Reprise/Forced Sterilizations

Sterilization of Native American Women
Reviewed by Omaha Master's Student

Bruce E. Johansen

For: José Barreiro (editor-in-chief of NATIVE AMERICAS)
September, 1998

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.

          Another estimate was provided by Lehman Brightman, who is Lakota, and who devoted much of his life to the issue, suffering a libel suit by doctors in the process. His educated guess (without exact calculations to back it up) is that 40 per cent of Native women and 10 per cent of Native men were sterilized during the decade. Brightman estimates that the total number of Indian women sterilized during the decade was between 60,000 and 70,000.
          By 1970, anecdotal evidence of the surge in sterilization began to accumulate, according to Torpy's detailed account. For example, welfare case workers in Apollo, Pennsylvania had removed Norma Jean Serena's daughter Lisa, three years of age, and son, Gary, age four, from her home before she underwent a tubal ligation after the birth of her son Shawn, in 1970. One day after Shawn was removed to a foster home, Serena signed consent forms for the surgery, emotionally battered by accusations of case workers that she was an unfit mother.

          Three years later, with legal assistance from the Council of Three Rivers Indian Center in Pittsburgh, Serena sued Armstrong County for return of her children from foster care. She also sued a number of area hospitals for damages related to her sterilization. A jury found that the children had been taken under false pretenses from Serena, who is of mixed Creek and Shawnee ancestry.
          During trial, attorneys for Serena questioned the "evidence" on which welfare case workers had decided to take her children and recommend her sterilization. The main "problem" seemed to have been the fact that black friends of Serena visited her home, as reported by anonymous tipsters in the neighborhood who asserted fear for their own children. While one caseworker described Serena's apartment as "dirty and unkempt," and her children as "undernourished and dazed," unable to walk, speak, or hold eating utensils, a doctor who examined the children shortly afterwards found them "alert and in good health." According to Torpy's account, Serena was awarded $17,000 by a jury, and her children were ordered released to her. The Armstrong County child welfare bureaucracy stalled several months before returning the children, according to Torpy's account, and did so only after officials were confronted with a contempt-of-court citation.
          Parts of Serena's case were not settled until 1979, when several doctors and a male social worker were acquitted of having violated her civil rights by taking part in her sterilization. The key issue was whether she had given consent for the operation. Serena said she could not recall having signed a consent form; the attending physician said he had explained the operation to Serena and that he was convinced she understood him. A jury agreed.
          At about the same time that Serena had her run-in with case workers, a twenty-six year old Native American woman entered the office of a Los Angeles physician in 1970 seeking a "womb transplant" because she had been having trouble getting pregnant. The doctor, who never asked her name, told the woman she had been the subject of an hysterectomy, removal of her ovaries, which cannot be reversed. The operation had been performed under false pretenses. The woman, who was engaged to be married and who had hoped to raise a family was "devastated," according to Torpy.
          The last vestiges of legally sanctioned eugenics played out during the 1960s, when concern about overpopulation expressed by industrial leaders in the United States (most notably by members of the Rockefeller family) became official federal policy -- with massive spending to back it up -- under the Nixon administration. Sterilization for the poor and minorities was officially sanctioned in 1970, just about the time students were killed at Kent and Jackson State universities as they protested expansion of the Vietnam War. Reservation populations became targets of a policy that also was being advocated nationally, especially for poor and minority women. In 1969, the American College of Obstetricians and Gynecologists also had relaxed its own restrictions on sterilizations.
          In 1970, when the IHS initiated its sterilization campaign (paid 100 per cent by federal funds), the Department of Health, Education, and Welfare vastly accelerated programs that paid 90 per cent of the costs to sterilize non-Indian poor women, following enactment of the Family Planning Act of 1970. The rate of sterilization for women as a whole in the United States then jumped by 350 per cent in five years, according to Torpy's research.
          Before 1969 (following Nixon's election as president) funding of sterilizations (as well as abortion) had been banned by the federal government. Between 1969 and 1974, HEW increased its family planning budget from $51 million to more than $250 million, Torpy found. HEW records reveal that between 192,000 and 548,000 women were sterilized each year between 1970 and 1977, compared to an average of 63,000 a year between 1907 and 1964, a period which included the zenith of the eugenics movement.

          Torpy reports that during 1977 Dr. R.T. Ravenholt, director of the United States Agency for International Development (office for population control), said that the United States hoped to sterilize 25 per cent of the world's roughly 570 million fertile women. Ravenholt linked such control measures to the "...normal operation of U.S. commercial interests around the world." These statements were published in a news story in the St. Louis Dispatch.
          During this wave of sterilizations, no other medical structure had the captive clientele of the IHS, however. "Native American women represented a unique class of victims among the larger population that faced sterilization and abuses of reproductive rights," Tropy wrote in her thesis. "They had, and continue to have, a dependent relationship with the federal government which has put them at greater risk..."
          Within half a decade, Indian Health Service doctors were sterilizing so many reservation women that, according to Torpy, one Native American woman was being sterilized for every seven babies born.

 

          Outside of very occasional, anecdotal reports in a few major newspapers, the mainstream media generally ignored the wave of sterilizations as it was happening. The first large-audience, detailed description of the sterilizations was published not in the United States, but in Germany. Torpy tapped sources of information in small, specialized (often leftist or health-related) journals of opinion that, taken together, sketch a history of the sterilization campaign. She credits Brightman and the International Indian Treaty Council and others, including Constance Redbird Pinkerton-Uri, for keeping the issue alive enough to spark the interest of Senator James Abourezk of South Dakota, which led to a General Accounting Office report and congressional oversight hearings that eventually curbed the practice.
          By 1974, some IHS doctors who were critical of the sterilizations began investigating on their own. Pinkerton-Uri, a physician and law student who is Choctaw and Cherokee, started her own inquiry after complaints were lodged by Native patients against the Claremore, Oklahoma, IHS hospital. Taking publicity about the Serena cases and what she had found at Claremore, along with other pieces of evidence, Pinkerton-Uri began calling Senator Abourezk's office. The office also had received inquiries from Charlie McCarthy, an IHS employee in Albuquerque, regarding sterilizations of Native American women.
          Torpy followed the trail of Abourezk's investigation, beginning with an intern in his office, Joan Adams, who took the initiative to investigate whether Native women were being sterilized "without their consent and under duress." This preliminary investigation convinced Adams (and, later, Senator Abourezk) that further study was needed. Abourezk, using Adams' research, then called for a GAO investigation.
          Torpy describes the findings of the GAO report, which surveyed IHS records in four of twelve Bureau of Indian Affairs regions: Albuquerque, Phoenix, Oklahoma City, and Aberdeen, South Dakota. The study covered only 46 months, between 1973 and 1976. (As of 1977, the IHS operated 51 hospitals and 86 health centers or clinics.) Within this sample, the GAO found evidence that the IHS or its contractors had sterilized 3,406 women, 3,001 of them of child-bearing age (15 to 44 years).
          Since the GAO study did not even begin to arrive at a total number of sterilizations, opponents of the practice looked at the data in another way, as a percentage of the women of child-bearing age in each examined area who were sterilized. In Oklahoma, using the GAO study's numbers, 1,761 of roughly 17,000 women of child-bearing age were sterilized. In Phoenix, the number was lower, 78 of 8,000; in Aberdeen, the figure was 740 of 9,000. They began to make a case that, with only 100,000 fertile Native women of child-bearing age in the United States, the sterilizations were putting a significant dent in the gene pools of many individual Native American nations.
          Regarding the threat to the Native American gene pool, Torpy quotes Ms. Pinkerton-Uri:

A 200 million population could support voluntary sterilization and survive, but for Native Americans it cannot be a preferred method of birth control. While other minorities might have a gene pool in Africa or Asia, Native Americans do not; when we are gone, that's it.

          At times, the battle over sterilization became localized and quite heated. In response to Pinkerton-Uri's charges at the Claremore Hospital, physicians threatened to close the facility. "In response," writes Torpy, "an unidentified group of Native Americans pitched a tipi on the hospital lawn alongside the American Indian Movement flag."
          By the mid-to-late 1970s, the sterilization program was well known on the Native movement circuit. By 1974, Akwesasne Notes was carrying reports describing sterilizations, and Native American women's attempts to mobilize against them. As a Ph.D. student in Seattle who had become involved in Native American issues (beginning with fishing rights), I requested an airing of the sterilization program in The Nation, the magazine that, in 1977, had allowed me a forum to present the first nationally published account of Leonard Peltier's case. An editor at The Nation told me the magazine would publish the story only if I could supply a written statement from the IHS that genocide was its policy. No statement, the editor said, no story. I was unable to find such a tidy admission, although I could see a wave of sterilizations as I combined the GAO report's findings with case-study materials from my files.
          By 1977, a class action suit had been initiated by three Montana Native American women. The names of the three Northern Cheyenne women who filed the class action suit were not released publicly out of fear that they would be condemned by other Cheyennes. The class-action suit never went to court, and never directly affected anyone other than the three claimants. Attorneys for the defendants approached the women's attorneys and offered a cash settlement on condition that the case remain sealed. The women accepted the settlement.
          At about the same time, Marie Sanchez, the Northern Cheyennes' chief tribal judge, conducted her own informal poll, and found that at least 30 women she contacted had been sterilized between 1973 and 1976. It was Sanchez who found two fifteen year old girls who said that they had been told they were having their tonsils out, only to emerge from a local IHS hospital without their ovaries.
          Torpy's account brings what became a general pattern down to a personal level:

Another woman who had complained to a physician about migraine headaches was told that her condition was a female problem, and was advised that a hysterectomy would alleviate the problem. Her headaches continued, however, until she was diagnosed with a brain tumor.

          Also during 1977, the American Indian Policy review Commission found the IHS lacking adequate policies, appropriations, delivery services, and oversight for provision of health services to Native Americans. Even in 1977, the rate of infant mortality on Indian reservations was three times that of the general population in the United States; the tuberculosis rate was still eight times as high. the average life span of a Native American living on a reservation was 47 years, compared with almost 71 years in the general population. The IHS seemed to be short of personnel and equipment to treat many things, but the agency always seemed to have enough doctors, nurses, equipment, and money to tie fallopian tubes and remove ovaries.
          By the late 1970s, sterilizations continued at some IHS hospitals despite protests and suits. Brightman visited Claremore's IHS facility for six months during late 1978 and early 1979, collecting records for six months, and found evidence of 81 sterilizations. Brightman later related his findings as part of a speech on the U.S. Capitol steps which was recorded and played for some of Claremore's nurses, who, according to Torpy, "validated that sterilizations were occurring and with greater frequency."
          Many Native women looked at the battle against sterilization as part of a broader, older, struggle to retain their families in a culturally appropriate context. The battle against sterilizations brought back memories of having children taken from their homes, beginning with the establishment of Carlisle School in 1879, to face a gauntlet of forced assimilation in a factory model of education. In 1977, roughly a third of reservation children were still attending the same system of boarding schools that had become a principal part of the assimilative model a century earlier. In 1973, 33,672 Native American children lived in federal boarding schools rather than at home, according to statistics compiled by Torpy.

          Many women also were reminded of the many Native children taken for foster care by non-Indians. In the middle 1970s, the proportion of Indian children placed in foster care in Western states (compared to the general population) ranged from 640 per cent, in Idaho, to 2,000 per cent, in North Dakota. This disparity was diminished (but not eliminated) by legislative measures beginning about 1980 which demanded that social workers appreciate Native ways of raising children instead of assuming that they were evidence of lack of parenting skills by Anglo-American, middle-class standards.
          On many reservations today, Indian midwives or nurses advise women on whether sterilization is appropriate. The number of births to Indian women had risen to 45,871 in 1988, compared with 27,542 in 1975, according to census records cited in Torpy's thesis.

          Even though the cruder abuses of the sterilization wave in the 1970s seem to have abated, "Even today," writes Torpy, "there remains a need for constant and close surveillance over physicians and health facilities and health facilities so that all poor women and women of color are allowed to make their own reproductive choices."