Hallie Montoya Tansey

Women In Politics- Final Paper

12-5-01

National Wombs: Sterilization of American Indian Women in the 1970s

\"They took our past with a sword and our land with a pen. Now they\'re
trying to take our future with a scalpel.\" -- Akwesasne Notes, Spring
1977

\"The Native American woman is the carrier of our nation.\" -- Marie
Sanchez

The increase in federal funds for sterilizations legislated in the
Family Planning Act of 1970, American Indian dependence on federal
health services, and the paternalism of some Indian Health Service
doctors combined to cause a dramatic increase in the rate of
sterilizations among Indian women in the early 1970s. Anecdotal evidence
that many of these sterilizations were coerced led Indian activists to
organize against the phenomenon. The history of attacks on and
disruptions of American Indian families by the Bureau of Indian Affairs
and other federal agencies created a climate in which activists saw the
increase in sterilizations as neocolonialist and genocidal. While
activism and government responses to it focused on coercion,
sterilization itself was the main issue. In the end, both parties tended
to cast aside the issue of reproductive freedom for individual Native
women, instead projecting their own national aspirations onto Indian
wombs.

Part I: The Historical Context of the Sterilization Issue

In his decision on the 1831 United States Supreme Court case, the
Cherokee Nation v. the State of Georgia, Chief Justice John Marshall
wrote that the continent\'s Indian tribes \"are people in a state of
pupilage. Their relation to the United States resembles that of a ward
to his guardian\"

. This influential decision on the forced migration of the Cherokee
people from their homes in Georgia led to more than a century of United
States policy that sought to transform Indians from \"children of nature
\[into\] children of the state\"

. But if Indian adults were children, incapable of self-government, much
less of governing others, who would parent their offspring? Since the
late 19th century, the United States government has attempted to fulfill
the role of parenting Indian children, through boarding schools,
campaigns of \'scientific motherhood\', out-adoption and foster care, in
each stage hoping to prevent the emergence of what they perceived as
\"another generation of savages\"

. If successful, the government\'s campaigns to prevent the passage of
Indian-ness from parents to offspring would accomplish what decades of
bloody Indian wars had not: the complete elimination of the country\'s
ever-inconvenient \"Indian Problem\". These policies have made Indian
families into perpetual sites of struggle and resistance against
assimilation and for the survival of Indian nations.

The first Indian boarding school was established at Carlisle,
Pennsylvania in 1879. At the peak of the boarding school movement, in
1901, 25 Indian boarding schools operated throughout the country,
enrolling more than 21,000 students

. In many cases, Indian families were threatened and intimidated into
sending their children to the schools, which aimed at \"civilizing\"
Indian children into conformity with the white American nation. Teachers
punished their pupils for speaking their native languages and forbade
them from practicing their nations\' religions. The schools were located
off reservations, physically isolating the students from the guidance of
their communities. In resistance to this isolation, Indian children
frequently ran away from their boarding schools and attempted to rejoin
their families.

Indian Bureau officials also sought to intervene in the care of
pre-school age children through early 20th century campaigns emphasizing
\'scientific motherhood\'. These programs, led by white female \'field
matrons\' recruited by the Bureau, linked the reduction of Indian infant
mortality to their mothers\' use of \'civilized\' childcare methods. In
the 1916 Indian Bureau pamphlet, \"Indian Babies: How to Keep Them
Well\", Commissioner of Indian Affairs Cato Sells summarized the idea:
\"it is because so many Indian mothers follow the wrong ideas in caring
for their children that so many of them die\"

. The campaigns identified all of the culpability for high infant
mortality rates with individual, unassimilated Indian mothers, ignoring
larger social forces that were detrimental to Indian health. The field
matrons of the \"Save the Babies\" campaigns instructed the mothers in
the \'proper\' ideas primarily through \'baby shows\'. At these shows, a
panel of judges, using \'scientific\' score cards created by the
American Medical Association, examined Indian babies and awarded prizes
to those they deemed the best. During the shows, field matrons also
presented films and exhibits to instruct Indian mothers in
\'scientific\' childcare, emphasizing assimilative behaviors, such as
adopting European dress. The fairs\' instruction encouraged Indian
mothers to look to \"field matrons and physicians, not extended family
networks, for education and assistance\"

. This encouragement mirrored the general orientation of Indian health
policy during the period, which, according to Robert A. Trennert, \"was
intended primarily to aid the assimilation process---to get the
\'uncivilized\' Indians away from their reliance on Native healers, who
were viewed as obstacles to progress\"

.

Around the period of the \"Save the Babies\" campaigns, the focus of
Indian educational policy was shifting. Although a few Indian boarding
schools still operate today, in the early 20th century, integrated
public schools and on-reservation day schools began to dominate US
policy on Indian education. This change, however, did not signal the end
of assimilative goals for Indian children. In 1914, Commissioner Sells
argued that integrated schools could more effectively accomplish
cultural assimilation, for when Indian and white students learned
together in public schools, the Indians gained a first-hand
\'appreciat\[ion of\] the better ways of the white man\'\"

. In the 1950s, the trend towards integrated education continued, as
Congressional opponents of the costly Indian Bureau began terminating
the legal status of many Indian tribes and stripping the Bureau of many
of its responsibilities. The budget for Indian education was greatly
reduced, resulting in the closure of many on-reservation day schools in
favor of enrolling the majority of Indian children in integrated public
schools.

As government bureaucrats ceased to busy themselves with education as
the \"institutional agent of colonization\"

, child welfare policy took its place. In 1958, the newly created Bureau
of Indian Affairs (BIA) initiated its Indian Adoption Project in
partnership with the Child Welfare League of America. The Project aimed
to promote the foster care and eventual adoption of Indian children by
non-Indian families. Three years later, the BIA was funding foster care
for 2300 children on their way to adoption

. By the mid-1970s, the proportion of Indian children that were in
foster care when compared to the general population ranged from 640
percent in some states to 2,000 percent in other states

. In 1974, the US Senate Subcommittee on Indian Affairs held hearings on
the out-adoption and foster care of Indian children. Dozens of Indian
women testified about the aggressive efforts of child welfare officials
to remove their children from their homes and place them on what was by
then referred to as the \'gray market\' for Indian adoptive children.
The mothers described frequent visits from social workers trying to
convince them it would be best to give their children up for adoption,
hearings held without their knowledge on their fitness as mothers, and
harassment by welfare bureaucrats.

By the 1970s, American Indians had withstood a century of US policy that
attacked the existence of Indian national identities through disrupting
the passage of Indian-ness from parents to children. It was at this
point that some Native people became aware of what they perceived as the
culmination of these policies: the total prevention of Indian
childbearing, caused by coerced sterilization at government health
facilities.

Part II: The increase in sterilizations

In the late 1960s, the interests of many parties converged on the idea
of federally funded sterilizations for poor women of color. Paul
Erlich\'s 1968 book, The Population Bomb, sparked a national debate on
overpopulation with its apocalyptic predictions of global famine and
ecological disaster. Thomas Littlewood comments in his book, The
Politics of Population Control, that elite concern over rising
populations of poor people of color was also linked to expanding welfare
rolls and the \"destructive urban riots\" that were sweeping the nation
at the time

. In November 1968, the Commission on Population and Family Planning,
headed by population control advocate John D. Rockefeller III and
Secretary of Health, Education, and Welfare Wilbur Cohen, issued its
report, including a recommendation for federally funded sterilization
for the poor. Feminists at Planned Parenthood also made federally
subsidized birth control one of their three national lobbying
priorities. Federal funding would make the reproductive freedom they
felt that privileged women were experiencing by then through expensive
birth control methods accessible to all. These developments helped to
create a convergence of policy makers\' views on federally funded
sterilization. Liberals in the Democrat-controlled Congress who were
\"inspired by a spirit of equal access to health services\" and
conservatives in the Nixon White House who were \"concerned with the
spiraling rise of dependency, the high incidence of illegitimacy and the
growth of the poor and/or black populations\" worked together to pass
the Family Planning Act of 1970

, which legalized the use of federal funds for hysterectomies, tubal
ligations, and vasectomies.

The African American community was quick to voice its concerns about the
possibility of coercion entering into federally funded sterilizations,
especially the sterilizations of poor black Medicaid recipients by white
male doctors. By the early 1970s, the idea that federally supplied birth
control was akin to \"genocide... became a standard for any young black
politician even mildly radical\"

. Under pressure from African American organizations, Dr. Leon Cooper,
an African American medical doctor working on distributing government
family planning grants at the Office of Economic Opportunity, wrote up a
set of guidelines on informed consent for federally funded
sterilizations, which he hoped would make coerced sterilizations less
likely

. Unfortunately, the Nixon team was by this time heavily courting the
Catholic vote in anticipation of the 1972 election, and did not want, by
issuing the guidelines, to appear as if they condoned Congress\'s move
to fund sterilizations. Despite an initial printing of 25,000 copies of
the guidelines, the White House would not allow them to be released from
warehouse storage and distributed to doctors for fear of alienating
Catholic voters

.

Nevertheless, several court rulings soon produced legal requirements for
informed consent procedures in federally funded sterilizations

. Relf et al. v. Weinberger et al. and National Welfare Rights
Organization et. al. v. Weinberger et al., addressed the coerced
sterilizations of two African American minors in Alabama. In August
1973, the Department of Health, Education and Welfare issued a
moratorium on federally funded sterilizations for minors that were not
medically necessary for reasons other than birth control in response to
these court cases. Additionally, Judge Gerhart Gesell ruled that
\"voluntary, knowing assent\" would be required of any person undergoing
sterilization procedures, and that this assent should be verified with a
consent form that included information on the risks and benefits of the
procedure and on alternative methods of birth control, and which stated
that the patient did not risk forfeiting any federal benefits if he or
she declined the operation. These regulations went into effect in April
1974.

With or without guidelines for informed consent, the federal funding of
sterilizations would have affected Indian women more than most other
groups because of their dependence on federally supplied health care.
Since sterilization could be offered to all Indian women free of cost
after 1970 through the Indian Health Service, it is not surprising that
many of them took advantage of this added birth control option. A study
of Navajo women living on their reservation indicated that the
percentage that had been surgically sterilized increased from 15.1
percent in 1972 to 30.7 percent in 1978

. During this same period, surgical sterilization became the most
preferred form of birth control among the general population of women in
the United States

. Unfortunately, the same factor that made Native women more likely to
voluntarily opt for a federally funded sterilization--- near universal
dependence on federal health care--- also made them more vulnerable to
the risk of coerced sterilization.

Since 1955 the Indian Health Service (IHS), operating under the
Department of Public Health, had been providing health care to the
tribes. Health services improved after responsibility for them was
transferred to the DPH since Congress allotted far more money to the DPH
for Indian health than it ever did to the Indian Bureau

; however, patient distrust and official paternalism were still
obstacles to quality Indian health care in the early 1970s. Dr. Charles
North, a career physician with IHS

, noted in my interview with him that no matter what the formal
procedures on informed consent are, the most important factor is a
trusting relationship between doctor and patient. Dr. North observed
that most patients of any social background who consent to a medical
procedure do not read the forms they are given in order to make their
decision, instead relying on the trust they have in their doctor, which
in many cases was lacking at IHS facilities.

Mary Bravebird, a Lakota Sioux woman, depicts the relationship between
her sister and the government doctors that performed her sterilization:
\"My older sister Barbara... went to the BIA hospital, where the doctors
told her she needed a cesarean. When she came to, the doctors informed
her they had taken her womb out. In their opinion at that time, there
were already too many red bastards for the taxpayers to take care of\"

. In this anecdote, Bravebird attributes racism and deception to the
government doctors, underscoring the lack of trust and respect that was
common in relationships between Indian women patients and their white
male doctors.

In 1974, Dr. Connie Uri, a Choctaw physician practicing in Oklahoma,
began investigating the possibility that coerced sterilizations had been
taking place at the Indian hospital where she worked in Claremore, after
noticing a sharp increase in the number of sterilizations performed. Dr.
Uri analyzed documents at the hospital, in which she found that the
formal consent procedures were often not followed correctly. She also
interviewed women who had undergone the procedure, several of whom
reported being harassed to obtain the consent forms. According to an
article in the Mohawk newspaper, Akwesasne Notes, \"one woman was told
by social workers that she was a bad mother and... they would place the
children in foster homes if she did not agree to the surgery\"

. As Dr. Uri began publicizing her findings throughout Indian Country,
others began making their own investigations. Marie Sanchez, a tribal
judge of the Northern Cheyenne reservation, interviewed 50 women, 26 of
whom reported that they were sterilized. In her interviews, Sanchez
found that \"one doctor told several women that they had each had
several children and it was time they stopped having children; others
were told that they could have children after the operation\"

. The anecdotal pattern of coercion that these women uncovered, if seen
in historical context, is not surprising. It represents a continuity
with a century of US policy of attacking Indian families as a way of
destroying Indian nations.

Part III: The Activists\' Response

In the early 1970s, American Indian activists were also projecting their
ideas of national destiny onto the wombs of Indian women. Bravebird, a
member of the American Indian Movement at the time, describes the some
of the prevailing attitudes of AIM members towards sexuality: \"Some of
the AIM leaders attracted quite a number of \'wives\'. We called them
\'wives of the month\'... Birth control went against our beliefs. We
felt that there were not enough Indians left to suit us. The more future
warriors we brought into the world, the better\"

. To counter Indian demographic vulnerability, Bravebird relates how
AIM\'s members saw their avoidance of birth control and relatively free
sexuality as contributing to the building of stronger Indian nations.

The idea of nation building through the rejection of sterilization, and
not the idea of reproductive freedom through the rejection of coercion,
dominated many of the statements Indian activists made on the
sterilization issue. Dr. Uri, who conducted the investigation at the
Indian hospital in Claremore, OK, argued in Akwesasne Notes in 1977:
\"voluntary sterilization among a population of 200 million isn\'t going
to wipe out the country, but in such a small group, it will wipe out
Indians. Sterilization can not be the preferred form of birth control
for minority groups\"

. Similarly, the International Indian Treaty Council, an organization
set up by former AIM members to represent American Indians in the United
Nations stated: \"\[The\] sterilization\[s\] of women are direct attacks
on nationhood. Sterilization must continue as a birth control choice for
women, but for Native people, it should be seen in the context of
national identity. If an Indian woman is a member of a 3,000 member
nation, sterilization has serious consequences for the survival of
\[her\] people as a whole\"

. Here, both Dr. Uri and the Treaty Council do not conceive of coercion
but of sterilization itself as the main problem. If as the Treaty
Council states \"sterilization\[s\] of women are direct attacks on
nationhood\", and a Native women chooses voluntarily to be sterilized,
is it she or the US government who launches the attack on the Indian
nation? These formulations set up a conflict between the interests of
Indian nations---which demanded the fertility of all Indians--- and the
freedom of individual Native women, who may actually have wanted to be
sterilized.

Neither Dr, Uri nor the International Indian Treaty Council used these
anti-sterilization arguments when they lobbied the US government itself,
most likely sensing that their main potential allies, feminists and
liberals, would be alienated by the devaluing of reproductive freedom
for individuals. Instead, Indian activists focused in their lobbying
efforts on the more universally sympathetic, less ambiguous symbol of
the coercively-sterilized Native American woman. Activists who lobbied
the federal government argued not against sterilization but against
coercion and occupied themselves with the bureaucratic details of
informed consent. After completing their small-scale investigations, Dr.
Uri, Marie Sanchez and others sent the evidence of coercion they had
gathered to Senator James Abourezk of South Dakota, chairman of the
Senate Interior Subcommittee on Indian Affairs

. Senator Abourezk then requested that the Government Accounting Office
(GAO) conduct a formal investigation into the sterilization issue in
April 1975.

The GAO investigation consisted of a government audit of the records of
sterilizations at four Indian health facilities between 1973 and 1976.
While the GAO report did not go so far as to state that the IHS had
performed coerced sterilizations, it did find numerous violations of the
guidelines for informed consent that had gone into effect in the
previous two years. For example, the investigators found that \"the IHS
had performed 23 sterilizations of women under the age of 21 between 1
July 1973 and 30 April 1974, despite the HEW moratorium on such
sterilizations\" during that time period

. The GAO also found that the forms the IHS used for sterilization
consent violated federal regulations in important ways. Though the IHS
was using several different forms, according to the GAO report, \"the
majority of the forms \'did not (1) indicate that the basic elements of
informed consent had been presented orally to the patient, (2) contain
written summaries of the oral presentation, and (3) contain a statement
at the top of the form notifying the subjects of their right to withdraw
consent\'\"

.

Both IHS doctors and Indian activists agreed that there were numerous
problems with the GAO investigation. The GAO auditors investigated
sterilizations at only four of the twelve IHS hospital facilities,
making it impossible to calculate accurate numbers of women who had been
sterilized or numbers of violations of informed consent. In addition,
since the auditors only analyzed paperwork, rather than interviewing
patients or doctors, they lacked vital information about verbal
interactions, which made it impossibly to really judge whether or not
women had been coerced. Even the auditors\' analysis of the forms lacked
sensitivity. Burton Attico, an obstetrician/gynecologist with IHS since
1967, recalls that GAO auditors did not appreciate the medical nuances
of sterilization, especially the distinction between therapeutic (i.e.
medically necessary) sterilizations and contraceptive sterilizations:
\"They reviewed charts of women who had hysterectomies for \[cancer\],
or for prolapse and/or bleeding, and ... regarded them as just
\'sterilizations.\'\"

.

Despite its flaws, the GAO investigation led to changes in the IHS\'s
informed consent procedures for sterilization. As a result, \"IHS was
expected to implement a standardized consent form compliant with court
ordered regulations, train doctors and administrators about informed
consent, and respect the moratorium on sterilizing women under 21 years
of age\"

. These changes in policy that related specifically to sterilization
ultimately had a less significant effect on Indian women\'s experiences
with IHS than did more sweeping legislation that was then making its way
through Congress. In 1976, Congress passed the Indian Health Care
Improvement Act, which \"gave tribes the right to manage or control IHS
programs\" with which they were dissatisfied

. This legislation was related to the Indian Self Determination and
Education Act, also of 1976, which allowed Indian tribes selectively to
assume any of the functions of the BIA, using that agency\'s federal
appropriations as they saw fit. Indian tribes who operate their own
health care systems now represent themselves through the National Indian
Health Board, a non-profit organization that monitors legislation and
\"presents a Tribal perspective\" on health care to the federal
government

. The demographics of the IHS itself have also changed significantly
since the 1970s; currently \"more than 62 percent of IHS employees are
of American Indian or Alaska Native descent\"

. These changes have been significant in decreasing Indian women\'s
vulnerability to coerced sterilization, because, ideally, they have
helped to create more trusting, respectful relationships between IHS
patients and their doctors.

The risk that an American Indian woman will be coercively sterilized is
less today than it was in the 1970s for many reasons, including more
stringent consent procedures, greater awareness of the issue among
Native women, and better relationships between Native women and their
doctors. The expansion of Native women\'s reproductive freedom, however,
has not fundamentally altered the central, though often veiled, issue of
Indian nationhood that underlay debates over coerced sterilization.
Attacks on Indian nations by the US government and Indian resistance to
them have not ended, but have only moved out of Indian women\'s wombs
and on to other arenas.

Bibliography:

Akwesasne Notes \"Killing Our Future: Sterilization and Experiments\"
Spring 1977

Akwesasne Notes \"Sterilization of Young Native Women Alleged at Indian
Hospital\" July 1974

Albuquerque Tribune \"Defense Says State Failing in Developing Gallup
Case\" May 24, 1973 Gallup UPI

Benson, Robert, ed. Children of the Dragonfly: Native American Voices on
Child Custody and Education Tuscon: University of Arizona Press 2001

Bravebird, Mary \"We AIM Not to Please\" in Reinventing the Enemy\'s
Language ed. Harjo, Joy and Bird, Gloria W.W. Norton & Company 1997

DeFine, Michael Sullivan \"History of Governmentally Coerced
Sterilization: the Plight of the Native American Woman\" University of
Maine School of Law, May 1997

Dillingham, Brint, \"American Indian Women and I.H.S. Sterilization
Practices\", American Indian Journal January 1977

Emmerich, Lisa E. \"\'Save the Babies!\': American Indian Women,
Assimilation Policy and Scientific Motherhood, 1912-1918\" in Writing
the Range: Race, Class and Culture in the Women\'s West ed. Jamison,
Elizabeth and Armitage, Susan Norman: University of Oklahoma Press 1997

Erlich, Paul The Population Bomb New York: Ballatine Books 1968

Jarvis, Gayle Mark. \"The Theft of Life\" Akwesasne Notes Autumn 1977.

Lawrence, Jane \"The Indian Health Service and the Sterilization of
Native American Women\" American Indian Quarterly Lincoln: University of
Nebraska Press , Summer 2000

Littlewood, Thomas The Politics of Population Control, University of
Notre Dame Press 1997

Prucha, Francis Paul The Great Father: the United States Government and
the American Indians, Vol. II University of Nebraska Press 1984

Torpy, Sally \"Endangered Species: Native American Women\'s Struggle for
their Reproductive Rights and Racial Identity, 1970s-1990s\" University
of Nebraska, masters thesis, defended summer 1998

Trennert, Robert A. White Man\'s Medicine: Government Doctors and the
Navajo, 1863-1955 Albuquerque; University of New Mexico Press 1998

personal interview with Charles North, M.D., Chief Clinical Consultant
for Family Practice at Albuquerque Indian Hospital, career physician
with Indian Health Service

email correspondence with Burt Attico, M.D., obstetrician/gynecologist
with Indian Health Service; Dottie Meyer, R.N., obstetric nurse with
Indian Health Service

Quoted in Bensen: 6

Bensen: 5

from the statement of the Lake Mohonk Conference of 1892, quoted in
Prucha: 707

Prucha: 816

Jameson and Armitage: 402

Jameson and Armitage: 400

Trennert: 12

quoted in Bensen: 9

Bensen:11

Prucha: 1153

Torpy

Littlewood: 53

Littlewood: 111

Littlewood: 75

Littlewood: 118

these maneuverings are laid out in great detail in Littlewood Chapter 7,
\"Richard Nixon\'s Catholic Strategy and the Murky Business of
Sterilization\"

Lawrence: 404-406

cited in Define: 3 The study did not distinguish between coerced and
voluntary sterilizations.

Littlewood

Lawrence: 401

these observations are based on a personal interview with Dr. North

Bravebird: 341

Akwesasne Notes 1974: 22

Dillingham: 28

Bravebird: 341

Jarvis, Akwesasne Notes

Torpy

Lawrence: 406

Lawrence: 407

cited in Lawrence: 407

from personal email correspondence with Dr. Attico

Akwesasne Notes, Spring 1977

Lawrence: 414

National Indian Health Board website, www.nihb.rorg

Indian Health Service website, www.ihs.gov

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