The Supreme Court of Namibia upheld a 2012 ruling that health care workers at government hospitals coerced three HIV-positive women to be sterilized without their proper consent, Al Jazeera reports.

Forcing HIV-positive women to sign sterilization consent forms they don’t understand is not an isolated problem, said Priti Patel, who leads the HIV program at the Southern Africa Litigation Centre. Other cases have been documented in South Africa and Kenya.

“The government needs to take active steps to make sure this stops happening,” Patel said.

In the Namibian case, one woman signed a document that used acronyms to describe the procedure, and another woman was told she had no choice but to sign. The court has yet to decide how much money to award the three women.

Expectant mothers can take medications to prevent mother-to-child transmission of HIV; as such, sterilization is a drastic and unnecessary procedure.