Women Under the Knife: A Look at Sterilization Abuse

A FEW MONTHS AGO, a woman walked into the hospital with cramps. The doctors thought she had appendicitis and decided to do exploratory surgery. The surgeon, an intern rotating through GYN, thought her appendix looked fine, so I thought we were going to close her up. But then he started to look at her tubes. He said, 'We should take her tubes; they don't look good.' I couldn't see anything wrong with them, so I said that we shouldn't do a tubal ligation until we got a second opinion. But this inter-surgeon kept insisting that her tubes be tied right then. Not knowing what to do, I got really angry and made them call the head GYN. A message came back to close her up. If I hadn't gotten angry, who knows what would have happened. The woman was only 23 years old."

HELEN HORNER is an operating room technician at Boston City Hospital. In her over fifteen years of experience, she has aided countless surgeons and seen hundreds of patients.

Horner has also witnessed numerous cases of actual or near sterilization abuse like the one she describes above.

For most Americans the idea of sterilization abuse conjures up images of Nazi Germany and Hitler's push for a pure race. Few Americans would believe that sterilization abuse continues in their public hospitals, as well as on Native American reservations. Fewer still would realize that hysterectomy (removal of the uterus and tubal ligation) is fast becoming the most frequently performed operation on this nation's women.

Whether from government audits of public hospital files of research conducted by private groups, evidence of massive sterilization and its abuse in this country abounds. Last month, the American College of Surgeons reported that in 1979 (the latest statistics available) hysterectomy was the second most frequently performed operation on women, the fourth most performed surgical procedure overall. The Surgeons listed tubal ligation fifth overall. In terms of actual numbers, out of 23.8 million operations performed in 1979, 639,000 of them were hysterectomies while 610,000 were tubal ligations.


Yet, despite the pervasiveness of sterilization, surgeons perform hysterectomies and tubal ligations on some ethnic groups more than others. In fact, the Committee to End Sterilization Abuse (CESA) and the Committee for Abortion Rights and Against Sterilization Abuse (CARASA), two of the most active reproductive rights groups, estimate that 37 per cent of Puerto Rican women (in Puerto Rico), 25 per cent of Native American women and 20 per cent of married Black women have been sterilized, many by hysterectomy. By comparison, only 7 per cent of white women have been sterilized.

"Doctors have this attitude with Blacks. If a woman comes in with cramps, they automatically assume she is diseased and they are ready to snatch her tubes out," Horner said.

Although some women require sterilization for medical reasons--a hysterectomy may be necessary to remove cancerous tissue, for example-- many of these women had no such medical problem. Moreover, some of these women were sterilized not only without medical reason without their consent.

DAWN GORE, a 31-year-old Native American woman from Holyoke, Massachusetts, entered Franklin County Public Hospital in Greenfield in 1969 for an appendectomy. She woke up in the recovery room with her doctor standing at her beside. While still in an anesthetic haze, she listed as her doctor explained that he had removed her appendix. Then, she cried as she learned that her doctor had also without her consent removed her fallopian tubes because he felt she already had enough children. At the time, she was a twenty-one year old mother of three. Unable to bear the male child she says her husband wanted, Gore divorced a year and a half after the 'operation; she has never remarried.

Many Native American women have faced a similar fate of sterilization without "informed consent," that is, knowledge of exactly what sterilization means and acceptance of never being able to have children. A 1976 General Accounting Office study of Indian Health Service records revealed that between 1973 and 1976, 3,406 Native American women had been sterilized without the patients' informed consent. In 1978, Dr. Connie Uri, a Chocktaw-Cherokee physician, estimated that only 100,000 fertile Native American women remained.

The reason for so much surgery remains unclear, but people involved with the issue, both doctors and activists, offer explanations. "There is a difference of value systems," an ex-worker at a Boston abortion clinic, who asks not to be identified, says. "Many people don't think big families are okay for people, especially for Third World women," she adds.

A physician at Boston City Hospital agrees. "Patients tell me that the reason why so much sterilization takes place is that some doctors give ultimatums," Dr. Kenneth Edelin, director of Obstetrics and Gynecology at Boston City Hospital, says.

"These doctors tell their patients, many of whom are pregnant, that I won't deliver your baby unless you have your tubes tied. You've had enough children," he adds.

But some activists lay the blame squarely on physicians' hunger for extrasurgical practice. Hysterectomy, the most drastic of sterilization procedures remains a complex and dangerous operation. According to a 1972 American Journal of Obstetrics and Gynecology, for every one million who undergo a hysterectomy, 1000 die and 150,000 have serious complications. This compares to 31 deaths and 600 serious complications for the pill and 9 deaths and 400 serious complications for IUD's. Nevertheless, many physicians actually encourage hysterectomy instead of tubal ligations or nonsurgical contraceptives.

In 1973, the Public Citizen Health Research Group, formed by Ralph Nader and Dr. Sidney Wolfe ten years ago, released a report of conversations among physicians at three major medical teaching facilities, Boston City Hospital, Los Angeles County Hospital and Baltimore City Hospital. In the report, a Boston City Hospital resident said, "We like to do a hysterectomy, it's more of a know a well-trained chimpanzee can do a tubal ligation."