Indigenous Sterilization Throughout 20th Century America

Charon Asetoyer’s Take

In her interview for “Voices of Feminism,” Charon Asetoyer reveals the various reproductive injustices committed against indigenous communities across the U.S. by the federally funded Indian Health Service (IHS). Despite its initial goal to provide medical and public health services to federally recognized indigenous groups, the IHS abused its resources and communal trust to perpetuate systemic social, health, economic, and political inequities that indigenous people face. Asetoyer illuminates IHS’s missed opportunity to spread awareness about Fetal Alcohol Syndrome (FAS) or provide rehabilitative programs for substance abuse, for example.1 The sterilization of thousands of indigenous people with reproductive capabilities was seen as the solution to the high number of babies being born with FAS on reservations. However, the U.S. government’s role in indigenous sterilization was instead a eugenic solution to the “Indian problem”—the centuries-long hegemonic perception that indigenous people are burdens, accompanied by negative stereotypes of the indigenous identity. 

Eugenics Explained

The history of indigenous sterilization in the United States is commonly thought to be restricted from the 1960s through the 1970s.2 However, the early twentieth-­century eugenics movement prompted sterilization movements on reservations as early as the 1920s.3 Eugenic ideologies upheld the notion that the ­human race could improve by preventing the reproduction of people deemed to have undesirable traits while encouraging the reproduction of “fit” individuals and families— those a part of the Anglo-Saxon race.4 These horrendous ideologies manifested in state policies promoting eugenic sterilization of anyone the did not fit within the Anglo-Saxon race, and in 1927 the Supreme Court echoed eugenic sentiments in Buck v. Bell. This ruling upheld a state’s right to forcibly sterilize a person they deem unfit to reproduce, based on Virginia’s case of forcibly sterilizing a woman because she had been considered “feebleminded.”5 Since the arrival of Europeans in North America, the continued perception that indigenous groups are hindrances to “real” Americans developing the U.S. national identity has aided in the justification for taking indigenous land, relocation, assimilation, and now the sterilization of thousands of wombs.

Even though the eugenics movement faded in its explicit manner, undertones of their racist ideologies remained in state and federal government anxieties regarding indigenous delinquency, degeneracy, and dependence.6 The threat of growing indigenous populations led agencies, like the IHS, to promote family planning services designed to provide information on birth control methods and how they work and are used.7

Types of Sterilization

 In 1965, the federal government permitted the IHS to provide family planning services to Native Americans. These services were designed to provide information about the different types of birth control and how they work. Though family planning is a fundamental right to which everyone should have access, the government’s desire to promote this service should be analyzed. The 1970 census revealed that the average Native woman bore 3.79 children, compared to the median for all groups in the United States was 1.79 children.8 The government saw the higher average of children per indigenous woman as a threat because it diluted the Anglo-Saxon population. Therefore, IHS targeted indigenous wombs for family planning to control and slow their reproduction.9  Family planning services promoted methods like the intrauterine device (IUD), the birth control pill, spermicidal jellies and creams, and sterilization.10

Surgical Sterilization  

Defined by the American College of Obstetricians and Gynecologists as a permanent method of birth control, sterilization, whether coerced or voluntary, was seen as an effective attack on indigenous motherhood.11 The IHS’s high rate of surgical sterilizations during the mid-1960s through the 1970s is similar to the federal government’s previous attacks on motherhood during the boarding school era when they forcefully removed Native children and forced them into non-Native families.12 Surgical sterilization ripped away people’s right to motherhood. The IHS employed tubal ligation, a procedure that closes, cuts, and removes pieces of the fallopian tubes. Sometimes, a bilateral salpingectomy would be conducted to remove the fallopian tubes.13 In 1975, the IHS performed approximately 25,000 surgical sterilizations, roughly equivalent to 15 percent of the indigenous population of age, to bear a child.14 The IHS’s effect was widespread because of improper consent forms, language barriers, and coercion. The consent forms were so weak that they failed to disclose the required information on the risks involved in the procedure and the alternative methods of birth control that the individual could use and might better fit their desires.15

Long-term Contraceptives

The overall trend of surgical sterilization has dropped since the mid-1970s, and long-term chemical contraceptives have replaced surgical procedures as the primary method of sterilization.16 Despite adverse side effects and potential abuse, IHS’s use of Depo-Provera and Norplant became increasingly common in the 1980s.17 Depo-Provera inhibits ovulation for up to three months through injection. Once the drug is not used anymore, the average time to ovulation is 5.8 months, making it temporary sterilization for 8 to 9 months.18 Depo-Provera was offered as a 3-month contraceptive and used by IHS physicians to manage menstruation in Native women with cognitive disabilities or chemical dependencies, as Asetoyer mentions in her interview.19 Unfortunately, IHS physicians put their eugenic ideologies into practice by preferring to stop women with substance abuse issues from reproducing by sterilizing them with technologies that had not yet been FDA-approved instead of providing them with proper resources for rehabilitation.20 As a result, Depo-Provera was an ineffective bandaid to what was happening on reservations, potentially exacerbating the indigenous condition due to women not being fully informed of the contraception’s side effects: headaches, depression, osteoporosis, sterility, and cervical cancer.

Birth Control Pill

The “pill” is an oral contraceptive with hormones taken once daily— an effective birth control option if always taken on time. The IHS provided these monthly cycle birth control pills; however, their accessibility and availability were limited. For example, IHS on the Pine Ridge Reservation only dispensed the pills one month at a time and necessitated a visit to the pharmacy every month. In addition, many Pine Ridge patients lived more than an hour away from healthcare facilities— an obstacle for many people because their rural and isolated locations challenged access to IHS facilities. Also, many people seeking contraception are at the pharmacy’s will, and their hours are often irregular and understaffed.21

Restrictions in access played a significant role in people’s ability to choose the pill as their method of contraception and narrowed their options. Therefore, IHS physicians preferred other long-term birth control methods, and in 1970 they prescribed IUDs more frequently than the pill. The pill requires the individual’s diligence to take it every day, whereas the IUD and Depo-Provera placed reproductive control in the hands of IHS physicians.22 The IHS’s preference for methods other than the pill signifies the lack of faith physicians had ­in the patients’ capacity to use the pill as an effective method of contraception.

Sterilization— A solution to FAS on the Reservations?

Even in less-than-ideal conditions, women exercise their agency in their reproductive lives— which sometimes includes opting for their sterilization. In the 1930s, during the first wave of sterilizations among Native American women, there were few options for­ birth control. On many reservations, poverty was compounded by discrimination faced in New Deal welfare programs, and the pressure that women faced increased, which could have led to more indigenous women seeking out sterilization.23 However, this process should be observed critically, including how consent was granted, which raises concerns about language and cultural barriers that could have prevented legitimate consent.

The “set it and forget it” methods of birth control, such as Depo-­ Provera and IUDs, are often thought of and advertised as convenient for the individual. Nevertheless, they impact the individual’s agency regarding their fertility. Additionally, using surgical sterilization to solve FAS or other social issues on reservations does not address the issue at the root.24 Instead, sterilization permanently rips the right to motherhood away from individuals and fails to stop the cycle of chemical dependency. The federal government used FAS births as an excuse to continue indigenous sterilization, whether it was through surgery or long-term contraceptives. Instead of helping, the IHS abused its power to promote eugenic ideologies by preventing the reproduction of thousands of indigenous people via force or coercion. Reproductive injustices committed by the IHS are swept under the rug in U.S. history and get lost in the mainstream due to systemic racism. It was not until 1993 that the Native American Women’s Health Education Resource Center (NAWHERC) began working with IHS to develop more robust, regular protocols for prescribing, distributing, and monitoring contraceptives.25

Despite their reproductive care being targeted, indigenous people have resisted these malpractices through collective organizing. Protests have been conducted by organizations like Women of All Red Nations (WARN) to pressure Congress to enact new regulations to protect indigenous lives from these injustices.26 Native Americans continue to seek access to better health care. In 2019, one of the first two Native American women elected to Congress, Representative Deb Haaland, co-sponsored a congressional briefing session on indigenous maternal and reproductive health. At this session, Haaland called for more federal funding to be allocated to the IHS and encouraged grassroots organizing.27 Grassroots organizing is essential for targeting these reproductive injustices by uplifting the very voices affected through collective action, which starts at a local level to affect change at a larger one.