4 NEWS
4 NEWS
8 DECEMBER 2023 ausdoc . com . au
Doctors , covert contraception and the Stolen Generations
ALAMY
Emeritus Professor Max Kamien Senior honorary research fellow at the University of WA .
Uncovering a shameful departure from basic medical ethics .
LAST month Australian Doctor reported on the campaign by indigenous women in Greenland for compensation after being fitted with IUDs , without their consent or knowledge , in an attempt to limit Inuit birth rates .
Records from the national archives in Denmark unearthed last year showed that between 1966 and 1970 , some 4500 early versions of an IUD called the Lippes loop were fitted , sometimes in girls as young as 13 .
While this insidious campaign was scaled back in later years , it contributed to reducing the fertility rate from seven children per woman to 2.3 children .
But it was interesting to me to read the responses to the article in the comments section .
Dr Nino Scuderi confirmed that this had also occurred in Australia , writing about one of his patients at an Aboriginal medical service in Victoria .
A female elder , she had presented with abdominal complaints . The radiological investigations showed she had been fitted with an IUD .
“ She looked at me blankly ,” he said . “ She had no idea she had an IUD , and had only had one pregnancy , after which she could not get pregnant again .
“ It was a normal vaginal delivery with a healthy baby she was allowed to keep .” They arranged a referral to a public hospital for the IUD ’ s removal . She did not want anyone at the medical centre to know what had been done to her . But she had always wanted more children . Dr Scuderi continued : “ The entire patient encounter left me with deep sadness and anger .”
From the 1960s to the present day , contraception with and without patient consent has been part of a worldwide response to the obvious dangers of overpopulation .
The dark side of covert contraception can be traced back to the pseudoscience of eugenics , which promoted the improvement of humanity through ‘ better breeding ’ and the sterilisation of ‘ inferior races ’ and other groups that endangered and / or financially burdened the dominant community .
In early 20th century Australia , the official policy was to ‘ breed out the colour ’, with state-based Protectors of Aborigines responsible for permitting only marriages that would achieve this aim .
In the early 1970s , I was a physician and psychiatrist in far west NSW . I had a fellowship from the NSW Institute of Psychiatry , with the brief to map out the epidemiology of mental illness and devise ways of treating it .
In the pre-Medibank / Medicare days , I also became , by default and inclination , the GP to some 800 Aboriginal people .
I had worked in developing countries and had a very broad view of the tasks of medicine and the need to tackle what today are called the ‘ social determinants
of health ’ — the non-medical factors that influence health outcomes .
One obvious problem was the birth rate of 61 / 1000 Aboriginal people , which was almost three times that of the non-Aboriginal population and one of the highest birth rates in the world .
On several occasions , I simultaneously treated five generations of the same family .
Closely spaced and often unwanted pregnancies with low-birthweight babies were a factor in the despondency and weariness of many Indigenous women .
This led to a survey of women ’ s beliefs and attitudes and the provision of one of the first Indigenous family planning clinics in Australia .
Its underlying philosophy was that contraception is a method of control and definitely not a means of being controlled . I thought it a coming of age of the service when a 20-year-old woman sought
The idea that a young Aboriginal woman had an ethical right to be informed and to consent was beyond his cultural competence .
advice about her inability to get pregnant .
Examination revealed the telltale polymer tails of the Lippes loop IUD protruding from her cervix .
Greenland ’ s birth rate , average births per woman
Source : Our World in Data
I saw three similar cases . The common denominator was that they had spent several years at the Cootamundra Domestic Training Home for Aboriginal Girls , an
Naja Lyberth , now a psychologist , is one of the Inuit women demanding compensation after being implanted with an IUD without her knowledge .
A Stolen Generations protest march , Sydney , February 2018 .
evil institution that housed Aboriginal and Torres Strait Islander children who had been removed from their families with the aim of assimilating them into the white Australian domestic workforce . The institution was at the heart of the Stolen Generations scandal .
Ten years later , in Perth , I was consulted by a young Aboriginal woman who could not get pregnant and was unaware that she had been fitted with a Lippes loop .
She had been a guest of the Longmore Remand and Assessment Centre , then run by the WA Department of Community Development . It housed girls aged 13-18 who had either been sentenced or who were on remand — including some who had stolen food because they were hungry .
Many had been treated with IM penicillin for infectious disease , and before their release they were given IM Depo-Provera .
In 1982 , this was a controversial medication , mainly because of its endocrine and skeletal side effects .
The issue of informed consent was never broached .
Happily , all the women I have mentioned were able to go on and have children .
In 1982 , the board of the East Perth Aboriginal Medical Service pilloried the high-profile visiting doctor to the Longmore Remand and Assessment Centre for his paternalistic attitude and neglect to obtain informed consent .
The doctor was distressed and nonplussed by this attack , since he was sure he was doing good — in his words — for his “ feckless ” patients .
The idea that a young Aboriginal woman had an ethical right to be informed and to consent was beyond his cultural competence .
Knowledge of these shameful departures from medical ethics should be a part of all doctors ’ medical education .