At several points in The Lone Ranger and Tonto Fistfight in Heaven, Alexie refers to Native Americans being forcibly sterilized (Victor's aunt Nezzy even undergoes the procedure herself). This practice was often overlooked by other Americans but nevertheless became an important component of life on reservations.
In the early 20th century, theories of eugenics became very popular in the United States. These theories generally centered around the idea that society could 'breed out' undesirable traits - including disabilities, physical characteristics, and membership in minority groups - by controlling the reproduction of people who had these qualities. The execution of eugenics took a variety of forms, ranging from anti-miscegenation laws to involuntary 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, eugenics quickly fell out of favor with the American public (Kaelber). Nevertheless, certain eugenics-based policies continued into the 1970s, including the involuntary sterilization of Native Americans, mostly under the auspices of Indian Health Services, a branch of the government-run Bureau of Indian Affairs (BIA).
The BIA as we know it today was established in 1849, and as the name suggests, it managed all aspects of the US government's interaction with American Indians. In 1921, Congress authorized the BIA to provide health services to Native Americans. For all its flaws, Indian Health Services (IHS) dramatically increased the Native community's access to doctors, and deaths from tuberculosis and childhood illnesses plummeted. Starting in 1965, IHS began to offer family planning services to Native Americans, an initiative which may have been driven by high birth rates on reservations.
Although there is little documentation of forced sterilizations, there were a great deal of anecdotal cases in which American Indian women either were sterilized without their consent or were misled into giving their consent - for example, by being told that their hysterectomies are reversible. This also occurred in the Hispanic and African-American communities. According to surveys, these procedures were driven by the desire to limit births in low-income, minority families - a mission doctors believed helped society (Lawrence 349). Unwanted sterilization became such a problem that in 1974, the Department of Health, Education, and Welfare published stricter guidelines intended to ensure that no one was sterilized without their consent. However, the abuses continued, and in 1976 the Government Accounting Office published a report verifying that IHS had violated guidelines and performed sterilizations based on inadequate documentation of consent. However, the report stopped short of accusing IHS of coerced sterilization (Lawrence).
Allegations of forced sterilization were controversial in the 1970s and remain so today. Some critics note that while the sterilization rates for Native women were higher than those for women of other ethnicities, there is no proof that these procedures were unwanted. Because of IHS's poor record-keeping, it is unclear how many sterilizations were performed and under what circumstances (Adams).