Sterilization of Native American women

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In the 1960s and 1970s, the Indian Health Service (IHS) and collaborating physicians sustained a practice of performing sterilizations on Native American women, in many cases without the free and informed consent of their patients. In some cases, women were misled into believing that the sterilization procedure was reversible. In other cases, sterilization was performed without the adequate understanding and consent of the patient, including cases in which the procedure was performed on minors as young as 11 years old. A compounding factor was the tendency of doctors to recommend sterilization to poor and minority women in cases where they would not have done so to a wealthier white patient.^[1] Other cases of abuse have been documented as well, including when health providers did not tell women they were going to be sterilized, or other forms of coercion including threatening to take away their welfare or healthcare.^[2]

In 1976, a U.S. General Accountability Office (GAO) investigation found that four Indian Health Service areas were noncompliant with IHS policies regulating consent to sterilization.^[3] Inadequate consent forms were a recurring problem; the most common form did not record whether the elements of informed consent had been presented to the patient or what they were told prior to obtaining consent, and physician misunderstanding of IHS regulations was widespread.^[4] The investigation found that these four service areas sterilized 3,406 women between the years 1973 and 1976, including 36 cases where women under the age of 21 were sterilized despite a declared moratorium on these sterilizations.^[5]

Limitations of the GAO investigation were quickly noted. Senator James Abourezk pointed out that while even 3,406 sterilizations would represent a startling proportion of Native American women, this number was the result of a report which examined only four out of twelve IHS areas.^[6] Attempts to count the total number of sterilizations that happened during this period differ widely in their results. While the limited count by the GAO represents a minimum, studies have accused the IHS of sterilizing between 25-50% of Native American women from 1970 to 1976.^[7] Should the highest estimate be accurate, up to 70,000 women may have been sterilized over the period. In comparison, the rate of sterilization for white women over the same period was approximately 15%.^[2]