What Should Physicians Consider About American Indian/Alaska Native Women's Reproductive Freedom?

Historically, American Indians and Alaska Natives (AI/AN) have been subjected to a lack of control over various aspects of their lives, including their reproductive health.In discussions of family planning with AI/AN patients, clinicians must consider past violations of reproductive rights and the need for transparent consent.This article explores the following questions: What were historical violations of AI/AN women's reproductive rights?How should physicians express respect for this history and for the autonomy of AI/AN female patients regarding surgical sterilization procedures today?Case Greg's ob-gyn rotation during medical school was at an Urban Indian Health Program (UIHP) clinic that served American Indian and Alaska Native (AI/AN) patients who lived on a nearby reservation.He had learned little about Indigenous populations throughout his undergraduate and medical education, and he was looking forward to learning more about how to care for different populations.On his first day, he accompanied Dr Smith to meet Ms Davis, an AI patient with bipolar disorder in the 34th week of her sixth pregnancy.Ms Davis had had no prenatal care until she presented to the emergency department with suicidal thoughts the week before.At that time, her drug screen was positive for amphetamines.Prior to entering the exam room, Dr Smith turned to Greg and said, "We need to make sure she has a reliable form of birth control after delivery."Ms Davis came to her appointment alone.When asked what she wanted to talk about at this visit, she said that she wanted to make sure that her baby was healthy, and she wanted to be a good mother.She revealed that she did not have custody of her other children.Dr Smith stated, "Thank you for coming to clinic today.Along with making sure you and your baby are healthy, I want to ensure you have good birth control after your upcoming delivery.You've had vaginal deliveries and one C-section in the past.If you get a C-section this time, we can tie your tubes then.Or, if you have a vaginal delivery, we can do it shortly after the birth.I think this would be a good option for you."Ms Davis looked surprised but did not respond.She cast her eyes to the floor.Dr Smith continued