Genevieve Johnson-Smith examines the history of state-funded sterilization of indigenous women in the United States.

'TRYING TO TAKE OUR FUTURE WITH A SCALPEL': STERILISATION AND INDIGENOUS WOMEN’S REPRODUCTIVE RIGHTS IN THE USA

Dr. Pinkerman-Uri found that in the majority of cases, consent was given by these women while they were heavily sedated, usually in the middle of a caesarean section, or not at all.  After being contacted by Dr. Pinkerman-Uri and WARN about these issues, Chairman of the Subcommittee of Indian Affairs, Senator James Albourezk, called for the investigation, leading to the GAO calling for better implementation of informed consent regulations in 1976. This response to such abhorrent crimes against Indigenous women was of course lacking, and was clearly viewed as such – indigenous female activism continued beyond this time.

The Indigenous women at the heart of investigating these crimes made their best efforts also to publicise them, appearing on the WNED radio show Woman. Between 1973-1977, Woman was host to a string of female authorities on women’s issues, including famous names like Gloria Steinem, Nora Ephron and Betty Friedan. One lesser known woman to appear on the show was Dr. Pinkerman-Uri, alongside Marie Sanchez. They spoke about the issues affecting Indigenous women at the time, one such issue being forced sterilisations. Both women agreed that these practices were a deliberate endeavour to reduce the Indigenous population and part of a centuries old genocide. They asserted that at the very least, their research, which included interviews with the survivors of sterilisation, had thus far shown that 25% of all Indigenous women had been sterilised, and that only between 100,000-200,000 Indigenous women who were able to conceive children remained in the US. 

These assertions were at odds with official Government Accountability Office findings which were released in the previous year.[5] Not only did the GAO report cover just four IHS areas over three fiscal years - Aberdeen (South Dakota), Albuquerque (New Mexico), Oklahoma City (Oklahoma) and Phoenix (Arizona) - it did not include communication with any survivors, as it was thought that this 'would not have been productive' due to predicted 'high levels of inaccuracy' from any women who had undergone sterilisations within a six-month period.  Their report found that 3,406 sterilisation procedures had been carried out between 1973-1976 in IHS facilities or IHS contracted facilities, 405 of these on females that were not yet considered of child bearing age. The report found that consent forms had been obtained for most sterilisations in question and that no women had been forced or coerced into undergoing procedures, which included hysterectomies and tubal ligations (clamping of the fallopian tubes).

The report did find that regulations set out by the Department of Health, Education and Welfare had not been followed by practitioners. These regulations prohibited the sterilisation of anybody under the age of 21, anybody who was mentally incapable of consenting, and stated that individuals must give their complete informed consent.[6] Varying consent forms had been used, and it was found that not only had physicians failed to get informed consent, they had also allowed women to believe that federal benefits would be withdrawn from them if they did not agree to be sterilised. Further to this, it was not explained to many of these women that they were undergoing an irreversible procedure. They had also violated the 72 hour waiting period between the signing of the consent form and the procedure. However, the report concluded that medical practitioners in these cases had simply used the wrong forms by accident.

According to historian Jane Lawrence the majority of physicians involved in these practices were white, Euro-American males who believed they were helping society by limiting births within low-income, minority groups – actively practising eugenics.  She further asserts that, by not offering Indigenous women alternative birth control, they were increasing their own personal income.  By performing such operations regularly, young physicians not only made more money, but gained obstetric experience at the expense of the federal government by practising on minorities. Referencing articles written about physician’s opinions on sterilisation at the time, she summarised:

Physicians also increased their own personal income by performing hysterectomies and tubal ligations instead of prescribing alternative methods of birth control. Some of them did not believe that American Indian and other minority women had the intelligence to use other methods of birth control effectively and that there were already too many minority individuals causing problems in the nation, including the Black Panthers and the American Indian Movement. Others wanted to gain experience to specialize in obstetrics and gynecology and used minority women as the means to get that experience at government expense.[7]

  The Indian Health Service, founded in 1955 and still operating today, comes directly under the jurisdiction of, and is directly funded by, the US government and is responsible for providing healthcare services to members of federally recognised indigenous tribes. Due to forced relocation away from tribal lands and often towards more urban areas without adequate support, many indigenous people faced poverty and were entirely reliant on whichever local IHS centre they could access, making indigenous women a particularly vulnerable group to forced sterilisation. Of twelve IHS areas which existed in this time, only four were investigated and included in the GAO report. The narrow scope of the report means that it is not possible to get a complete view of the impact this had nationwide using it alone, making this subject even narrower whilst indicating that the number would probably be far higher if this investigation had encompassed a wider area or was repeated for other years.

These sterilisations epitomise long systems of colonialism manifesting in gender-based oppression, resulting in the complex and unique intersectional issues faced by minority women in not only the US, but in Canada, Mexico and several other countries settled by patriarchal societies. To quote Kimberle Crenshaw’s landmark work on intersectionality,  'dominant conceptions of discrimination condition us to think about subordination as disadvantage occurring along a single categorical axis.'[8] Reproductive control in the US is a topic which should absolutely be studied along several axes, primarily those of race and gender, but certainly also within the studies of eugenics and genocide.

[1] 'The Theft of Life,' WARN newsletter, reprinted for the 'Hearing Before The United States Commission on Civil Rights, National Indian Civil Rights Issues, 1979,' Hathi Trust Digital Library.

[2] Jane Lawrence, 'The Indian Health Service and the Sterilization of Native American Women,' American Indian Quarterly 24, no. 3 (2000): 400.

[3] 'Connie Uri, M.D. and Marie Sanchez, Chief Judge of the Northern Cheyenne Tribe, FIX IT+ Transcript' 

[4] Marie Sanchez, 'For The Women,' Akwesasne Notes, December 1977, 14. 

[5] 'Investigation of Allegations Concerning Indian Health Service, 1976,' Government Accountability Office.

[6] HEW’s six elements of informed consent are written in full on page 6 of the GAO investigation. 

[7] Lawrence, 'The Indian Health Service and the Sterilization of Native American Women,' 410.

[8] Kimberle Crenshaw, 'Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics,' University of Chicago Legal Forum 1, no. 8 (1989): 139.

Genevieve Johnson-Smith is a PhD candidate in the history department at Newcastle University, working on a project around fugitive abolitionism, emancipatory activism and anti-slavery radicalism in the UK, particularly Wales. She has carried out extensive research on forced and coerced Indigenous sterilisation and remains dedicated to this very important work. She contributed a chapter to the collective Sacred Bundles Unborn (2021) and has also contributed her research and writing to the BBC history/comedy podcast You’re Dead To Me.