Forced Sterilizations and Maternal Health in the Canadian Context

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By: Hani Rukh-E-Qamar, Founder and Executive Director of the Canadian Advisory of Women Immigrants (CAWI), currently pursuing a Master of Science in Epidemiology at McGill University; Harini P. Aiyer, PhD, MS, Health equity and global health researcher ; Ksenia Kholina, Family Medicine resident physician, Director of Research and Education at CAWI, registered dietitian, and health researcher based in Halifax, Nova Scotia; Pram Thennakoonwela, psychologist, researcher, and advocate at intersection of immigration and mental health; Radha Maradiya, MPH, Sexual and Reproductive Health researcher and advocate ; Rehma Khan, Master of Science in Public Health student at the University of Alberta, specializing in Health Promotion and Socio-Behavioural Sciences; Zara Ahmed, Master of Public Health student at the University of Alberta

Intergenerational trauma is defined as “the way in which trauma experienced in one generation affects the health and well-being of descendants of future generations”. A long-standing practice in Canada that has resulted in intergenerational trauma is the forced sterilization of Indigenous women. In 1928, Alberta introduced the Sexual Sterilization Act that disproportionately targeted Indigenous women. Unfortunately, the total number of affected women in Canada is unknown, with estimates in the thousands.

According to Collier (2017), just between 1970 and 1975, 1200 Indigenous women were sterilized in Canada. 77% of Indigenous women who were sterilized during this period were viewed as sexually promiscuous or diagnosed as intellectually impaired through systematically biased IQ tests. Within North America, forced or coerced sterilization has resulted from colonization, the eugenics movement, and forced assimilation.

Since 2018, over 100 Indigenous women have come forward, reporting that they felt forced or coerced into undergoing sterilization procedures in Canada in recent years. Boyer & Bartlett (2017) conducted an independent review where they interviewed healthcare providers and women who were forced or coerced into sterilization. They found Indigenous women were pressured by healthcare providers to consent to sterilization while they were in labor or shortly after labor. The women felt that they were given inadequate information about the procedure and were not given alternative family planning options. This lack of information led to women consenting to sterilization without completely understanding the risks or dangers associated with the procedure. This goes against current Canadian medical ethics and the understanding of informed consent in medical practice.

Forced or coerced sterilization of Indigenous women is an extreme violation of human rights, medical ethics, and reproductive rights, and an assault on the cultural integrity of Indigenous women. These experiences have had massive adverse impacts on Indigenous women’s physical and mental health. Some have described feeling the loss of their identity as a woman, “empty with maternal instinct and God-given ability to bear life”. This has in turn, caused deep mistrust and avoidance of healthcare services, dispersed Indigenous communities, and contributed to the genocide of Indigenous Peoples in Canada.

In 2019, Canadian Prime Minister Justin Trudeau acknowledged the crimes against Indigenous women, families, and communities, promising a national action plan and a significant monetary investment to address these cases. An Advisory Committee on Indigenous Women’s Wellbeing was also established in 2019 to provide advice on issues relating to sexual and reproductive health. Canada has also committed to investigating any reported allegations of forced sterilizations to ensure justice. Currently, there are at least 5 class-action lawsuits of forced sterilizations against authorities across Canada.

While forced sterilizations are a violation of the Criminal Code under sections pertaining to assault, doctors have not faced any consequences. A 2022 report by the Senate Committee on Human Rights has extensively reported on the experiences of Indigenous women, impacts of sterilization, and 13 recommendations to address this issue. One of the recommendations called for amending the Criminal Code to explicitly include the criminalization of forced sterilization with up to 14 years in prison. This Act is still in consideration in the Senate.

Other recommendations include a compensation framework for survivors, Indigenous health courses in medical and nursing schools, and public education campaigns about patient’s rights and consent procedures tailored to the needs of racialized and marginalized communities. Spreading awareness, changing how consent is obtained, and collecting national sterilization data is imperative to preventing future cases of forced sterilizations and ensuring the reproductive rights of Indigenous women are upheld. These actions are a part of the larger response of the Canadian government to the Truth and Reconciliation Commission calls to action around Indigenous health.

While legal action, national support, and systemic change are crucial to address the injustice Indigenous women have faced, we believe that raising awareness and public education are also paramount. Ignorance is harmful as it silences the pain, suffering, and voices of Indigenous women. Thousands of Indigenous women were forcefully sterilized in Canada. This injustice needs to be given space. It is our responsibility to educate ourselves, facilitate hard conversations, and work to address stigma and discrimination in healthcare and beyond. Healthcare practitioners need to ensure a safe space for patients to understand procedures and treatments, discuss options and provide true informed consent. As allies, we need to advocate to amplify Indigenous voices and follow their lead to ensure Indigenous women can exercise their rights to reproductive justice and sovereignty. It is on all of us to prevent forceful sterilization from happening again.