In the 1960s and 1970s, the Indian Health Service (IHS) and collaborating physicians sustained a practice of performing sterilizations on Native American women, in many cases without the free and informed consent of their patients. Tactics for sterilization included healthcare providers neglecting to tell women they were going to be sterilized and forms of coercion such as threatening to take away welfare or healthcare. In some cases, women were misled into believing that the sterilization procedure was reversible. In yet other cases, sterilization was performed without the adequate understanding and consent of the patient, including cases in which the procedure was performed on minors as young as 11 years old. The American eugenics movement set the foundations for the use of sterilization as a form of birth control, or a method to control populations of poor and minority women. This practice was widely seen in America throughout the early and middle decades of the 20th century. The compounding factor was that doctors tended to recommend sterilization to poor and minority women, where they would not have done so to a wealthier white patient. This trend of sterilization was seen widely amongst Native American populations. Many instances of abuse were documented throughout this practice. Following the abusive methods, the medical community often took an effort to mask their coercive tactics. In 1976, a U.S. General Accountability Office (GAO) investigation found that four Indian Health Service areas were noncompliant with IHS policies regulating consent to sterilization. Inadequate consent forms were a recurring problem; the most common form did not record whether the elements of informed consent had been presented to the patient or what they were told prior to obtaining consent, and physician misunderstanding of IHS regulations was widespread. The investigation found that these four service areas sterilized 3,406 women between the years 1973 and 1976, including 36 cases where women under the age of 21 were sterilized despite a declared moratorium on these sterilizations. Limitations of the GAO investigation were quickly noted. Senator James Abourezk pointed out that while even 3,406 sterilizations would represent a startling proportion of Native American women, this number was the result of a report which examined only four out of twelve IHS areas. Attempts to count the total number of sterilizations that happened during this period differ widely in their results. While the limited count by the GAO represents a minimum, studies have accused the IHS of sterilizing between 25 and 50% of Native American women from 1970 to 1976. Should the highest estimate be accurate, up to 70,000 women may have been sterilized over the period. In comparison, the rate of sterilization for white women over the same period was approximately 15%.
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