20 September 2023 by Pascalinah Kabi

‘Mamalapane Hlabanyane was sterilised by Queen ‘Mamohato Memorial Hospital without her knowledge. Credit by Thabelo Monamane

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This investigative reporting was supported by the International Women’s Media Foundation’s Howard G. Buffett Fund for Women Journalists.

The government has sabotaged a legal bid aimed at exposing secret forced sterilisation programmes at Lesotho’s health facilities. It did this by offering the face of this legal campaign, a well-known survivor of forced sterilisation, a job in the ministry of health shortly before the case was due in court. This has raised uncomfortable questions around Lesotho’s commitment to protect the rights of HIV positive women and eliminate all forms of HIV-related discrimination.

The survivor, Mamalapane Hlabanyane, was allegedly recruited as an assistant officer at the ministry of health.

“Mamalapane Hlabanyane is an assistant officer at the ministry of health. She was recruited around 2020 or early 2021,” an inside source at the ministry told MNN Centre for Investigative Journalism.

Chairperson of Community of Women Living with HIV (CW) ‘Mamoletsi Moletsi says the ministry’s decision to recruit Hlabanyane led to the collapse of her organisation’s plans to launch a strategic litigation against the Lesotho government. Strategic litigation involves selecting and bringing a case to the courtroom with the goal of creating broader changes in society.

“The person that we prepared so well (as lead applicant) was Mamalapane and she was ready to go to court. But, she was awarded the job by the ministry of health to silence her. She is an assistant officer,” Moletsi said.

Community of Women Living with HIV in Lesotho says Ministry of Health silenced Mamalapane Hlabanyane. Because of this and funding challenges, plans to get justice on behalf of the 470 HIV positive women remain uncertain.

Hlabanyane hotly denies the accusation and in an interview with MNN she said:“Do you know that I applied for that job? I no longer want to discuss issues of my health and if you write that story, I will report you to WILSA (Women and Law in Southern Africa).”

The ministry of health was first contacted for comment in July. MNN’s repeated efforts to follow up on this and to obtain a quote from the ministry have been unsuccessful.

In March 2017, Hlabanyane made headlines after it emerged that Queen ‘Mamohato Memorial Hospital (QMMH) sterilised her without her consent or knowledge. Upon going into labour on 3 October 2011, Hlabanyane was transferred to QMMH, Lesotho’s only tertiary hospital, because she could only deliver by caesarean section (C-section).

At the time, Hlabanyane told the Lesotho Times that she started bleeding intensively a year after giving birth and that a Maseru-based clinic referred her to QMMH for a scan.

“I took the scan results back to the doctor and he discovered that a subtotal hysterectomy was done on my body after a PPH (post-partum haemorrhage) in 2011. The doctor went through my hospital booklet which confirmed what the scan had revealed,” she said.

Subtotal hysterectomy is a surgical procedure that removes the uterus, leaving the neck of the womb or cervix in place.

She then showed Lesotho Times a letter written by then QMMH Operations Director, Dr Karen Prins in 2017. In the letter, Dr Prins said Hlabanyane was unconscious when doctors rushed her into an emergency room shortly after giving birth. 

“She was unconscious and not aware of the critical situation. Clinicians had to act fast in this emergency situation. A subtotal hysterectomy had to be performed because the bleeding was not controllable with any other methods,” Dr Prins said.

Upon discovering that her womb was removed without her consent or knowledge, she turned to CW, WILSA, Lesotho Council of Non-governmental Organisation (LCN) for help.

‘Money talks in Lesotho’

In 2014, CW’s Moletsi attended a conference organised by the International Community of Women Living with HIV (ICW) to discuss issues of forced and coerced sterilisation targeting HIV-positive women in southern Africa. Moletsi was forced to get sterilisation 25 years ago after a doctor at then Queen Elizabeth II Hospital discovered stage CIN3 cancer cells in her body.

She shared her story at the ICW conference in Gauteng, South Africa in 2014. This sparked interest in Lesotho and CW and WILSA were given “small funding” to interview HIV positive women in Lesotho.

They discovered that Moletsi was not the only one who experienced involuntary sterilisation and immediately after submitting the 2014 report, the two organisations received additional funding to carry out an in-depth investigation into forced sterilisation.

The results of that study, according to Moletsi, were going to be used to launch a strategic litigation against the Lesotho government. 470 women living with HIV in Lesotho reported that they were survivors of forced sterilisation.

Moletsi says Hlabanyane was prepared to take a stand as a lead applicant in litigation that would open a can of worms in Lesotho health system.

Explaining why it has taken a long time to go to court Moletsi explained that:“We did not go to court because we no longer had funds and secondly, there was no lead applicant.”

When MNN asked her why none of 470 women did not take up the stand, Moletsi said that most victims do not want to share their stories publicly for fear of breaking their marriages and being stigmatised in their communities.

“I was ready to go to court, but I was told that my case is too old. With ‘m’e Mamalapane, Tšepong (Queen ‘Mamohato Memorial Hospital) said it was going to settle with her out of court. They (QMMH) have not settled with her even now,” Moletsi said.

Caroline Lelosa of Community of Women Living with HIV in Lesotho (CW) suggests that the settlement was in a form of an assistant officer’s post at the Ministry of Health.

“But they have given her a job, maybe that is that settlement,” Lelosa said.

QMMH Public Relations Officer Thakane Mapeshoane told MNN a decision not to comment on the matter was made by the hospital management on 8 September 2023.

“I had a meeting with the clinical manager and the legal officer, and it has been decided that we cannot comment in the media without consent from a patient. We are bound to keep patient-hospital confidentiality,” Mapeshoane said. 

Sources in the ministry of health and rights groups believe the ministry awarded Hlabanyane an assistant officer’s post to stop CW and WILSA from going ahead with their envisaged court case whose success depended on Hlabanyane speaking out.

“Government knew that without Hlabanyane, CW and WILSA’s case would simply collapse because they needed a victim as a lead applicant and many women who have undergone sterilisation do not want to speak publicly about their experiences,” authoritative sources said.

Sterilisation remains taboo in Lesotho. Sterilised women are stigmatised as many Basotho men believe that a sterilised woman losses vaginal warmth and therefore, she does not have anything to offer in bed. 

Moletsi also believes that the ministry of health silenced Hlabanyane by giving her a job. Prior to working at ministry of health, Hlabanyane was a factory worker and was constantly missing work to attend to her medical needs or meetings over the removal of her womb. Clothing industries in Lesotho operate on a no work, no pay policy.

“The person that we prepared very well was Mamalapane (to be a lead applicant in strategic litigation) and she was ready to go to court. But you know that money talks here in Lesotho. Maybe she thought she was not going to benefit anything by going to court,” Moletsi said.

Hlabanyane told MNN that: “This is my personal life, I no longer want you people writing about me, stay away from me, you are using me to make money.”

She repeated her threat to MNN and said: “I have not been silenced. Who silenced me? I am going to report to you to ‘m’e ‘Mamosa (Mohlabula from WILSA), I am going to take you for discipline. The nice thing about this is that I have recorded you. No one has silenced me.”

While Hlabanyane says she has application forms and “everything” to prove that she has not been silenced, she abruptly cut the call to prevent this reporter from asking her more questions, including providing evidence to her applying for the job.

Meanwhile, Moletsi says plans to get justice on behalf of the 470 HIV positive women remain uncertain.

“Until we get someone who says I am ready to go to court…we pray that the Human Rights Commission get functional very soon because it can sue on our behalf,” Moletsi said. 

Legal framework on informed consent

As illustrated by the National University of Lesotho (NUL) Head of Department of Procedural and Adjectival Law, Dr Itumeleng Shale, Lesotho does not have a specific law to enforce informed consent for some procedures, including sterilisation.

“However the constitution protects a number of rights which are violated when medical treatment is imposed without one’s consent. For instance, Section 11 provides for the right to respect for private and family life; thus guaranteeing amongst others, individual autonomy over one’s own body and would be violated by arbitrary control of a woman’s sexuality and fertility.

“If consent is not established, there may be legal consequences for health professionals who administered the treatment without consent,” Dr Shale said in her research into the rights of disabled women in Lesotho.

Meanwhile, the United Nations Human Rights Office says women living with HIV face challenges to being able to make autonomous and informed decisions about their bodies and lives.

“Despite robust evidence of the effectiveness of interventions to reduce the risk of mother-to-child transmission, HIV positive women have been coerced to undergo sterilisations, or agree to be sterilised without adequate information and knowledge about their options.”

It says the UN Committee against Torture has called on states, including Lesotho, to adopt legislative and policy measures to prevent and criminalise forced sterilisation of people with HIV.

Countries must clearly define “the requirement of free, prior and informed consent with regard to sterilisation and by raising awareness among medical personnel of that requirement.”

Additional reporting by Health Journalist Limpho Sello.

This story was produced and first published by the MNN Centre for Investigative Journalism.