As if 2020 could get any worse. On September 14, reports emerged that immigrants in an ICE detention centre in Georgia are allegedly being coerced or tricked into hysterectomies without their consent. The revelation came from a whistleblower named Dawn Wooten, a former nurse at the Irwin County Detention Center. According to the BBC, the facility houses immigrants detained by Immigration and Customs Enforcement (ICE). In her complaint, which was filed with the Department of Homeland Security’s Office of Inspector General, Wooten expresses concern over the high number of hysterectomies she says are being performed on Spanish-speaking women while in custody. “We’ve questioned among ourselves like, goodness he’s taking everybody’s stuff out…That’s his speciality, he’s the uterus collector,” Wooten said in her complaint. The nurse also further alleges that detained women told her they didn’t fully understand why they had to get a hysterectomy and that the centre’s doctor removed the wrong ovary from one young detainee.
These are horrifying claims. Here is everything you need to know about the allegations of coerced hysterectomies and forced sterilization. Because it’s a thing, and it happens in Canada, too.
What exactly is ICE being accused of doing?
The most egregious accusation in Wooten’s complaint pertains to the reproductive health of Spanish-speaking women in the detention centre. According to the nurse’s complaint, a number of migrant women were given hysterectomies (a procedure to remove a woman’s uterus), either without their consent or with limited understanding about why they needed one. Speaking to MSNBC on September 15, Wooten—who is represented by the Government Accountability Project, a whistleblower protection organization, and Project South, a social justice advocacy group—elaborated on her concern, recalling when she first found out something was going on. “I had several detained women on numerous occasions that would come to me and say, ‘Miss Wooten, I had [a] hysterectomy. Why?’ I had no answers as to why they had those procedures,” she said. “And one lady walked up to me, between October 19 and July 2, and she said ‘What is he? Is he the uterus collector? Does he collect uteruses?’ And I asked her what does she mean, and she says: ‘Everyone that I’ve talked to has had a hysterectomy.’”
According to Project South, a detained woman also spoke to the organization, revealing that she had spoken with five women at the facility who’d received hysterectomies in the time between October and December 2019. According to this source, when talking about the procedure, the women “reacted confused when explaining why they had one done.”
“When I met all these women who had had surgeries, I thought this was like an experimental concentration camp,” the woman told Project South. “It was like they’re experimenting with our bodies.”
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In addition to these allegations, Wooten also claims to have witnessed several instances of medical negligence related to COVID-19, including the centre refusing to test detainees for the novel coronavirus, fabricating medical records, allowing employees to work while symptomatic and awaiting COVID-19 test results, withholding information from detainees and employees about who has tested positive, underreporting COVID-19 cases, and allowing the transfer of detained immigrants (including some who were COVID-positive).
Wooten also says that she was reprimanded for missing work after coming down with COVID-19 symptoms, facing “retaliatory reprimand and demotion” as she waited for test results.
What is a hysterectomy?
If the term hysterectomy sounds incredibly scary to you, it shouldn’t, according to Dr. Dustin Costescu, a Family Planning Specialist in the Department of Obstetrics and Gynecology at McMaster University. The procedure is actually very common in the United States and Canada. “A hysterectomy usually involves a surgery—either using key holes in the belly or making an incision on the skin like a C-section scar—where the uterus and cervix are removed,” Costescu explains. In some rare cases, he says, the procedure will be done via a vaginal surgery. “[A hysterectomy] removes the part that bleeds every month and that [means] removing the womb where pregnancies take place in some patients. They may also have removal of the fallopian tubes and ovaries.”
Generally, hysterectomies are performed for patients when they either have cancer or pre-cancerous changes to the uterus or ovaries. A hysterectomy might also be performed when a patient has heavy bleeding and all other options have failed, Costescu says. But that doesn’t mean that hysterectomies are a doctor’s first choice for treatment. “The standard in Ontario, for instance, to have a hysterectomy for heavy menstrual bleeding or heavy periods would be to fail at least one highly effective alternative,” Costescu says. Meaning the patient would have to have not responded to an IUD, and endometrial ablation, or other hormonal options to mitigate the bleeding. “So we wouldn’t jump to a hysterectomy that early.”
When it comes to women who may be incarcerated or detained, Costescu says: “Usually for a hysterectomy to be performed in these circumstances, [it would be because] somebody unexpectedly has a cancer or pre-cancer diagnosis; but in these patients you would have detected the cancer on biopsies or tests prior to doing the surgery.”
Is a hysterectomy the same thing as sterilization?
While the terms “forced hysterectomies” and “forced sterilization” have been used interchangeably in reporting on the allegations about what’s happening at ICE detainment centres, hysterectomies and sterilization aren’t *exactly* the same thing. “There’s an important distinction to be made between a hysterectomy and sterilization,” Costescu says.
As opposed to a hysterectomy, which can take on different forms (for example, in a partial hysterectomy, the patient’s uterus is removed, which allows them to continue to ovulating, but unable to carry a child, while a complete hysterectomy involves removing a patient’s uterus and ovaries, prompting immediate menopause), sterilization typically involves cutting or blocking the fallopian tubes in order to prevent the sperm and egg from meeting, per Healthline.
Both procedures leave the patient unable to become pregnant.
The issue lies with consent
But while the process behind the procedures may be different, being subjected to either one without consent or a full understanding of *what* procedure you’re having or *why* you’re having it is not only incredibly upsetting, but also ethically wrong. While Costescu says that it’s difficult to glean what exactly is medically happening to the detained women who are reporting hysterectomies from reading the reports, “it sounds like some of these women did undergo sterilization procedures without their consent.”
And that is not good. “As a physician, my initial thought is one of disgust and disappointment,” he says of the reports. “No clinician would be considered professional [for performing] any surgery without patient consent.” And that includes when said patients have English as a second language. While Costescu says that, theoretically, there could be a small subset of patients who are newcomers to a country like Canada who, upon arrival, are found to have medical issues or need medical care resulting in a hysterectomy, “it would be very unlikely that such a large number of patients would really need this sort of aggressive management.” Not to mention the fact that even if the detainees *did* need this procedure, it’s imperative that they understand what’s happening to them and why it’s happening to them. The only exception is in truly dire situations.
“The only situation where you would do a hysterectomy on a patient without express consent would be [one] where the patient is basically experiencing a catastrophic or traumatic bleed,” Costescu says. “In gynecology, that’s almost never.” In addition, Costescu says these types of situations are more related to excessive bleeding due to childbirth or a major trauma like a car accident. “Otherwise, there’s always enough time to get a proper consent from a patient. [Which means] they always have to know what they’re having done, why they’re having it done, the risks, the benefits and any alternatives—that’s standard consent for anything you would do with any patient.”
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So how does this happen? While it’s impossible to know what the motives behind a doctor’s decision to perform mass hysterectomies may be, in many of these cases, Costescu says, physicians can fall into one of two categories: a legitimate lack of respect for patient autonomy, meaning doctors that truly feel that they’re better than the patient and know what’s best for them, or the misguided idea that they’re somehow saving these patients from themselves. “Both are narcissistic beliefs,” Costescu says. “But when we think about structural racism more and more, I think it’s more likely that this is more of a lack of respect and propagating false stereotypes to serve these patients.”
Regardless of intent, if someone is forced into receiving a hysterectomy or sterilization against their will, it can be a difficult and emotional experience. This is something Costescu has seen firsthand with patients who have chosen to undergo hysterectomies. “Many of my patients will actually grieve the loss of their reproduction, even if they weren’t planning on having pregnancies,” he says. “We have a strong, emotional attachment to our reproductive organs, regardless. So I think anyone whose had a hysterectomy is allowed to grieve that loss of fertility.
“So the fact that the patients didn’t understand the reason they were having it done and were not offered alternatives really speaks to them not having consent and this would be considered assault.”
Are forced hysterectomies ever legal?
No. Full stop. “Outside of an emergency, doctors in Canada may not perform this or any invasive procedure on an adult patient without consent,” says Karen Segal, a labour and human rights lawyer and a board member of CLAIHR (Canadian Lawyers for International Human Rights). In fact, it’s what Segal refers to as “an abhorrent human rights violation.”
“Forced sterilization violates numerous human rights and international law conventions,” she continues. “Forced sterilization is a form of genocide and a crime against humanity.” Referring to the Convention on Genocide, which includes “imposing measures intended to prevent births within the group,” Segal says that international and regional human rights bodies have recognized forced sterilization as an act that “constitutes torture, and cruel, unusual and inhumane treatment.” Further, she says, “It has also been defined by some international courts as a form of sexual violence and violence against women.” In the United States, where detainees are being held by ICE, the right to equality without discrimination on the basis of sex is protected in the Convention on the Elimination of Discrimination Against Women, a document the U.S. has signed. “This convention requires states to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning,”she says. And in addition, this document protects the rights of women “to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights.”
So Sparknotes version: giving women a hysterectomy without their full consent violates these rights.
Why would someone give forced hysterectomies?
While any guesses as to the intention behind the alleged hysterectomies is speculative until there’s a thorough investigation, there are several reasons physicians have historically performed forced sterilization, the central of which is population control. This is a tried and true practice that has been implemented in both past and current genocides. “Reproductive control—whether that’s forced childbirth or forced sterilization—has historically been used to control populations. So if the hysterectomy is being performed as a means of population control, that constitutes a war crime,” Costescu says of the gravity of the surgery.
Another reason hysterectomies could be given without consent, according to Bernard Dickens, Professor Emeritus of Health Law and Policy at the University of Toronto’s Law School and Co-Director of the International Reproductive and Sexual Health Law Program, is due to the for-profit medical system in the United States. “It could be that they are earning income for doing it,” he says. “It could be money-making, but it could also be if you’re dealing with younger surgeons, there’s the experience of doing them.” As Dickens points out, a hysterectomy is a surgery that has to be done on a living person (translation: it can’t be effectively practiced on corpses in med school). “But again, this is exploiting abominable pain.”
Ultimately, in the case of the detained women in Georgia, Dickens says an independent investigation has to be done into the allegations and any of the facility’s justifications.
What has the response been?
Yesterday, I was briefed by attorneys representing women who were subjected to forced, invasive procedures by a gynecologist connected with a private, for-profit detention center in GA. It has become clear that the initial reports are likely part of a horrific pattern of conduct.
— Rep. Pramila Jayapal (@RepJayapal) September 16, 2020
On September 15, US immigration said an external watchdog organization had been dispatched to investigate Wooten’s complaints.
In a statement to FLARE, Dr. Ada Rivera, Medical Director of the ICE Health Services Corp (IHSC) said that while the accusations will be fully investigated by an independent office, “ICE vehemently disputes the implication that detainees are used for experimental medical procedures.
“ICE’s mission is to protect the homeland and to swiftly and quickly remove people from the country; the health, welfare and safety of ICE detainees is one of the agency’s highest priorities, any assertion or claim to the contrary is false and intentionally misleading.” In addition, Rivera’s statement noted that all female ICE detainees receive “routine, age-appropriate gynecological and obstetrical health care, consistent with recognized community guidelines for women’s health services.” And stated that: “According to U.S. Immigration and Enforcement (ICE) data, since 2018, only two individuals at Irwin County Detention Center were referred to certified, credentialed medical professionals at gynecological and obstetrical health care facilities for hysterectomies in compliance with National Commission on Correctional Health Care (NCCHC) standards. Based on their evaluations, these specialists recommended hysterectomies. These recommendations were reviewed by the facility clinical authority and approved.”
“To be clear, medical care decisions concerning detainees are made by medical personnel, not by law enforcement personnel. Detainees are afforded informed consent, and a medical procedure like a hysterectomy would never be performed against a detainee’s will.”
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Wait, does forced sterilization happen in Canada?
It’s important to know that forced sterilization has historically occurred in our country as well—and it’s still happening. Forced sterilization has disproportionately affected Indigenous women in Canada, with dozens of women coming forward since at least 2017 to share their stories of being coerced into sterilization, according to a report by the International Justice Resource Centre. In many cases, these women were sterilized by health practitioners, and as Saskatchewan-based lawyer Alisa Lombard told CBC in an April 2019 article, “some of the women did not realize that physicians, nurses, other health-care professionals, the government—couldn’t make decisions for them about their bodies.”
In 2018, a group of Indigenous women in Saskatchewan brought a class-action suit against the Saskatoon Health Authority. In the lawsuit, the women claimed that doctors—from several decades ago and up to the 2000s—had either forcibly sterilized or tricked Indigenous women into giving consent for sterilization when they were under stress or heavily drugged.
It’s a horrific historical and contemporary legacy, and one that shouldn’t be repeated. “Hysterectomies are one of the most common surgeries performed in the U.S. and Canada, but they themselves are not without risks,” Costescu says. “I think what we don’t know yet about these cases is: were there any harms associated with it? Patients who undergo removal of the ovaries before menopause may need to go on hormone therapy. So we don’t know at this point if these patients are able to access healthcare beyond that; are they getting help in these detainment centres?
“It’s imperative patients understand that no surgery is risk free, and that’s why we want them to make this decision. As a gynecologist, we talk many patients out of hysterectomies if there are other options they can try, and then we use hysterectomy as a last resort. So that’s why this is such a shocking case.”