‘Forced’ sterilizations a systemic failure

On Thursday, the Saskatoon Health Region (SHR) released the report of an independent inquiry into allegations that Aboriginal women giving birth in the city’s hospitals had been coerced into being irreversibly sterilized by means of tubal ligation. I am being careful in my language here. All of the women who spoke with Boyer and Bartlett had signed consent forms agreeing to a sterilization procedure. In a court of law, this fact would give the doctors, nurses, social workers, and other professionals involved in the scandal plenty of cover.

That makes me a little reluctant to talk of “forced” sterilization per se. But everybody qualified to do any of these jobs knows (and are all bound to agree if challenged) that the soul of informed medical consent does not reside in a signature.

If you read the Boyer-Bartlett report, and consider the vulnerability of Aboriginal women undergoing labour or having pre-natal care far from their own communities, you do not need recourse to a word like “forced.” Pick your own language: the witnesses who came forward tell — very believably and with implied corroboration from hospital and social-worker interviewees — of being pressured, isolated, ignored, sometimes bullied.

Some aspects of their experience will make perfect sense to anyone who has ever been in a hospital. Some will require an act of imagination for a non-Aboriginal reader.

The investigators — lawyer and nursing expert Yvonne Boyer and physician Judith Bartlett, who are both Métis — had phone calls with 16 women who had bad experiences with tubal ligation. In the end, they were able to interview seven. This may not sound impressive or notable, and as a statistic it is not. But look at the creeping catastrophe that is the ongoing federal inquiry into missing and murdered Aboriginal women. The SHR and the experts it recruited were able to produce a fairly clear and sensible report on a social problem that is just as difficult. It contains the testimony of only a handful of witnesses, but it shouldn’t be overlooked just for that reason. The opposite might be true.

When you need health care in Canada, you are inevitably entering an impersonal system, and you are bound to sometimes feel that it is a powerful adversary, a sort of chess opponent. For Aboriginal Canadians, this effect is multiplied by a hundred; for Aboriginal women who have reason to fear state seizure of their children, it is more like a million.

Saskatoon’s hospitals are full of social workers. But as the report explains, some of these are SHR social workers, there to defend the patient’s interests and make them comfortable, and some of these are Child and Family Services Ministry social workers, endowed with child-snatching powers. They don’t wear uniforms or badges to help a patient tell them apart, and it wouldn’t help if they did. Although they have distinct duties, they share information, and the white hats are positively obligated to report suspicions of child abuse or neglect to the black hats.

It would be natural for the most dedicated Aboriginal mother on earth to feel fear when in the clutches of such a system — even if we leave aside literally every other fact in the history of Aboriginal-state relations in Canada. You could call the feelings paranoia if the rational justification for them were not so stunningly obvious. And it is easy to see how this syndrome can make a total mess of an Aboriginal patient’s interactions with social workers, nurses and doctors. All are there to help and want to help — but what constitutes “help”?

Sometimes, “help” might take the form of a doctor warning a pregnant woman, using technical language, that she has vague health problems that might affect future pregnancies. Sometimes, he might tell scary stories of women who were killed or injured by a risky childbirth, perhaps as a wellintended way of avoiding the same technical language. Sometimes, doctors and nurses — knowing that a particular woman is not likely to have or obtain a regular family physician — might go a little further than they ought in selling tubal ligation as a contraceptive solution. It is mostly innocent behaviour — until you consider it from the other side.

One of the more heartbreaking parts of the report is the part in which the witnesses talk about the after-effects of having to live with an unwanted tubal ligation. Some of these effects are strictly emotional. But some women found that their relationships with men suffered, or their chances of finding a relationship compromised, because they were no longer fertile.

Most of us are trained by schools and media to think of contraception as a good thing, and I suppose most of us would encourage these women to accept that femininity is separate from fertility. But words will not solve their practical problem, or reverse the procedure that has altered their lives in a negative way. Nor is it really an answer to propose that they may simply be suffering buyer’s remorse. Their consent to permanent sterilization was supposed to have been informed: that is a duty that pertains to the doctor and the hospital, not to the patient.