At several points in The Lone Ranger and Tonto Fistfight in Heaven, Alexie refers to Native Americans being forcibly sterilized, including Victor's Aunt Nezzy. This practice was often ignored by other Americans, but it had a devastating impact on Native communities.
In the early 20th century, theories of eugenics became very popular in the United States. These theories were grounded in the ideology of white supremacy, and they centered around the idea that society could 'breed out' other races, as well as traits like disabilities, by preventing people in these groups from having children. The execution of eugenics took a variety of forms, ranging from anti-miscegenation laws to forced sterilization. The success of American eugenics programs influenced the policies of the Nazi party. When the atrocities of the Holocaust became widely known after the Second World War, it became less socially acceptable for white Americans to openly espouse eugenics, even as white supremacist ideology continued to support the oppression of Indigenous and other marginalized peoples (Kaelber, 2009). But nevertheless, certain eugenics-based policies continued into the 1960s and 1970s, including the forced sterilization of Native Americans, mostly under the auspices of Indian Health Services, a branch of the Bureau of Indian Affairs (BIA) within the US federal government.
Starting in the 1930s and increasingly throughout the 1960s and the 1970s, physicians employed by Indian Health Services and other collaborating organizations sterilized thousands of Indigenous people without their permission. They did this using a variety of methods, including performing the procedure without telling their patients what they were doing, coercing patients to accept the procedure by threatening to take away their healthcare or other types of welfare, or by lying to their patients that procedures like hysterectomies were reversible. These forced sterilizations were conducted on adults as well as children as young as 15 (Adams, 2019).
In 1974, the Department of Health, Education, and Welfare changed their guidelines in an attempt stop these abuses in response to Indigenous activism and critiques. However, the changes proved inadequate and the abuses continued, and in 1976 the Government Accounting Office published a report verifying that IHS had violated guidelines and performed sterilizations without adequate documentation of consent. However, the report stopped short of admitting to coerced sterilization (Lawrence, 1998), and it attracted heavy criticism for downplaying the full extent of the abuses. For example, the report only documented 3,406 sterilizations in the three years before it was written, but the Lakota scholar Lehman Brightman estimated the figure to be as high as 40% of Native American women in the United States (Ralstin-Lewis, 2005). Activism by Indigenous leaders including the group Women of All Red Nations eventually led to Congress enacting stricter regulations to prevent the practice in 1979 (Adams, 2019).
Volscho (2010) explained that even after forced sterilization was supposedly ended in the 1970s, sterilization racism continues in the area of reproductive health. He conducted a study that found that Indigenous women, along with Black women, were much more likely than white women to receive permanent sterilization when they sought contraception.
