Decades after forced sterilization, Native American women in the US still face rejection and retraumatization in healthcare

Decades after forced sterilization, Native American women in the US still face rejection and retraumatization in healthcare

Since the founding of the United States, the battle for reproductive rights has been fraught. Despite Native women’s historic practices of timing pregnancies and regulating their numbers of children, the Puritan foundations of the country came to outlaw such autonomy. Through lawsuits and legislation, those rights were gradually restored. With the ruling of Roe v Wade in January of 1973, women across the country celebrated a milestone marking their right to determine reproductive outcomes. 

At the same time, crushing policies from the US government seized childbearing potential from thousands of Native people. The Indian Health Service (IHS), formed in 1955 within the Department of Health, Education, and Welfare (HEW), forcibly sterilized as many as 70,000 Native women during the 1970s, often without their consent or knowledge. This action demonstrated the harsh contrast between the increasing freedom of white women and the continuing genocide of Native communities.

“Across the entire country, an estimated 25 percent of Native women of childbearing age were sterilized by 1976.”

Under the Economic Opportunity Act of 1964, HEW and other federal agencies were tasked with administering family planning programming to poor and indigent populations. In accordance with this policy, IHS began providing family planning services for Native Americans in 1965. While a directive stressed that “family planning” should include information about different types of birth control and their side effects, the reality of the services rapidly escalated from contraception to eugenics.

When eugenics dangerously surged in popularity in the early 20th century, many states introduced compulsory sterilization statutes. In Virginia, the Racial Integrity Act of 1924 encouraged the sexual sterilization of the institutionalized to promote the "health of the patient and the welfare of society." That same year, Carrie Buck, a “feeble-minded woman” committed to a mental institution, unknowingly provided the perfect opportunity for the state to test the legality of its new law. In the case of Buck v Bell, which upheld Virginia’s new statute for forced sterilization, Supreme Court Justice Oliver Wendell Holmes, Jr. wrote that “it is better for all the world if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.”

But even when 26 states followed suit and passed similar legislation, physicians initially still feared possible malpractice suits for unnecessary procedures. Marion Jessin, a Northern California woman, sued her county hospital for refusing to perform a medically unnecessary sterilization operation. A California Court of Appeals judge ruled "voluntary sterilization is legal when informed consent has been given, that sterilization is an acceptable method of family planning, and that sterilization may be a fundamental right requiring constitutional protection." This decision has been applauded by women’s rights’ activists across the country for opening a door for women to willingly seek out sterilization for contraceptive purposes. At the same time, it set a dangerous foundation for IHS physicians to ramp up their sterilization practices. Following the 1969 ruling of Jessin v. County of Shasta, doctors became confident in their legal ability to perform the procedures provided they had the consent of the patient.

IHS was formed to fulfill US treaty obligations to provide healthcare, though it didn’t take on that name until its third year of operation in 1958. The agency, historically underfunded, has never provided an adequate level of care to Native people. (In 2014, the IHS per capita expenditures for patient health services were just $3,107, compared to $8,097 per capita nationally). While resources stagnated and Native populations grew, the number of patients per physician in the IHS system rose from 1,220 in 1966 to 1,500 in 1980. 

Motivated by racist stereotypes and laws that empowered eugenics, the overworked federal employees of IHS saw the high birth rate of Native Americans as a problem that could only be solved with their extreme family-planning methods. Historian Jane Lawrence writes that some IHS doctors “did not believe that American Indian and other minority women had the intelligence to use other methods of birth control effectively” and thought there were already “too many minority individuals causing problems in the nation.” 

The 1970 census revealed that the average Native woman bore 3.29 children, whereas the median for the entire US was 2.48 children. Following the end of the forced sterilization period, the 1980 census showed that the average number of children born per Native woman had plummeted to 1.3. 

The American Indian Movement (AIM) first discovered evidence of the ongoing involuntary sterilization of Native American women in records they removed after occupying the Bureau of Indian Affairs in 1972. Four years after the practice was uncovered, the US Government Accountability Office began investigating. In a survey of four IHS locations, they found that between 1973 and 1976, 3,406 sterilization procedures were performed on Native women in Aberdeen, Alburquerque, Oklahoma City, and Phoenix. 

Across the entire country, an estimated 25 percent of Native women of childbearing age were sterilized by 1976. While sterilization procedures should only have been presented as one of many contraceptive options, Native women were often coerced into signing forms or given incorrect information about their options. 

In one case, two 15-year-old Native girls on the Northern Cheyenne Reservation in Montana were admitted to the local clinic for tonsillectomies and released with tubal ligations. Another woman in Los Angeles was told her hysterectomy would be reversible, only to find out six years later that she had been lied to. Others still were given forms to sign for painkillers or appendectomies, finding out later that they had relinquished their ability to bear children.

“For the Indigenous victims, their lifelong pain is compounded by the fact that IHS has never issued an apology.”

Unfortunately, the history of forced sterilizations in the US extends far beyond Native women. In 1973, African American sisters Minnie and Mary Relf, 12 and 14 years old at the time, were secretly sterilized by a federally funded clinic under the premise of giving the girls birth-control shots. Mexicans and their US-born descendants were described as “immigrants of an undesirable type,” and thousands of women were forcibly sterilized in California institutions from 1920 to 1950. The US is responsible for tens of thousands of state-sponsored non-consensual sterilization procedures, all done to control populations of people deemed inferior. For the Indigenous victims, their lifelong pain is compounded by the fact that IHS has never issued an apology.

Charon Asetoyer (Comanche), the Executive Director of the Native American Women’s Health Education Resource Center, spoke to ReWire News in 2018 about the effect this practice had on women’s mental health. “Women were ashamed when the power to give life was stripped from them” Asetoyer said. “Women are considered sacred in Native cultures; they are the life givers. Many women drank themselves to death when they learned that IHS had sterilized them.” 

For Native families, this is a painful part of a very recent memory. Many women that were victims of these cruel policies have difficulty discussing their stories, and they are often shamed into silence. After finding out about the IHS policy, the British filmmaker Lorna Tucker decided to create a documentary; because of the stigma, it took years of building trust with community members before they would speak openly about their experiences. The film, Amá, is currently screening in the UK.

To this day, Native people are wary of IHS. Though the forced sterilizations contribute to the suspicion, a poll from NPR, the Robert Wood Johnson Foundation, and Harvard’s T.H. Chan School of Public Health found that a quarter of Natives reported experiencing discrimination when going to a doctor or health clinic. Additionally, the IHS remains underfunded; procedures that aren’t vital to “life or limb” rarely get approval. Given the compounding historical trauma and racism that Natives experience, one would hope they’d be eager to claim the healing provisions their ancestors secured through treaties. Instead, the conditions of the IHS leaves Indigenous people who seek treatment wondering if they’ll find only rejection—or worse, retraumatization.

Image credit: Northern Cheyenne Indian Reservation, photograph by Boyd Norton, 1936 (Wikimedia Commons | Public Domain)

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