Black and Indigenous mothers say they were sterilized without their full consent in Quebec hospitals
On a cold fall morning in 2018, a 44-year-old Haitian woman was in labor at a Montreal hospital, hours away from welcoming her seventh child in the world.
After learning that she would have to have an emergency Caesarean section, the woman was asked if she would like her tubes to be ligated at the same time.
She remembers telling the obstetrician on call that she didn’t know what the procedure – called tubal ligation – was or what it involved.
In an interview with Radio-Canada investigate, the woman said she refused the sterilization procedure. Indeed, no consent form appears in his medical file.
However, two months after giving birth, during a follow-up with her family doctor, she learned that she had been permanently sterilized.
CBC agreed not to identify the woman due to privacy concerns.
After receiving this news, the woman filed a complaint with the hospital and the CollÃ¨ge des mÃ©decins du QuÃ©bec.
The regional health board that oversees the hospital and college determined in their investigation that the woman had given verbal consent although she never signed a consent form.
Infantized women of color, says doula
Ariane MÃ©tellus, a doula and consultant who works with the woman, said it was possible there was a communication problem or a language barrier, although she was not convinced.
The woman’s mother tongue is Creole, and she also speaks English and French. During her visit to the hospital, she was treated in French.
While this may help explain a misunderstanding about verbal consent, Metellus said his client may also have been treated differently due to the color of her skin.
Metellus says that in her experience helping women navigate the health care system, she has found that women of color are often infantilized or treated paternalistically by doctors and other health workers.
Metellus, who is participating in a pan-Canadian maternal health study, said this was not the first time she has heard stories of women who have been sterilized without their full consent.
“For me, this is the height of violence a woman can suffer, to take away her right to reproduce, to have children, without her asking,” said MÃ©tellus.
Metellus believes that the physician in question should have given his client time to reflect and the opportunity to obtain a second medical opinion.
Another doctor, who reviewed the complaint against the hospital on behalf of the Regional Health Authority, wrote that if they believed in the attending physician’s statement – that the woman had given consent verbally – they questioned the validity of the consent because it was given when the woman was exhausted and in pain after several hours of labor.
“I am of the opinion that it is possible to conclude that the condition you were in, in the minutes leading up to your Caesarean section, may have affected your understanding of the proposed sterilization surgery,” wrote the doctor in response to the complaint.
CBC agreed not to name the doctor who reviewed the complaint.
The College of Physicians accepted the attending physician’s version of events and did not blame her for offering the procedure or not asking the woman to complete the necessary paperwork, but acknowledged that the time was not right. not “ideal”.
“When you are in pain, now is not the time to think”
This is not the only such case reported by Radio-Canada in recent years, with around 10 indigenous women in the province sharing stories of undergoing a sterilization procedure without their free and clear consent.
One of those women was Nicole Awashish, who was only 18 when doctors suggested that she have her tubes tied immediately after the birth of her second child.
âI didn’t have time to think about it because I was already having contractions,â she said. “When you are in pain, now is not the time to think.”
Awashish, who is Atikamekw, confirmed that she signed a consent form minutes before having a Caesarean, but said at the time she believed the procedure was reversible.
It was in La Tuque, Quebec, in 1980. Years later, when she wanted to have another child, she learned that it was impossible.
âI felt guilty. Why did I say yes? I got depressed, I didn’t feel good. I felt finished,â she said.
Another native woman said investigate that she had been sterilized against her will in Val-d’Or, Quebec, in the mid-2000s.
The woman, who CBC agreed not to name, said she was told she would have a tubal ligation after giving birth in hospital.
“[The doctor] said, “I’ll tie up your tubes.” I said, ‘Why?’ She said, “Because you’ve had too many children by Caesarean section.” I said I wouldn’t sign the consent form, but she did anyway, “the woman said.
“I felt helpless. I was strapped to the operating table. I had no way of escaping,” she said.
Cases dating back 40 years
A third Indigenous woman, who gave birth in Quebec City in the early 2000s, said she had no recollection of anyone asking for her consent before having a tubal ligation during a Caesarean section.
She said she was “shocked” to learn of the procedure months later and fell into depression afterward.
The two women asked that their indigenous communities not be identified in order to protect their privacy.
Radio-Canada spoke to women who said they had undergone sterilization procedures to which they had not fully consented or understood in La Tuque, Val-d’Or, Sept-Ãles, Quebec and Montreal.
The cases span a period of almost 40 years, from the 1980s until recently.
The health establishments concerned declined to comment on specific cases, but most said they were making great efforts to combat racism and more generally develop cultural safety measures in hospitals.
Mauril Gaudreault, president of the College of Physicians, said he was worried about hearing the stories of women who felt coerced or forced to be sterilized.
Gaudreault said work may not be the best time to have a conversation with a patient about such a permanent procedure and that it is best to discuss options like this beforehand. .
However, the College of Physicians does not intend to issue a directive prohibiting the practice of tubal ligation during childbirth.
A ban was put in place by the Saskatoon Regional Health Authority in 2016 after Indigenous women revealed they had been sterilized without consent, and sometimes under duress.
Class Action Attempts Underway in Saskatchewan, Manitoba
Alisa Lombard, a Mi’kmaq and Acadian lawyer, is trying to certify a class action lawsuit to compensate women in Saskatchewan and Manitoba who have undergone unwanted sterilization procedures.
Lombard says, in her experience, that women of color are more likely to be targeted by the practice.
“It’s a question of skin color and race that the doctor assigns to you,” she said.
Lombard said women are often intimidated and pressured into giving consent when there really is no rush to decide.
“There is nothing urgent, there is nothing therapeutic. It is not medically necessary,” she said.
In some cases, doctors have criticized a patient’s ability as a parent to justify sterilization.
This is the experience of MÃ©lanie Vollant, an Innu woman from Sept-Ãles, Quebec, who refused the tubal ligation offered to her following the birth of her second child.
“She [the doctor] said to me: ‘We know that you are going to end up drinking, taking drugs. It is better that you do not have any more. You are going to lose your children. ‘”
The young woman declined the procedure but said she feared what might happen next.
âI was afraid they would take my baby away from me. I thought about my other child at home – would they take her? ” she said.
Researchers collect testimonies
A research team from the University of Quebec in Abitibi-TÃ©miscamingue is trying to shed light on the history of this practice in Canada, which according to them is not well documented.
The team is led by Professor Suzy Basile, an Atikamekw researcher with a Canada Research Chair in Indigenous Women’s Issues.
She said her team had collected testimonies from women who had been pressured to be sterilized.
âWe assume that native women are irresponsible, lead depraved lives, have too many babies, so we use that false impression to get them to agree to tubal ligation,â said Basil.
In her own family, Basil said she suspected her grandmother had been sterilized while she was in a sanatorium.
âAlthough she was young at the time, she never had children afterwards,â she said.
The work of Basile and his team is all the more important given that Quebec is the only province to have refused to participate in a federal initiative launched in 2018 to examine the situation of sterilization imposed in the county.
Need help? Find below a list of resources:
Hope for Wellness Helpline (1-855-242-3310): Provides immediate mental health counseling and crisis intervention to all Indigenous peoples in Canada. Telephone and chat advice is available in English and French. On request, telephone consultations are also available in Cree, Ojibway and Inuktitut.
Crisis Services Canada (1-833-456-4566)
MMIWG Hotline (1-844-413-6649): An independent, national and free helpline is available for anyone in need of assistance. This line is available free of charge, 24/7.