Population Matters-USA – working for a sustainable world

From: Changing Fertility Patterns of
Three Generations of Navajo Women

“Coercive Sterilizations: Between 1973 and 1976, an estimated 3,406 sterilization procedures were performed on Native American women in four Indian Health Service (IHS) locations” —Google Artificial Intelligence

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 that claim this is the case.

My concern is sparked by a patient, Magdalena, when I was 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 had asked before surgery.

“No”, he had replied. She told me that when she woke up from the anesthesia, she found out that her uterus, tubes and ovaries had all been taken out because of serious infection. She was young and didn’t have children. She was heartbroken.

A recent issue of The Durango Herald carried the headline “Study sought into forced sterilization”. This article originally appeared in “New Mexico In Depth”, under the title “New Mexico Senate calls for a study of forced sterilization”.

I need to preface my remarks by writing that I know that women have been sterilized without their consent. This was true in China, Peru and our Southeast. The term “Mississippi appendectomy” has been used by Black women who were told that they needed to have their appendix removed, but they had their tubes tied instead. In my 40 years of practice, the only tubal ligation I encountered without the patient’s consent was unusual. The victim was of the dominant group—she was White. Her tubes had been tied without her knowledge at the time of a cesarean in Texas.

Most women who have been sterilized against their will belong to minority groups. That is the concern of an article that recently appeared in the Durango Herald. An accompanying image has 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 the fiscal years 1973-76.”

Is this a low, normal or high rate of sterilization? It should be compared to sterilization rates in the USA as a whole. Also, how many of these surgeries were done without proper informed consent?

In looking at the original document, it turns out that only 3,001 of the procedures were done on women of childbearing age; the rest must have been hysterectomies done on older women. Furthermore, an unknown number of those 3,001 procedures would have been hysterectomies, done for reasons other than sterilization.

1975 is the only year for which I could find good numbers to compare IHS female sterilization rates with the rest of the USA. In 1975, one in 30 Indian woman was sterilized; the comparable number of US women is one in 69. The rates of tubal ligation and hysterectomy combined for Indian women was about double that of the general population.

So it seems correct that more Native women were sterilized than non-Native women. Were these coerced surgeries? The report states:

“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 if surgeries that happened 50 years ago were coerced or not. However, I was amazed at 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 had a rapid decrease in family size, as shown in the attached chart. I wondered if McCloskey detected any sign of coercion among the small number of women she interviewed. I searched her thesis and the book she wrote based on her interviews, but cannot find any indication of women having felt coerced to use contraception or be sterilized.

The grandmothers in McCloskey’s study didn’t use contraception or abortion, but the young mothers used both. All the grandmothers were traditional Diné (Navajo), while the young mothers were more acculturated to western society. They were more educated and many of them had jobs.

It is possible that some of the women who were sterilized by IHS doctors didn’t understand that they wouldn’t be able to bear children after surgery. Perhaps they didn’t understand English well, or perhaps the doctors didn’t explain the surgery well. However, the available evidence does not support the Google AI statement. Furthermore, careful reading of the original document is more reassuring than the newspaper article. Finally, the current standards for informed consent require much more care than a half century ago.

PS: After writing this essay, I realized that I had made a mistake. The “Young Mothers” were all under 30 years old and still of childbearing age when this doctoral thesis was written. Thus, they may have had more children. Although the same is true for the Midlife Mothers group, it would be less so.

Although the groups are not directly comparable, it is interesting to see the marked decrease in number of live births that this group of women experienced.

Image used courtesy of La Revuelta Colectiva Feminista

As a kid, and then as a university student, Aye Maldonado used to see women protesting almost every day. As time went on, more and more of the women were wearing green bandanas as signs of their unity.

Maldonado grew up in Córdoba, Argentina, that country’s second largest city. It was also the site of rebellion against patriarchy that achieved miracles. I had heard that Maldonado had participated in the Green Wave and was able to chat with her last month at a Durango restaurant.

The Green Wave started about 2015 as a movement against femicide—the murder of women and girls. This was a daily occurrence, according to Maldonado—and even more frequently than murder, females were “disappeared”. What set off this massive reaction to toxic machismo was the death of a pregnant 14 year old. That young teen was killed by her boyfriend; he then buried her corpse.

Tens of thousands of women, young and old, were spurred to protest gender-based violence. In 2019, the newly elected President Alberto Fernández ordered the creation of the Ministry of Women, Gender and Diversity in response to the demands of women. Laws were passed to support women and girls; unfortunately, these laws aren’t always enforced, from what I have read.

The Green Wave movement became a powerful sorority. The demonstrators were not in positions of power, in most cases. However, some of the women had relatives, husbands or friends in the government and were able to convince them of the importance of their cause.

Unfortunately, Argentina is not the only place in Latin America with high rates of femicide. Women in other countries started wearing green bandanas causing the Green Wave to spread across Argentina to Mexico, Brazil and Peru, among other countries.

The USA is not immune from femicide. I was shocked to learn that the most common cause of death during pregnancy is homicide.

Maldonado told me that there were a few physicians whom women could trust when they needed an abortion. Information about these few doctors was passed around by word of mouth. She told me that her role with the Green Wave was protection; she helped keep people safe by keeping them informed.

Patriarchy was strong; the Roman Catholic Church and many men in government fought against legalizing abortion. Furthermore, the laws against abortion were very strict. If a person were caught performing, or having, an abortion, it meant a long time in jail—especially if they didn’t have connections or were poor. To make the situation even worse, relinquishing a baby for adoption was very difficult. This meant that a woman with an unintended pregnancy didn’t have that option.

Realizing their power, the sorority of women in the Green Wave turned their attention in Argentina from stopping abuse and femicide to the right to have safe, legal abortion care. Similar to most countries where abortion was illegal, women with unintended pregnancies often attempted to cause an abortion themselves. Sometimes they took toxic herbs or used mechanical means that introduced bacteria into their uterus. Where abortion is not legal, hemorrhage or septic abortions are common and may end with the woman’s death.

Maldonado told me that in 2020 hundreds of women waited outside the National Congress while senators debated the issue of legalizing abortion. I can imagine the relief and the cheer that greeted the announcement that the Voluntary Interruption of Pregnancy Bill had passed. Now women can have safe, legal abortions in Argentina. The Green Wave has helped spread liberalization of laws to other Latin countries, including Mexico and Columbia.