Standing up Against Coerced Sterilization in the Health Care System


A message from Dr. Unjali Malhotra, FNHA Office of the Chief Medical Officer​


I am Dr. Unjali Malhotra. I am the daughter of Drs. Lalita and Tilak Malhotra, who served the Indigenous community of Prince Albert, Saskatchewan for 45 years, where I grew up. I worked in their offices and learned about the importance of creating a safe space for community members when seeking health care. The teachings of my parents guided me, while the stories of their patients—as well as the community I grew up in—would go on to inform my life's work.

In my parents' offices, I heard from many Indigenous girls and women. I have heard many more voices since that time in my training and work. But I have also witnessed silence. Many women will not or cannot speak due to the trauma caused by generations of abuses perpetrated against Indigenous people in the health care system.

Today, I speak humbly as medical director for women's health at the First Nations Health Authority about the subject of coerced sterilization of Indigenous women and girls. I draw upon my experiences not only from those years growing up in Prince Albert, but the past 20 years serving as a reproductive health doctor throughout Canada.

These experiences led me one day in April of 2022 to stand before the Canadian Senate's Human Rights Committee on Coerced Sterilization to share the truth of Canada's shameful medical track record.

A history of fear and mistrust

In my administrative and clinical practices I have found that Indigenous women are, at times, afraid to seek medical care, especially if it means leaving their home communities. Whether it be for pap smears, referrals to other health services, or to deliver their babies, there is a fear of coerced sterilization.  

If a woman does not have a strong advocate to come with them, if she doesn't understand the forms she is presented with, or if she is unfamiliar with their health care provider, there is fear. This fear is not misplaced, as existing biases and anti-Indigenous systemic racism throughout BC's health care networks were confirmed by an extensive study conducted in 2020 and 2021.

I know that when one person has experienced coerced sterilization, it can impact an entire community both in the present day and for generations to come. This impacts the health of many people over a long period of time.

How coerced sterilization can happen in our health care system

It is important to know that until as recently as 1973, there was a Sexual Sterilization Act in BC that disproportionately impacted Indigenous women. The act gave the BC Eugenics Board the right to make decisions to sterilize people without their consent – and sometimes even without their knowledge.

In more modern-day scenarios, women can be coerced into making decisions surrounding sterilization based on fear, being threatened, forced to make decisions under duress or stress such as childbirth, or while under sedation, or not being given time to think about this life-changing decision. As well, women have experienced coercion in being unable to change their minds, not being told the truth surrounding the medical procedure, not having an advocate, or receiving biased care or information.

One of the most dangerous forms of coercion is seemingly innocuous: the current health care system involves many forms that ordinary people who do not work in health care may not understand.

Moving forward to help and protect women against coerced sterilization

To challenge these issues, I, along with Métis Nation of Ontario member and Canadian Senator Yvonne Boyer, and Perinatal Services BC, have created a shared decision-making document that changes how people provide consent for contraception.

This means the system has to shift in its thinking of consent. The decision to have or not have contraception is led by patient choice, and that choice could simply mean “no." We aim to have consent completed over time, without stress or pressure, and certainly not under any of the stresses I mentioned above.

I am also a co-lead on a storytelling project with UBC that allows communities throughout BC to share how they have received and how they wish to receive reproductive health care, and how we can change our system to achieve culturally safe care.

The goal is to create accountability, empower choice, create safe spaces and dialogue, ensure that the people receiving care are leading it, and consider someone's entire life journey and not just present circumstances.

I, along with Senator Boyer, Perinatal Services BC, UBC and other Allies, am bringing to light coercion in health care, which is fundamentally and inherently unacceptable. As Senator Boyer says, “We cannot be complacent—it is still happening and we need to protect our aunties and sisters."

Other voices in the fight against coerced sterilization

Senator Yvonne Boyer: Our Fight Against Coerced and Forced Sterilization (PDF)

“The first step in eradicating this unspeakable crime is to listen and hear the voices of Indigenous women who have been sterilized."

Morningstar Mercredi: Sacred Bundl​es Unborn (book)

Mercredi, an off-reserve member of the Athabasca Chipewyan First Nation in Treaty 8 Territory, says her book also aims to educate people about the dark reality of Canada's negligence of the human rights of Indigenous women and women of colour, who are at greater risk within the health system in their most vulnerable state during pregnancy.​

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