Post by Okwes on Sept 6, 2006 17:07:15 GMT -5
The Indian Health Service and the Sterilization of Native American Women
Jane Lawrence
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A young Indian woman entered Dr. Connie Pinkerton-Uri's Los Angeles office on a November day in 1972. The twenty-six-year-old woman asked Dr. Pinkerton-Uri for a "womb transplant" because she and her husband wished to start a family. An Indian Health Service (IHS) physician had given the woman a complete hysterectomy when she was having problems with alcoholism six years earlier. Dr. Pinkerton-Uri had to tell the young woman that there was no such thing as a "womb transplant" despite the IHS physician having told her that the surgery was reversible. The woman left Dr. Pinkerton-Uri's office in tears. 1
Two young women entered an IHS hospital in Montana to undergo appendectomies and received tubal ligations, a form of sterilization, as an added benefit. Bertha Medicine Bull, a member of the Northern Cheyenne tribe, related how the "two girls had been sterilized at age fifteen before they had any children. Both were having appendectomies when the doctors sterilized them without their knowledge or consent." Their parents were not informed either. Two fifteen-year-old girls would never be able to have children of their own. 2
What happened to these three females was a common occurrence during the 1960s and 1970s. Native Americans accused the Indian Health Service of sterilizing at least 25 percent of Native American women who were between the ages of fifteen and forty-four during the 1970s. The allegations included: failure to provide women with necessary information regarding sterilization; use of coercion to get signatures on the consent forms; improper consent forms; and lack of an appropriate waiting period (at least seventy-two hours) between the signing of a consent form and the surgical procedure. This paper investigates the historical relationship between the IHS and Indian tribes; the right of the United States government to sterilize women; the government regulations pertaining to sterilization; the efforts of the IHS to sterilize American Indian women; physicians' reasons for sterilizing American Indian women; and the consequences the sterilizations had on the lives of a few of those women and their families. 3 [End Page 400]
The IHS evolved out of various government programs designed to address the health care issues of American Indians. Under the auspices of the War Department in the early 1800s, "Army physicians took steps to curb smallpox and other contagious diseases of Indian Tribes living in the vicinity of military posts." Army physicians used vaccinations and other medical procedures to prevent both military men and the Indians they came in contact with from being infected with diseases. The first treaty that included medical services was signed between the United States and the Winnebago Indians in 1832. In 1832 Congress provided funding for Indian health care in the amount of twelve thousand dollars. 4
In 1849 Congress transferred the Bureau of Indian Affairs (BIA) from the War Department to the Department of the Interior, including all health care responsibilities for American Indians. By 1875 half of the federal Indian agencies had physicians, and the BIA built the first federal hospital for Indians in Oklahoma during the late 1880s. After the turn of the century, the BIA created a separate health division and appointed district medical directors. The health division started special programs to combat tuberculosis and other diseases and established health education classes to support these programs. The Snyder Act of 1921 included congressional authorization for the BIA to provide Indian health care "for the benefit, care, and assistance of the Indians throughout the United States." The BIA contracted with the Public Health Service (PHS) in 1928 to provide sanitation engineers to investigate water and sewage problems at BIA facilities and renewed and expanded that contract through the early 1950s. 5
In 1955 Congress transferred total responsibility for Indian health from the Department of the Interior to the Public Health Service. The legislation stated that "all facilities transferred shall be available to meet the health needs of the Indians and that such health needs shall be given priority over that of the non-Indian population." The PHS, a division of the Department of Health, Education, and Welfare (HEW), formed the Division of Indian Health, which was renamed the Indian Health Service in 1958. At the time of the transfer, there were not enough physicians or medical facilities available to provide the proper medical care for American Indians. Congress believed that the PHS would be able to recruit a greater number of physicians by offering more attractive salaries and fringe benefits and to increase and improve medical facilities with higher Congressional appropriations for the HEW. 6
The PHS has greatly improved the health of Native Americans and the governmental medical facilities in the years since it became responsible for American Indian health. The PHS received better funding for Indian health services because Congress appropriated more money for health concerns to the HEW than it ever did to the BIA. Alan Sorkin in Public Policy Impacts on American Indian Economic Development reveals that "congressional appropriations increased [End Page 401] nearly twelve-fold on a per-Indian basis between 1955 and 1983." Deaths from diseases, such as tuberculosis, have dropped significantly, and infant mortality has also declined dramatically. The majority of Indians living on reservations are using the medical services of the IHS as their primary caregiver. The number of IHS doctors increased from 125 in 1965 to 600 in 1980. Even though there have been increases in the number of medical personnel, statistics show that the number of doctors and nurses in relation to the number of Indians seeking service from the IHS has actually decreased since 1966. The actual number of patients per physician rose from 1,220 in 1966 to 1,500 in 1980 because of the increase in the Native American population. Despite the low ratio of medical personnel to Native American patients, it must be remembered that the IHS improved the overall health of Native Americans following its inception in 1958. 7
The IHS began providing family planning services for Native Americans in 1965 under the authority of the HEW and the PHS. Family planning services provide women with information on the different methods of birth control, how the methods work, and how to use them. They are supposed to provide patients with assistance in determining which form of contraceptive is right for them. Family planning methods include the birth control pill, the intrauterine device, spermicidal jellies and creams, and sterilization. Unless there is a medical problem that a specific form of contraception can either alleviate or aggravate, a woman is supposed to choose whether or not she wishes to participate in the program and what type of birth control she wishes to use since only she can know how the usage of a specific contraceptive measure will affect her life overall. 8
Jane Lawrence
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A young Indian woman entered Dr. Connie Pinkerton-Uri's Los Angeles office on a November day in 1972. The twenty-six-year-old woman asked Dr. Pinkerton-Uri for a "womb transplant" because she and her husband wished to start a family. An Indian Health Service (IHS) physician had given the woman a complete hysterectomy when she was having problems with alcoholism six years earlier. Dr. Pinkerton-Uri had to tell the young woman that there was no such thing as a "womb transplant" despite the IHS physician having told her that the surgery was reversible. The woman left Dr. Pinkerton-Uri's office in tears. 1
Two young women entered an IHS hospital in Montana to undergo appendectomies and received tubal ligations, a form of sterilization, as an added benefit. Bertha Medicine Bull, a member of the Northern Cheyenne tribe, related how the "two girls had been sterilized at age fifteen before they had any children. Both were having appendectomies when the doctors sterilized them without their knowledge or consent." Their parents were not informed either. Two fifteen-year-old girls would never be able to have children of their own. 2
What happened to these three females was a common occurrence during the 1960s and 1970s. Native Americans accused the Indian Health Service of sterilizing at least 25 percent of Native American women who were between the ages of fifteen and forty-four during the 1970s. The allegations included: failure to provide women with necessary information regarding sterilization; use of coercion to get signatures on the consent forms; improper consent forms; and lack of an appropriate waiting period (at least seventy-two hours) between the signing of a consent form and the surgical procedure. This paper investigates the historical relationship between the IHS and Indian tribes; the right of the United States government to sterilize women; the government regulations pertaining to sterilization; the efforts of the IHS to sterilize American Indian women; physicians' reasons for sterilizing American Indian women; and the consequences the sterilizations had on the lives of a few of those women and their families. 3 [End Page 400]
The IHS evolved out of various government programs designed to address the health care issues of American Indians. Under the auspices of the War Department in the early 1800s, "Army physicians took steps to curb smallpox and other contagious diseases of Indian Tribes living in the vicinity of military posts." Army physicians used vaccinations and other medical procedures to prevent both military men and the Indians they came in contact with from being infected with diseases. The first treaty that included medical services was signed between the United States and the Winnebago Indians in 1832. In 1832 Congress provided funding for Indian health care in the amount of twelve thousand dollars. 4
In 1849 Congress transferred the Bureau of Indian Affairs (BIA) from the War Department to the Department of the Interior, including all health care responsibilities for American Indians. By 1875 half of the federal Indian agencies had physicians, and the BIA built the first federal hospital for Indians in Oklahoma during the late 1880s. After the turn of the century, the BIA created a separate health division and appointed district medical directors. The health division started special programs to combat tuberculosis and other diseases and established health education classes to support these programs. The Snyder Act of 1921 included congressional authorization for the BIA to provide Indian health care "for the benefit, care, and assistance of the Indians throughout the United States." The BIA contracted with the Public Health Service (PHS) in 1928 to provide sanitation engineers to investigate water and sewage problems at BIA facilities and renewed and expanded that contract through the early 1950s. 5
In 1955 Congress transferred total responsibility for Indian health from the Department of the Interior to the Public Health Service. The legislation stated that "all facilities transferred shall be available to meet the health needs of the Indians and that such health needs shall be given priority over that of the non-Indian population." The PHS, a division of the Department of Health, Education, and Welfare (HEW), formed the Division of Indian Health, which was renamed the Indian Health Service in 1958. At the time of the transfer, there were not enough physicians or medical facilities available to provide the proper medical care for American Indians. Congress believed that the PHS would be able to recruit a greater number of physicians by offering more attractive salaries and fringe benefits and to increase and improve medical facilities with higher Congressional appropriations for the HEW. 6
The PHS has greatly improved the health of Native Americans and the governmental medical facilities in the years since it became responsible for American Indian health. The PHS received better funding for Indian health services because Congress appropriated more money for health concerns to the HEW than it ever did to the BIA. Alan Sorkin in Public Policy Impacts on American Indian Economic Development reveals that "congressional appropriations increased [End Page 401] nearly twelve-fold on a per-Indian basis between 1955 and 1983." Deaths from diseases, such as tuberculosis, have dropped significantly, and infant mortality has also declined dramatically. The majority of Indians living on reservations are using the medical services of the IHS as their primary caregiver. The number of IHS doctors increased from 125 in 1965 to 600 in 1980. Even though there have been increases in the number of medical personnel, statistics show that the number of doctors and nurses in relation to the number of Indians seeking service from the IHS has actually decreased since 1966. The actual number of patients per physician rose from 1,220 in 1966 to 1,500 in 1980 because of the increase in the Native American population. Despite the low ratio of medical personnel to Native American patients, it must be remembered that the IHS improved the overall health of Native Americans following its inception in 1958. 7
The IHS began providing family planning services for Native Americans in 1965 under the authority of the HEW and the PHS. Family planning services provide women with information on the different methods of birth control, how the methods work, and how to use them. They are supposed to provide patients with assistance in determining which form of contraceptive is right for them. Family planning methods include the birth control pill, the intrauterine device, spermicidal jellies and creams, and sterilization. Unless there is a medical problem that a specific form of contraception can either alleviate or aggravate, a woman is supposed to choose whether or not she wishes to participate in the program and what type of birth control she wishes to use since only she can know how the usage of a specific contraceptive measure will affect her life overall. 8