A damning new report released last week has exposed the ongoing practice of imposed sterilization of First Nations and Inuit women in Quebec.
The report, published by the Universite du Quebec en Abitibi-Temiscamingue (UQAT), Canada Research Chairs, and the First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC), includes the testimonies of 35 people who have experienced or witnessed imposed sterilization and/or obstetric violence.
“My colleagues and I already knew that Indigenous women have been sterilized in Quebec,” explained professor Suzy Basile, the primary author of the report. “I wasn’t surprised to hear the stories, but it was tough, much tougher than I thought. We found that many women went through other traumas as well, and on top of that they had experiences of a hysterectomy, or sterilizations, or obstetric violence.”
Many of the accounts in the report detailed highly traumatic cases of women undergoing tubal ligation, often without their knowledge or informed consent. This process involves the cauterizing or clipping of the fallopian tubes, permanently preventing pregnancy.
Some women were not actually informed that they had a tubal ligation, and only found out that they had undergone sterilization when they began experiencing fertility issues. Most women either did not sign consent forms, were made to sign consent forms during active labor, or signed consent forms without being fully informed of the details of the procedure.
One testimony highlights how doctors gave incorrect information regarding tubal ligation to a patient, violating her right to free and informed consent. She stated: “Before he did the tubal ligation, he swore to me that if I wanted to have more children, it was possible to reverse the tubal ligation […] so that’s when I said OK.” In this specific testimony, the patient was pressured to have a tubal ligation during a bowel surgery.
Dr. Ojistoh Horn, a Kahnawa’kehró:non physician currently working in Akwesasne, makes clear that important decisions about permanent contraception should be made after birth.
“No way should a decision about definitive contraception be made when women are pregnant, at the end of their pregnancy, during labor, or even right after labor – that shouldn’t be happening,” she said. “They’re implying consent, but the women are not consenting. Women need to have free and informed consent.”
Informed consent means that women must be aware of all possible risks and benefits before permitting a procedure. This report mentions that free and informed consent requires patients be afforded the proper time to make a decision, in the appropriate environment and atmosphere, with no coercion. The report found that these requirements were “undermined if not ignored” by medical staff.
“People may only realize after that this happened to them, because they didn’t give consent,” said Horn. “There’s a lot of retrospective evaluation, you look back and you realize that was racism.”
Horn also noted that tubal ligation is almost never a reversible procedure, contrary to many of the women’s testimonies in the report. Finding a doctor to attempt to reverse the procedure is almost impossible, because of how uncommon the reversal process is. “It’s not common, because it’s not something that’s easily done at all,” she explained. “You have to find the scar tissue, cut out the place where the ligation happened, and sew the sides of the fallopian tube together. It’s so, so hard.”
The report also details how the Quebec government has declined to participate in the federal government’s working group on cultural competency in health care, with government officials claiming that they were “already ‘aware’ of the issue.” The government also claimed that “there have been no cases of imposed sterilization reported in Quebec and that jurisdiction over health care is exclusively provincial.”
The report notes that this claim is incorrect – provincial and federal governments share jurisdiction over health care for First Nations in Canada. Though victims of imposed sterilization have, according to the report, repeatedly spoken out in the media, Quebec has continued to refuse to participate in the working group, against the wishes of Indigenous and non-Indigenous politicians and senators, as well as Indigenous researchers and organizations in the province.
“Quebec said if there were any cases, they would have heard about it,” explained Basile. “This is what the health minister said at the time.”
Basile noted that there were frequent reports of intergenerational experiences of obstetric violence. One testimony in the report shared a mother’s experience accompanying her daughter to prenatal visits and childbirth: “Every time she gave birth, she had a C-section. I had to go, she didn’t know why I wanted to be there, I had to be there […] I don’t know what they’re going to do to her.”
Since the report was released, Basile has received a number of calls and emails from women sharing their experiences. She noted that more than one woman told her that they would not let their daughter go alone to prenatal visits or childbirths. She has also received messages from women who have felt empowered to share their stories after reading the testimonies.
The report concludes by detailing recommendations made both by participants in the project as well as by the research team. These recommendations include listening and believing First Nations and Inuit women who speak out about this type of violence, funding information campaigns about the issue, and imposing penalties and revoking permits of doctors who commit these crimes.
In support of the recommendations, the chiefs of the Assembly of First Nations Quebec-Labrador (AFNQL) adopted a commitment to denounce the practices of imposed sterilization and obstetric violence and demand that they cease immediately.
In a statement, AFNQL grand chief Ghislain Picard noted that the research reveals “the high degree of colonial violence of an odious and little-known reality, stemming from genocide, in a context as intimate as that of gynaecological and obstetrical care for our First Nations and Inuit mothers and sisters.” He further affirmed that “the imposed sterilization suffered by Indigenous women is a violation of their physical and psychological integrity as well as a theft of their fundamental right to bear children.”
Derek Montour, current president of the FNQLHSSC board of directors and executive director of Kahnawake Shakotiia’takenhnhas Community Services (KSCS), also added, “Men play an equally crucial role: we must take action by refusing this kind of treatment regardless of the environment, and by showing respectful behavior for women in all spheres of daily life.”
Basile noted that the government has taken notice of the report. “From Quebec, the minister of Indigenous affairs said that it’s an unacceptable situation and they will take real action to address the issue,” explained Basile. “I hope that this will never happen again. And I hope that measures will be put in place to make sure everybody does their job, and the voices of Indigenous women will be heard and believed.”