Combating Physician-Assisted Genocide and White Supremacy in Healthcare through Anti-Oppression Pedagogies in Canadian Medical Schools to Prevent the Coercive and Forced Sterilization of Aboriginal Women

The historical and contemporary cases of coercive and forced sterilization of Aboriginal Women are acts of genocide rooted in colonialism and white supremacy. The legacy of coercive and forced sterilization of Aboriginal Women within the Canadian healthcare system demands a change to undergraduate medical education to prevent genocide. Through my Major Research Project, I examine the response taken by undergraduate medical programs to incorporate antioppressive pedagogies within the curriculum to teach Indigenous content requirements. Currently, undergraduate medical education centres around culturally based learning, which does not challenge racism and colonialism. Guided by 24th Call to Action of the Truth and Reconciliation Commission of Canada, I call upon Canadian undergraduate medical programs to implement anti-oppressive pedagogies throughout the curriculum to facilitate unlearning of colonial rhetoric amongst educators, administrators, and students. Anti-oppressive pedagogies establish learning that promotes anti-racism and anti-colonialism to Indigenize and decolonize the curriculum. Therefore, anti-oppressive pedagogies challenge genocide and white supremacy to promote the eradication of coercive and forced sterilization of Aboriginal Women.


My parents
For learning and unlearning with me throughout my education.

The Department of Gender Studies at Queen's University
For the opportunity to grow within a community of brilliant scholars.

Karen Stote, PhD
For her academic work and contribution to reviewing my work.

Karen Lawford, PhD
For her guidance, mentorship, and leadership as my supervisor. This work would not be possible without her contribution.

Introduction
The coercive and forced sterilization of Aboriginal Women, within the Canadian healthcare system, is a eugenics intervention rooted in white supremacy, which perpetuates genocide of Aboriginal Peoples. Eugenics is the science of controlled breeding within humans to yield a population with desired inherited traits (Harris-Zsovan, 2010). Therefore, eugenics was employed as a tool to advance fertility amongst those deemed fit and prevent fertility amongst unfit people. Coined by Francis Galton in 1883, eugenics was built on a Eurocentric hierarchy of race that placed Northern European/ Anglo Saxon white people as most desirable and Indigenous Peoples and Black People as most inferior (Harris-Zsovan, 2010;Stote, 2015). Eugenics gave white people a scientific justification for enacting Eurocentric policies that permitted European imperialisms and colonization. Therefore, eugenics is a science based in white supremacy.
Scholarship typically emphasizes white privilege, the benefits of being white on the basis of skin colour, as opposed to white supremacy, which is the production and violence of racial structures to uphold whiteness in settler societies (Bonds & Inwood, 2016). Eugenics, thus, is a product of white supremacy and not white privilege, because it functions to maintain white power through genocide; it prevents the fertility of racialized populations. My Major Research Project (MRP) will discuss the historical and contemporary involvement of Canadian physicians in the cases of coercive and forced sterilization of Aboriginal Women as an act of genocide rooted in white supremacy.
The first traces of eugenics in Canada took place in the early 1900s and was largely influenced by American eugenics models (Harris-Zsovan, 2010). Medical practitioners, charities, suffragettes, and other social reform organizations began educating the Anglo-Saxon population on eugenics. Eugenicists believed that social purity and moral reform would establish healthy families, low crime rates, eradicate poverty, prevent alcoholism, stop child abuse, and mental illness (Dyck, 2013;Stote, 2015). Sterilization, as a eugenics intervention, was viewed as a public health measure to prevent reproduction of feebleminded and non-Anglo-Saxon people, who were seen to threaten Anglo Saxon society (Stote, 2015).
Sterilization, commonly referred to in eugenics policies as sexual sterilization, is a permeant form of birth control (Reece & Barbieri, 2010). In assigned females, sterilization involves the physical occlusion of the uterine tubes through a variety of methods, such as cauterization. For eugenicists, gaining reproductive control over female fertility was essential because, "as child bearers, [women] held the ability to produce future progeny and were viewed as either helping or hindering the forward march of civilization" (Stote, 2015, p. 19). To advance this forward march in Canada, Alberta and British Colombia implemented a provincial Sexual Sterilization Act in 1928 and 1933, respectively. Arguably, the most well-known example of eugenics was the Holocaust. Nazi Germany adopted North American models of sterilization laws to establish the Law for the Protection of Hereditary Health in 1933. Sterilization laws were implemented to protect German Nationalism, which aided in the formation of the Nuremberg Laws. These laws provided the legal basis to kill Jews, people with disabilities, Gypsies, Queer people, Black People, People of Colour, andnonconformists until 1945 (Harris-Zsovan, 2010).
As a great-granddaughter of Holocaust victims and granddaughter of a holocaust survivor, I work to contribute to the body of literature that condemns eugenics, not just for Jews but for all peoples who have and are experiencing genocide as result of white supremacy.
After the Holocaust, eugenics was replaced with social hygiene interventions; however, this rebranding did not change the practice of coercive sterilization through sterilization policies in Canada (Dyck, 2013;Stote, 2015). For Aboriginal Peoples, the practice of coercive sterilization was amplified in the 1960s. Earlier in the eugenics movement, the government, medical community, and other eugenics supporters were not as concerned with managing Aboriginal Peoples' reproduction because Aboriginal populations were in decline until the 1960s (Dyke, 2013). With the subsequent increase in the population of Aboriginals Peoples, public health officials increased sterilization measures taken within Aboriginal communities (2013). My MRP focuses solely on the coercive and forced sterilization of Aboriginal Women, although many Aboriginal Men were sterilized under these policies. Although, Aboriginal Peoples were the least populous racial group in Canada, Aboriginal Women were targeted for sterilization more so than another identity (Dyke, 2013;Stote, 2012). For example, in Alberta from 1969 to 1972, 3.4 percent of the population identified as Métis and First Nations, however they composed 25.7 percent of all sterilization cases that were approved by Eugenics Boards, composed of two physicians that decided, which patients were candidates for sterilization (Dyke, 2013;Harris-Zsovan, 2010). Furthermore, in the 1970s, 26 percent of Inuit Women age 30 to 50 in Igloolik, Nunavut were sterilized (Boyer & Bartlett, 2017). Physicians and the state ushered in unethical coercive and forced sterilization of Aboriginal Women as a means to reduce the Aboriginal population by preventing births.
It is worthwhile to mention that other methods of birth control were used by medical practitioners to control reproduction within Aboriginal communities at this time. Allegations of coercive abortions in Canada's North began in 1969 with the legalization of abortion (Stote, 2015). Therapeutic Abortion Committees, similar to Eugenics Boards, were comprised of medical practitioners who determined if a pregnancy was unhealthy and thus eligible for abortion. However, at many federally run hospitals in the North, abortions for Aboriginal Women were approved for economic reasons, even though these institutions were not accredited to make these decisions (2015). Pressure to consent to sterilization surgeries during abortion care or as a perquisite to obtaining an abortion also took place in these institutions (2015). While my MRP does not explore coercive abortions for Aboriginal Women, it is important to appreciate that medical practitioners retained a great deal of power over reproduction of Aboriginal Peoples.
Physicians and the state exercised coercive reproductive health practices to create, what was thought to be, a moral and civilized Canadian society.
Across Canada, policies were introduced to protect surgeons, nurses, and other individuals a part of sterilization procedures who manipulated informed consent (Dyck, 2013;Stote 2015). Informed consent protocols became routine in medicine on an international basis in 1947 with the development of the Nuremberg Code of medical ethics. This code was developed to address the unethical and completely immoral medical experimentation and procedures carried out by the Nazis (Dyck, 2013). However, in Canada, when patients were deemed mentally defective by medical practitioners, the parameters of informed consent were waived (Stote, 2012). Consequently, more than 77 percent of Aboriginal Peoples who were sterilized were deemed to be mentally defective, therefore consent was not needed (

Terminology
Language is an important aspect to this paper, so I offer an explanation for the terminology I have chosen to utilize. I am a white Euro-Canadian settler to Turtle Island. The term settler in this paper will be associated with people of white European decent. When white Euro-Canadians are asked to identify, we commonly pick terms that blend us with everyone else (Vowel, 2016 Canadian in refence to settler intuitions, settler healthcare, and medical policies and practices, because settlers reinforce a national identity onto the Canadian healthcare system that is connected to the assimilation, containment, and genocide of Aboriginal Peoples for the purposes of obtaining land to build a white settler state.

Theoretical Framework
In the application of Indigenous feminist theory, I position myself as a white-settler woman who demonstrates feminist solidarity with Aboriginal Peoples. I have chosen to articulate my work through Indigenous feminist theory because it is used to educate "movements unfamiliar with issues of colonialism, racism and sexism, and builds critical political consciousness and solidarity…" (Green, 2007, p. 24). My work is a form of activism that seeks to demonstrate to the medical community the need to engage with the recommendations of TRC and to stop white supremacy and the genocide of Aboriginal Peoples by decolonizing healthcare.
The healthcare system in Canada has worked to oppress Aboriginal People, therefore I employ Indigenous feminist theory "to critique oppressive traditions -and to claim and practice meaningful non-oppressive traditions" (Green, 2007, p. 27). My call for anti-oppressive pedagogies in medical schools is a call to end coercive sterilization and other medical practices rooted in white supremacy that permits genocide of Aboriginal Peoples.
I employ Indigenous feminist theory to discuss "issues of colonialism, racism and sexism, and the unpleasant synergy between these three violations of human rights" (Green, 2007, p. 20).
Feminist theory and movements "are concerned with women's flourishing -women controlling adequate resources, of all sorts, to live well," through "respect for women's own perspective and authority" (Frye, 2000, p. 195). While feminist theory and movements establish a foundation for an analysis of the role of women, little scholarship has centered on the experiences unique to Indigenous Women, who face colonial oppression within settler society (Green, 2007). The ongoing cases of coercive and forced sterilization of Aboriginal Women demonstrates that colonial oppression is tied to sexism and racism and other forms of oppression that can be examined with the use of Indigenous feminist theory.
Within the context of a colonial society, racism and sexism are internalized within dominate and Indigenous political cultures to oppress Aborginal Women (Green, 2007).
Therefore, Indigenous feminism offers tools to analyze colonialism, racism, and sexism within medical policy and practice of coercive and forced sterilization of Aboriginal Women. By engaging with Indigenous feminist theory, I examine the historical and contemporary social, economic, cultural and political issues in relation to one another (Green, 2007).
The coercive and forced sterilization of Aboriginal Women by medical practitioners is a multi-dimensional ethical issue rooted in white supremacy and genocide within Canada's healthcare system (Grenier, 2020;Dyck, 2013;Stote, 2015). Therefore, Indigenous feminist theory offers a structure to articulate the ongoing impositions of colonialism on Aboriginal Women in contemporary Canadian society. When considering coercive and forced sterilization of Aboriginal Women as a call for anti-oppressive pedagogies in undergraduate medical education, Indigenous feminist theory is a lens that "interrogates power structures and practices between and among Aboriginal and dominant institutions" (Green, 2007, p. 25 (Smith, 2012;Boyer, 2017). Based on the Call to Action of the TRC, anti-oppressive pedagogies in undergraduate medical education proposes an approach to counter white supremacy within the Canadian healthcare system.
In the early to mid-twentieth century, medical practitioners and the Canadian government operationalized eugenics to justify the coercive and forced sterilization of Aboriginal Women.
Consequently, the coercive and force sterilization of Aboriginal Women is founded on colonial constructions of race and gender. Race, as a Western category, linked human morality to whiteness in order to justify racialization through colonialism (Smith, 2012). Gender, as defined through an imperial lens, intersects with race to constitute the roles of men and women, and establishes differences between genders to build an understanding of desired qualities of women as tied to whiteness through the roles of wifehood and motherhood (2012). Using principals of eugenics, the state and medical practitioners justified sterilization policies and practices in an attempt to fix issues of poverty and poor health that were argued to be a direct result of Aboriginal Peoples' lower racial evolution (Stote, 2012). Eurocentric constructions of gender and race was used by the settler state to target Aboriginal Women for sterilization as a eugenics intervention.
Coercive and forced sterilization were made possible through tactics of aggressive colonization, whereby Euro-Western intuitions forcibly and violently gained control of Aboriginal lands and bodies (Dyck, 2013;McCallum & Perry, 2018;Million, 2013;Smith, 2012;Stote, 2012). Such an approach aligned with settle ontologies and epistemologies, which "are under pinned by a cultural system of classification and representation, by views about human nature, human morality and virtue, by conception of space and time, by concepts of gender and race" (Smith, 2012, p. 46). Through the application of decolonizing methodology, I challenge the culture of settler intuitions that uphold white power by following an Indigenous research agenda immersed in a sense of optimism and hope for Indigenous survival, resistances, and recovery from colonialism (Smith, 2012;Wilson, 2008). I further assert decolonizing methodologies are imperative to evaluating the commitment of medical schools to embed anti-oppressive pedagogies within curriculums to prevent the practice of coercive sterilization and by extension, the ongoing genocide of Aboriginal Peoples.

Thematic Analysis
The literature I used for research was selected via research databases. For the analysis of literature pertaining to coercive and forced sterilization of Aboriginal Women, I selected books and articles that focused on terms like "Aboriginal," "Indigenous," "coercive sterilization," "Sexual Sterilization Act," "eugenics in Canada," "colonization," "genocide of Aboriginal People," and "white supremacy." After scanning databases like the Bibliography of Native North Americans and Gender Studies Database, I found a lack of research articles on recent cases of coercive sterilization of Aboriginal Women. From there, I turned to reports, news articles, and broadcasts that highlighted the previously listed terms.

I selected literature that described the relationships between Aboriginal Peoples and
Canadian healthcare systems and used terms such as "Aboriginal," "Indigenous," "Canada," "healthcare," "healthcare system," "eugenics," "white supremacy," "institution," and "hospital." To scan literature referencing medical education and the 24 th call to action of the TRC, I selected books and articles through databases by using terms like, "medical education," "cultural safety," "intercultural competency," "cultural humility," "anti-oppression," "decolonizing education," and "Indigenizing education." I also examined curriculums and course options through publicly available documents that were produced by the Association of Faculties of Medicine Canada (AFMC). I analyzed the materials provided by these organizations for implementation or plans to implement the recommendations proposed by the Calls to Action of the TRC.

Literature Review
In the scope of my research, I elected to examine the ongoing practice of coercive and forced sterilization of Aboriginal Women within the Canadian healthcare system as a means to advocate for anti-oppressive pedagogies in undergraduate medical education to eradicate medical practices rooted in colonialism and white supremacy. Historically, the practice of sterilization was a eugenics intervention positioned as a public health initiative that targeted people deemed mentally deficient, based on Intelligence Quotation (IQ) tests, and were therefore presumed to have a moral short coming causing poverty, poor health, and other social issues in Canada (Dyck, 2013;Harris-Zsovan, 2010;Ladd-Taylor, 2017;McLaren, 1990;Stote, 2012;Stote, 2015). Within Aboriginal communities, sterilizations as a eugenics intervention targeted Aboriginal women, separated Aboriginal Peoples from land, and reduced the Aboriginal population through genocide (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2012;Stote, 2015). Sterilization was used by the state to prevent growth within Aboriginal communities through genocide to maintain white power.
Coercive and forced sterilization took place under provincial legislation known as the Sexual Sterilization Act in Alberta and British Columbia from 1928to 1972and 1933to 1973 respectively. Coercive and forced sterilizations were performed in Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Prince Edward Island, Nova Scotia, and Canada's North without legislation (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2012;Stote, 2015). Sterilization of people deemed mental deficient was a national eugenics intervention carried out by physicians with the support of federal and provincial governments.
Sterilization, as a eugenics intervention, was performed on Aboriginal Women by physicians more so than any other racial, ethnic, political, or cultural identity group, even though Aboriginal Women made up the smallest percentage of the Canadian population (Dyck, 2013;Stote, 2015). Colonial rhetoric described Aboriginal Women, "as 'savages,' 'depraved,' or of 'loose moral character' and their sexuality was intensely policed. For those who proved unwilling to assimilate or whose sexuality was deemed difficult to control, sterilization was sometimes the result" (Stote, 2012, p.119 (Rao, 2019;Virdi, 2018;Zingel, 2019). Coercive and forced sterilization of Aboriginal Women is an act of genocide (Stote, 2015), which must be eradicated as a healthcare practice within the Canadian healthcare system. Media reports circulated that indicated several Aboriginal Women were coerced, at University Hospital in Saskatoon, into tubal ligation, a type of sterilization surgery performed immediately after childbirth (Boyer & Bartlett, 2017;Reece & Barbieri, 2010;Soloducha, 2017). Yvonne Boyer and Judith Bartlett (2017) conducted an external review of the recent cases of coercive sterilizations of First Nations and Métis Women in the Saskatoon Health Region (SHR), where women disclosed they felt invisible, profiled, and powerless. Many women reported that physicians and other healthcare staff provided false information about tubal ligation, with one respondent stating, "I refused the tubal so many times that they had the doctor and another person come in and say, 'it just clamps and we can remove them.'" (Boyer & Bartlett, 2017, p.18). In interviews with healthcare professionals about Aboriginal Peoples, one interviewee reported, "one resident on labour and delivery said, I f…g hate you people more than any other race on this entire earth" (Boyer & Bartlett, 2017, p. 27). Even though Saskatchewan, like many other provinces, never fully developed sterilization legislation, a legacy of sterilization of Aboriginal Women remains within Canada's healthcare system (Boyer & Bartlett, 2017 (Lux, 2016). The legacy of assimilation and containment of Aboriginal Peoples within the healthcare system affects the provision of healthcare for Aboriginal Peoples in present day. Anti-Indigenous racism is a social determinate of health that produces inequities within health and the provision healthcare for Aboriginal Peoples as it enforces a racial hierarchy that privileges white people through white supremacy (Bonds & Inwood, 2016;Grienier, 2020;McCallum & Perry, 2018). Through these racial categories, Aboriginal Peoples face racial violence that is embedded within the settler state, therefore is present in the Cases of coercive and forced sterilization of Aboriginal Women have occurred as recently as 2018 (Rao, 2019;Virdi, 2018;Zingel, 2019). Allegations of coercive and forced sterilization have been reported in the Yukon, North West Territories, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec (Rao, 2019;Virdi, 2018;Zingel, 2019), which speaks to a need for healthcare professionals to unlearn colonialism and white supremacy. For these reasons, I advocate for the implementation of anti-oppressive pedagogies in undergraduate medical education to eradicate the practice of coercive and forced sterilization of Aboriginal Women.

Coercive and Forced Sterilization
The Royal Proclamation of 1763 built the foundation for colonial relations in Canada (Woolford, 2009). British settlers saw the proclamation as a device to restrict Aboriginal Peoples to reservations through treaty agreements to gain access to resources ( Enfranchisement had severe consequences specifically for First Nations Women. Women lost status and rights to property within her community, if she married a non-Aboriginal man (Hampton, Bourassa, McKay-McNab, 2004). Furthermore, disenfranchisement was passed onto her children (2004). For First Nations Women, their identity and the identity of their children was dictated by their husband, however this was not the case for First Nations Men (2004).
Under the Indian Act, Aboriginal Women were also banned from participating in Aboriginal governance systems until 1951 (Hampton, Bourassa, McKay-McNab, 2004;Stote, 2015). The Indian Act imposed Eurocentric legislation onto Aboriginal Peoples that was steeped in racism and sexism (Green, 2007;Hampton, Bourassa, McKay-McNab, 2004). The colonial agenda in Canada is bound to racist and sexist policies that have systemically targeted Aboriginal Women to aid in containment and assimilation of Aboriginal Peoples.

Targeting Aboriginal Women for Coercive Sterilization
Sexual sterilization as a eugenics and social hygiene intervention is a product of the colonial agenda through classism, ableism, racism, and sexism. Industrializing Canada created high rates of poverty and illness, thus eugenicists posited sterilization the most cost-effective solution to fix social problems instead of implementing better housing, sanitation, nutrition, living wages, and safer work environments (Stote, 2012). Moreover, sterilization addressed public health problems by placing blame on individuals for illness and poverty with failure to mention systemic causes (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2015).
Eugenicists did not consider the implications of colonialism on Aboriginal Peoples, but instead looked to Aboriginal Peoples as possessing traits resulting in illness that made them a threat to Anglo-Saxon society. In 1904, the deputy superintendent of Indian Affairs explained that poor health on reserves and in Aboriginal communities is a product of moral failure of Aboriginal Peoples, high birth rates, and some inherent mental, moral, or physical defect (Stote, 2015). The presumed moral short comings of Aboriginal Peoples resulting in poor health became a means for eugenicists to target Aboriginal Women for sterilization.
Eugenicists targeted people with mental defectiveness for sterilization (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2015). Mental defectiveness, also referred to as mental deficiency or feeblemindedness, was described in legislation as, "any person in whom there is a condition of arrested or incomplete development of mind existing before the age of eighteen years, whether arising from inherent causes or induced by disease or injury" (Harris-Zsovan, 2010, p. 77-78). The intelligence quotient (IQ) test and other psychometric examinations were deployed to determine the degree of mental defectiveness of an individual, across eugenics interventions in North America (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2015). IQ tests became the primary method to diagnosing mental defectiveness because this tool was thought to establish a level of scientific merit to the diagnosis (Stote, 2015). Under the Sexual Sterilization Act, "records indicate that patients whom the [Eugenics] Board wished to sterilize were often subject to more than one test in hopes that their score would fall within the criteria for mental deficiency" (Stote, 2015, p.47). The designation of mental deficiency was used, in an ableist fashion, by physicians and the state to justify a patient's sterilization.
Mental deficiency was commonly associated with women who were non-Anglo Saxon,  (Stote, 2015). Children born with vitamin deficiencies score 20 to 40 percent lower than the average on IQ tests (2015). Therefore, the use of IQ tests to determine mental defectiveness of a patient by physicians as a justification for sterilization disproportionality targeted Aboriginal Peoples because of the conditions colonization created, which privileged settler knowledge over Aboriginal knowledge systems and forced Aboriginal Peoples to live in unethical conditions that perpetuated illness, thus lowing IQ scores.
Colonialism allowed for Aboriginal Women to be targeted by eugenics interventions.
Policing of the sexual activity of Aboriginal Women began after confederation in Canada (Stote, 2015). During the early years of colonization, Aboriginal Women were exploited by settlers as sexual and political commodities (2015). Since colonization, the sexual practices of Aboriginal Women were portrayed as disrespectful to Anglo-Saxon values (2015). Aboriginal Women were seen as sexually promiscuous therefore, "blamed for prostitution, the spread of venereal disease and alcohol problems, and were generally said to represent a threat to the public" (2015, p.40). In the late 19 th and early 20 th century, social reform movements enforced Eurocentric-Christian ideals onto Aboriginal communities, whereby Aboriginal Women were relegated to the private sphere to complete domestic work (McLaren, 1990;Stote, 2015). Reformist forced Aboriginal Women to conform to Christian understandings of womanhood (Stote, 2015). To combat resistance to assimilation, the state forced Aboriginal Women into prisons, reformatories, or training school to instill middle-class, settler notions of womanhood (2015). The criminalization of Aboriginal Women and their sexuality resulted in settlers labelling them as bad mothers, thus unfit for child rearing (2015). Criminalizing the sexuality of Aboriginal Women became a means of assimilation and containment of Aboriginals Peoples that worked to prevent growth of Aboriginal populations.
Within eugenics, two models of understanding the role of women emerged in the early twentieth century. There was the mother of the race -moral, civilized women (Stote, 2015).
These women were deemed fit by eugenicists, meaning they were white, Anglo Saxon, abled bodied, and of socioeconomic means. The second model, moron girl, described women that were immoral, uncivilized and therefore posed a biological threat to advancement of the white settler state (2015). Women that were placed into the latter category were more likely to experience coercive sterilization as a means to mitigate the threat of their ability to reproduce. Maternal feminists leveraged this model of conceptualizing womanhood to gain voting rights and reproductive freedom for white women. Maternal feminism aimed to gain societal privileges for white women and protect white families by limiting contact with unfit and/or non-white people (2015). Women who were prostitutes, sexually active prior to marriage, had illegitimate children, multiple sexual partners, deemed mentally deficient, and/or belonged to an Aboriginal community were seen by maternal feminist as threating to white society through perceived promiscuity (2015). Maternal feminism was a racist form of feminism, "that excluded certain women from the specifically Anglo-Saxon work of building the nation" Court Judge and presided over cases advocating for women to be sterilized as oppose to jailed for crimes committed (Dyck, 2013;Stote, 2015). Maternal feminism wanted to bring social purity to Canadian society, by ensuring a white settler state and worked with the state policy makers and physicians to accomplish this goal. Maternal feminists reinforced eugenic attitudes that women should be defined by reproductive capacity (Dyck, 2013;McLaren, 1990;Stote, 2015). Eugenics discourse became tied to feminism focused on securing rights for middle-class, Christian white women (Dyck, 2013). Therefore, maternal feminism and eugenics aligned to institute classism, racism, ableism and sexism onto societal understanding of womanhood and motherhood to further colonization in Canada.
Women, namely middle-class, white feminists, began lobbying for sterilization due to the strain that multiple pregnancies placed on families. The rhetoric of sterilization became heighted during the Depression because of the economic burden children presented on families (Dyck, 2013). Since the Catholic Church and other Christian-based religious intuitions condemned contraception and abortions, sterilization became an option for birth control. However, members of both church and state feared that sterilization of middle-class, white women meant that, "the race…is being robbed of its future in the name of medical science" (2013, p.96). Canadian eugenics figure R.C. Wallace encourage women to: "be brave, clean, resolute, with a firm determination with the sacred issues of life, but rather than we be mothers in the true spirit of motherhood, with the uniting zeal to fill the full measure of our being here as instruments in the hands of God in people, Christianizing and redeeming the human family" ( 2013, p.97).
Wallace wanted white women to reproduce to grantee a white future in Canada. Eugenics supporters hold beliefs rooted in white supremacy, as they wanted to ensure a white majority in Canada to maintain a white settler state. Thus, the state along with physician support created strict policies around the sterilization of white women who voluntarily wanted to be sterilized as a form of birth control. In the late 1960s, stigma surrounding contraception and abortion continued, sterilizations became a more common form of birth control amongst white mothers (2013). Sterilization surgeries amongst middle-class, married, white women were only preformed in the 1970s if women met one of the following criteria: 1) if a woman has five or more children at any age; 2) if a women had four or more children and was over twenty-five years of age; 3) if a women had three or more children and was over thirty years of age; 4) if a woman was over thirty-five years of age (2013, p.110).
The opposition of both church and state to the sterilization of white women in Canada is rooted in white supremacy. The coercive and forced sterilization of Aboriginal Women was of no concern for the church and state, however the consensual sterilization of middle-class white

Physicians and the Coercive and Forced Sterilization of Aboriginal Women
Aboriginal communities have managed health and wellness of their Peoples for many generations prior to contact with colonizers. Many early-colonizers made use of medicine and healthcare provided to them by Aboriginals Peoples (Lux, 2016;RCAP, 1996;Stote, 2015 Aboriginal Peoples to receive healthcare through settler institutions, while making resistance to these policies illegal (Stote, 2015). Aboriginal Peoples were forced to depend on the Canadian healthcare system for health services.
The impositions of the Indian Act caused poor health for many Aboriginal Women that resulted in pregnancy and postpartum complications, causing low birth rates and high infant mortality (Stote, 2015). The Government of Canada refused to acknowledge that poor health in Aboriginal communities, such as high infant and maternal mortality, was a direct result of colonization. Instead the state increased medicalization of Aboriginal communities, which aided in colonization through assimilation and containment of Aboriginal Peoples within the Canadian healthcare system (Lux, 2016). Aboriginal Women living in the North or on reserves were evacuated to settler institutions in the South for gestational and postpartum care (Lawford & Giles, 2012;Stote, 2015). Additionally, Canadian physicians critiqued Aboriginal birth practices by blaming Aboriginal Midwives for infant and maternal death (Stote, 2015). Aboriginal health practices were seen by medical practitioners to be in direct contrast to the Euro-Canadian biomedical model, thus Aboriginal Midwifery became criminalized within health policy (2015).
Through assimilation tactics, health policy in Canada aimed, "to turn Aboriginal peoples into citizens to whom the federal government no longer had obligation or responsibilities, and it was hoped that Aboriginal peoples would take fiscal responsibility for their own health care" (Stote, 2015, p. 40 (Lux, 2016;Stote, 2015). Hospitals and other settler healthcare institutions allowed for, "increased surveillance over First Nations families and borrowed the language of modern scientific medicine to justify aggressive health interventions…" (Dyck, 2013, p. 61 (Lux, 2016). The Indian Problem refers to settlers' anxieties around Aboriginal Peoples as threats to national hygiene and morality. The first Indian Hospital was opened in 1946 in Alberta and soon after, Indian Hospitals were constructed from coast-to-coast-to-coast. Within these institutions, medical practitioners took on the dual role of doctor and Indian Agent (Dyck, 2013). Indian Agents, a role created under the Indian Act, were state officials that policed the movement and organizing of First Nations Peoples to aid assimilation (Titley, 2009;Satzewhich & Mahood, 1995). Indian Agents took on the views of the state with interest in controlling First Nations lands, power, education, and other aspects of life including culture (Titley, 2009;Satzewhich & Mahood, 1995). Physicians take on the role of Indian Agents in healthcare settings, like hospitals, by policing Aboriginal Peoples' health and movement through the healthcare system in alliance with the Canadian Government. In Indian Hospitals, Aboriginal patients received unethical healthcare, which ranged from experimental surgeries, to drug and vaccine testing, and to coercive and forced sterilization (Lux, 2016). Indian Hospitals, thus, became another device employed by Canada and maintained by medical doctors to assimilate and contain Aboriginal Peoples, thus advancing the colonial agenda.
Within the Canadian healthcare system, racism informed by eugenics and other forms of Social Darwinism influenced medical practices on the basis of a patient's race (Dyck, 2013). As a result, medicine became a solution to fixing social problems commonly associated with racialized peoples (Dyck, 2013;Lux, 2016;McLaren, 1990;Ladd-Taylor, 2017). During the eugenics movement, but prior to official sterilization policies being enacted in Canada, "doctors managed to sway government and public health officials to turn to medical sciences for efficient methods of social management and in doing so, made themselves the authority on all things related to health" (Stote, 2015, p. 17). Since Anglo-Saxon society perceived biological and hereditary traits as the cause of social issues, physicians leveraged these racist perspectives to strengthen their position as the profession to implement eugenics interventions (McLaren, 1990).
Within the early twentieth century, medical practitioners gained social and political power to become medical experts.
Many pro-sterilization physicians were able to advocate to the medical community and

Physician-Assisted Genocide in Canada
Aboriginal Women were disproportionality targeted for sterilization in comparison to other identity groups. The bias of coercive and forced sterilization of Aboriginal Women through eugenics policies and practices across Canada was known to and supported by the federal government. Indian Health Services was aware that Aboriginal Women were being sterilized by physicians without proper legal channels of consent (Stote, 2015). Additionally, many Aboriginal Women were sterilized for non-medical reasons, which was illegal.  In an external review on cases of coercive sterilization in Saskatoon Health Region, Boyer and Bartlett (2017) reported that First Nations and Métis Women were profiled and discriminated against by healthcare professionals that promoted sterilization as the responsible option to control births. In their work, Tubal Ligation in the Saskatoon Health Region: The Lived Experience of Aboriginal Women, Boyer and Bartlett (2017), demonstrate that women were told the procedure was reversible, which is untrue. Some women actively resisted by refusing to consent to the procedure, but doctors went ahead with sterilization. Women felt powerlessness and experienced racism by physicians, nurses, and social workers, who in many cases were providing care for them during labour and delivery. The review called for education in medical schools to ensure medical practitioners understand the people they serve. This recommendation, along with the Calls to Action of the TRC demonstrates a formal request for medical practitioners to un-learn colonialism and anti-Indigenous racism during medical school and to build anti-oppressive practices to structurally change the provision of healthcare in Canada. The subsequent chapter will look to the work medical schools have done to counter the racism, sexism, ableism and classism as products of colonialism within Canada that informs medical practices, which permitted the genocide of Aboriginal Peoples through coercive and forced sterilization.

Canadian Undergraduate Medical Education
Colonial medical practices embedded in racism, sexism, classism, and ableism must be

Situating Anti-oppressive Pedagogies in Undergraduate Medical Education
The TRC (2015) demands that medical schools incorporate courses to build intercultural competency, conflict-resolutions, human rights, and anti-racism, which can be understood as anti-oppressive pedagogies, by educating students on Aboriginal health issues, Indian Residential Schools, United Nation Declaration on the Rights of Indigenous Peoples, Treaties, Aboriginal rights, and Indigenous teachings and practices, which will be referred to as Indigenous content requirements. I leverage the TRC Call to Action to insist on anti-oppressive pedagogies in undergraduate medical education embedded within the curriculum to ensure all students to unlearn biases they hold towards members of the communities they will serve. Anti-oppressive pedagogies acknowledge culture, race, class, religion, gender, ability, sexuality, and other factors that bias the provision of healthcare by medical doctors. Instead of focusing on one form of activism, education, and opposition, anti-oppressive practices is an umbrella term for social justice-oriented approaches like cultural safety, anti-colonial, and anti-racism, which is In a 2013 review of undergraduate medical programs with cultural safety-related curriculums, many medical schools took steps to increase Aboriginal student representation by offering supplementary application processes and designated spots for Aboriginal students (Baba, 2013). These initiatives increased enrollment of students that self-identified as First Nations, Métis, and Inuit (2013). Furthermore, some schools offered elective courses on Aboriginal health and elective clerkships in Aboriginal communities. However, the Northern Ontario School of Medicine was the only medical school that had taken steps to embed Aboriginal health within the curriculum for all students (2013). While increasing the number of Aboriginal students in medical schools is a promising initiative, the reality is that white-settler students are the majority of applicants (Friesen, 2019). The advantages of white-settlers is noted by the University of Manitoba, which revealed a pattern in their admissions process: wealthy white students from big cities were more likely to be interviewed and more likely to get in, partly because of built-in advantages. As undergrads they don't have to work part-time to pay for school, they're able to pay for MCAT prep courses and, in interviews, they can cite an impressive range of travel and volunteer experiences (2019).
The white majority amongst medical students demonstrates the systematic advantage of the  (Verma, 2017, p.1). In 2019, the AFMC released the Joint Commitment to Action on Indigenous Health to guide, "Canadian medical schools to respond to the TRC Calls to Action and fulfill their social accountability mandate with respect to Indigenous health" (AFMC, 2020). Curriculum was one of the themes the AFMC prioritized to answer the 24 th Call to Action of the TRC and identified that "in order to meet this call, Canadian medical schools are faced with a number of challenges, from developing curricula that address both national and regional Indigenous health issues, to mobilizing resources and overcoming barriers to implement this curricular change" (Anderson et al., 2019, p. 11). The goal of the curriculum outlined by the AFMC would be to teach about anti-Indigenous racism, cultural competency, cultural safety, and anti-colonialism.
Within the report, the AFMC acknowledges that currently, "concepts that form the core of anti-racist/ anti-colonial pedagogy, such as privilege, systemic power dynamics, Whiteness, settler, and oppression, are not present in the framework" (Anderson et al., 2019, p. 13). The AFMC demands, through an action statement that, "medical schools commit to the development and implementation of a longitudinal Indigenous health curriculum with anti-racism/ anticolonialism as the core pedagogical approaches" (2019, p.14). To review the advancements made in undergraduate medical school curriculums in achieving the action statement proposed by the AFMC, and more importantly the 24 th Call to Action of TRC, results from a scan of publicly available undergraduate medical school curriculums are displayed in Table 1.
Additionally, my research results include data from a 2013 study that examined cultural safetyrelated curriculum in undergraduate medical education. Through a scan of medical curriculums, the AFMC and other stakeholders can better understand each school's progress in developing curriculum that meets the AFMC's action statement and Calls to Action of the TRC.

Results of Undergraduate Medical Curriculum Scan
Undergraduate medical education programs across Canada vary in engagement with antioppressive pedagogies that complies with the action statement made by the AFMC and the Call to Action of the TRC. While each medical school is implementing some degree of cultural competency and/or cultural safety programming through courses and/or clerkship opportunities, anti-Indigenous racism is not specifically addressed in undergraduate medical curriculums. Many curriculums focused on cultural sensitivity, competency, and safety. Cultural sensitivity can be understood as awareness about ethnic and cultural preferences of an individual in order to explain attitudes and responses of the individual to their environment (Baba, 2013;Sekerci & Bicer;Unver, Uslu, Kocatepe, & Kuguogle, 2019). Education on cultural competency focuses on skill-building exercises that increases healthcare providers understanding of diverse cultures and how to ensure the needs, values, beliefs, and practices of the client is incorporated into care (Baba, 2013;Karnick, 2016;Polster, 2018). Coined and developed by Māori midwives and nurses in the 1980s, cultural safety addresses power relations between the client and healthcare provider to hold the provider responsible for addressing professional and institution powers that make an environment unsafe or safe for a client (Allen & Smylie, 2015;Baba, 2013). Cultural safety reaches beyond cultural sensitivity and competency to look to power imbalances, institutional discrimination, and colonization within healthcare (Baba, 2013). While cultural sensitivity, competency, and safety training offer valuable skills to healthcare professionals serving diverse clients, these trainings do not counter racism that underpins poor and unethical healthcare provided to Aboriginal Peoples.
The action statement made by the AFMC specifically stated that curriculums need to include anti-racism and anti-colonialism as the core of pedagogical framework (AFMC, 2019).
Out of the 17 medical schools in Canada, anti-racism was not named in any curriculums nor was anti-colonialism, however 8 schools (University of Alberta, University of British Columbia,

University of Calgary, Université Laval, McGill University, Université de Montréal, Northern
Ontario School of Medicine, and Université de Sherbrooke) outlined colonialization as a course topic. Therefore, all undergraduate medical programs have to make curriculum revisions to answer the Call to Action of the TRC.

Medical Education
Practices and policies rooted in anti-racism and anti-colonialism are critical to the improvement of Aboriginal health. The relationship between race and colonization are intertwined, because white Europeans used socially constructed racial categorization to justify colonization, slavery, and other containment projects involving racialized peoples that benefited white people (Allen & Smylie, 2015). Racism can broadly be defined as, "actions that further disadvantage the disadvantaged or further advantage the advantaged" (Paradies, Harris, & Anderson, 2008, p.4). Racism is operationalized through institutional, interpersonal, epistemic, and internalized racism. Institutional racism, which is also known as structural or systemic racism, maintains injustice across racial groups through social systems that inform societal practices, policies and progress, which remain unchallenged by those in positions of power that can reduce inequities (Paradies et al. 2008, Reading 2013Smylie & Allen, 2015). The disproportionate coercive and forced sterilization of Aboriginal Women in settler healthcare institutions is a current example of institutional racism. Interpersonal racism occurs between people through verbal, behavioural, and/or violent slights, slurs, stereotypes, insults, microaggressions, and assaults that are hostel derogatory, and/or negative racial attacks towards an individual or group (Smylie & Allen, 2015). Epistemic racism is the positioning of knowledge, commonly Eurocentric knowledge or knowledge produced by white people as more superior than knowledge from racialized peoples (Reading, 2013;Smylie & Allen, 2015). The Peoples from their communities, and remove Aboriginal children from their mothers and communities at disproportionate rates when compared to non-Aboriginal people (Stote, 2015). I impress upon medical school administration to actively commit to the action statement made by the AFMC to make anti-racism and anti-colonialism a core component of medical education by implementing anti-oppressive pedagogies.
By opting to teach cultural sensitivity, competency, and safety in medical schools, educators and administrators of these intuitions risk conflating culture and race. The focus on cultural differences in medical curriculums between Aboriginal Peoples and non-Aboriginal people can be appreciated as a method to avoid addressing racism in healthcare and on a larger scale in Canada (Browne, 2005Smylie & Allen, 2015. The use of culture to diffuse discussions of racism in Canada is not new (Browne, 2005;Henry, Tator, Mattis & Rees, 2006). By pinpointing culture within medical education as the social determinate of health causing health disparities in Aboriginal communities, medical school administrators fail to acknowledge institutional and epistemic racism, racism happening at macro-levels of social interaction, within the Canadian healthcare system, which permits racism at micro-levels in the form of interpersonal and internalized racism. In other words, undergraduate medical school curriculums do not acknowledge the role of institutional and epistemic racism in shaping interactions between Aboriginal clients and healthcare provides. Medical school curriculums that are culturally-focused must analyze how culture became a way of oppressing Aboriginal Peoples.
Racism and colonialization, both in historical and contemporary contexts, influence the marginalization of Aboriginal culture from white culture (Smylie & Allen, 2015). Therefore, culturally-focused curriculums must be adapted to be paired with anti-racism and anti-colonial pedagogies to properly discuss health disparities within Aboriginal Communities.

Working towards Anti-Oppressive Pedagogies in Undergraduate Medical Education
The historical and ongoing coercive and forced sterilization of Aboriginal Women demands justice in medical education to prevent medical practitioners from continuing this genocidal practice. Through Aboriginal-led and institutionally funded and supported Indigenous course requirements rooted in anti-oppressive pedagogies, medical schools can properly begin Indigenizing and decolonizing medical education to lay a foundation to combat racism, colonialism, sexism, classism, and ableism within the Canadian healthcare system. Indigenous scholars and anti-racist scholars in Canada identify ignorance as an impediment to the process of decolonization (Grenier, 2020;Schaefli, Godlewska, Korteweg, Coombs, Morcom, & Rose, 2018). Within healthcare, and other institutions, ignorance permits the continuation of unjust systems that retrench inequities faced by Aboriginal Peoples (Couthard, 2014, Dion, 2009, Schefli et al., 2018. It is through "what is taught and what is omitted from curricula and textbooks, through how content is taught, and through the mindsets of teachers and teacher educators" (Schaefi et al., 2018, p. 692) that ignorance within medical education programs is maintained and passed along to every cohort of learners. I strong insist that by answering the TRC Calls to Action and embodying the social accountability action statement regarding Indigenous Health made by the AFMC, Canadian medical schools can begin to decolonize and Indigenize undergraduate education.
A study conducted across 10 Ontario Universities involving 2,899 first year undergraduate students who graduated from an Ontario secondary school answered a questionnaire to determine knowledge surrounding Aboriginal geographies, histories, culture, governance, and current events (Schaefli et al., 2018). The questionnaire was designed in partnership with over 200 Frist Nations, Métis, and Inuit educators based on what students should know from the Kindergarten to Grade 12 (K-12) curriculum in the province of Ontario.
The average score on the questioner was 24.28% (SD = 16.06%, range of 0 to 86%), with Aboriginal students scoring higher than non-Aboriginal students on average, thus suggesting that most students have had little to no exposure to question topics. The results of this study demonstrate that non-Aboriginal university students do not have an understanding of Aboriginal geographies, histories, culture, governance, and current events, therefore ignorance is prevalent amongst individual students and the education system when it comes to the lives of Aboriginal communities within Canada.
One of the most overwhelming findings of this questionnaire was that, "students seem to believe that wherever Indigenous people are, they are not here; not present and by implication not relevant to their daily lives" (Schaefli, 2018, p. 718 The maintenance of white power in Canada to create a white settler state is an act of white supremacy because colonial policies use race to develop the hierarchal organization of society to position white people as superior (Allen & Smylie, 2015;Grenier, 2020;McCallum & Perry, 2018). I assert the historical and ongoing cases of forced and coercive sterilization of Aboriginal Women are acts of white supremacy that must be unlearned as a medical practice through the implementation of Indigenous content requirements through anti-oppressive pedagogies in undergraduate medical education in Canada.

Healthcare as White Supremacy
White supremacy is produced through violence and racial structures to create and maintain a white settler state (Bonds & Inwood, 2016 (Bronca, 2016;Shevell, 2012).
Consider by the CBC in 2004 to be on the list of "Greatest Canadians," Douglas, during the first half of the 20 th century, advocated for sterilization of mentally deficient and un-moral women (Shevell, 2012 (Allen & Smylie, 2015;Berg, 2012;Grenier, 2020;Hole et al., 2015;McCallum & Perry, 2018;Wilkes, 2020). The normalization of whiteness has a long-standing history. In the late 19 th and early 20 th century, Social Darwinism theorized that Indigenous Peoples and Black People, globally, were the least evolved race and as such, they presented uncivilized behaviours that needed saving by white people (Berg, 2012, Dyck, 2013Grenier, 2020;Harris-Zsovan, 2010;Hole et al., 2015;McLaren, 1990;Stote, 2015 (Lalonde, Butt & Bucio, 2009;Lux, 2016;Neufeld & Cidro, 2017;Stote, 2015). The criminalization of Aboriginal health knowledges is an act of assimilation to ensure Aboriginal Women would have to use healthcare that was provided by the settler state, which allowed for increased surveillance of their sexualities and reproduction. Physicians, Indian Agents, and government officials used the healthcare system to quarantine, contain, and institutionalize Aboriginal Peoples to aid the state in gaining access to land that housed Aboriginal communities (Grenier, 2020;Lux, 2016;Neufeld & Cidro, 2017, Stote, 2015. Within the Canadian healthcare system, physicians were able to coercively and forcibly sterilize Aboriginal Women because the settler state saw this intervention as a means to curb illness, poverty, and other social problems that were presumed to be caused by the moral short comings of Aboriginal Peoples. Through the implementation of Social Darwinism, eugenicists theorized that Aboriginal Peoples lacked morality compared to white people, therefore interventions like coercive and forced sterilization were a permanent solution to public health problems because Aboriginal populations decreased (Dyck, 2013;Harris-Zsovan, 2010;McLaren, 1990;Stote, 2015;Stote, 2012). To ensure the genocide of Aboriginal Peoples through the coercive sterilization of Aboriginal Women, the state enacted policies to prevent fertility of Aboriginal Women, whilst promoting the fertility of white women by banning their sterilization, unless they met strict criteria, like having five or more children (Dyck, 2013). Aboriginal Women, described as the moron girl, were seen as threats to the white settler state because of their ability to reproduce (Stote, 2015). Therefore, the state enacted policies to ensure that Aboriginal Women would be sterilized. The use of IQ tests by physicians, to avoid patient consent for sterilization procedures, assessed intelligence based on Eurocentric knowledge.
Physicians, along with Eugenics Boards and policy makers, not only position whiteness in terms of race as superior, but also in terms of knowledge. Placing Eurocentric knowledge systems as superior to Aboriginal knowledge systems positions white people as intellectually superior to Aboriginal Peoples. Physicians used IQ tests to label Aboriginal Peoples as mentally defective to forced Aboriginal Women to undergo sterilization procedures to prevent their reproduction to maintain a white settler state. Furthermore, white women, described as the mother of the race, were encouraged to reproduce and were not allowed to be sterilized unless they a had a certain number of children to aid in building of the nation to be a white settler state (Dyck, 2010;Stote, 2015). Sterilization maintained white power through the genocide of Aboriginal Peoples by preventing reproduction and through the promotion of fertility amongst white women.
Building of a white settler state through genocide via forced and coercive sterilization mediated by the Canadian healthcare system is an act of white supremacy permitted by the state and carried out by physicians and other healthcare professionals. The ongoing practice of coercive and forced sterilization of Aboriginal Women, and genocide of Aboriginal Peoples demonstrates that the healthcare system in Canada still operationalizes white supremacy.

Eradicating White Supremacy in Undergraduate Medical Education
Considering the coercive and forced sterilization of Aboriginal Women is a contemporary healthcare practice in Canada, many physicians remain complicit in building a white settler state, and thus are engaging in white supremacy and genocide. Healthcare in Canada is complicit in keeping "anti-Indigenous colonial relations alive through the continued oppression and exploitation of Indigenous individuals" (Grenier, 2020, p.4). To challenge anti-Indigenous racism in the Canadian healthcare system, white supremacy must be unlearned. Anti-oppressive pedagogies in undergraduate medical education programs must be imbedded into the curriculum to lay a foundation for the eradication of white supremacy in healthcare services.
continues to exist in Canada as there are over 100 cases, as recent as 2018, of Aboriginal Women being forced and coerced into sterilization. White supremacy is a part of healthcare in Canada.
To answer the Calls to Action of the TRC, medical schools must make a commitment to dismantling white supremacy within the healthcare in Canada. Considering the results of undergraduate medical curriculum review, displayed in table 1, medical educators and administrators must build upon culturally-based learning to incorporate anti-racism and anticolonialism within the curriculum. By rooting undergraduate medical education in anti-racism and anti-colonialism, medical schools challenge white supremacy by Indigenizing and decolonizing the curriculum, which challenges education that establishes racial hierarchies that position whiteness as superior and justifies colonization. Education that solely focus on accepting, acknowledging, and allowing for cultural difference through cultural sensitivity, competency, and safety training does not challenge racism or white supremacy in undergraduate medical education. The Canadian government promoted multiculturalism, through culturallybased training in Canadian institutions as a method to avoiding the use of language surrounding race and ethnicity (Grenier, 2020). Within healthcare and medical education in Canada, cultural sensitivity, competency, and safety training is seen as the method to promote health equity.
However, "cultural competency should be regarded not as a response to, but rather as a logical product of, institutionalised racism that functions as a tool in the reproduction of White supremacy in healthcare systems" (2020, p.3). Culturally-based training in healthcare normalizes whiteness and makes Black People, Indigenous Peoples, and People of Colour the Other. The presumed white physician is learning about the Other and prefects their skills to abilities to treat all Others (2020). Therefore, the white healthcare provider is pictured as the knower of the Other and the problem solver in the fight against oppression, whilst the Other is the problem that becomes fixed (Grenier 2020;Razack 1995). Using a more self-reflexive culturally-based education, like cultural humility training, which "provides a personal evaluation of one's own cultured positioning such that it brings about greater understanding for others' cultures, perspective and realities" (Carey, 2015, p. 835), decenters whiteness from learning, such that whiteness is no longer normalized. Dismantling white supremacy cannot only consist of cultural humility, medical schools must go beyond the rhetoric of multiculturalism and dismantle anti-Indigenous racism.
Currently, medical education at Canadian medical school focuses solely on cultural competency, sensitivity, and safety in relation to Aboriginal Health. In order to deconstruct white supremacy within the healthcare system in Canada, education needs to de-centre whiteness, so Eurocentrism is no longer normalized within the provision of care. Anti-oppressive pedagogies enforce an educational framework that pivots from normalizing whiteness through cultural competence, by dismantling Eurocentric knowledge systems that maintain white supremacy and there by anti-Indigenous racism (Grenier 2020;Gaudry & Lorenz, 2019). To answer the Calls to Action of the TRC and implement the action statement made by the AFMC, medical school administration needs to imbed anti-oppressive pedagogies within undergraduate medical education curriculums.

Conclusion
Over 100 Aboriginal Women have bravely come forward, in recent years, to voice their experience of coerced and forced sterilization by Canadian physicians. The experiences of these women are a part of a legacy of colonialism, genocide, and white supremacy within the Canadian healthcare system. In the early 20 th century, physicians with the support of federal and provincial governments ushered in eugenics interventions, which targeted Aboriginal communities across Canada (Dyck, 2013;McLaren, 1990;Stote, 2012;Stote, 2015). Additionally, the Canadian government criminalized Aboriginal healthcare, such that Aboriginal midwifery and other reproductive health practices were illegal (Stote, 2015). Through the Indian Act and other colonial policies, Aboriginal Peoples were forced to use the Canadian healthcare system, which allowed physicians to surveil Aboriginal bodies that were contained within institutions, like Indian Hospitals (Lux, 2016). As Aboriginal Women were forced to seek healthcare by settler physicians, they became targets for eugenics interventions, such as sterilization. The goal of sterilization was to prevent births in Aboriginal communities, through genocide, to aid in assimilation of Aboriginal Peoples in order for Canada to remain a white settler state (Stote, 2015). As physicians continue the practice of coercive and forced sterilization of Aboriginal Women in present day, they also continue the genocide of Aboriginal Peoples and maintain white supremacy that was established with colonization.
I implore physicians, governing bodies of medicine and medical education, and future physicians to understand that coercive and forced sterilization of Aboriginal Women must end because it is an act of genocide. I leverage to educators and administrators of undergraduate medical education in Canada the need for proper training to unlearn anti-Indigenous racism in healthcare that permits genocide of Aboriginal Peoples. Based on the 24 th Call to Action of the TRC (2015) and the action statement made by the AFMC on Indigenous health, I ask that medical schools implement Indigenous content requirements through anti-oppressive pedagogies within undergraduate medical education. In a review of undergraduate medical educations curriculums, medical schools have taken steps to incorporate Indigenous content requirements through cultural sensitivity, competency, and safety training through courses and clerkships.
However, education must now be root in anti-oppressive pedagogies to combat racism and colonialism. An-overhaul of Canadian undergraduate medical education is a small price to pay for the long-standing legacy in healthcare of coercive and forced sterilization of Aboriginal Women. Thousands of Aboriginal Peoples have been sterilized within the past 100 years.
Unlearning anti-Indigenous racism, colonialism, and white supremacy is no longer an option, it must be a requirement to be able to work as a physician in Canada.
I urge the 17 medical schools in Canada, the AFMC, the Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada to act on the 24 th Call to Action of the TRC to decolonize and Indigenize medical education. Reconciliation is not only accomplished by Aboriginal Peoples' resistance against colonialism, settlers need to act in solidarity with Aboriginal Peoples. We, as white settlers, have been given recommendations to facilitate reconciliation and decolonization in Canada, it is time that we act.