Family Planning – 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.

Some words carry baggage, which may interfere with their utility, and even with their use. “Population” and “overpopulation” are examples of this vilification.

For years people concerned about the human effects on our environment have avoided using the word “overpopulation”. Is it time to end that taboo?

This word implies that there are too many people, and that we are injuring our environment. Thus, it is critical of humanity. To some, the word also recalls past histories of abuse, genocide and racism.

How many people does it take to be overpopulated? Thirty years ago, Professor Joel Cohen wrote the book “How Many People Can the Earth Support”. The answer to the title’s question is, “it depends”—in part it depends on our lifestyle. Cohen found a wide range, the maximum human population ranges from fewer than one billion to over 1000 billion people.

Here is a typical definition of “overpopulation”: “…when there are more people than can live on the earth in comfort, happiness, and health and still leave the world a fit place for future generations.” That definition looks at our use of limited resources, but it only considers the effect of too many people on our own species. What about the rest of the living world?

Philosophy professor Phil Cafaro suggests a new definition that considers the impacts both on humans and on the rest of life. In the abstract of a recent paper, he wrote:

“Human societies, or the world as a whole, are overpopulated when their populations are too large to preserve the ecosystem services necessary for future people’s wellbeing or to share the landscape fairly with other species.”

What is unique about this definition is that it includes harm to other flora and fauna, as well as to our own species.

My favorite way to measure human’s effect on the natural world is with the Ecological Footprint (EF). An individual’s EF is a measure of the demands made by a person on natural resources, using the areas of biologically productive land and water as its yardstick. Overall impact increases with increasing population, of course, and also increases with increasing consumption.

The planet can support more people if their consumption is low. For example, Kenya, a low-income country, has an average EF of 2 acres per person, versus the USA with over 20 acres. Currently, the global average EF of an individual is almost 7 acres.

Unfortunately, there is only enough productive land and water for each person to draw from 4 acres, on the average. Thus, using the Ecological Footprint as a measure, the planet is already overpopulated. Indeed, we are overpopulated by a whopping 75%! If, however, we all consumed as little as Kenyans, we would be fine.

Regrettably, there are not many people who want to decrease their consumption. Still fewer actually make the sacrifices necessary to consume less. Instead, many millions are trying to increase their income so they can consume more.

On the other hand, there is a long history of people aspiring to limit their fertility. For centuries women have tried to have control over their family size. All too many have risked death to abort unintended pregnancies. Now that effective contraception and safe abortion methods are available, the fertility rate is decreasing in most parts of the world. Sadly, the latest estimate is that over 250 million women want to avoid pregnancy but are not using modern, effective contraception. The “low hanging fruit” to approaching sustainability is to remove barriers to family planning.

Let’s accept that we are overpopulated, and start using that word fearlessly. I suggest that you explore The Overpopulation Project (https://overpopulation-project.com). You will find useful information about the relationship between human numbers and ecological sustainability.