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The Saskatoon Health Region is apologizing and changing its policies after two aboriginal women felt pressured by medical staff and social workers to have tubal ligation surgeries.

“They made it pretty clear they didn’t want me discharged until my tubes were tied,” said Brenda Pelletier, who had the procedure at Royal University Hospital in 2010.

“They bug you and bug you and bug you.”

Pelletier, now 39, had just given birth to her seventh child when the hospital social worker came to her room and asked her to sign a consent form to have the procedure. She refused.

Her mother was raising her six older children in another community. Pelletier, who was and is a recovering addict in the methadone program and committed to a healthy life, was determined to raise her daughter herself.

She didn’t want the new baby to be raised as an only child, so she declined repeated requests by the social worker, and then by the nurse, too.

Pelletier said the social worker told her that seven children was enough and she should just enjoy the baby and have her tubes tied. The woman also told Pelletier some women couldn’t have children so she should be happy with what she had.


Comment: Sounds more like the social worker was inflicting her twisted ideals onto a vulnerable patient, and/or doing a high pressure sale job on behalf of her employers.

Nurses who came into her room during the night to check on her and the new baby also said she should sign the form, Pelletier said.

In the morning, a nurse told her an operating room was being prepared for her procedure.

The social worker returned that morning along with a doctor, who recommended Pelletier sign the consent form.


Comment: This sort of harassing pressure is not uncommon in the health care industry! Surgeons make money doing surgery…

“I was tired and frustrated and I signed it against my will to get them to leave me alone,” Pelletier said.

Brenda Pelletier had a tubal ligation five years ago, against her will. She says that in the hours immediately after the night time birth of her 7th child, she was pressured by the hospital social worker to have the sterilization procedure.

She was told her Fallopian tubes would be clamped and she went into the procedure thinking it would be reversible, she said.

In the operating room, she voiced her opposition again.

“On the table I told them again, ‘I don’t want to.’ ” she said.

The female doctor asked a nurse if Pelletier had signed a consent form and was told she had. She then proceeded with the sterilization without further discussion, Pelletier said.

She weeps remembering the smell of her own burning flesh. When she asked, the anesthesiologist said her Fallopian tubes had been cut and cauterized.

The experience haunts Pelletier, who said she still feels angry and sad.

“Now I’m 39 and it’s hitting me. I’m still angry. How many other girls have they done this to?”

Pelletier, who is Metis, said indigenous woman often have many children and it’s not unusual for grandparents to raise some of their grandchildren.

“It’s my decision,” she said.

Pelletier has since learned she isn’t the only aboriginal woman who has been urged to undergo the procedure.

She reconnected in recent years with an old friend, Tracy Bannab, who said she’d been pressured, too.

In the hours after Bannab gave birth to her ninth child in 2012, three staff members from a family support program urged her to have her tubes tied. A nurse agreed with them.

“I was so pressured by them. They were in my room a lot,” she recalled.

Bannab said she was relieved when her obstetrician arrived and called them off.

“He said, ‘You guys can all leave her be. She needs to heal. She just had a baby. You guys are overwhelming her,’ ” Bannab said.

Pelletier and Bannab approached the Saskatoon StarPhoenix because they wanted others to know about their experience and to ensure no other women go through what they did.

Women waived privacy

Pelletier and Bannab gave their permission for health region personnel to access their records for the purpose of this story, but Jackie Mann, vice-president of integrated services, declined to comment on the specifics of their cases.

She did not deny the women’s stories.

“I truly am sorry for the experience that these women had. I regret that they felt the way they did in our care,” Mann said.

“It would not be acceptable for a patient to feel they were being coerced or that they were being badgered.”

Mann said she would expect any staff who saw a patient being badgered to intervene in support of the patient.

New process implemented

Two weeks after the discussion with Mann, the health region confirmed it is implementing a new process to ensure that only women who have decided with their physicians before coming to hospital will undergo tubal ligation following vaginal delivery.

“This change, which is a direct result of the issues raised by the two women, (Pelletier and Bannab) makes sure that women are supported in their decision-making process in advance of entering the hospital,” Mann wrote in an email.

“We applaud the courage of these two women in coming forward, are grateful for the opportunity to hear firsthand their experiences, and have thanked them for inspiring this change in procedure.”

The change also follows a downward trend in tubal ligations after vaginal births. The number performed in Saskatoon gradually fell to 24 in 2014-15, from 95 in 2010-11, Mann wrote.

The reduction is likely because women have more long-term but not permanent contraception options, such as an intrauterine device that can remain in place for five years and hormone injections that provide contraception for three months, said Leanne Smith, director of maternal services.

The maternal service recently developed a new mission and vision that includes accepting and honouring the diversity of all the families it serves, Smith said.

Historical sterilization of aboriginal women

Pelletier’s experience cannot be separated from the history of forced sterilization of indigenous women in Canada, says an expert on the subject.

“Imposing measures to prevent births within a group falls under the internationally accepted definition of genocide,” said Karen Stote, author of An Act of Genocide: Colonialism and the Sterilization of Aboriginal Women.

Stote’s research in the national archives revealed about 1,200 documented cases of sterilization across Canada between 1970 and 1975. Many were in the northern territories and almost half were in federally funded Indian Hospitals in the Prairie provinces and Ontario.

Sometimes they were done without informed consent. Sometimes the reason given was that the woman had two or more children. Often there was no explanation in the documents Stote found.

Sterilizations also were performed in British Columbia and Alberta between 1928 and 1972 under provincial legislation enacted to prevent “mental defectives” from reproducing. A disproportionate number of people so labelled were aboriginal, Stote found.

“These were not about eugenics per se, but were also about how to most efficiently intervene in what were considered social or public health problems,” she said.

To focus on reducing what some perceive as a social or economic burden on the state is to overlook the broader social, economic and political context that creates poverty, marginalization, and even substance abuse, Stote said.

“The ideology that justified historical coerced sterilization continues to shape state and medical interventions in the reproductive lives of women, (especially) marginalized, racialized and Indigenous women, pressuring them to get sterilized for their own good, to save them and society from having to care for additional children,” Stote stated.

“You can’t talk about individual instances of abuse without putting them in that broader context.”

While there was no legislation directly sanctioning sterilization of aboriginal people, the federal government did not condemn the practice and enacted policies that affected other areas of aboriginal life that made sterilization more likely, Stote said. It also provided financial support to provinces, allowing sterilizations to be done more effectively, she said.

Many aboriginal women feel powerless as patients in the health care system because of “racism, discrimination and the whole history of colonization and residential schools,” said Yvonne Boyer, the Canada Research Chair in Aboriginal Health and Wellness at Brandon University and the author of Moving Aboriginal Health Forward: Discarding Canada’s Legal Barriers.

The Pelletier and Bannab incidents demonstrate an attitude in the health care system that once informed all government policy toward indigenous people, Boyer said.

“This has the underpinning of the ‘guardian and ward’ theory, in which health system staff assume, ‘We know what’s best for you because we don’t believe you’re capable of making those decisions on your own.‘ ” Boyer said.

The idea was imported into Canada from the United States in the 1800s and continues to underpin many Canadian health policies toward indigenous people, Boyer said.

It was supposedly discarded in 1984 with the Supreme Court of Canada’s Guerin decision, which held that the Crown has a fiduciary duty towards (a legal obligation to act in the best interests of) indigenous people, she said.

In Pelletier’s case, employees breached the “free, prior and informed,” standards for consent set out by the United Nations, Boyer said.

“Her consent was not free. She was under duress. Was it informed? Did she know? No,” Boyer said, noting Pelletier’s belief that the procedure would be reversible.

“It was not prior because the nurse says the operating room is ready (before Pelletier signed the form.) She revoked her consent on the table. They should have stopped there,” she said.

“Historically we’ve got problems here with aboriginal women because they’re on the bottom rung of the social ladder and because of the other laws and legislation that were targeted against them.”