What Should Physicians Consider About American Indian/Alaska Native Women's Reproductive Freedom?

Abstract

Historically, American Indians and Alaska Natives (AI/AN) have been subjected to a lack of control over various aspects of their lives, including their reproductive health. In discussions of family planning with AI/AN patients, clinicians must consider past violations of reproductive rights and the need for transparent consent. This article explores the following questions: What were historical violations of AI/AN women's reproductive rights? How should physicians express respect for this history and for the autonomy of AI/AN female patients regarding surgical sterilization procedures today? Case Greg's ob-gyn rotation during medical school was at an Urban Indian Health Program (UIHP) clinic that served American Indian and Alaska Native (AI/AN) patients who lived on a nearby reservation. He had learned little about Indigenous populations throughout his undergraduate and medical education, and he was looking forward to learning more about how to care for different populations. On his first day, he accompanied Dr Smith to meet Ms Davis, an AI patient with bipolar disorder in the 34th week of her sixth pregnancy. Ms Davis had had no prenatal care until she presented to the emergency department with suicidal thoughts the week before. At that time, her drug screen was positive for amphetamines. Prior to entering the exam room, Dr Smith turned to Greg and said, "We need to make sure she has a reliable form of birth control after delivery." Ms Davis came to her appointment alone. When asked what she wanted to talk about at this visit, she said that she wanted to make sure that her baby was healthy, and she wanted to be a good mother. She revealed that she did not have custody of her other children. Dr Smith stated, "Thank you for coming to clinic today. Along with making sure you and your baby are healthy, I want to ensure you have good birth control after your upcoming delivery. You've had vaginal deliveries and one C-section in the past. If you get a C-section this time, we can tie your tubes then. Or, if you have a vaginal delivery, we can do it shortly after the birth. I think this would be a good option for you." Ms Davis looked surprised but did not respond. She cast her eyes to the floor. Dr Smith continued

Barriers to Achieving Reproductive Justice for an Indigenous Gulf Coast Tribe

“…Although sterilization has been extensively discussed in relation to IHS, this topic has not yet been explored among state-recognized tribes. However, consistent with national literature on the sterilization of Indigenous women, in this study, sterilizations and hysterectomies often took place immediately following childbirth, which scholars have noted raises concerns about informed consent (Cordova-Marks et al, 2020). Other research has noted that Indigenous women who have been sterilized are over twice as likely to suffer from poor mental health than those who have not been sterilized (Cackler et al, 2016).…”

“…The framework of stratified reproduction can also be seen in the regulation of Indigenous women's contraceptive options. Indigenous women were also frequently pressured to use LARCs, while simultaneously being denied access to services such as tubal ligation reversals (Cordova-Marks et al, 2020;Gurr, 2014). This form of non-permanent contraption offered to Indigenous women discourages autonomy and true reproductive choice, while reinforcing historical practices of reproductive oppression and surveillance of Indigenous women's bodies (Harris & Wolfe, 2014).…”

“…On some reservations, up to 70% of women of child-bearing age were sterilized (Gurr, 2014). In cases where sterilizations were “elected,” Cordova-Marks et al (2020) have noted that these sterilizations were often performed immediately following childbirth, at a time when the physical and mental stress of childbirth may compromise a woman's decision-making abilities. In many cases, women were not even aware that these surgeries were being performed, and for some tribes, sterilization was performed on anywhere from 24% to 80% of all women of childbearing age (Gurr, 2014).…”

An Adapted Cancer Screening Education Program for Native American Women With Intellectual and Developmental Disabilities and Their Caregivers: Protocol for Feasibility and Acceptability Testing

“…Women with IDD and Native American women are at an increased risk of interpersonal violence [ 15 - 19 ]. In addition, individuals with IDD have experienced ableism and trauma in broader society and health care interactions [ 17 ], and those who are also Native American experience historical trauma [ 18 ]. Historical trauma refers to the violence imposed on Native American communities over multiple generations and includes US policies of forced relocation, family separation, and the prohibition of spiritual activities [ 20 ].…”

“…Historical trauma refers to the violence imposed on Native American communities over multiple generations and includes US policies of forced relocation, family separation, and the prohibition of spiritual activities [ 20 ]. While violence and trauma arise from different histories, these individual and collective experiences may result in hesitance to engage with health care institutions [ 18 ]. We discuss our approach to address these experiences in the Theoretical Frameworks section.…”