According to Google’s AI, when searching “coercive sterilizations,” the following appeared: “Between 1973 and 1976, an estimated 3,406 sterilization procedures were performed on Native American women in four Indian Health Service locations.”
Most doctors are ethical and wouldn’t sterilize women without informed consent. However, the claim of sterilization without permission has caused me to look more closely at articles asserting that this was the case.
My concern is sparked by a patient, Magdalena, whom I treated in general practice. She had gone to a gynecologist because she had severe pelvic pain. He recommended surgery.
“You won’t perform a hysterectomy, will you?” she asked before the procedure.
“No,” he replied. She told me that when she woke from anesthesia, she learned that her uterus, tubes and ovaries had all been removed because of serious infection. She was young and didn’t have children. She was heartbroken.
The Durango Herald recently carried the headline “New Mexico Senate calls for study of forced sterilization” (Herald, Feb. 22).
I should acknowledge that women have been sterilized without their consent. This was true in China, Peru and the Southeastern U.S. The term “Mississippi appendectomy” has been used by Black women who were told they needed to have their appendix removed but had their tubes tied instead. In my 40 years of practice, the only tubal ligation I encountered without the patient’s consent was unusual in another respect – the victim was white. Her tubes had been tied without her knowledge during a caesarean in Texas.
Most women sterilized against their will belong to minority groups. That is the concern raised by the Herald article. An accompanying image includes this quote: “Indian Health Service records show that 3,406 sterilization procedures were performed on female Indians in the Aberdeen, Albuquerque, Oklahoma City, and Phoenix areas during fiscal years 1973-76.”
Is this a low, normal or high rate of sterilization? It should be compared to sterilization rates in the U.S. as a whole. Also, how many of these surgeries were performed without proper informed consent?
Looking at the original document, it turns out that only 3,001 of the procedures were performed on women of childbearing age; the rest were likely hysterectomies performed on older women. Furthermore, an unknown number of those 3,001 procedures would also have been hysterectomies, done for reasons other than sterilization.
1975 is the only year for which I could find reliable numbers to compare IHS female sterilization rates with those of the rest of the U.S. In 1975, one in 30 Native women was sterilized; the comparable figure for U.S. women overall is one in 69. The combined rates of tubal ligation and hysterectomy for Native women were roughly double those of the general population.
So it does appear that more Native women were sterilized than non-Native women. Were these coerced surgeries? The report says:
“We found no evidence of IHS sterilizing Indians without a patient consent form on file, although we did find several weaknesses in complying with HEW’s sterilization regulations.” (HEW was the Department of Health, Education, and Welfare.)
It is impossible to determine whether surgeries that happened 50 years ago were coerced. However, I was struck by the findings of a doctoral thesis from the University of New Mexico titled “Changing Fertility Patterns of Three Generations of Navajo Women.” Dr. Joanne McCloskey found that a small sample of Native women showed a rapid decrease in family size. Searching her thesis and the book she wrote from those interviews, I found no indication that women had felt coerced to use contraception or undergo sterilization.
The grandmothers in McCloskey’s study used neither contraception nor abortion, but the younger mothers used both. All the grandmothers were traditional Diné (Navajo), while the younger mothers were more acculturated to Western society – more educated, and many working outside the home.
It is possible that some women sterilized by IHS doctors did not understand that they would be unable to bear children after surgery – perhaps because of language barriers, or because physicians did not explain the procedure adequately. However, the available evidence does not support the Google AI statement. Whatever the cause, there has been a decrease in childbearing among Native women, following a trend seen across the U.S. and most of the world.
Richard Grossman, M.D., is a retired obstetrics-gynecology physician who lives in the Bayfield area. Read his blog at population-matters.org.