In Review

AUTHOR: In a new book, Theobald traces more than a century of federal efforts to manage the reproductive lives of Native women.

In the 1970s, doctors in the United States sterilized at least a quarter of Native American women of childbearing age—some as young as 15—with some estimates running much higher.

The sterilizations, subsidized by the federal government and often undertaken without consent or under great duress, marked the culmination of a long colonial relationship between the federal government and Native population, which included copious efforts by federal and local authorities to manage the reproductive lives of Native families. Brianna Theobald, an assistant professor of history, traces the efforts—as well as Native women’s resistance to them—in her new book, Reproduction on the Reservation: Pregnancy, Childbirth, and Colonialism in the Long Twentieth Century (University of North Carolina Press).

What were the ways in which federal authorities intervened in the family lives of Native Americans?

In the late 19th century, the forerunner of the Bureau of Indian Affairs, the Office of Indian Affairs, had all these different employees on the reservation. Some were supposed to teach the men to farm; field matrons were supposed to go into women’s homes and teach them the art of domesticity; there were teachers, doctors, nurses.

At the Crow Reservation in Montana, I found that the superintendent’s directive to these employees was to watch what was going on and to report back. They were to report any pregnancies, to curb abortion but also to know paternity—to know if this was out of wedlock, and if so, to pressure a legal Christian marriage. And if a woman had had several births out of wedlock, to determine if punishment might be in order. This surveillance was also concerned with knowing if a woman had left her husband, which in Crow society would have been fine, but was very much frowned upon and sometimes punished by the federal authorities.

What precipitated the mass sterilizations in the 1970s, and how did Native women resist them?

The Family Planning Services and Population Research Act of 1970 subsidized sterilizations for Medicaid and Indian Health Service patients. Many Native people received their health care through the IHS. We know that after passage of the bill, sterilization rates on many reservations increased. On the Navajo Reservation, for example, they doubled between 1972 and 1978.

That doesn’t mean that all these procedures were performed coercively—some women saw it as their best family planning option, given their circumstances—but we do know that the subsidization of the procedure as well as the increased legitimacy of sterilization as a form of birth control at the time facilitated coercive use of the technology.

In the 1970s, Native activism and resistance became very visible, more widespread, and ultimately coordinated nationally and internationally. Under pressure, the US Government Accountability Office investigated the issue in 1976. They released a report that stopped short of saying that government divisions performed sterilizations coercively but did raise concerns regarding the consent process. In the aftermath of this report, amidst Native activism, and also activism by African American and Latina women, the Department of Health, Education, and Welfare adopted new regulations that offered some tangible protections for women, which went into effect in 1979.

Where are Native women today in terms of control over their reproductive health?

There’s a movement now among Native women who do not want a medicalized birthing experience in any hospital, and who are trying to create alternatives that seem more culturally appropriate to them, and which they view as an enactment of their bodily autonomy and sovereignty. As a result, we see pockets of a resurgence of Native midwifery and Native doulas.

At the same time, there are other Native women who are upset that government hospitals on reservations have been forced to limit services or have closed due to chronic underfunding and staffing shortages. That means that some women in labor are forced to travel an hour or two to the nearest hospital to deliver.

I see these two movements as quite complementary, in terms of the reproductive justice agenda, in that women should have some control over the circumstances under which they give birth. It’s important to note that the Native maternal mortality rate continues to outpace that of white women, for a variety of reasons that are squarely rooted in the colonial history.