The American College of Obstetricians and Gynecologists, National Women's Health Network, and Hysterectomy Educational Resources and Services Foundation have all condemned the practice.

By Karen Pallarito
September 16, 2020
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A nurse at an Immigration and Customs Enforcement (ICE) detention facility in Ocilla, Georgia, is speaking out about high rates of hysterectomies being performed on immigrant women under custody, allegedly without their full knowledge and consent.

The accusation came to light in a whistleblower complaint filed on Monday. Human rights and immigration advocacy groups filed the complaint with the US Department of Homeland Security’s (DHS) Office of Inspector General.

Dawn Wooten, the whistleblower, disclosed a raft of unsafe medical practices and abuses at the Irwin County Detention Center (IDCD). The facility is operated by LaSalle Corrections, a private detention center operator, according to a joint news release issued by the Government Accountability Project and Project South, which filed the complaint outlining Wooten’s concerns.

In a statement, per NBC News, a LaSalle Corrections spokesperson cited “a strict zero tolerance policy for any kind of inappropriate behavior at its facilities, adding that it “strongly refutes these allegations and any implications of misconduct at IDCD.”

Along with a litany of unsafe COVID-19-related conditions, the complaint reveals that several women who were being held in detention had been seen by a gynecologist outside the facility who performed hysterectomies on them. One detainee, who reported her concerns to Project South, said that she had talked to five different women at the facility who’d had a hysterectomy between October and December 2019 and “reacted confused” about why they had undergone surgery. The woman added, “When I met all these women who had had surgeries, I thought this was like an experimental concentration camp. It was like they’re experimenting with our bodies.”

Wooten also expressed concern, noting that “just about everybody” seen by this particular doctor gets a hysterectomy. “We’ve questioned among ourselves like goodness he’s taking everybody’s stuff out,” she is quoted in the complaint. “That’s his specialty, he’s the uterus collector.” (Wooten was demoted from her full-time nursing position in July, a move she believes was an act of retaliation for asking hard questions.)

What is a hysterectomy and when is the procedure necessary?

Hysterectomy is the technical term for a type of surgery to remove a woman’s uterus—meaning that she can no longer become pregnant. About 400,000 hysterectomies are performed in the US each year, making it the second most common surgery for women after Cesarean delivery, Kristen Matteson, MD, associate professor of obstetrics and gynecology at Brown University’s Warren Alpert Medical School and Women & Infants Hospital of Providence, Rhode Island, tells Health.

The most common reason for having a hysterectomy is as a treatment for uterine fibroids, and a hysterectomy is a "100 percent effective treatment for patients [with] symptomatic uterine fibroids or heavy menstrual bleeding," Dr. Matteson says. But there are numerous other conditions, from endometriosis to gynecologic cancer, for which this type of surgery may be an option.

Different types of hysterectomies—of which there are three—involve different reproductive structures, according to American College of Obstetricians and Gynecologists (ACOG):

  • Total hysterectomy, in which the entire uterus, including the cervix is removed
  • Supracervical (or subtotal or partial) hysterectomy, where the upper part of the uterus is removed, but the cervix is left in place
  • Radical hysterectomy, which is a total hysterectomy that also includes removal of structures around the uterus, possibly including the ovaries, fallopian tubes (known as a salpingo-oophorectomy)

Regardless, any type of hysterectomy is definitely “major surgery,” in Mayo Clinic’s words. If removal of the ovaries is required, then the woman will immediately experience menopause. And, as ACOG points out, a woman who has had her ovaries removed may need to start hormone therapy to relieve menopausal symptoms and help reduce the risk of osteoporosis.

ACOG’s website says hysterectomy is “one of the safest surgical procedures.” Yet, as with any surgery, there are risks involved. These include infection, heavy bleeding, injury to the urinary tract, blood clots, breathing or heart problems related to anesthesia, and even death, notes the ob-gyn physician group.

Women are likely to experience pain in the first few days after surgery and vaginal bleeding for several weeks, ACOG adds. Plus, there may be physical side effects, such as constipation and temporary bladder-emptying difficulties, and emotional ones, like feeling depressed over not being able to bear children or relief that your symptoms have resolved.

Still, Dr. Matteson says a hysterectomy can be an appropriate treatment for women who have been adequately informed about the risks and potential benefits of surgery and alternatives to surgery and who have provided their informed consent. “I think women are the best judges of what the risks and benefits are for her in her particular situation,” she tells Health. Women need that information presented in a way that they can understand so that they can “make the best informed choice” for themselves, she adds.

So what are health advocates saying about allegations of hysterectomies on women detainees?

Sarah Christopherson, policy advocacy director at the National Women's Health Network (NWHN) in Washington, DC, tells Health that if the complaint it accurate, the use of hysterectomy on multiple women is “verging on genocide.” In her view, “These unnecessary medical procedures seem clearly designed to rob these women of their ability to get pregnant and have children.” NWHN, in a statement, strongly condemned the practice, which “appears to be an effort to sterilize women against their will.”

ACOG CEO Maureen G. Phipps, MD, sent a letter to DHS Inspector General Joseph Cuffari on Tuesday urging “a swift and thorough investigation.” According to Dr. Phipps, “ACOG opposes the unethical practice of reproductive coercion in any form.” Under ACOG clinical guidelines, procedures resulting in sterilization “may be performed for medically indicated reasons” only after a patient’s informed consent, with the assistance of medical interpreters when women don’t speak fluent English.

Additionally, Nora W. Coffey, president of the nonprofit Hysterectomy Educational Resources and Services (HERS) Foundation, tells Health her first reaction to the news “was just horror.” She insists that every woman should be provided with all of the information she needs to make an informed decision. “These circumstances are particularly heinous because these women were so vulnerable and didn’t even have the benefit of the same language,” and therefore lacked the ability to give their informed consent.

Are there hysterectomies that are lifesaving? “The answer is yes,” says Coffey, but women are still morally, ethically, and professionally entitled to full disclosure about what the procedure bodes for their health and wellbeing. And for that reason, and more, Coffey hopes there will be a full investigation.

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