page_title: Sterilization of Native American women
section_title: Motivations
hierarchical_section_title: Sterilization of Native American women / Motivations
caption_attribution_description: English: This is a pamphlet made by the Department of Health and Education urging Native American individuals to be sterilized
context_page_description: In the 1960s and 1970s, the Indian Health Service and collaborating physicians sustained a practice of performing sterilizations on Native American women, in many cases without the 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. 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.
  In 1976, a U.S. General Accountability Office investigation found that four Indian Health Service areas were noncompliant with IHS policies regulating consent to sterilization.
context_section_description: Native American women were not the only individuals to be subjected to forced sterilizations; black and poor women were also affected by these practices. In the 1970s, after being forced onto reservations by the United States government, or relocated into urban areas without adequate support, many Native Americans were struggling with poverty. Native American people depended on government organizations like the IHS, Department of Health, Education and Welfare (HEW) and the Bureau of Indian Affairs (BIA). The Indian Health Service (IHS) was their main health provider. Because Native Americans were dependent on these government organizations for health services, they were more at risk for forced sterilization than other groups.
  Most of the physicians performing this procedure viewed sterilization as the best alternative for these women. They claimed it would improve their financial situation and their family's quality of life. Many of these physicians believed that Native American women were not intelligent enough to use other methods of birth control. Thus, sterilizing these patients was seen as the most reliable birth control method. When doctors were polled on their recommendations to patients they received in private practice, only 6% recommended sterilization, while 14% would recommend it to those on welfare. When they were asked about their attitudes regarding birth control policies, 94% said they would approve of compulsory sterilization for a mother on welfare with three or more children. With fewer people applying for Medicaid and welfare, the federal government could decrease spending on welfare programs. Poor women, the disabled, and the women of color were targeted for similar reasons. In addition, the influx of surgical procedures was seen as good training for physicians and as a practice for resident physicians.
  One theory suggests that IHS doctors were underpaid and overworked and they sterilized Native American women so that would have less work in the future. The average new IHS recruit made $17,000 to $20,000 a year and worked around 60 hours per week. In 1974 the ratio of doctors to patients was dangerously low, with "only one doctor to 1,700 reservation Indians." The problems caused by a lack of doctors were exacerbated even further when a program to draft doctors into the military was terminated in 1976. This directly affected the IHS because they recruited many of their doctors from the military. Between 1971 and 1974 applications for vacant IHS positions went from 700 to 100 applications, meaning that the burden of additional work fell on an ever decreasing number of doctors. 
  One important distinction is between doctors who worked for the IHS directly, and other doctors who performed sterilizations through a contractual arrangement with the IHS. For IHS doctors, there was no financial incentive to perform sterilizations, and therefore other considerations likely played the primary role. Doctors under contract were paid more when they sterilized women instead of giving them oral contraceptives, making a financial incentive more plausible. Even though there was no financial incentive for the IHS doctors to recommend sterilization, as previously discussed, sterilization was seen as the ideal form of contraception for Native American patients during the 1960s and 1970s. IHS doctors had mostly white and middle-class views of family planning, with an emphasis on a nuclear family containing a small number of children. The presumption that Native American women desired the same family structure as middle class white Americans helped make sterilization abuse possible.
caption: This was a pamphlet created by the Department of Health, Education, and Welfare (HEW) to urge Native American women to have fewer children. The left shows how the parents would be before adopting  promoted family planning practices (tired and with little resources) and afterwards (happy and wealthy).
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