Involuntary Sterilization by Allison McKibban — (Un)Silenced: Institutional Sexual Violence

Content warning: This article discusses sexual and reproductive violence on the basis of gender and race. 

In 1972, a 26-year-old Native American woman walked into a California medical office requesting ‘a womb transplant’. Six years earlier, as a young mother struggling with alcoholism, a doctor working for the Indian Health Service (IHS) had removed her uterus—assuring her that it could be ‘replaced’ later. Dr Connie Redbird Pinkerman-Uri, herself of Choctaw and Cherokee descent, explained to the devastated woman that she had been involuntarily sterilized.

Fifty years later, in January 2022, the state of California began paying reparations to individuals who since 1909 had been involuntarily sterilized in state-run hospitals, institutions, and prisons. Yet, notably ineligible for compensation are the thousands of Indigenous women sterilized within the 50-plus Indian Health Service facilities located in California, as these facilities are federally administered. This exclusion is hardly surprising: no branch of the U.S. government has issued an acknowledgement of or an apology to the estimated 25 to 50 percent of Indigenous women of childbearing age involuntarily sterilized during the 1970s.

Forced sterilization has been historicised as a phenomenon of the early twentieth-century eugenics movements in which prominent scientists, businesspeople, and lawmakers sought to ‘improve’ the composition of the gene pool by limiting the fertility of women of colour, disabled women, and the poor. In 1927, the Supreme Court upheld Buck v. Bell—affirming Virginia’s compulsory sterilization law that endorsed fertility control over the ‘unfit’. Drawn from colonialist logics, ‘unfitness’ was socially constructed through pervasive racist ideas of white intellectual superiority. During the 1960s, this racist and xenophobic discourse was weaponized against  Black, Mexican, and Puerto Rican women through government-sponsored programs of coerced sterilization. For Indigenous women, the legal precedent was leveraged in the 1970s through an organized campaign of mass involuntary sterilization by the Indian Health Service.

Rather than a remnant of a bygone era of eugenics, forced and coerced sterilization must be (re)historicised as a component of ongoing colonial genocide targeting Native American women. Too often non-Native scholars use their writing to stereotype Native communities as traumatized, broken, and dysfunctional. Situating the program of involuntary sterilization in the broader framework of colonial institutional violence instead problematises the U.S. settler state and honours the activism, resilience, and survival of Indigenous peoples.

Beginning in the 1830s, the U.S. ratified a series of treaties with Native nations, in which tribes ‘traded’ land, sovereignty, and jurisdiction for goods and services, including medicine and healthcare. Simultaneously, the Supreme Court began detailing the federal trust responsibility; this legal precedent established that because tribes were relegated to a ‘domestic dependent status’, the federal government assumed authority over and responsibility for tribes and their members. Although unevenly applied, the treaties and the trust responsibility positioned healthcare as a commodity for which Native peoples had already paid. This process culminated in 1954 as healthcare provisions for Native Americans were formally consolidated into the Indian Health Service (IHS). Unlike the privatized, pay-per-service system of healthcare generally available in the U.S., the IHS provides no-cost healthcare services via federally administered hospitals and clinics primarily located on reservations.

During the early 1970s, fears of overpopulation and resource scarcity, as well as changing racial demographics, motivated the Nixon administration to promote ‘family planning’. Under this policy, federally-funded sterilizations increased nearly 300 percent from 1970 to 1977. Because the IHS was often the only healthcare provider geographically and financially available to Indigenous women on reservations, they were particularly vulnerable to paternalistic and racist abuse by IHS physicians and social workers. Shocked by the experience of her young sterilized patient in the early 1970s, Dr Pinkerman-Uri began systematically asking other Indigenous women about their experiences of sterilization. Quickly, she concluded, IHS doctors were running a ‘sterilization factory’.

In some cases, doctors did not provide an interpreter to explain procedures or options in the appropriate language, nor a witness to the consent. If they verbally warned of procedural risks, physicians often failed to explain the procedure’s irreversibility or to discuss alternative modes of birth control. Some providers included a social worker who would threaten halted welfare payments or removal of the patient’s children if they refused sterilization. Others waived the mandatory 72-hour waiting period before a sterilization, pressuring postpartum women already under sedation to consent. These practices culminated in a horrific pattern of exploitation, in which Women of All Red Nations (WARN)—an Indigenous women’s activist organization—contends sterilization rates were as high as 80 percent on some reservations, as compared to a national average of 15 percent for white women. By the close of the 1970s, Dr Pinkerman-Uri estimated that less than 100,000 Indigenous women of childbearing age remained unsterilized.

Statistics alone cannot represent the enormity of the injustice, nor situate the abuse within the ongoing patterns of genocidal violence against Indigenous women. In Montana, when two 15-year-old girls were referred for appendectomies (an operation to remove an inflamed appendix), they also received tubal ligations without consent from the girls or their parents. These two children were stripped of control over their reproductive, sexual, and familial futurities by government agents. This form of institutionalized violence was a direct manifestation of colonialism’s logic of elimination, and a continuation of the pivotal role of medicine in the way that the U.S. government enacted this violence.

Rather than a historical point from which ‘the nation’ has departed, U.S. settler colonialism is a persistent and constantly shifting project. As philosopher Maria Lugones argues, settler colonialism necessarily involves a ‘civilizing mission’ to cleanse the bodies of Indigenous peoples through exploitation, violent sexual violation, control of reproduction, and systematic terror. Native women’s bodies have consistently been represented in American society and media as dirty and sinful in order to necessitate cleansing—or even sterilization. Indigenous scholar Ines Hernandez-Avila (Nez Perce/Tejana) further explains, ‘It is because of a Native American woman’s sex that she is hunted down and slaughtered, in fact, singled out, because she has the potential through childbirth to assume the continuance of the people’. Thus, Native women’s motherhood challenges efforts to produce a hegemonically white national settler identity, so their reproductive bodies become a site for management by the U.S. government. The IHS doctors acted as a tool of colonial violence, violating the sovereignty of Indigenous women’s bodies. Ho-Chunk anti-rape activist Bonnie Clairmont summarizes the impact of this violence on tribal communities, writing ‘women’s sovereignty is central to Indian sovereignty because nations cannot be free if their Indian women are not free’.

Indigenous activists have similarly connected involuntary sterilization and broader colonial violence. Dr Pinkerman-Uri used the accounts she gathered from Native women to persuade Senator James Abourezk of South Dakota to initiate an investigation by the General Accounting Office (GAO). In 1976, after months of investigation, the GAO concluded that while there were inconsistencies in consent procedures, there was no evidence of forced sterilizations. Vastly unsatisfied with the outcome, a small group of Indigenous women active in the American Indian Movement—led by Lorelei DeCora Means (Minneconjou Lakota), Madonna Thunderhawk (Hunkpapa Lakota), Janet McCloud (Tulalip), and Phyllis Young (Hunkpapa Lakota)—formed Women of All Red Nations (WARN). The group focused on resistance against violence specific to Indigenous women, including the loss of women’s reproductive rights, loss of Indian children through coercion, and the destruction of Native lands.

Simultaneously, Marie Sanchez (Northern Cheyenne), a former tribal judge, and Lehman Brightman (Sioux), past president of the United Native Americans, combined anti-sterilization campaigning with legislative lobbying against U.S. resource extraction from Indigenous lands. They argued just as the federal government stripping tribal land of natural resources critically threatened ecological and economic sovereignty, the demolition of Native women’s reproductive rights removed the power to sustain Native nations. While Brightman and Sanchez helped coordinate and lead marches to Washington, D.C. to protest the appropriation of land and the sterilization of women, WARN continued mass information campaigns through its regularly published newsletter, frequent conferences, and appearances at international events and meetings. This activism vitally connected the violence of involuntary sterilization with the settler state’s ongoing campaign to terrorize and eliminate Indigenous communities.

Fifty years on from these powerful acts of resistance, the legacy of forced sterilization persists. Recent studies indicate Native American women are still significantly more likely to be sterilized—and at younger ages—and to report feeling regret that the sterilization prevented them from having wanted children. Yet, in the face of this persisting violence, Indigenous women’s organizations—including the Native American Women’s Health Education Resource Center, Indigenous Women Rising, the Sacred Hoop Coalition, and Tewa Women United—and Native women at large have continued the powerful activism started by Dr Pinkerman-Uri. As sociologist Barbara Gurr reminisced of her time spent with Lakota mothers, ‘sometimes, “activism” is the simple act of doggedly, determinedly surviving. Sometimes resilience is really resistance, and survival is defiance’.