The Scythe and the Scalpel:
Dissecting the Sterilizations of Native American Women in the 1970's
by Amy Skylark Elizabeth

In the old days, genocide used to be so simple. Such things as biological warfare used to keep Indians warm with small pox infested blankets furnished by the United States government, and the only thing barren and infertile was the land set aside for reservations. In the 1970s, genocide became a little more complex. Biological warfare invaded the reproductive rights of Native American women, making their wombs as barren and infertile as reservation land. The sterilization policies during this time perpetuated the genocidal tendencies that have made the eugenics movement a viable legacy of terror in the biological history of Native Americans.

According to some accounts, the eugenics movement died out in the 1930s. However, the forty two percent of Native American women who were sterilized under questionable circumstances by 1982, stand as testament that eugenics was alive and kicking during the seventies (Define 1997). Sparked by concern about overpopulation in the 1960s, eugenics was legally sanctioned under the Nixon administration (Johansen 1998). This sanctioning was given life in a campaign to sterilize the impoverished. For instance, between 1969 and 1974, the budget for family planning increased from $51 million to more than $250 million (Johansen 1998). This money helped to sterilize between 192,000 and 548,000 women each year between 1970 and 1977 compared to an average of 63,000 a year between 1907 and 1964, a period that included the pinnacle of the eugenics movement (Johansen 1998).

This wave of sterilization came crashing down on Native American women the hardest. As Sally Torpy asserts in her thesis, Endangered Species: Native American Women Struggle for Their Reproductive Rights and Racial Identity, 1970s-1990s, "Native American women represented a unique class of victims among the larger population that faced sterilization and abuses of reproductive rights...They had, and continue to have, a dependent relationship with the federal government which has put them at a greater risk..."(Johansen 1998 p. 4). In fact, the federally funded Indian Health Service, the very agency that was supposed to protect and provide for Indians, was the perpetrator of these sterilizations.

The American Indian Policy Review Commission's report on the health of Native Americans said it best when they stated,"the federal responsibility to provide health services to Indians has its roots in the unique moral, historical, and treaty obligations of the federal government, no court has ever ruled on the precise nature of that legal basis nor defined the specific legal rights for Indians created by those obligations" (DeFine 1997 p.4). Thus, the Indian Health Service has always worked in strange and ambiguous ways.

By the time sterilization for both the poor and minorities became an official sanction in 1970, and reservation populations became main targets of this policy, the IHS was ready to initiate its campaign against Indian women. Policy turned into perpetration, and people turned into victims.

For example, in 1970 a twenty six year old Native American woman went into the office of a Los Angeles doctor and asked for a "womb transplant" (Johansen 1998). She was devastated when she was told that such a procedure did not exist. Years earlier, at an IHS hospital, she had been coerced to have a hysterectomy under false pretenses. She was not alone. There were thousands of women who had shared similar experiences.

In a lot of cases, women were told that hysterectomies could be reversed, that they would lose the children that they already had, lose the federal aid that they were getting if they did not comply, or were given consents to sign when they were still drugged after having given birth to other children (Akwesasne Notes Spring 1977). One doctor said, "I used to make my pitch while sewing up the episiotomy, when the anesthesia started wearing off" (Lindsay 1978). Even more horrifying, two fifteen year old girls were even led to believe that they were having their tonsils taken out, when they actually had their ovaries removed (Johansen 1998).

This coercement was eugenically based genocide where hegemony and hospital faculty were partners in crime against these women. According to the Rocky Mountain News, a survey done in the seventies of medical professionals showed that large numbers of doctors were of the opinion that "poor minority people are reproducing at higher rates than is good for the economy" (Lindsay 1978).

Such attitudes translated into abhorrent mistreatment of Native American women. First of all, some doctors decided the appropriate number of children that these women should have. When tribal judge Marie Sanchez interviewed fifty women on the Northern Cheyenne Reservation, she found out that several of the twenty six women that were sterilized had been told that each had enough kids, and that they should not have anymore, while others were told that they could have more kids after the operation if they wished (DeFine 1997).

A study of the Navajo Reservation sponsored by the Public Health Service, calculated that the percentage of interval sterilizations had doubled from 15% in 1972 to 31% in 1978, making it evident that the attitudes of the health care practitioners greatly influenced a woman's decision (DeFine 1997). According to the researchers, "older women who become pregnant were less concerned about reducing their childbearing and "did do so primarily when they were influenced by health care providers" (DeFine 1997 p.5).

In light of what many Native American women experienced at the hands of these practitioners, it can be assumed that the nature of this "influence" was harassment and deception. Nurses and doctors played on the fears of these women in order to make them compliant. White middle class America had always acted as if they knew what was in the best interest of the Native American child. For example, in the mid seventies, 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 (Johansen 1998). Therefore, the fear in the Indian woman's mind that her children could indeed be taken away from her was real and easily exploitable.

It is also theorized that some doctors saw their income going out in taxes that were used toward welfare and unemployment benefits and were therefore champions of sterilization because it not only reduced populations of minorities, but also brought them money from the fees they were paid by the government to perform these procedures (Lindsay 1978). Consequently, it is not surprising that hysterectomies were the fourth most commonly performed surgery on Native Americans (Akwesasne Notes Spring 1977).

As Choctaw doctor Connie Uri said when she investigated hospital records at the IHS hospital in Claremore, Oklahoma, and discovered that a large percentage of women were sterilized by having hysterectomies, "in normal medical practice, hysterectomies are rare in women of child bearing age unless there is cancer or other medical problems" (DeFine1997). Hysterectomies however, earned the doctors a thousand or two more dollars than tubal ligations did (Akwesasne Notes Spring 1977). Also, doctors, particularly in teaching hospitals, admitted to performing hysterectomies instead of more minor surgeries just so they could get the practice" (Lindsay 1978). When people such as Dr. Uri started publicizing the claims about reproductive abuse, Native Americans began to realize the appalling frequency of such procedures and the unethical tactics that were being used to gain consent.

In 1974, she started her own inquiry into complaints made about the Claremore, Oklahoma IHS hospital (Johansen 1998). Evidence against Claremore, provided by her, as well as research done by other concerned parties, was brought to the attention of Senator James Abourek. He in turn orchestrated an investigation to be carried out by the General Accounting Office.

This study covered 46 months spanning between 1973 and 1976, and only focused on the IHS records of hospitals in Albuquerque, Phoenix, Oklahoma City, and Aberdeen, South Dakota, even though there were twelve IHS hospitals (Akwesasne Notes Spring 1977). Because of this narrow focus and small time frame, the total number of women who were sterilized will never be known (DeFine 1997). The study did prove however that at least 3400 were sterilized over the course of the three years that were analyzed (Akwesasne Notes Spring 1977). In terms of total population numbers, this would be equivalent to sterilizing 452,000 non-Indian women (Jarvis 1977). Investigators also found that all four areas were "generally not in compliance with government regulations requiring informed consent" (Akwesasne Note Spring 1977). In places such as Albuquerque and Aberdeen, thirty percent of the sterilizations were done by contract facilities whose consent procedures were not monitored and whose doctors were not required to follow any federal guidelines (DeFine 1997).

In general, all of the consent forms did not provide several important features. They did not indicate that the basic elements of informed consent had been orally presented to the client, contain written summary of an oral presentation, or have a statement at the top of the form notifying the person of their right to withdraw consent (Jarvis 1977). They also did not have information on the top of the page telling the patient that she would not lose any federal benefits if she did not go through with a sterilization (DeFine 1997). In addition, if the subject was married, the husband was bound by law to sign the consent form, even though there wasn't a space made for his name (Akwesasne Notes July 1974).

As a result of the study, IHS was expected to implement a standardized consent form compliant with court ordered regulations, train doctors and administrators about informal consent, and respect a moratorium on sterilizing women under twenty one years of age (Akwesasne Notes Spring 1977). Also, some Indian Health Service Area Directors were pressured by local Indians to either suspend certain members of hospital staffs, or send them to other posts (DeFine 1997).

Despite the findings and the agreement to implement better policies, consent was still not being properly gained. Consent forms were not getting any clearer and still lacked vital information. In 1978, a Cheyenne Indian leader and minister went to a hearing on sterilization regulations proposed by HEW. He and twenty four others testified that consent forms needed to be presented in the patient's native language, and needed to explain about the nature and consequences of the operation (Lindsay 1978). He also argued that doctors were still not documenting that they had explained everything, and that there was nothing on the form that assured the woman that she would not forfeit her federal benefits if she declined the procedure (Lindsay 1978). West also advocated changing the waiting period from seventy two hours to thirty days, as well as not using hysterectomies as a main form of sterilization (Lindsay 1978). In addition, he wanted to ensure that no one under twenty one was being sterilized. Even though IHS had agreed to a moratorium on this, thirty six women had been sterilized nonetheless (Akwesasne Notes Spring 1977).

Evidently, after the GAO study, the government did very little to make sure that the IHS acted responsibly. Indians were outraged that nothing was done to right all of the wrongs that this and other studies had uncovered. They felt as if the GAO study, a poorly organized, subjective investigation that relied merely on hospital records rather than empirical data from the victims themselves, was done to merely placate them (Johansen 1998). They accused the IHS of practicing genocidal policies. The IHS tried to hide under what they considered to be inaccurate figures supplied by the GAO (DeFine 1997).

Interestingly, some surmise that the statistics were indeed inaccurate. In fact, 3400 women were said to have been sterilized each year between 1973 and 1976, rather than the 3400 total for which the study accepted responsibility (DeFine 1997). Even though there were suits and protests, sterilizations continued into the late 1970s at some hospitals. In a visit to Claremore's facility between 1978 and 1979, one researcher collected records for six months and found that there had been eighty one sterilizations (Johansen 1998). He spoke to several of Claremore's nurses who "validated that sterilizations were occurring and with greater frequency" (Johansen 1998).

No one will ever really know how many women were really sterilized during the seventies. Lehman Brightman, a Lakota who has made this subject his life's work, estimates that the total number of Indian women sterilized during the decade was somewhere between 60,000 and 70,000 (Johansen 1998). As Dr. Uri explained, "voluntary sterilizations 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" (Jarvis 1977).

The sterilization of the multitude of Indian women was indeed a governmentally orchestrated practice of incipient genocide, based on eugenic precepts. As the International Indian Treaty Council stated: "The United Nations Convention on Genocide states that imposing measures intended to prevent births within a group of people...are acts of genocide...[such as] sterilization 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 the 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" (Johansen 1998).

In essence, this sterilization of Native American women was a symptom of a larger problem. The United States has always been concerned with the "Indian problem". The solution for this has always been to eliminate Indians rather than to eliminate their problems. According to census figures, forty percent of Indians are below the poverty line, making them the poorest minority in America (Miller 1978).

The funds used for sterilization could certainly have been put to more constructive use by treating the symptoms of poverty, so that it does not have to be a debilitating epidemic. Safe water, sanitary disposal services and preventive health care measures would solve problems better than sterilizations. By relegating them into mere biological specimens and sterilizing them for population control, the government was treating them no better than rutting animals. As Senator Abourezk snidely commented, "put them under the Fish and Wildlife Service and declare them an `endangered species' along with...the Yellow Scissor-Tailed Flycatcher" (Miller 1978).

Sadly, they would be treated better if they were endangered animals. When threatened with extinction, no federal program can infringe on the "critical habitat the endangered species, which it requires to survive (Miller 1978). There are programs to propagate animal populations that are dying out. With Native Americans, thinking deluded by eugenics made federal policy much less kind in the seventies. Fortunately, on reservations today women are now counciled by nurses and midwives when they are considering sterilization (Johansen 1998). Although the wave of sterilizations in the 1970s has since ebbed in the nineties, Torpy asserts that "Even today there remains a need for constant and close surveillance over physicians and health care facilities so that all poor women and women of color are allowed to make their own reproductive choices" (Johansen 1998).

Birth rates have reflected the decline in sterilizations. In 1988 there were 45,871 children born, compared to the 27,542 born in 1975 (Johansen 1998). The IHS has projected that Native American populations will continue to increase at a rate of 25 percent in ten years at the contraceptive use of 30 percent (Miller 1978).

Ultimately, genocide wasn't so simple in the 1970s. Eugenics was the poison that perpetuated the governments policy of sterilization of Native American women. By examining claims of mistreatment and deception, studying the hows and whys of hegemonic bedside manners, seeing the results of such investigations as the GAO report, analyzing the shortcomings of the consent forms, and questioning the inaction of the government, a clearer picture of genocide can be seen lurking behind these sterilizations. This was the government's legacy to the biological history of Native Americans in the 1970s. The thoughts of Indians was best represented in the American Indian Journal when they wrote about the governments abuses with sterilizations: "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).