Were 40% of Native American women forcibly sterilized in the 1970s?
I attended a national Native American health conference recently and heard a startling statistic. A speaker showed a slide that read something like, "40 percent of Native American women accessing care through the U.S. Indian Health Service in the 1970s were sterilized against their will." I looked this up on the Web and found this statement on a lot of sites: "In 1975 alone, some 25,000 Native American women were permanently sterilized--many after being coerced, misinformed, or threatened." This seemed unbelievable to me, but a number of resources I checked and people I asked insisted it was true. Wouldn't the Native American population have drastically decreased since the 70s if this were the case?
Not necessarily. According to the National Center for Health Statistics, 41 percent of U.S. women of childbearing age (or their partners) had been surgically sterilized as of 1995--a surprisingly high number, I'm sure you'll agree. "Surgical sterilization has grown to be the most common method of contraception among women of reproductive age in the United States," the NCHS says. I mention these facts to put claims about Native American sterilization in perspective. They may be greatly exaggerated--come on, 40 percent sterilized against their will?--but they're not completely insane.
Allegations of forced sterilization of Native American women were controversial in the 70s and are only slightly less so today. Some activists at the time accused the U.S. government of genocide. Scholar Jane Lawrence rehashed the whole affair in "The Indian Health Service and the Sterilization of Native American Women," American Indian Quarterly, summer 2000, writing, "Various studies revealed that the Indian Health Service sterilized between 25 and 50 percent of Native American women between 1970 and 1976."
While sterilization on that scale wouldn't necessarily have caused the population to plummet, surely it would have slowed things down. Not so: today there are 2.5 million Native Americans, three times as many as in 1970--a much faster rate of increase than for the U.S. population as a whole. The more you look into it, in fact, the more unlikely a program of wholesale sterilization seems. Belief to the contrary can be attributed in large part to the efforts of one woman, Connie Redbird Uri Pinkerman, a Los Angeles doctor/lawyer/Native American activist.
In 1972 a Native American woman came to Dr. Pinkerman and asked for a womb transplant. An IHS doctor had performed a hysterectomy on her six years earlier, when she was an alcoholic with two children in foster homes, and now she wanted to have children again. When Pinkerman told her womb transplants were impossible, the woman left in tears. After collecting other tales of forced sterilizations by IHS physicians, Pinkerman was instrumental in persuading South Dakota senator James Abourezk to request an inquiry by the General Accounting Office, the investigative arm of Congress. The GAO report, published in 1976, reviewed sterilization consent forms from 4 of the IHS's 12 service areas, where 3,406 women had been sterilized over a four-year period. The GAO didn't find that the women had been coerced but did find the IHS guilty of sloppy paperwork--consent forms didn't comply with Health, Education and Welfare regulations, and management and record keeping were inadequate.
Native American activists, however, took this conclusion as vindication of their claims. According to Lawrence, Pinkerman "conducted a study that revealed that IHS physicians sterilized at least 25 percent of American Indian women between the ages of fifteen and forty-four." She also "conducted a study that indicated that twenty-five thousand Native American women would be sterilized by the end of 1975." Many activists today take for granted that this came to pass.
I wanted to ask Dr. Pinkerman how she arrived at her conclusions, but she didn't return repeated calls. As far as I can determine, her numbers were grossly inaccurate. A 1979 letter from the director of the IHS to a member of Congress indicates that from 1973 through 1977 the IHS performed 8,021 sterilizations on women ages 15 to 44. This includes operations for problems unrelated to birth control, e.g., hysterectomies due to cancer.
Accounts in the medical journals suggest that surgical sterilization rates for Native Americans rose during this period but were lower than for the general population. (IHS data for 1975 indicates that the tubal ligation rate was about the same as for the non-Native American population, while the hysterectomy rate was much lower.) Pinkerman thought the Native American population was declining during the 1970s; in fact, it was rising rapidly. She is variously quoted as believing there were then only 45,000 or 100,000 Native American women of childbearing age; 200,000 is more like it.
All that having been said, fears of coercion weren't just paranoia. HEW had imposed relatively stringent regulations only because of a federal court order in 1974, issued after two poor black girls were involuntarily sterilized. The judge in that case noted that 100,000 to 150,000 poor women were being sterilized each year under federally funded programs. A fair number of them were Native Americans. Were some of them coerced? Possibly. All of them? No way. Many? I'm not buying it. Whatever Pinkerman may have thought, many activists opposed any attempt to limit the Native American population, even if it was the woman's own choice.