Sovereign Bodies: Native Women and the Indian Health Service
Casey Cabral, Fall 2020
In September 2020, a whistleblower complaint alleged that hysterectomies were being performed on immigrant women held in the Irwin County Detention Center (ICDC), one of the now infamous ICE detention facilities, at an alarming and troubling rate. According to Dawn Wooten, the nurse who first alerted the public to the goings on at ICDC, many of the procedures were medically unnecessary and performed without the informed consent of the patients. [1] These claims were corroborated by several women, now released from ICE custody, who had undergone these procedures. These allegations understandably shocked many, sparking investigations from both Congress and the Department of Homeland Security. If true, these allegations are only the latest chapter in the long story of reproductive abuse against women of color at the hands of the U.S. federal government. Though the topic of the federal government’s involvement in women’s reproductive health remains a hot topic to this day, white women and women of color are impacted in vastly different ways. In fact, at the same time that strides were made towards greater reproductive freedom, many U.S. citizens were being stripped of the ability to bear children by agencies of the government. [2] This paper will focus on the staggering rate of sterilization of American Indian women in the care of the Indian Health Service throughout the mid-20th century. My project will touch upon the legacy of colonialism, Indian wardship, and later eugenics in America in how they impacted the actions and attitudes of the Indian Health Service. I will seek to prove how agents of the federal government, under an obligation to care for the medical needs of Native women, used its power to limit their ability to reproduce and how that same obligation ultimately drove the sterilization campaign.
The history of the United States government’s involvement with Indian healthcare in fact predates universal Indian citizenship. The War Department was tasked with providing vaccines and treatment to Native Tribes living near military bases in the early 1800s, mostly in an effort to protect servicemen from disease.[3] Throughout the 1800s, treaties forged between individual tribes and the government established the government’s obligation to protect the wellbeing of Native people in exchange for use of their land with the responsibility falling under the Department of the Interior.[4] The Snyder Act of 1921 reinforced this duty of the federal government, allowing Congress to appropriate funds towards Indian healthcare services.[5] It is important to remember that at this point, Native people were not American citizens, and the federal government interacted with Native tribes as foreign, occupied states. It was only in 1924 that Native Americans were granted American citizenship under the Indian Citizenship Act. However the prevailing attitude that Native people were not American lived on past the point of their citizenship. In 1956, the Indian Health Service was formally established by the Transfer Act and providing healthcare services to Native people became an obligation of the federal government. Under the Transfer Act, “all functions, responsibilities, authorities, and duties…relating to the maintenance and operation of hospital and health facilities for Indians, and the conservation of Indian health … shall be administered by the Surgeon General of the United States Public Health Service.”[6] It appears that the mass sterilization of Native women coincides with the founding of the Indian Health Service.
Sterilization of women through tubal ligation or hysterectomy was not unheard of as a contraceptive measure [7]. However, the rate of sterilization among Native women points to an organized campaign to reduce native birthrates. Estimates vary, but it’s possible that as many as 70,000 Native women were sterilized from the early 1960s through 1976.[8] In this time period, the number of Native women of childbearing age was around 150,000. [9] Evidence suggests that many women did not give their informed consent to undergo such a procedure. This means that women were either deliberately ill-informed of the permanency of the procedures or denied other options for contraception. There are even cases of outright coercion, where women were told that they could lose their health benefits if they did not undergo a sterilization. [10] Additionally, language barriers between doctors and patients contributed to Native women being ill-informed of the ramifications of undergoing such a procedure. Another factor that made Native women especially vulnerable to this malpractice was the state of dependency to the federal government that they often lived under. Pervasive poverty, which is of course a direct result of American colonial policy, left Native Americans in need of government assistance to survive. This dependency gave IHS doctors a significant amount of power and influence over their patients, which left them vulnerable to coercion.
Essential to understanding why coerced sterilization ran so rampant in the IHS during this time is the rise of family planning, and by extension population control, as a priority of the federal government. Family planning and population control became a popular social theory that was touted as a solution to poverty. This belief was an extension of the eugenics movement, which held the core belief that poverty was hereditary and that limiting the birthrate of the poor, addicts and the disabled would cure a number of society’s ills. Make no mistake that this stated desire to improve society through population control was, more than anything, profoundly racist. The core of the push for federal population control measures was that, “many eugenicists, feeling that whites were more advanced than other races in the evolutionary process, viewed higher birth rates among Native Americans and other people of color with alarm. Compounding matters, many whites saw declining birthrates of white women as the harbinger of “race suicide” for whites.” [11] The Family Planning Act of 1970 coincided with extension of the sterilization program in the IHS, “the IHS began offering family planning services in 1965 and officially launched its sterilization campaign in 1970 with federal funding. Between 1969 and 1974, the department of Health, Education and Welfare greatly escalated funding programs, paying ninety percent of the costs to sterilize poor native women” [12] Here we can see what the priorities of the federal government were; in that they would rather put funds towards decreasing the population of Native communities to combat poverty than address its underlying causes. This is to say that the federal government was content for there to be fewer Native people living in the United States, and therefore fewer people they would be obligated to care for.
This attitude is a holdover of the attitude that Native people are wards of the federal government, not citizens of the United States. This paternalistic attitude made it more likely that physicians would view Native women as incapable of making decisions regarding their reproductive health nor raise their children. [13] Similarly, the obligation of care and the cycle of dependency meant that more native children resulted in more federal resources would have to go towards their care. It appears as though the pervasive attitude amongst IHS physicians was that it was, “their social responsibility to prevent the reproduction of “unfit” populations that they believed “drained” government resources.” [14] The sterilization campaign certainly achieved its stated goal of reducing the Native Population. In the 1970s, the birth rate for Native women fell at a rate seven times greater than that of white women. [15] This is significant, as by the mid-20th century, Native Americans had already suffered centuries of population decline at the hands of the U.S. government. Disease, warfare, and displacement led to the erosion of Native population. [16] The sterilization campaign, therefore, was not only an attack on the women’s bodies and rights to reproductive freedom, but on Native survival and sovereignty as a whole. It is the belief of many Native leaders that, “Sterilization of Indian women, and the resulting loss of children, endangers the sovereignty and economies of Indian nations. Leaders in Indian Country, therefore, assert that the sterilization campaigns are schemes to get remaining Indian land and constitute a backlash against gains in Native sovereignty.” [17] It’s therefore fair to assume that the sterilization program is merely a continuation of the colonial ethnic cleansing campaign against Native Americans that predates the founding of the United States.
The mass sterilization of Native women under coercion and/or without the informed consent of the patients is an interesting case study in the U.S. federal government’s attitudes towards Native Americans in general. Despite being U.S. citizens, Native Americans, and in this case Native women, are seen as incapable of self-determination due to the legacy of wardship. This coincided with the mainstreaming of population control measures, a holdover of the eugenics movement, as a priority of the government. At the same time, the federal government’s obligation to provide medical care to Native Americans meant that the government had a financial incentive to reduce the native population through sterilization. Even in 2020, we can see, as evidenced in the Irwin County Detention Center case that when tasked to look after the health of women of color, the United States government has often operated unethically.
Notes
[1] Project South, “Lack of Medical Care, Unsafe Work Practices, and Absence of Adequate Protection Against COVID-19 for Detained Immigrants and Employees Alike at the Irwin County Detention Center”, Project South Institute for the Elimination of Poverty and Genocide, (14 September, 2020) , https://projectsouth.org/wp-content/uploads/2020/09/OIG-ICDC-Complaint-1.pdf
[2] Rebecca M. Kluchin, “Locating the Voices of the Sterilized”, The Public Historian 29 no. 3, (Summer 2007)
[3] Jane Lawrence, “The Indian Health Service and the Sterilization of Native American Women”, American Indian Quarterly 24 no.3 (Summer 2000), 401
[4] Alina Baciu et al, “Native American Health: Historical and Legal Context”, Communities in Action: Pathways to Health Equity, (Washington DC: National Academies Press, 2017), 507.
[5] Donald Warne and Linda Bane Frizzell, “American Indian Health Policy: Historical Trends and Contemporary Issues”, American Journal of Public Health 103 no. 3, (June 2014): 263
[6] Ibid, 263
[7] Rebecca M. Kluchin, “Locating the Voices of the Sterilized”, The Public Historian 29 no. 3, (Summer 2007),
[8] D. Marie Ralstin-Lewis, “The Continuing Struggle against Genocide:Indigenous Women’s Reproductive Rights” Wicazo Sa Review 20 no. 1, (Spring 2005), 71
[9] Ibid, 72
[10] Rebecca M. Kluchin, “Locating the Voices of the Sterilized”, The Public Historian 29 no. 3, (Summer 2007), D. Marie Ralstin-Lewis, “The Continuing Struggle against Genocide:Indigenous Women’s Reproductive Rights”
[11] D. Marie Ralstin-Lewis, “The Continuing Struggle against Genocide: Indigenous Women’s Reproductive Rights” 75
[12] Ibid, 78
[13] Thomas W. Volscho, “Sterilization Racism and Pan-Ethnic Disparities of the Past Decade: The Continued Encroachment on Reproductive Rights” Wicazo Sa Review 25 no. 1 (Spring 2010)
[14] Rebecca M. Kluchin, “Locating the Voices of the Sterilized”, The Public Historian 29 no. 3, (Summer 2007), 133
[15] D. Marie Ralstin-Lewis, “The Continuing Struggle against Genocide:Indigenous Women’s Reproductive Rights”
[16] Thomas W. Volscho, “Sterilization Racism and Pan-Ethnic Disparities of the Past Decade: The Continued Encroachment on Reproductive Rights” Wicazo Sa Review 25 no. 1 (Spring 2010)
[17] D. Marie Ralstin-Lewis, “The Continuing Struggle against Genocide:Indigenous Women’s Reproductive Rights”, 83
Further Reading
Kluchin, Rebecca. “Locating the Voices of the Sterilized.”, The Public Historian 29 no. 3. (Summer 2007).
Ralstin-Lewis, D. Marie “The Continuing Struggle against Genocide: Indigenous Women’s Reproductive Rights.” Wicazo Sa Review 20 no. 1, (Spring 2005)
Volscho, Thomas. “Sterilization Racism and Pan-Ethnic Disparities of the Past Decade: The Continued Encroachment on Reproductive Rights.” Wicazo Sa Review 25 no. 1, (Spring 2010)