Genocide or Family Planning? Indian Health Service Policy in the 1960s and 1970s – “In the early 1970s a young American Indian woman visited her physician and made an unusual and troubling request. She wanted to know if her doctor could perform a uterus transplant. Her doctor asked why. The young woman reported that during her teens after the birth of a child, her doctors on the reservation told her that they’d `fixed it’ so she could not have children for a while,” said Professor Lisa Emmerich, History.
Emmerich explored this scandal in her talk, “Erasing the Race: Native Americans and Federal Family Planning Policies in the 1960s and 1970s,” the first in this year’s Friends of History lecture series.
Emmerich’s sample is not an isolated misunderstanding between a patient and her doctor. During the 1960s and the 1970s, thousands of Indian women across the country were sterilized by Indian Health Service (IHS) medical personnel with little or no regard for the women’s cultures, traditions, or desires.
The sterilization story surfaced in a 1974 Akwesasne News article. Dr. Connie Uri wrote that women at the Claremore, Oklahoma IHS facility were sterilized, apparently without informed consent, an action Uri defined as “genocide of the Indian people.” Emmerich said, “Outraged American Indians picketed the Oklahoma, IHS hospitals, denouncing sterilization both as a means of birth control and as a means of exercising political control over tribal communities.”
The sterilization scandal occurred in a historical context of a long-term contentious relationship between Native Americans striving to maintain tribal cultures and traditions and a federal government determined to force assimilation into middle-class American culture. Within tribal communities, women played vitally important roles as wives, mothers, workers, political activists, and religious leaders—roles attacked by goverment assmiliation policies, explained Emmerich. By the mid-nineteenth century, Native American women were seen as “helpless captives of their own cultures” doomed to a life of drudgery and poverty that could only be relieved through so-called “rescue initiatives,” such as Bureau of Indian Affairs (BIA) sponsored schools.
Forced Sterilizations – On the phone, during long marches, occupying federal surplus property, in court fighting for treaty rights — wherever Indian activists gathered during the “Red Power” years of the 1970s, conversation inevitably turned to the number of women who had had their tubes tied or their ovaries removed by the Indian Health Service. This was, I heard one woman joke bitterly at the time, a “fringe benefit of living in a domestic, dependent nation.” Communication spurred by activism provoked a growing number of Native American women to piece together what amounted to a national eugenic policy, translated into social reality by copious federal funding. (See sidebar) They organized WARN (Women of All Red Nations) at Rapid City, South Dakota, as Native women from more than thirty nations met and decided, among other things, that “truth and communication are among our most valuable tools in the liberation of our lands, people, and four-legged and winged creations.” WARN and other women’s organizations publicized the sterilizations, which were performed after pro-forma “consent” of the women being sterilized. The “consent” sometimes was not offered in the women’s language, following threats that they would die or lose their welfare benefits if they had more children. At least two fifteen-year-old girls were told they were having their tonsils out before their ovaries were removed. The enormity of government-funded sterilization has been compiled by a masters’ student in history, Sally Torpy, at the University of Nebraska at Omaha. Her thesis, “Endangered Species: Native American Women’s Struggle for Their Reproductive Rights and Racial Identity, 1970s-1990s,” which was defended during the summer of 1998, places the sterilization campaign in the context of the “eugenics” movement. No one even today knows exactly how many Native American women were sterilized during the 1970s. One base for calculation is provided by the General Accounting Office, whose study covered only four of twelve IHS regions over four years (1973 through 1976). Within those limits, 3,406 Indian women were sterilized, according to the GAO.
Forced Sterilization of Native Americans – Women, Color, Health, and Indian – JRank Articles – During the late 1960s and the early 1970s, a policy of involuntary surgical sterilization was imposed upon Native American women in the United States, usually without their knowledge or consent, by the federally funded Indian Health Service (IHS), then run by the Bureau of Indian Affairs (BIA). It is alleged that the existence of the sterilization program was discovered by members of the American Indian Movement (AIM) during its occupation of the BIA headquarters in 1972. A 1974 study by Women of All Red Nations (WARN), concluded that as many as 42 percent of all American Indian women of childbearing age had, by that point, been sterilized without their consent. A subsequent investigation was conducted by the U.S. General Accounting Office (GAO), though it was restricted to only four of the many IHS facilities nationwide and examined only the years 1973 to 1976. The GAO study showed that 3,406 involuntary sterilizations were performed in these four IHS hospitals during this three-year period. Consequently, the IHS was transferred to the Department of Health and Human Services in 1978. During this and earlier periods, similar involuntary sterilization programs were being performed on other women of color, among them Chicanas of the Los Angeles area (Acuña 2004). It is estimated that by 1966, one-third of the women of childbearing age on the island of Puerto Rico had been sterilized without their ‘ ‘ informed consent. ’ ’ In addition, MULANEH (Mujeres Lationoamer-icanas de New Haven), a mainland Puerto Rican women’s organization, discovered that 44 percent of Puertorriqueñas in New Haven, Connecticut, had been sterilized by 1979. In Hartford, Connecticut, the figure stood at 51 percent. Women in Puerto Rico were also part of experimentation studies of the early birth control pill before it was released on the U.S. mainland.
In the old days, genocide used to be so simple. Such things as biological warfare used to keep Indians warm with small pox infested blankets furnished by the United States government, and the only thing barren and infertile was the land set aside for reservations.In the 1970s, genocide became a little more complex.
Biological warfare invaded the reproductive rights of Native American women, making their wombs as barren and infertile as reservation land. The sterilization policies during this time perpetuated the genocidal tendencies that have made the eugenics movement a viable legacy of terror in the biological history of Native Americans.
Forced Sterilization of Native Americans: Late Twentieth Century Physician Cooperation with National Eugenic Policies | The Center for Bioethics & Human Dignity – What may be the most disturbing aspect of the investigations followed: it was physicians and healthcare professionals in the IHS who coerced these women. It was they who abandoned their professional responsibility to protect the vulnerable through appropriate, non-eugenic indications for surgery and informed consent prior to the procedures. On a Navaho reservation alone, from 1972-1978, there was a 130% increase in abortions (a ratio of abortions per 1000 deliveries increasing from 34 to 77).[vii] The same study demonstrated that between 1972 and 1978, sterilization procedures went from 15.1% to 30.7% of total female surgeries on that one reservation. Healthcare professionals’ coercive tactics included the threat of withdrawing future healthcare provisions or custody of Native American children already born—if consent for sterilization was withheld.[viii] The scandal of this replay of earlier twentieth century eugenic programs and genocidal tactics led to a congressional hearing (Senator James Abourzek, Democrat, South Dakota), but little else in terms of publicity, justice, or public outcry. It has also not been scrutinized from a careful bioethical perspective. Although the travesty of forced sterilization and abortions targeting Native Americans occurred a generation ago, and has apparently ended, a revisit in 2009 is critical. First, the breech in ethics took place in America. The record for such immoral activities has already been questioned in light of California’s record with forced sterilization from 1909 through 1979, subsidized through federal funding.[ix] Approximately 20,000 similar operations were performed in that State (mostly on African-Americans and Latinos), a significant number of these occurring after the Nuremberg Trials. Secondly, if the centuries-long treatment of Native Americans is a protracted genocide, not merely archetypal, the addition of physicians to the armamentarium of genocide, especially at this late juncture, is ominous. Physicians in the IHS during the time in question were young. Since their generation, additional medical graduates have moved even further from the Hippocratic tenet of “do no harm.” Furthermore, the ever-increasing shift from a covenantal model for medical practice to a contract model is relevant to the ethics at hand. Physicians who performed abortions and sterilizations on Native American women were contracted and reimbursed in full for their work. Similar models for specialty care which is contracted and reimbursed in full exist today under the umbrella of managed care. Payment for medical technique removed from context of ethical considerations may tempt many physicians in an era of decreasing reimbursement rates. Erosion of Hippocratism inhabits every aspect of the tragedies of care for these Native American women, and serves as more than a warning to us of the danger of divorcing ethical conviction from medical care.