A report from the South African Commission for Gender Equality released on Wednesday found that dozens of women who were HIV positive and pregnant were forcibly sterilized by doctors and nurses throughout the country.

Chief Executive Officer of the Commission for Gender Equality Keketso Maema detailed the trauma many women faced in the 58-page report which was prompted by a 2015 complaint filed by the Women’s Legal Centre.

In their March 2015 filing, nonprofits Her Rights Initiative and International Community of Women Living with HIV wrote that the National and Provincial Departments of Health violated the rights of their clients by subjecting them "to forced and/or coerced sterilisation in public hospitals."

"To subject women to forced sterilization because they are HIV positive is a fundamental human rights violation. The Complainants in this case alleged that a number of them were expressly told that they ought to be sterilized because HIV positive women could not be allowed to bear children. To deny women the right to have children because of their status amounts to discrimination," the report said.

Maema described dozens of laws and regulations violated by South African hospitals while dealing with pregnant women with HIV and other illnesses. The report includes personal statements from women who said they were harassed, threatened and intimidated when they expressed any opposition to sterilization if they were even informed of the procedure beforehand.

While dozens of women were in labor, nurses allegedly threatened to deny them care if they didn't sign consent forms allowing the hospital to sterilize them. The study stated that the people usually targeted by this procedure include people living with HIV, people with disabilities, indigenous peoples and ethnic minorities, transgender and intersex people and poor women.

The 48 documented cases took place over the last 20 years and involved hospitals across the country, including 15 in Gauteng Province and KwaZulu-Natal Province. Major facilities like Tambo Memorial Hospital, Tembisa Hospital and Leratong Hospital in Johannesburg as well as Addington Hospital, Stanger Hospital and Albert Luthuli Hospital in Durban were involved, according to the report. 

"From the affidavits, it is evident that all the women who had lodged the complaint were Black women who were mostly HIV positive and whom, at that time of the alleged forced/coerced sterilisations, were pregnant, and in the process of seeking medical assistance at various hospitals in the country. Just before giving birth, but either while in labour and/or in extreme pain, they were coerced or forced to sign forms that they later learnt through various means were consent forms allegedly permitting the hospital to sterilise them. In addition, all women who were allegedly subjected to this process of sterilisation gave birth through caesarean section," the report read.

Maema noted that the women were humiliated by medical personnel at hospitals and were told they would be denied service if they did not agree to sterilization, all while the women were in the middle of labor. For those who did sign consent forms for the procedures, they said they were in extreme pain or desperate for help when they were forced into signing them.

Others said the forms were not explained to them or were in a language they didn't understand. A number of women said they didn't know what the word sterilization meant until years later when they visited gynecologists seeking answers as to why they couldn't conceive. 

"A thorough analysis of the affidavits by the investigative team has revealed that most Complainants have been suffering from depression from the time they learnt that they would never be able to conceive due to the coerced/ forced sterilisation they had been subjected to. Most of these complaints are women from the KwaZulu-Natal region and a number of them stated that their partners have since left them due to their inability, and failure to conceive more children. They could no longer fulfil their partners’ wishes for larger families," the report said.

The report also included personal statements from women who said marriages and engagements were ruined when it was confirmed they could never conceive again. 

One woman referred to as "Ms. A" in the report said she visited Nkandla hospital and a doctor told her that she was being sterilized because she had too many children. When she refused to sign the consent form, nurses began shouting at her saying she must be sterilized. They told her doctors would not help her give birth until the forms were signed, so she did.

The doctors also lied to Ms. A, saying it was the law of the country to be sterilized. When she told her fiancé that the doctors forced her into the sterilization procedure, she was ridiculed by family members, and her engagement was called off.

Another woman told the commission that she signed consent forms for a cesarean procedure but learned years later that her fallopian tubes had been cut.

The report cites a 2012 study that found a longstanding pattern of South African doctors sterilizing HIV-positive women.

"The South Africa National Aids Council's 2015 stigma index revealed that out of 6,719 HIV-positive women interviewed, an estimated 500 said they had been forcibly sterilised," the report stated. 

To make matters worse, Maema said the commission was routinely stopped from investigating what happened by the hospitals and many had no records of treating most patients. 

"Members of the Commission who interviewed staff at the various hospitals also reported they experienced hostile reception from the hospital staff who were in most cases not very cooperative. The hostility was from both management and medical personnel. In some instances, members of the Commission reported that in some hospitals (in Durban) the hospital staff tried to hide documents from them while others blatantly refused to indulge them," the report stated. 

South Africa has one of the largest HIV-positive populations in the world, with more than 7 million people living with the illness, according to The World Health Organization. Almost 20% of the world's HIV-positive population lives in South Africa, ABC News reports.

Health Minister Zweli Mkhize told Time that he plans to meet with the commissioner to look over the report next week and discuss ways to move forward.

"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,'" one complaint read.

The forced sterilization of HIV-positive women is a global problem plaguing a number of countries according to the United Nations’ Office of the High Commissioner for Human Rights.