Reports of forced sterilization of Native American women began to surface in the 1970s. Of the 100,000 to 150,000 Native American women of childbearing age, 3,400 to 70,000 of these women were involuntarily sterilized through tubal ligation or hysterectomy. They were not given a choice to refuse or accept to undergo the sterilization procedure. Many were manipulated into thinking that they would risk losing their welfare aid or even their lives should they refuse to undergo a sterilization procedure. However, the procedure was most often done under the pretense of a check up or abortion, and most of the victims didn't know they were sterilized until years afterwards.
Contents
The sterilizations had an appreciable effect on the fertility rates of Native American women. In the 1970s, the average birth rate of Native American women was 3.79 children, but by 1980 the birth rate had fallen to 1.8 children.
Types of sterilization
Most Native Americans at the time faced poverty and were heavily dependent on federal aid. The Indian Health Service (IHS) provided most healthcare to them. However, Native Americans' dependence on the IHS was manipulated, as woman were lead to believe sterilization was necessary due to 'hyperfertility,' or excessive fecundity. The most popular sterilization procedure was the hysterectomy, a form of permanent sterilization in which the uterus is removed through the patient's abdomen or vagina. Hysterectomies were often performed on Native women by residents without the patient's knowledge. Another common form of sterilization was tubal ligation, a sterilization procedure in which a woman's fallopian tubes are tied, blocked, or cut.
Quinacrine was also used to sterilize Native American women. Quinacrine is commonly used to treat malaria, but it can also be used for non-surgical sterilization. Capsules inserted into the uterus spread and destroy the lining of the fallopian tubes.
Non-permanent forms of sterilization were also used including Depo-Provera and Norplant. Depo-Provera was used mainly on intellectually disabled Native American women before it gained clearance from the FDA in 1992. Norplant was developed by the Population Council and was also promoted by the IHS. Side effects of these two types of sterilization include the cessation of the menstrual cycle and excessive bleeding.
Using 2002 data from the National Survey of Family Growth, the Urban Indian Health Institute found that among women using contraception, the most common methods used by urban American Indian and Alaskan Native women age 15–44 years were female sterilization (34%), oral contraceptive pills (21%), and male condoms (21%). However, the order of most common methods used among urban Non-Hispanic-Whites were oral contraceptive pills first (36%), then female sterilization (20%) and male condoms (18%).
Reasons for sterilization
Factors that made Native American women targets of sterilization included belief of racial inferiority and negative stereotypes of the Native American population. They were often represented by the media negatively as a 'Squaw' who was "dirty, subservient, abused, alcoholic and ugly woman who loves to torture white men." Racial stereotypes propagated the belief that Native American women were unfit to raise or have children in comparison to white women. In the 1970s, Native American women were under the impression that sterilization was mandatory and were coerced into giving consent. They were afraid of having their welfare benefits withdrawn if they did not agree to the sterilization procedure. Consent forms presented to them failed to indicate that the decision would not affect their benefits. This abuse was driven by social and economic factors, as demonstrated studies done by the Health Research Group in 1973 and Doctor Bernard Rosenfeld's interviews in 1974 and 1975.
The majority of the physicians performing the sterilizations decided that sterilization was the best alternative for these women. They claimed it would improve their financial situation and improve the quality of life for the children that they already had. Additionally, with fewer people applying for Medicaid and welfare, the federal government could decrease spending on welfare programs. The physicians were also paid more for performing hysterectomies and tubal ligations than for prescribing other forms of birth control. The influx of surgical procedures was seen as a way for new physicians to train and resident physicians to practice. When a student in 1971 asked why hysterectomies were favored over tubal ligations, Dr. James Ryan responded that "it's more of a challenge...and it's good experience for the junior resident".
Due to negative stereotypes of Native American women and beliefs of racial superiority, many physicians believed these women did not possess the intelligence to limit the number of children or use birth control effectively, which led to the sterilization abuse in the 1970s.
Modern IHS regulations
The IHS offers sterilization as a method of family planning. Tubal ligation and vasectomy are the only procedures which may be performed for the primary purpose of sterilization. The IHS requires for the patient to give informed consent to the operation, be at least 21 years of age, and not be institutionalized in a correctional or mental health facility.