Holly McKenzie and her colleagues argue for broader public conversations and institutional responses to reproductive coercion.

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In late 2015, many of us sat together around a boardroom at a community organization in Saskatoon with some joining by conference call to discuss the next stage of our study about Indigenous women’s experiences of reproductive justice and injustice on the Homeland of the Métis and Treaty One (Winnipeg), Treaty Four (Regina) and Treaty Six (Saskatoon) Territories. Our study involved research circles, open-ended interviews and collaborator meetings (such as the meeting described here) with urban Indigenous women, Two-Spirit, and ally collaborators. At this meeting, some of our conversation focused on recent media coverage where Brenda Pelletier and Tracy Bannab shared their stories about healthcare and social service providers pressuring them, and in Brenda’s case forcing her to have a tubal ligation at the Royal University Hospital in Saskatoon. Reflecting that this media coverage resonated with study conversations thus far, we decided to also analyze policies and related media coverage as part of our project.

Photo Credit: Wikimedia Commons. Image Description: Royal University Hospital in Saskatoon.

Buttressed by this conversation, we documented a growth in media coverage about coercive sterilization in our study, much of which was prompted by Indigenous women sharing their stories with journalists. Further, as this study progressed, we continued to hear the resonance between this media coverage and stories collaborators shared about healthcare practitioners and other service providers coercing them to agree to tubal ligations, long-term contraceptives (particularly intrauterine devices [IUDs]) or pregnancy terminations. Collaborators described healthcare providers’ or social service providers’ coercive practices in three distinct ways: a) pressuring, rushing, or tricking women into making these decisions; b) proceeding as if women had already consented to the procedure or treatment; and/or c) referring to racist and colonial stereotypes to justify their actions or convince women to follow their recommended practice.

Indigenous women also discussed ways they navigate coercive contexts: sharing community knowledge, and refusing and negotiating coercive encounters, for instance by not filling prescriptions for long-term contraceptives, avoiding coercive healthcare providers, and seeking out supportive healthcare providers. These findings demanded action: in 2016 we submitted a policy brief addressing coercive sterilization to the Saskatchewan Health Region and representatives of the federal and provincial governments. In 2020 we published a fact sheet Your Right to Informed Consent for Medical Treatment in Canada, and recently we published these findings in Qualitative Health Research

Since our study, public conversations and actions about coercive sterilization have grown. For instance, the Standing Senate Committee on Human Rights recently began its study of forced and coerced sterilization of persons in Canada, and Morningstar Mercredi and Fire Keepers recently published the book Sacred Bundles Unborn. While this public attention is promising, there is a need for public and media conversations that address healthcare and social service providers’ pressuring and forcing women to have abortion procedures and to use long-term contraceptives. In addition, women’s stories point to the need for transforming institutional cultures that foster safe and antiracist care. In order to do so, it is integral that staff and leadership have the necessary training, resources, and meaningful partnerships with Indigenous-led organizations to do this work. This training should address:

a) racism, colonialism, and heterosexism within healthcare institutions and society;

b) trauma- and violence-informed care that explicitly addresses colonial violence;

c) harm-reduction approaches to providing care for pregnant and parenting people who use substances;

d) recognizing individual and institutional bias to foster safe care;

e) voluntary and informed consent; and

f) Indigenous peoples’ rights to free, prior, and informed consent.

Simultaneously, institutions must ensure they have safe mechanisms for people to report experiences of coercion so perpetuators can be held accountable, and receive reparations for these violations of their human rights. This deep work of transforming institutional and organizational cultures is integral to cultivating contexts for safe interactions between providers and Indigenous women.

To learn more about this study and view study products, visit hollyannmckenzie.ca/Indigenous-RJ .

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Holly A. McKenzie is a postdoctoral fellow with the College of Medicine at the University of Saskatchewan. She has published peer-reviewed articles in Qualitative Health Research, International Indigenous Policy Journal, Cultural Studies and Critical Methodologies and other journals.

Colleen Varcoe is a Registered Nurse and Professor and Associate Director of Faculty Development in the University of British Columbia School of Nursing. She has published peer-reviewed articles in Social Science and Medicine, Journal of Interpersonal Violence, BMC Nursing and other journals. She is the co-author of How to Nurse: Relational Inquiry in Action and co-editor of the volume Women’s Health in Canada: Challenges of Intersectionality.

Dory Nason is an Associate Professor of Teaching at the University of British Columbia in First Nations and Indigenous Studies and the Institute for Gender, Race, Sexuality and Social Justice. Dory is Anishinaabe and an enrolled member of the Leech Lake Band of the Minnesota Chippewa Tribe. She is co-editor of the volume Tekahionwake: E. Pauline Johnson’s Writings on Native America.

Betty McKenna is Ojibway and the guiding Knowledge Keeper on this project. She is the Elder in Residence with First Nations and Métis Education at the Regina Public School Board, as well as the guiding Elder for RESOLVE (Research and Education to End Violence and Abuse) Saskatchewan and the Canadian Virtual Hospice. Betty also is an Instructor at First Nations University of Canada.

Karen Lawford is an Assistant Professor in the Department of Gender Studies at Queen’s University, an  Anishinaabe midwife (Namegosibiing, Lac Seul First Nation, Treaty 3) and a Registered midwife (Ontario). She has published peer-reviewed publications in Atlantis: Critical Studies in Gender, Culture, and Social Justice, Health Care for Women International, AlterNative: An International Journal of Indigenous Peoples and other journals.

Mary-Ellen Kelm is a Professor and Associate Dean, Research and International, in the Faculty of Arts and Social Sciences at Simon Fraser University. She is the author of Colonizing Bodies: Aboriginal Health and Healing in British Columbia and a co-editor of the volume Talking Back to the Indian Act: Critical Readings in Settler Colonial Histories.

Cassandra Opikokew Wajuntah is from Canoe Lake Cree First Nation and an Assistant Professor at the First Nations University of Canada in Indigenous Health and a PhD candidate in the Johnson Shoyama Graduate School of Public Policy. She has published in Health Diplomacy Monitor and other journals.

Laverne Gervais is an Anishinaabe (Dakota/French colonial settler) woman with a Master of Arts in First Nations Studies at the University of Northern British Columbia. She is a project manager at Ka Ni Kanichihk. She has published peer-reviewed articles in International Indigenous Policy Journal and other journals.

Jannica Hoskins is a Métis two-spirit woman, independent filmmaker, and Manager with First Nations and Métis Relations with the Saskatchewan Health Authority.

Jaqueline Anaquod is a Nêhiyaw and Saulteaux woman pursuing her Master of Arts in the Social Dimensions of Health Program and an Indigenous Nationhood certificate in the Indigenous Governance Program at the University of Victoria. She has published peer-reviewed articles in Housing and Society and other journals.

Jasmond Murdock is a Cree woman and a member of Fisher River Cree Nation who studied Urban and Inner City Studies at the University of Winnipeg. She now works at Ka Ni Kanichihk with the Kisewatisiwin Youth Hub.

Rebecca Murdock is a Cree woman and a member of Fisher River Cree Nation who has been involved with various Indigenous women’s groups.

Katryna Smith is a Cree/Dakota/Saaimi/Metis First Nations Woman who is from Onion Lake Cree Nation. She is the author of a book of poetry What the Heart Wants (Freedom Book 1).

Jillian Arkles completed a Master of Arts degree at the University of Toronto in Women’s and Gender Studies. She is the Operations Director for Public Health Response with the BC Centre for Disease Control.

Sharon Acoose is a Saulteaux woman and a member of Sakimay First Nation. Sharon is a Professor of Indigenous Social Work at First Nations University of Canada. She is the author of An Arrow in My Heart: A First Nations Woman’s Account of Survival From the Streets to the Height of Academia and A Fire Burns Within: Teaching from Ceremony and Culture.

Kayla Arisman is a MA student in the Department of Sociology at the University of Saskatchewan. She has published peer-reviewed articles in Community Mental Health Journal and other journals.