Sterilization of Native American women in the USA

Both permanent and temporary sterilization were used, but hysterectomy and tubal ligation were the two main methods. Hysterectomy is a common procedure used to sterilize when the uterus is removed through the abdominal cavity or vagina. This operation was used to sterilize Native American women in the 1960s and 1970s in the United States. ^[6] Another common form of sterilization was tubal ligation: a procedure in which a woman's fallopian tubes bind, block, or cut. ^[7] For many women, these procedures were performed without consent, which led to numerous visits to doctors for procedures such as uterine implants. ^[8]

Other forms of sterilization used include quinacrine and contraceptives Depo-provera and Norplant. Quinacrine is usually used to treat malaria , but can also be used for non-surgical sterilization. This method was used for continuous sterilization when capsules were inserted into the uterine cavity to destroy the lining of the fallopian tubes. ^[9]

Two other drugs were used for temporary sterilization. Depo-provera was primarily used for Indigenous women with intellectual disabilities, even before it received official permission from the Food and Drug Administration for medical use, issued only in 1992. . ^[10] Norplant, promoted by IHS, was sold by Wyeth Pharmaceuticals (which was subsequently sued for inadequately investigating the drug’s side effects, including menstrual irregularities, headaches, nausea, and depression). Side effects of these two types of sterilization included even the cessation of the monthly cycle and heavy bleeding. ^[eleven]

Using data from the 2002 National Family Growth Survey, the Urban Indian Health Institute found that among women using contraception, 15–44 years old, the most common for Native Americans and Alaskan Natives were sterilization (34%), oral birth control pills (21%) and male condoms (21%). At the same time, among urban non-Hispanic whites, the most common methods were oral contraceptives (36%), female sterilization (20%) and male condoms (18%). ^[12]

Native American Health Service (IHS) is a government-owned organization established in 1955 to help combat the poor living and health conditions of Native Americans and Alaska Natives. IHS is still used in the United States and is a series of organizations created to deal with the specific health problems of Native Americans and Alaskans. ^[13] She remains responsible for providing federal health services to Native Americans and Alaska Natives. ^[14] Her website states that “IHS is the primary federal provider of medical services and healthcare for the Indians, and its goal is to raise their health status to the highest possible level. IHS provides a comprehensive health care delivery system for approximately 2.2 million Native Americans and Alaska Natives, belonging to 573 federally recognized tribes in 37 states. ” ^[fourteen]

The use of eugenics to control the “unsuitable” is derived from the work of Francis Galton on how to use genetics to improve the human race. ^{[2] [15]} In the twentieth century, the eugenics movement became increasingly popular, and in 1907 Indiana became the first state in America to allow forced eugenic sterilization [CES]. ^[2] CES became normal, and over the next twenty years another fifteen states passed similar laws. ^[2]

The 1927 lawsuit Buck vs. Bell upheld the CES law in Virginia. Three women from the Buck family were examined in court: Emma, ​​Carrie, and Vivian. All of them were recognized as mentally retarded, which corresponded to the eugenic belief that traits such as retardation are hereditary. The eugenics lobbyist won the case, and Carrie Buck was sterilized. Judge Oliver Wendell Holmes’s decision stated that he “made the decision to sterilize , because for the whole world this is preferable to waiting for degenerate offspring to be executed for crimes or to starve because of their mental retardation. Society can prevent the continuation of the lineage of those who are clearly unable to do so. The principle of compulsory vaccination is wide enough to include cutting the fallopian tubes. ” ^[2] This case, along with a quote from Holmes, shows the general train of thought at the time. Moreover: this case supported the belief that undesirable traits such as mental retardation, poverty and immorality are inherited, and thus, by sterilizing the mother, these undesirable traits will ultimately be eliminated from society. ^[2] Sterilization expanded during the 1960s and 70s, as there was no legislation prohibiting it, and this was considered an acceptable form of contraception. ^{[2] [16] [17]}

Native American women were not the only ones who underwent forced sterilization; blacks and poor women have also been affected by this practice. ^[18] In the 1970s, after the United States government forced the Indians to go on a reservation or move to cities without proper support, many Native Americans struggled with poverty . At the same time, the indigenous population of America depended on government organizations — such as the IHS, the Department of Health, Education and Welfare (HEW), and the Bureau of Indian Affairs (BIA). ^[2] Native American Health Service (IHS) was their primary provider of health services. Therefore, the indigenous population of America was more susceptible to forced sterilization than other populations. ^[2]

Most white doctors who performed this procedure considered sterilization the best alternative for women who underwent it. They argued that this would improve their financial situation and the quality of life of their families. ^[7] Doctors were more generously paid for performing hysterectomy and tubal ligation than for prescribing other forms of birth control. ^[8] The influx of surgical procedures was seen as training for doctors and practice for resident doctors. In 1971, Dr. James Ryan stated that he preferred a hysterectomy to tubal ligation because "it is more a challenge ... and it is a good experience for a younger resident." ^[19] With a decrease in the number of people applying for Medicaid and social security , the federal government could cut spending on social programs. ^[8] Dr. Ryan's quote is consistent with the view that doctors were financially encouraged to do more surgery. In addition, many doctors believed that patients from the social security group were not sane or smart enough to take oral contraceptives or use condoms effectively, so sterilizing them is the most reliable option. ^{[2] [20]} In fact, when doctors were asked about their attitude to birth control policies, 94% of respondents said that if a mother was on benefits with three or more children, they would approve of her forced sterilization . ^[21]

There is no evidence that the IHS specifically required its employees to sterilize Native American women, which was beneficial for IHS doctors. However, in the 1960s and 1970s, sterilization was considered an acceptable form of contraception. ^[17] Moreover: IHS doctors believed in it as a form of middle-class family planning — for example, they believed that there were enough two children in the family and the woman should be married to become pregnant. ^[2] There is an opinion that IHS doctors were underpaid and overloaded with their work, and they sterilized Native American women so that there would be less work in the future. ^[22] On average, a new IHS employee earned between $ 17,000 and $ 20,000 a year and worked about 60 hours a week. ^[23] By 1974, the number of doctors had dropped to an extremely low level: only one doctor per 1700 Indians reservations. ^{[2] The} shortage of doctors was further exacerbated when recruitment was stopped in 1976 because IHS had previously recruited members of the military. ^{[2] [24]} Between 1971 and 1974, the number of applications for vacancies at IHS fell from 700 to 100, which means that the remaining doctors had a huge load. ^{[22] [23]} However, a distinction needs to be made between IHS doctors and other doctors with whom sterilization contracts have been concluded. There was no financial incentive for IHS doctors, and they were most likely motivated to reduce their workload, while contracted doctors received financial benefits when they sterilized women instead of giving them oral contraceptives. ^[22]

Since IHS doctors did not benefit from sterilizing Native American women, there must be social / cultural factors that led IHS doctors to do this. In the 1970s, negative stereotypes of Native American women's behavior helped convince white doctors that these women could not limit the number of children or use contraceptives effectively. ^[8] Thus, in the white middle class's view of the family, sterilization was the most effective form of birth control. ^[22] When doctors were asked if they would sterilize private patients, only 6% thought it was acceptable, while 14% were sure that sterilization would be suitable for people receiving benefits. ^[25] Thus, doctors have different points of view regarding people from different socio-economic classes.

Today, the Native American Health Service uses sterilization as a family planning method, for which only tubal ligation and vasectomy are used . Today, the IHS legally requires that the patient give informed consent to the operation, is 21 years old and not held in a correctional facility or psychiatric facility . ^[8]

The immediate effect of sterilizing Native American women was a reduction in the number of Native Americans. In the 1970s, there were an average of 3.7 children per Indian woman, in 1980 this figure dropped to 1.8. ^[8] Between 1960 and 1970, at least 25% of Native American women between the ages of fifteen and forty-four were sterilized. ^[8]

The decline in fertility can be quantified, but sterilization has also affected people psychologically and socially. In Native American culture, the fertility of a woman and family is greatly appreciated. If a woman cannot have children, this may cause tribal condemnation because of Indians' views on motherhood. ^[2] These emotions could be aggravated due to the fact that the culture of the Indians is based on the values ​​of the family. In 1977, lawyer Michael Zawalla filed a lawsuit in Washington State after three Cheyenne women from Montana were sterilized without their consent. ^[2] However, the names of the sterilized women were left in secret because they were afraid of the reaction of their tribe.

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