Durango Herald – Population Matters-USA

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.

I started writing these essays in 1995 with certain goals in mind. For those of you who didn’t start reading Population Matters! (this is the title of the Durango Herald column) back then, here’s a little background.

Gail, my wife, and I drove to hear Paul Ehrlich speak in Gothic, a bit north of Crested Butte, Colorado, in the fall of 1994. On the way home I pulled the car over and parked.

“Why are you stopping?” Gail asked.

“I’ve got an idea,” I replied.

I wanted to emulate the best-selling book, “50 Simple Things You Can Do to Save the Earth”, by writing a similar one on human population. After drafting a few chapters I realized that it would be necessary to find a publisher. Ballantine Books had published some environmental paperbacks, so I asked Morley Ballantine (then the editor of the Herald) if she could help.

I was disappointed when she told me that she no longer had connections that would help, but accepted her offer to serialize my proposed masterpiece in the Herald. In retrospect, there is no way that I could write a book while working 60 to 80 hours each week at my day (and night) job of obstetrics and gynecology.

The mission of these monthly essays was to keep population issues in people’s minds. I would try to be optimistic, provide information and also suggest ways that readers could slow population growth. Those goals haven’t changed.

Bill Roberts, who still writes occasional editorials for the Herald, was my initial editor. He was gentle in his efforts to keep me in line. The initial word limit was 750, but sometimes I would go hundreds of words beyond that maximum before Bill reined me in. Once he sent me a terse message “Stick to the subject” when I got off into the weeds. I was pleased, however, when he published stories I wrote about some of my favorite Durango people, including Linda Mack and the late Sister Sharon.

A dozen years ago I had a realization: if someone else had written a book such as what I had envisioned, I probably wouldn’t bother buying it, let alone read it. Furthermore, Gail had gently told I was too “preachy”. Somehow, I was missing the mark.

I tried new ideas. Do you remember the tire made from condoms that was exhibited in the Durango Art Center? It illustrates the punchline of the joke “What do you do with 365 used condoms?” Answer: “Make them into a tire, and call it a Goodyear.” I also collaborated in making a documentary film about overpopulation in the Four Corners area.

A friend recently commented that people don’t like to be told what to do, and suggested that using imperative verbs in the title might be a bad idea. This is my first essay that doesn’t start with a command.

One of Bill Robert’s successors at the Herald, Hollis Walker, came up with a great idea: my book should be stories rather than essays. Rather than selecting, revising and compiling the over 200 essays that I’ve written through the ages, I’m having fun writing people-centered stories. These accounts are based on my memories of people I’ve encountered during my medical career. Of course, I’ve changed the names, and sometimes I’ve tried to obfuscate details to further prevent identifying characters in the stories. Many of the stories include information about reproductive health, of course.

I just turned 80. I’m hoping to be able to finish this book-writing project before another 28 years goes by. In the meantime, thank you for reading Population Matters! Past essays and a few other features are available on my blog: www.population-matters.org. Please help spread the word that population, indeed, matters.