On a cold autumn morning in 2018, a 44-year-old Haitian woman was in labour at a Montreal hospital, hours away from welcoming her seventh child into the world.
After learning that she would have to undergo an emergency C-section, the woman was asked whether she’d like to have her tubes tied at the same time.
She recalls telling the obstetrician on duty that she didn’t know what the procedure — called tubal ligation — was or what it entailed.
In an interview with Radio-Canada’s Enquête, the woman said that she refused the sterilization procedure. Indeed, no consent form appears in her medical file.
However, two months after she gave birth, during a follow-up with her family doctor, she learned that she had been permanently sterilized.
CBC has agreed not to identify the woman due to privacy concerns.
After receiving this news, the woman filed a complaint with the hospital and the Quebec College of Physicians.
Both the regional health board that oversees the hospital and the college determined in their investigation that the woman had given verbal consent despite never signing a consent form.
Women of colour infantilized, says doula
Ariane Métellus, a doula and consultant who is working with the woman, said it’s possible there was a miscommunication, or language barrier, though she’s not convinced.
The woman’s first language is Creole, and she also speaks English and French. During her visit to the hospital, she was treated in French.
While this could help explain a misunderstanding about verbal consent, Métellus said her client may also have been treated differently because of the colour of her skin.
Métellus says that in her experience helping women navigate the health-care system, she has found that women of colour are often infantilized or treated in a paternalistic manner by physicians and other health-care staff.
Métellus, who is participating in a Canadawide study on maternal health, said this is not the first time she’s heard stories from women who were 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 requesting it,” said Métellus.
Métellus thinks the doctor in question should have given her client time to reflect and the chance to get a second medical opinion.
Another doctor, who examined the complaint filed against the hospital on behalf of the regional health board, wrote that while they believed the attending doctor’s statement of events — namely, that the woman gave her consent verbally — they questioned the validity of the consent because it was given while the woman was exhausted and suffering after multiple hours of labour.
“I am of the opinion that it is possible to conclude that the state 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 has agreed not to name the doctor who examined the complaint.
The College of Physicians accepted the attending doctor’s version of events and did not blame her for proposing the procedure or for failing to have the woman fill out the necessary paperwork but acknowledged that the timing was not “ideal.”
‘When you’re in pain, it’s not the time to reflect’
This isn’t the only such case reported by Radio-Canada in recent years, with about 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 she have her tubes tied, immediately following the birth of her second child.
“I didn’t have time to reflect because I was already having contractions,” she said. “When you’re in pain, it’s not the time to reflect.”
Awashish, who is Atikamekw, confirmed she did sign a consent form a few minutes before having a C-section but said that at the time, she thought the procedure was reversible.
This was in La Tuque, Que., in 1980. Years later, when she wanted to have another child, she learned it was impossible.
“I felt guilty. Why did I say yes? I became depressed, I didn’t feel good. I felt finished,” she said.
Another Indigenous woman told Enquête that she had been sterilized against her will in Val-d’Or, Que., in the mid-2000s.
The woman, who CBC has agreed not to name, said she was told she would be getting a tubal ligation after giving birth in hospital.
“[The doctor] said: ‘I’m going to tie your tubes.’ I said, ‘Why?’ She said: ‘Because you’ve had too many children by C-section.’ I said I wouldn’t sign the consent form, but she did it anyway,” said the woman.
“I felt helpless. I was strapped to the operating table. I had no way of escaping,” she said.
Cases going back 40 years
A third Indigenous woman, who gave birth in Quebec City in the early 2000s, said she has no memory that anyone asked for her consent before doing a tubal ligation during a C-section.
She said she was “shocked” to learn about the procedure months later, and said she fell into a depression after.
Both women asked that their Indigenous communities not be identified in order to protect their privacy.
Radio-Canada spoke with women who reported undergoing sterilization procedures that they didn’t fully consent to or understand in La Tuque, Val-d’Or, Sept-Îles, Quebec City and Montreal.
The cases span a period of almost 40 years, from the 1980s until recently.
The health-care facilities concerned refused to comment on specific cases, but most said they were making great efforts to counter racism and develop cultural security measures more generally in the hospital setting.
Mauril Gaudreault, president of the College of Physicians, said he was concerned to hear the stories of women who felt pressured or forced into sterilization.
Gaudreault said labour may not be the best time to have a conversation with a patient about such a permanent procedure and that it’s better to discuss options like this in advance.
However, the College of Physicians has no plans to issue a directive to prohibit the practice of tubal ligation during childbirth.
A prohibition 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 Sask, Manitoba
Alisa Lombard, a Mi’kmaw and Acadian lawyer, is trying to get a class action lawsuit certified to compensate women in Saskatchewan and Manitoba who underwent unwanted sterilization procedures.
Lombard says, in her experience, women of colour are more likely to be targeted by the practice.
“It’s a matter of what colour your skin is and what race the doctor attributes to you,” she said.
Lombard said women are often intimidated and pressured into giving consent when really there is no rush to decide.
“There’s nothing urgent, there’s nothing therapeutic. It’s not medically necessary,” she said.
In some cases, doctors have criticized a patient’s ability as a parent as a way of justifying a sterilization.
This was the experience of Mélanie Vollant, an Innu woman from Sept-Îles, Que., who refused the tubal ligation that was proposed to her following the birth of her second child.
“She [the doctor] said to me: ‘We know you’re going to end up drinking, doing drugs. It’s better that you don’t have any more. You’re going to lose your kids.'”
The young woman refused the procedure but said she feared what might happen next.
“I was afraid they would take away my baby. I was thinking of my other child at home — would they take him away?” she said.
Researchers collecting testimonies
A research team at the Université du Québec en Abitibi-Témiscamingue is attempting to shed light on the history of this practice in Canada, which they say is not well documented.
The team is led by Prof. Suzy Basile, an Atikamekw scholar who holds a Canada Research Chair in Indigenous Women’s Issues.
She said her team has been collecting testimonies from women who have been pressured into getting sterilized.
“We assume Indigenous women are irresponsible, live a depraved life, have too many babies, so we use this false impression to push them to accept a tubal ligation,” said Basile.
In her own family, Basile said she suspects her grandmother was sterilized while staying at a sanatorium.
“Despite being young at that time, she never had any kids after that,” she said.
The work being done by Basile and her team is especially important given that Quebec is the only province that refused to participate in a federal initiative launched in 2018 to examine the situation of imposed sterilization in the county.
Need help? Find a list of resources below:
Hope for Wellness Help Line (1-855-242-3310): Offers immediate mental health counselling and crisis intervention to all Indigenous peoples across Canada. Phone and chat counselling is available in English and French. On request, phone counselling is also available in Cree, Ojibway and Inuktitut.
Crisis Services Canada (1-833-456-4566)
MMIWG Support Line (1-844-413-6649): An independent, national, toll-free support line is available for anyone who requires assistance. This line is available free of charge, 24 hours a day, 7 days a week.