The lost generation: American Indian women and sterilization abuse.

• Date: 22 December 2004
• Author: Carpio, Myla Vicenti
• Published date: 22 December 2004
• Author: Carpio, Myla Vicenti

I had been sterilized at the age of eleven, at the IHS [Indian Health Service I hospital here in the early 1950s. I got married in the 1960s and I went to the doctor and he told me that I had a partial hysterectomy. [When I was a child] they were giving us vaccinations and mine got infected and a nurse came and gave me some kind of shot so I wouldn't hurt. When I woke up my stomach was hurting and I was bleeding (Woman speaking on radio show, "Native America Calling," 2002). NEITHER THIS WOMAN NOR HER PARENTS HAD CONSENTED TO THE STERILIZATION procedure. Many Native women have such stories about being sterilized, either without their consent or through coercive means. Although voluntary sterilization is a popular, safe, and reliable form of birth control for many women, the unauthorized use of sterilization procedures on marginalized women constitutes abuse. Furthermore, numerous women in countries outside the United States have faced sterilization abuse.

Various ideologies have contributed to the involuntary sterilization of women, especially women of color. Imperialism, capitalism, patriarchy, and Malthusianism have shaped social and socioeconomic standards by which many women and their fertility are valued. As capitalism and industrialization have expanded, so too has international interest in fertility control of "lower-class" people. The United States filters monies through agencies such as U.S. Agency for International Development, the Rockefeller Foundation, and the Ford Foundation for population control programs. These agencies were responsible for the sterilization of men and women in regions such as Puerto Rico, Brazil, Guatemala, Africa, and Panama (Mass, 1976). Some abuses continue today. "More than 20 years since testimony against the practice at the United Nations, Indigenous women in Mexico and other Latin American nations are still routinely sterilized without their consent" (Giago, 2000: A5).

Likewise, colonialism intersected with patriarchy to directly threaten American Indian women through sterilization abuse. Scholars, such as Lisa Poupart and Andrea Smith, have examined the ramifications of colonialism and oppression on Indigenous women's bodies, reproductive health, and lives. Poupart (2002) discusses the devastating impact of Western European and American historical domination and oppression on American Indians, which has created and perpetuated injustices throughout Indian Country. The continued political, social, and economic oppression has left American Indian people, especially women, vulnerable to systematic abuse--in this case Indian Health Services (IHS). Paternalistic policies toward American Indians allow the federal government to make decisions on their behalf without their full consent or participation. "Just as a father makes decisions for his children, then, the oppressive structures within patriarchy--particularly those of state bureaucracies and multinational corporations--and those individuals acting as vehicles of authority make decisions for those groups deemed in need of guidance" (Poupart, 1996: 5). Furthermore, Smith (2003) points out that Native women threaten colonial structures through their ability to reproduce the next generation of colonial resistance.

The state and mainstream U.S. society justify themselves in the encroachment upon the private lives of Native women by assuming control over their right to make their own decisions concerning their lives and their bodies. This encroachment has a double-edged blade. One side carries a sharpened edge that has cut away at women's right and ability to bear children, our next generation. It has inflicted invisible abuse and violence upon America Indian women and their cultures and communities because we cannot look at each other and know who has been sterilized. The other edge of the blade is silence. Sterilization abuse has silenced Indian women's voices through fear and shame. Many women do not speak out in fear of retribution through loss of services or other such harms. Moreover, governmental bodies commissioned to investigate accusations concerning involuntary sterilizations by the IHS have cut away their voices and stories by refusing to interview the sterilized women (Staats, 1976). I also encountered this edge of silence when I began to research this topic (Carpio, 1995). Some women, understandably, did not wish to talk about their sterilizations and I am grateful to those women who did talk with me.

Protests and investigations that emerged during the 1970s showed that the public health system, primarily the HIS, was sterilizing American Indian women without their knowledge or informed consent. (1) It is difficult to define involuntary sterilizations or prove instances of coercion because there are many shades of gray. Some medical grounds do warrant therapeutic hysterectomies and other sterilization procedures, but there is evidence that these procedures were performed on Indian women without just medical cause.

American Indian women are susceptible to uninformed or involuntary sterilizations because of the different ways in which doctors or health care professionals present hysterectomies and tubal ligations. Some women reported that questionable delivery room diagnoses led to their sterilizations. IHS doctors used consent forms for medically required sterilization procedures rather than forms that distinguished voluntary sterilizations from required ones. Other women were told outright lies about their conditions and treatments. Involuntary and uninformed sterilizations can occur even if a consent form is signed and on file (Dillingham, 1977; Staats, 1976; Jarvis, 1977).

American Indian women, doctors, and Indian publications (for example, the American Indian Journal and Akwesasne Notes) contributed to the awareness of sterilization abuse. Hospital staff and sterilized women began to speak out about sterilization abuse and other problems within the IHS and public health system. Investigations into sterilization abuse arose from an inquiry made by Dr. Connie Uri and the 1976 General Accounting Office (GAO) investigation requested by Senator James Abourezk of South Dakota. Dr. Uri, Choctaw and Cherokee, became involved when one of her patients asked for a womb transplant. This woman, then 26, was persuaded by her doctor that because she was an alcoholic with two children, she should be sterilized by a hysterectomy for birth control purposes. Six years later, no longer drinking, planning to marry, and having knowledge of kidney transplant procedures, the patient thought her womb could be replaced (Jarvis, 1977). Dr. Uri stated:

At first I thought I had discovered a case of malpractice.... There was no good reason for a doctor to perform a complete hysterectomy rather than a tubal ligation on a 20-year-old, healthy women. I began accusing the government of genocide and insisted on a congressional investigation (Jarvis, 1977: 30). From these demands came Senator Abourezk's request for a GAO investigation. The GAO investigated four of 12 areas serviced by the Indian Health Service: Aberdeen, South Dakota, Albuquerque, New Mexico, Oklahoma City, Oklahoma, and Phoenix, Arizona. These districts serve a significant number of the total Indian population (Dillingham, 1977). The GAO examined a three-year period, 1973 to 1976, and found that 3,406 Indian women were sterilized. In 1973, 857 sterilizations were performed; 886 sterilizations were done in 1974, 901 in 1975, and 762 in 1976 (Staats, 1976). Of total sterilizations, 3,001 were done during childbearing ages (15 to 44) and 1,024 (30%) were sterilized at contract health facilities. These health care facilities provided additional services that IHS lacked (Staats, 1976; Dillingham, 1977).

The GAO investigation report (1976: 26), released November 23, 1976, stated that it found "no evidence of IHS sterilizing Indians without a patient consent form on file." In 1976, the GAO report focused on "allegations concerning Indian Health Service" and investigated the charge of sterilization abuse. Nothing was confirmed and only a revision of the procedures and requirements of sterilizations was recommended. However, this investigation found weaknesses in compliance with Department of Health, Education, and Welfare (HEW) sterilization regulations (Staats, 1976). Still, these weaknesses are a myopic consideration regarding consent and non-consent. By limiting the evidence to consent forms, investigators ignored possibilities of abuse in the form of...