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• ABSTRACT It is argued that despite formidable foes—including powerful
feminist organizations and Native American rights groups—
Indigenous women’s activism had an important influence on the
larger movement for the termination of sterilization abuse in
1970s USA.
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• ABSTRACT It is argued that despite formidable foes—including
powerful
feminist organizations and Native American rights groups—
Indigenous women’s activism had an important influence on the
larger movement for the termination of sterilization abuse in
1970s USA. Their work highlighted coerced sterilization as a most
agonizing example of compromised tribal sovereignty—and
demanded that political leaders address it. The article describes
the tangible achievements of these women in effecting federal
regulations as well as their influence on mainstream American
feminist ideology and Indian Country’s interpretation of women’s
rights as sovereign ones. In the late 1970s a segment of Women of
All Red Nations (WARN) advanced a scathing
critique of the federally-funded sterilizations that occurred at
Indian Health Services (IHS)
and its contract facilities; they charged that there existed a direct
correlation between
coerced sterilization and ‘the government’s drive for energy
resources on the reservations.’1 Three of WARN’s founding
members, Lorelei Means, Pat Bellanger, and
Vicki Howard, cited Northern Cheyenne as an example of an area
that was energy rich,
‘almost 80% sterilized,’ and subject to high numbers of non-Indian
adoption and foster
care placements for children.2 In the estimation of these women,
the connection
between sterilization abuse and energy resources was clear:
3. leaders in Indian Country consider women’s rights an integral part
of sovereignty and thus
urged a broad and dynamic interpretation of tribal political power.5
In both instances,
Indigenous women initiated changes within movements already
dedicated to the progressive and sometimes radical reform of
unjust practices. Yet neither organizations in Indian
Country nor a majority of second-wave feminists willingly
championed Native women’s
attempts to draw attention to and arrest the practice of sterilization
abuse. Some Indigenous organizations viewed the subject as too
politically risky, and a powerful faction of the
women’s movement found the issue at odds with its own agenda.
The ultimate reduction
in these unwanted operations and broadening of reproductive
justice and tribal sovereignty rested, in part, with Native American
women—despite the federal government’s
robust funding of sterilization, the silence of their own
communities about the issue,
and the mainstream feminist movement’s control over the meaning
of reproductive rights.
For roughly the past forty years, the field of women’s history has
engaged with topics,
historic figures, and narratives previously untold. Many of these
studies—out of necessity
—simply alerted scholars and students alike to the presence and
contributions of women.
Increasingly, works on the lives of women, such as Danielle
McGuire’s At the Dark End of
the Street, ask readers not only to consider women’s experiences
but to acknowledge the
ways in which their contributions fundamentally alter what we
thought we knew about an
historic moment (in this case the Civil Rights movement).6 In a
modest way, this article
4. seeks a similar objective. In conversation with an extensive
scholarship that looks at reproductive justice and an emerging one
on the era of Red Power, this essay argues that the
issue of coercive sterilization among Native American women and
their activism to
arrest it were important influences on the larger movement for the
termination of sterilization abuse. Forced or coerced sterilization
was also an agonizing example of compromised tribal sovereignty
—which Indigenous women articulated as not only a personal
problem but a tribal crisis for Native nations to address.
Nonconsensual sterilization did not first emerge in the 1970s, nor
did it center exclusively on Indigenous women. During the early
twentieth century, American scientists,
medical professionals, law makers, and welfare agents put into
practice a theory of
eugenics, grounded firmly in paternalism and based loosely on
Malthusian and Darwinian
ideas about population control and natural selection.7 Eugenic
control, including sterilization, was a tool to eliminate ‘defective’
genes and people.8 Eugenicists, wardens of prisons
and institutions, and some sociologists believed that it was best for
both the afflicted and
the rest of society that these ‘deficient’ individuals (frequently
women) did not reproduce
because they understood degeneracy as inheritable.9 In practice,
the people sterilized in the
first half of the twentieth century—those labeled dependent,
‘feeble-minded,’ or criminal
—overwhelmingly came from the working and impoverished
classes.10 Proponents targeted the ‘unfit,’ and launched a
campaign to ensure that they did not procreate and supposedly
further degrade American society with their offspring.11 By the
1930s, however,
eugenicists came under considerable attack for their single-minded
interpretation of the WOMEN’S HISTORY REVIEW 967
5. importance of heredity. In the immediate post-war era, Americans
grew wary of eugenics
and forced sterilization because of their connection to Nazi
policy.12 Yet World War II did
not signal the end of eugenics. Existing beliefs about race and class
combined with new
ideas about overpopulation and welfare expenses to yield a
contemporary form of population control.13 Earlier in the century,
eugenic campaigns arrested the proliferation of
dependents. During the second half of the twentieth century,
sterilization reemerged as
a way to address population explosion and the ‘welfare crisis.’
Policy makers, physicians,
and self-proclaimed experts commenced a targeted plan for
compulsory reproductive
control on those deemed undesirable economic and social burdens.
By the mid-twentieth century, the world’s population expanded at
a seemingly exponential pace because of an unprecedented drop in
the death rate. Technological and
medical advances, such as penicillin, improved food production,
and public health initiatives allowed people to live far longer than
ever before.14 Longevity coupled with stable,
even increasing, birth rates produced a significant population
increase with no natural
end in sight. Individuals concerned about unbridled population
growth feared that ‘developing’ countries faced inevitable famines
and economic collapse. In ‘developed’ countries,
anxieties focused on ecological and ‘quality of life issues.’ On the
whole, those concerned
with population explosion worried about the ‘carrying capacity of
the earth.’15
To address such concerns, groups like the Population Control
Council, founded by John
D. Rockefeller III in 1952, formed ‘to stimulate, encourage,
promote, conduct, and support
6. significant activities in the broad field of population.’16 More
specifically, the group funded
the development of ‘contraceptive technology,’ provided ‘technical
assistance on family
planning,’ and educated the public about ‘population matters.’17 In
1968, Rockefeller and
President Lyndon B. Johnson supported the creation of the
Committee on Population
and Family Planning, which attempted to assist poor families with
fertility control. In
1970, President Richard Nixon created the Commission on Public
Growth and the American Future, to further investigate the
population problem.18 Organizations such as the
Association for Voluntary Sterilization, Office of Population
Research, Population Association of America, and Zero Population
Growth worked on potential solutions to the crisis,
ranging from voluntary programs and incentive plans to
involuntary governmental controls.19 One such strategy involved
developing a safe way to put ‘fertility control agents
in the water,’ similar to the way some areas added fluoride to water
supplies. Another
scheme proposed to enforce ‘compulsory sterilization after N [a set
number of] children.’20
In practice, however, a targeted effort to control the population
emerged. Legislation in
California, Connecticut, Delaware, Georgia, Illinois, Iowa,
Louisiana, Maryland, Ohio,
South Carolina, Tennessee, and Virginia discouraged the birth of
illegitimate and
largely impoverished children.21 In 1958, a failed bill in
Mississippi subjected an unmarried woman to mandatory
sterilization after she gave birth to a ‘second subsequent
illegitimate child.’ This bill did not pass, although in 1964 a
revised version did. House Bill 180
made it a felony for a woman to have a ‘second subsequent
7. illegitimate child,’ requiring jail
time for the offense.22 By the late twentieth century, concerns
about overpopulation justified the sterilization of women
authorities considered a social burden.23
In addition to attempts by the states to legislate instances of
compulsory sterilization,
the federal government significantly increased financial support for
family planning
during the late 1960s and early 1970s. Prior to 1969, federally-
funded sterilizations did
not exist.24 In 1970, the Family Planning Act promised to
reimburse up to 90% of 968 M. D. O’SULLIVAN sterilization
costs. During this time, the Department of Health, Education, and
Welfare’s
(HEW) budget for family planning increased from $51 million to
$250 million.25 Starting
in 1971, the Office of Economic Opportunity federally-funded
clinics that provided sterilizations to its population of
beneficiaries.26 The government made sterilization inexpensive
and available for Americans on public assistance in an era
overwhelmingly marked by
reductions in healthcare services.27 From 1970 to 1977, federally-
funded sterilizations
increased nearly 300%, from 192,000 to 548,000 each year.28
(These numbers represent
a significant increase, as only 63,000 sterilizations occurred in the
United States
between 1907 and 1964.)29
There were two primary justifications for the targeted sterilization
of welfare recipients.
The first was anxiety over the supposed population crisis. The
second channeled this fear to
focus on the fertility of poor American women whom doctors, law
makers, and population
experts defined as particularly fertile and a drain on American
8. society. In the early 1970s, Dr
Dwight J. Ingle, a physiologist at the University of Chicago,
argued that the growing trend of
‘spending large amounts of money’ to address social problems was
a mistake. According to
Ingle, ‘selective population control’ more effectively solved these
issues because ‘millions of
people are unqualified for parenthood and should remain
childless.’30 These ‘unqualified’
parents were primarily poor women on welfare.31 According to
estimates Ingle advanced,
a majority of educated women practiced birth control, but only
10% of uneducated women
did.32 Ingle proposed that the government pay ‘most welfare
clients to remain childless.’33
Believing welfare recipients incapable of monitoring their fertility
and guilty of passing a set
of degenerate social conditions on to their children, Ingle and
others defined them as ‘a
drain on the taxpayers.’34 In 1965, the Senate held hearings on the
cost of overpopulation
to the United States, where individuals testified that they saw a
connection between overpopulation and violence in poor
neighborhoods, such as the Watts riots in Los Angeles.35
For some, sterilization represented a solution to economic and
social dilemmas, as well as
generalized anxieties about a rapidly growing population. It also
evidenced the racialized
and racist thinking of many who championed such plans;
overwhelmingly the women
who suffered sterilization abuse were women of color.
Native American women emerged as accessible candidates for
sterilization because of
the contractual nature of healthcare between the federal
government and Native
9. nations. Indigenous women who belonged to tribes possessing a
government-to-government relationship with the United States
could receive federal healthcare. Some nations
had rights to medical care by treaty, others through congressional
action. Federal
medical care to Native groups was not welfare, but rather a service
historically provided
in exchange for land.36
Many Americans, including some doctors at Indian Health
Services—the body that
provided this healthcare as a subset of HEW—were unaware of the
legal basis for federally-supported medical facilities on
reservations. They also did not realize that not all
Native women relied on the federal government for their
healthcare. Indigenous
women only received federal services if they returned to the
reservation of their citizenship
to claim them. Wealthier Native Americans frequently sought
treatment elsewhere.37 And
an impoverished Native woman living in an urban area, or
otherwise unable to return to
her appropriate facility, received the same welfare health benefits
as non-Native recipients.
In 1973, 40% of Native Americans lived in poverty. Almost a
decade earlier, the Council
on Indian Affairs had petitioned successfully to be a part of the
Johnson administration’s WOMEN’S HISTORY REVIEW 969
War on Poverty and beneficiaries of the Economic Opportunity
Act.38 Participation in the
War on Poverty existed outside of provisions made in previous
treaties and laws regarding
Native healthcare and other services, but it included Native
Americans in a federal support
program applicable to all Americans in need. By July of 1965,
more than thirty tribes
10. received War on Poverty benefits through federal funding of Head
Start and Community
Action programs.39 An inadequate understanding of treaty rights
and obligations combined with a focus on Indigenous citizens as
poor, fertile (Native birth rates were slightly
higher than the national average), and beneficiaries of the War on
Poverty programs made
Native women prime candidates for coerced sterilization.40
By the late 1970s, 678,000 Native Americans qualified for care
from IHS. In 1977,
IHS hospitals and contract facilities treated and discharged
106,290 patients. Of this
number, roughly 29% of admissions utilized contract facilities—
public and private institutions with which the IHS negotiated to
perform surgeries and offer expertise that it
could not.41 Although these relationships with contract providers
benefited Native
Americans by offering them superior care, HEW had no effective
way to monitor
these institutions or insure that they complied with IHS standards.
This unregulated
scenario became especially problematic when IHS offered family
planning assistance
in 1965 that included sterilization. Obstetric patients represented
nearly 20% of those
treated at both contract facilities and IHS hospitals.42 By 1976,
97.8% of Native births
occurred in IHS facilities and after childbirth Native women
encountered particular
risk for sterilization operations.43
Despite the significant advances made by the federal government
on behalf of Indigenous healthcare during the second half of the
twentieth century, paternalistic attitudes
about Native Americans prevailed throughout IHS facilities. A
1969 publication of the
11. Public Health Service on the Indian Health Program described its
clients as ‘not familiar
with modern health concepts’ and unable to ‘understand the
scientific basis of illness and
medical treatment.’44 These assumptions caused providers to
privilege their perspectives
as well as personal and professional gain over women’s health and
rights. Some young
IHS physicians even commenced their careers looking for ‘an
opportunity to complete
certain requirements necessary for specialization certificates.’45
There also existed the
possible motivation of financial gain. Tubal ligations earned
hospitals $250, and radical
hysterectomies $720.46 Hysterectomies, irreversible because they
removed the entire
uterus, became a lucrative and popular means of sterilization,
although they were often
unnecessary. The cheaper and less invasive procedure involved
surgery on the fallopian
tubes in order to prevent eggs released by the ovaries from
reaching sperm during intercourse. This included tubal ligation that
cut and tied the tubes, and resection, which surgically removed a
large section of the tube. Doctors also occasionally clamped
fallopian
tubes with clips or rings and destroyed the tubes through
cauterization or chemical
treatment.47
In a different but parallel context to those of IHS doctors,
physicians from urban hospitals serving welfare clients confessed
to the very claims activists increasingly put forth,
namely that there existed professional and financial gains in these
operations. As one
physician at Metropolitan Hospital in New York admitted: ‘We’re
a city hospital, so
12. most of our patients are poor. They are considered chattel by the
physicians here. We
practice on the poor so we can operate on the rich. Hysterectomies
and simple tubal ligations are performed all the time just for the
practice.’48 According to another doctor, ‘a girl 970 M. D.
O’SULLIVAN with lots of kids, on welfare, and not intelligent
enough to use birth control, is better off
being sterilized.’49 One more argued, ‘As physicians we have
obligations to individual
patients, but we also have obligations to the society of which we
are a part … . The
welfare mess … cries out for solutions, one of which is fertility
control.’50 Yet another
claimed, ‘Welfare women become pregnant over and over again.
They give up babies
like fish … They know the government will support them. They
are too stupid to take
the pill. … Banning clinics for welfare women or withholding their
welfare payments
would be a good idea.’51 Paternalism informed these doctors, but
so too did the antagonism that many Americans felt toward the
poor. The policy makers who increased federal
funding for sterilization and the doctors who performed the
surgeries saw no problem
with curbing the populations of poverty-stricken people by limiting
the reproductive
rights of poor women.
As one critic aptly described the dynamic that led to abuse: ‘The
medical profession
reproduces the hierarchical structure of the surrounding society …
medicine reinforces
the dependence and oppression of the people.’52 In other words,
the conditions under
which physicians obtained consent and performed sterilizations
were part of a larger
13. power dynamic. According to one Indigenous activist, ‘the women
have a great deal of
faith in their doctor—they do as they are told … [fear] of subtle
reprisals against a
woman’s people, her reservation, is an invidious and powerful tool
in repressing
expressions of dissatisfaction.’53 These analyses shed light on the
structural inequality
that informed the lives of Native American people. Native women
‘do as they are told’
because centuries of federal Indian policy rooted in a settler-
colonial framework established unequal political relationships
between Native nations and the federal government.
In this circumstance of dependency by design, the question of how
best to describe these
sterilizations emerges. In such a context, was full consent possible?
Thus, were all such
operations nonconsensual by default? Moreover, stratified
experiences existed even
within a larger context of structural inequality: one instance might
be best described as
forced, another coerced, and yet another as nonprocedural.
Acknowledging these realities,
all of the aforementioned terms have applicability, although
‘coerced’ may best describe
the larger structural relationships that informed these operations as
well as their material
conditions.
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