A shocking report in South Africa shows that dozens of women in the country who are HIV-positive were either forced or coerced into sterilizations after having babies in public hospitals.

The Commission for Gender Equality, a constitutionally-based advocacy organization, released the results of an investigation that reveals at least 48 women complained of “cruel, torturous or inhumane and degrading treatment” in the medical facilities where they were being treated. 

In the 58-page report, the CGE documents say that just prior to giving birth, but as they were in labor or suffering extreme pain, the women were pressured to sign documents that they later learned were consent forms giving permission to the hospitals to sterilize them. Each of the women who were subject to sterilization delivered their children through cesarean section.

A nonprofit group called the Women’s Legal Centre lodged a complaint with the CGE of the 48 cases, which then investigated and found several gross human rights violations as well as denial of legal structuring around consenting to be sterilized.

In a 2011 case, a woman was told that she was being sterilized because she had too many children and that the law required it. She protested, saying that she was in the hospital without her family. When she tried to contact them, nurses took away her cellphone. Months later when she revealed to her fiance’ what happened, causing him to be furious. Eventually, she said, their marriage could not take place because he was no longer interested in their relationship.

In a case that stretches back to 2001, a woman who was seven months pregnant went to a hospital for prenatal care. She was diagnosed with high blood pressure, which nurses were unable to lower or stabilize and she was scheduled for a caesarean section the next day.  A nurse told her she needed to sign a series of forms before being taken for the procedure. But while she gave birth, she was also sterilized. After two weeks, the scar from the cesarean had not healed and she was admitted into a better-equipped hospital, where she stayed for more than two months. A few years later, a doctor who examined her because she was failing to conceive revealed that her fallopian tubes had been cut.

In another affidavit, a woman described the curt treatment she got from a nurse.

“When I asked the nurse what the forms were for, the nurse responded by saying: ‘You HIV people don’t ask questions when you make babies. Why are you asking questions now, you must be closed up because you HIV people like making babies and it just annoys us. Just sign the forms, so you can go to theatre.’ “

According to the World Health Organization, South Africa has the world’s worst HIV epidemic at 7 million people infected. As many as 19 percent of all people living with HIV are in the country, which also has 15 percent of new infections.

Meanwhile the CGE has recommended that more inquiry be conducted into how widespread the practice of forced sterilizations in South Africa has become. The report does not indicate how many women have undergone the illegal procedure.