into seeking justice for more than a decade. After a criminal case she pursued against the operating surgeon was ineffectively prosecuted and subsequently dismissed, the Center for Reproductive Rights along with Vivo Positivo, a Chilean HIV/AIDS organization, brought Francisca’s case before the Inter-American Commission on Human Rights (IACHR).
The IACHR monitors the compliance of member states—of which Chile is one—with regional human rights treaties, including the American Convention on Human Rights and the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women.
This month—five years after the case was filed—the IACHR made history when it announced that it will hear Francisca’s case, known as F.S. v. Chile. It is the first case the IACHR has admitted that addresses the sexual and reproductive rights of women living with HIV.
“The admissibility of the F.S. case is a huge step forward in the solidification of the recognition of reproductive rights under the American Convention, as it places before the IACHR the question of forced sterilization on the basis of HIV status,” says Monica Arango, the Center’s Regional Director for Latin America and the Caribbean. A favorable decision could hold the Chilean government accountable for ignoring its obligation to respect, protect, and fulfill the reproductive rights of HIV-positive women.
Like many other HIV-positive women, Francisca’s status was discovered in her first trimester of pregnancy during a routine prenatal test. In the face of such overwhelming news, she assumed her diagnosis was an automatic death sentence.
In Francisca’s home country of Chile, stigma and misconceptions surrounding HIV abound, and even her doctors offered her no information about how to take care of herself during her pregnancy or her chances to live a relatively normal life in spite of her HIV status.
Fortunately, a nurse mentioned that there was a good chance the baby could be born healthy if Francisca took medication. This glimmer of hope cemented Francisca’s commitment to do everything possible to avoid transmitting HIV to her child by obtaining regular prenatal care, doing antiretroviral therapy, and scheduling a cesarean delivery. Francisca awaited the day of her cesarean with much apprehension, but also with excitement.
That’s when the unthinkable happened. Although Francisca had delivered a healthy baby boy, the surgeon’s decision to perform a tubal ligation on her while she was sedated meant that she would no longer be able to have children. Francisca had not agreed to—or even been informed about—this drastic and life-altering measure. No doctor had ever even discussed the possibility with her.
Regrettably, Francisca’s experience is not unusual. In Chile, according to a 2004 study done by the Center and Vivo Positivo, of the 23 women who were sterilized after learning they were HIV-positive, 50% did so under pressure or had been sterilized without their knowledge. Although giving birth as an HIV-positive woman carries extra risks, the chance of mother-to-child transmission of HIV is less than 2% when the proper precautions are taken, and mandating sterilization is borne of fear and prejudice rather than of sound public health policy. Discrimination against women with HIV is pervasive throughout Latin America, where patients seeking reproductive health services are frequently refused care because of their HIV status and reprimanded by health professionals for having become pregnant.
As Arango points out, “The admissibility of the case brings Francisca a step closer to accessing justice.”
The IACHR’s willingness to confront these biases on the international stage marks an important shift. Still, much remains to be done to protect the dignity and autonomy of the millions of women throughout the world who, like Francisca, are particularly vulnerable to discrimination and human rights violations as the result of their HIV status.