TORONTO (AP) — Decades after many other wealthy countries stopped forcibly sterilizing Indigenous women, scores of activists, doctors, politicians and at least five class action lawsuits claim the practice has not ended in Canada.
A Senate report last year concluded, “This heinous practice is not confined to the past, but clearly continues today.” In May, a doctor was sanctioned for forcibly sterilizing an Indigenous woman in 2019.
Indigenous leaders say the country has yet to fully reckon with its troubled colonial past — or end a decades-long practice deemed genocide.
There are no hard estimates of how many women are sterilized against their will, but Indigenous experts say they regularly hear complaints about it. Senator Yvonne Boyer, whose office collects the limited data available, says at least 12,000 women have been affected since the 1970s.
“Whenever I speak to an Indigenous community, I am inundated with women telling me that forced sterilization has happened to them,” Boyer, who has Indigenous Metis ancestry, told The Associated Press.
Medical authorities in Canada’s Northwest Territories in May sanctioned a doctor for forcibly sterilizing an Indigenous woman, according to documents obtained by the AP.
Dr. Andrew Kotaska performed the 2019 surgery to relieve an Indigenous woman’s abdominal pain. He had her written consent to remove her right fallopian tube, but not her left, which would render her infertile.
Despite objections from other medical personnel during the surgery, Kotaska removed both fallopian tubes.
The investigation found that there was no medical justification for the sterilization and that Kotaska had engaged in unprofessional conduct. Kotaska’s “serious error in surgical judgment” was unethical, cost the patient the chance to have more children and could undermine confidence in the medical system, researchers said.
The case was probably not exceptional.
Thousands of Indigenous Canadian women have been forcibly sterilized over the past seven decades, in accordance with eugenic law that considered them inferior.
The Geneva Conventions describe forced sterilization as a form of genocide and crime against humanity and the Canadian government has condemned forced sterilization elsewhere, including of Uyghur women in China.
In 2018, the UN Committee against Torture told Canada it was concerned about continued reports of forced sterilization and said all allegations should be investigated.
In 2019, Prime Minister Justin Trudeau acknowledged that the killings and disappearances of Indigenous women across Canada amounted to “genocide”, but activists say little has been done to address deep-seated prejudice against Indigenous people, allowing forced sterilizations to continue.
In a statement, the Canadian government told the AP it was aware of allegations that Indigenous women were being forcibly sterilized and the case is before the courts.
“Sterilizing women without their informed consent constitutes sexual assault and is a criminal offence,” the government said. It acknowledged that bias in the health system “continues to have catastrophic consequences” for Indigenous peoples.
Indigenous people make up about 5% of Canada’s nearly 40 million population. The more than 600 Indigenous communities across Canada, known as First Nations, face significant health challenges compared to other Canadians.
Until the 1990s, Indigenous peoples were usually treated in segregated hospitals, where there were reports of rampant abuse.
It is difficult to say how ordinary sterilization – with or without consent – happens. Canada’s National Health Service does not routinely collect sterilization data, including patient ethnicity.
In 2019, Sylvia Tuckanow told the Senate Judiciary Committee investigating forced sterilizations how she gave birth in July 2001 at a Saskatoon hospital. She described being disoriented from medication and being tied to a bed while crying.
“I smelled something burning,” she said. “When the (doctor) was done, he said, ‘There: tied, cut and burned. Nothing gets through that,” Tuckanow said, referring to her fallopian tubes. She said she hadn’t agreed.
In November, a report documented nearly two dozen forced sterilizations in Quebec from 1980 to 2019, including a woman who said her doctor told her after bladder surgery that he had removed her uterus at the same time — without her consent.
The report concluded that it seems to be a common practice in Quebec for doctors and nurses to “constantly question whether a First Nations or Inuit mother wants to be (sterilized) after the birth of her first child.”
Some women didn’t even know they were sterilized.
Morningstar Mercredi, an Alberta native author, was sterilized as a 14-year-old, but didn’t find out until decades later when she sought help after she couldn’t conceive.
“I went into a catatonic phase and had a nervous breakdown,” wrote Mercredi in her 2021 book, “Sacred Bundles Unborn.”
She said the impact of forced sterilizations on First Nations people was “staggering,” and described the generations of indigenous lives lost as a “genocide.”
The Senate report on forced sterilization made 13 recommendations, including compensation to victims, measures to address systemic racism in health care, and a formal apology.
In response to questions from the AP, the Canadian government said it recognized “the urgent need” to end forced sterilization. The government said it had invested more than 87 million Canadian dollars ($65 million) to improve access to “culturally safe” health services, a third of which supports Indigenous midwifery initiatives.
Last year, the government allocated 6.2 million Canadian dollars ($4.7 million) to help survivors of forced sterilization.
Dr. Alika Lafontaine, the first Indigenous president of the Canadian Medical Association, recalls times when it was unclear whether Indigenous women had consented to sterilization.
“During my residency, there were situations where we were doing cesarean sections on patients and someone leaned over and said, ‘So we’ll cut hair (fallopian tubes) too,'” he said. “It never occurred to me whether these patients were having an informed conversation” about sterilization, he said, adding that he assumed this had happened before the patients were on the operating table.
Dr. Ewan Affleck, who made a movie in 2021, “The Unforgotten”, about the pervasive racism against Canada’s Indigenous people, noted an ongoing “power imbalance” in health care. “If you have a white doctor who says to a Native woman, ‘You need to be sterilized,’ that can very likely happen,” Affleck said.
There are at least five class action lawsuits against health, provincial and federal authorities regarding forced sterilizations in Alberta, Saskatchewan, Quebec, British Columbia, Manitoba, Ontario and elsewhere.
May Sarah Cardinal, the prosecutor’s representative in the Alberta case, said she was pressured to have her fallopian tubes tied after giving birth to her second child in 1977, but the doctor never explained that the procedure was irreversible.
“The doctor said to me, ‘Tough times are coming and how are you going to take care of a bunch of kids? What if your husband leaves?’” Cardinal told the AP. “I didn’t feel like I had anything to say.”
In the case against Kotaska, documents show that an anesthetist and surgical nurse became alarmed when he said during surgery to remove the woman’s right fallopian tube: “Let’s see if I can find a reason to take the left fallopian tube as well. “
Kotaska said he was “out loud his thought process” that removing both tubes would reduce the woman’s pelvic pain.
Describing Kotaska’s actions as “a violation of his ethical obligations
,” investigators suspended Kotaska’s medical license for five months and ordered him to take an ethics course. The woman is suing Kotaska and the hospital authorities for 6 million Canadian dollars ($4.38 million).
There was no suggestion in the documents that Kotaska was motivated by racism. He declined to comment to the AP.
“People don’t want to believe that things like this happen in Canada, but cases like this explain why the entire First Nations population still feels unsafe,” said Dr. Unjali Malhotra, chief of medical services for the First Nations Health Authority in British Columbia.
Mercredi said she continues to suffer from sterilization without her knowledge.
“No amount of therapy or healing can reconcile the fact that my human right to have children has been taken away from me,” she said.
The Associated Press Health and Science division is supported by the Science and Educational Media Group of the Howard Hughes Medical Institute. The AP is solely responsible for all content.