Weytk, bonjour and good afternoon.
Thank you for inviting us here today to testify on a very difficult but important topic, the forced and coerced sterilization of indigenous women and girls.
I'm Francyne Joe, a proud member of the Shackan First Nation, just south of Merritt, British Columbia, and president of the Native Women's Association of Canada. I use she and her pronouns.
I would like to acknowledge that we are gathered on the unceded and unsurrendered traditional territory of the Algonquin people.
Since 1974, NWAC has represented the collective voices of indigenous women, girls and gender diverse people of first nations, on and off reserve, both status and non-status, disenfranchised, Métis and Inuit. By using a gender-based approach to the issues our people face, we are improving the overall well-being of individuals, and through extension, their communities, as our women are the foundations of the families. NWAC has 45 years of expertise conducting culturally relevant, gender-based analysis.
The forced, coerced and involuntary sterilization of indigenous women and girls is an extremely serious violation not only of human rights and medical ethics, but of the reproductive rights of indigenous women and girls. Impairing the reproductive status of indigenous women and girls against their will violates the rights to equality, non-discrimination, physical integrity, health and security, and constitutes an act of genocide and violence against women. This reprehensible procedure is not only an assault on the individual rights of indigenous peoples, but also affects indigenous families, communities and populations, continuing the history of colonization and assimilation in Canada.
Historically, forced sterilization was routinely inflicted on indigenous women in Canada and was permissible by law. This was an attempt by the Canadian government to reduce the population of indigenous peoples in Canada. This sterilization legacy remains intact through the intergenerational impacts of targeted cultural groups, distrust of settler systems and the complex socio-economic and health status of indigenous women. Racism and colonization are deeply rooted in the health care system and are fundamental mechanisms of the sexist and paternalistic health policies.
Combined with the forced assimilation of indigenous children of earlier generations in residential schools and modern-day failures of social services to place indigenous children in the care of indigenous parents in accordance with modern child welfare laws, the coerced sterilization of indigenous women continues to perpetuate mistrust within the health care system.
Canada's Charter of Rights and Freedoms expressly prohibits discrimination based on sex, race and ethnic origin, and further guarantees the right to life, liberty and security of the person. In 2018, the United Nations Committee Against Torture stated that forced and coerced sterilization is an act of torture. However, this practice continues within a country that holds itself as a champion of human rights.
The failure of health care practitioners to obtain proper consent perpetuates colonial attitudes where indigenous women and girls are treated as wards of the state, or less than human.
Canada has been aware of this issue for decades. In fact, this issue was brought up in the House of Commons at the very least in 1976, well after most eugenics legislation in the provinces had been repealed. At that time, there were still high levels of sterilization. These procedures were being performed on indigenous people in “Indian hospitals”. As well, there were high levels of sterilization of Inuit women in the north.
Remarkably, Canada did not take action then. There is no excuse for Canada to fail to act now. Immediate action must be taken to recognize and protect indigenous women and girls in a way that centres, respects and appropriately addresses their experiences and their voices.
I would like to take some time to discuss NWAC's recommendations to return birth closer to home and bring about reproductive justice that protects the rights of indigenous peoples.
Too many indigenous women and girls have had to leave their communities to give birth, which in many cases leaves them alone to give birth, far away from their families, communities and culture, increasing their vulnerability to forced and coerced sterilization. We need increased access to culturally safe birthing supports, such as indigenous midwives and doulas, immediately. If indigenous midwives and doulas were present, forced and coerced sterilization would not be happening.
In addition to these supports, which are necessary for prevention, we need to have adequate and appropriate culturally safe and trauma-informed supports and services closer to home to respond to women who have been impacted by forced sterilization and to respond to those who might be re-traumatized by the media attention surrounding recent allegations.
We recommend that the committee speak to the National Aboriginal Council of Midwives, NACM. They have recently released a position statement on forced and coerced sterilization of indigenous peoples.
Our indigenous women and girls deserve what anyone else deserves in the health care system: free, prior and informed consent and the right to have that consent respected and followed.
Therefore, health care providers need to examine how and when they counsel their patients about birth control, particularly when working with indigenous women, given the history of colonialism and the resulting systemic racism within the health care system.
Therefore, we also recommend that health care providers move beyond informed consent to informed choice.
Informed choice is a decision-making process that relies on a full conversation in a non-urgent, non-authoritarian setting. It provides the patient with autonomy and control and places authority on other forms of knowledge, values, lived experiences and relationships of the patient.
Oftentimes, informed consent involves providing the standard information, for example, the description, risks and benefits of a procedure, without recognizing the social context in which decisions are made and the relational autonomy of the patient.
Informed choice is a way of addressing this gap and of shifting from a physician-led to a client-centred conversation. Informed consent is the end goal of the informed choice process.
It is clear that hospitals need to be safer places for indigenous women and girls to attend, as there is clearly a risk for severe human rights abuses against indigenous women and girls.
We recommend developing funding and implementing an accountability mechanism or mechanisms within hospitals to hold practitioners accountable for obtaining consent in these medically unnecessary procedures. These mechanisms require the full co-operation of medical regulatory authorities and must be done with the leadership of indigenous women and their chosen representatives.
Hospitals in Canada need an indigenous ethics and advocacy office in every hospital, equipped with indigenous midwives and indigenous advocates.
This is not only to ensure the availability of traditional healing and equitable access to culturally appropriate service delivery, but it will also help ensure that patients are protected from racism, sexism and harmful stereotypes that are clearly informing the medical staff.
We recommend that both provincial and federal medical regulatory authorities work with indigenous women's organizations and governments to identify and improve on sterilization surgery policies and procedures at a minimum, obtaining and defining free, prior and informed consent and anti-racism in the medical practice.
Furthermore, NWAC recommends that annual reports must be generated from medical regulatory authorities to identity the number of indigenous women sterilized, in order to monitor trends and identify practices regionally and nationally. If troubling trends arise, then investigations must take place. This may be done with the assistance of the indigenous ethics and advocacy offices in hospitals.
We recognize that the final report of the national inquiry is calling for significant milestones and an important step toward identifying the causes of all forms of violence faced by indigenous women, girls and 2SLGBTQQIA people in Canada.
As forced and coerced sterilization constitutes an act of genocide and violence against indigenous women and girls, we recommend that the 231 calls for justice from the final report of the MMIWG inquiry must be implemented.
Last, the TRC calls to action that the Government of Canada has already committed to must be implemented, specifically the calls to action around health, numbers 19 to 24.
The direction forward, as we see it, is relatively simple. We must end all forms of violence against our women, girls, gender diverse people and communities. This includes forced and coerced sterilization of indigenous women and girls.
Thank you. Merci. Kukwstsétsemc.