The Long and Sordid History of Forced Sterilization Programs

The whistleblower nurse in Georgia told a grim story that’s been a part of American history for decades

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Charmaine Fuller Cooper was outraged — but not surprised — when she heard recent allegations that a Georgia detention center performed medically questionable hysterectomies on undocumented immigrants without their consent.

On September 14, advocacy groups filed a complaint that accused the Irwin County Detention Center, which houses immigrants for federal Immigration and Customs Enforcement (ICE), of subjecting some immigrants to unnecessary hysterectomies and denying critical services, such as diabetic care and coronavirus testing.

“I was horrified because, in the back of my mind, I saw all the children in the detention camps (because that’s what I’m calling them on the border),” Cooper says. “And I was concerned because, going back into the history, we have petitions for children as young as five years old to be sterilized in North Carolina.”

Cooper served as executive director for the NC Justice for Sterilization Victims Foundation from 2010 until 2012. In that position, she was empowered to research, find, and offer up to $50,000 in compensation to North Carolinians who were forcibly sterilized by the state.

North Carolina had one of the nation’s longest-running state sterilization programs, which spanned from the 1920s to the 1970s. Threatening residents with the loss of welfare benefits or family separation, local health departments and networks of social workers and clinicians rendered 7,600 residents unable to have children because they were considered “defective, “deviant,” or “feebleminded.”

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They earned those labels for stigmatized health conditions or behaviors: petty theft of bicycles, cognitive disabilities, mundane school troubles, dressing as a different gender, getting pregnant or staying out late as teen, or simply being born into a poor family at a time when many people believed poverty and criminality were inherited traits. In 2002, North Carolina Democratic Gov. Mike Easley apologized for the program. But it took almost a decade for the legislature to approve $10 million dollars in restitution to 250 people, only a fraction of those affected.

At one time, virtually every state advocated “human betterment” by culling the ranks of so-called undesirable people — often working-class White people, girls and women judged to be sexually precocious or promiscuous, the mentally ill, the incarcerated or substance abusers, and those with chronic illnesses. Increasingly, those undesirables were Black, Latinx, and Native people.

Justice Oliver Wendell Holmes took only three pages to explain that forced sterilization was not only constitutional but also, in some instances, a service to society.

And for the most part, legislators didn’t try to hide it. The late North Carolina Republican Sen. Wilbur Jolly sponsored a 1957 mandatory sterilization bill that would have declared any woman with two children outside marriage to be “feebleminded,” and he notoriously wagged his finger at Black visitors to the General Assembly, saying that “one out of four of your race is illegitimate.”

In North Carolina’s 7,600 documented cases, about 5,000 of those sterilized were Black, and others were Native people, particularly from the Lumbee tribe.

The Georgia allegations and the North Carolina program are part of a long and sordid history of forced sterilization programs, which often initially focused on White women. The legal part of that history can be traced back to the 1927 U.S. Supreme Court decision Buck v. Bell.

In a majority opinion that was nakedly explicit about how easy it is to revoke indigent people’s rights, Justice Oliver Wendell Holmes took only three pages to explain that forced sterilization was not only constitutional but also, in some instances, a service to society. The respected jurist wrote, “It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.”

At issue was the case of Carrie Buck, an 18-year-old White Virginia resident. An unmarried mother of a baby girl, Buck had been labeled morally bankrupt and beyond redemption. Authorities claimed “like mother, like daughter” as they declared Buck’s mother an unfit parent who roamed the streets and later became institutionalized. Carrie was living with relatives when she, then 17 years old, became pregnant. Later reports revealed that Carrie had been sexually assaulted by a foster parent’s relative, and her mother had been married, though authorities claimed she wasn’t when she gave birth. Furthermore, Carrie’s young daughter performed well in school, despite claims of “imbecility.”

Carrie Buck was the perfect test case for Albert Priddy, superintendent of the Virginia State Colony for the Epileptic and Feebleminded. Priddy fervently believed that the government had an interest and investment in making sure the “wrong people” didn’t reproduce and become a burden on the state through crime, welfare payments, or sexual high-jinx.

With the U.S. Supreme Court’s ruling, more states embarked on full-fledged sterilization programs. Doctors — Black and White — and cultural commentators such as W.E.B. Du Bois discussed, with disdain, how the large families of the huddled masses multiplied scandalously and increased suffering. In May 1937, Elaine Ellis wrote “Sterilization: A Menace to the Negro” in the NAACP’s Crisis magazine and mentioned Arkansas Gov. Junius Futrell’s efforts to sterilize sharecroppers of any race. In the United States and beyond, Ellis pointedly quipped, “the therapy of the knife is not forced upon the wealthy.”

In 1949, Puerto Rico’s health commissioner told a Spanish-language newspaper that the U.S. territory’s district hospitals could be used once or twice a week for clinics that would sterilize up to 50 people a day.

In August of the same year, journalist H.L. Mencken made his position clear with the essay “Utopia by Sterilization.” He piggybacked on Futrell’s suggestion, opining that sterilization was the way forward in “the sharecropper areas of the South [where, if it weren’t for high numbers of child deaths], the region would swarm like a nest of maggots.” Mencken did also suggest that sharecroppers be paid for their fertility. At first, he suggested an “honorarium” of $1,000. He quickly reconsidered the sum after thinking the windfall would cause riots among the deprived. In Mississippi, he wrote thoughtfully, a sharecropper might take in $32 annually, so a one-time payment of $50 to $100 might be more appropriate.

Ironically, a Mississippi sharecropper became the most visible voice of the anti-sterilization movement in the South. In 1961, civil rights legend Fannie Lou Hamer went into the hospital to remove a troublesome uterine growth and left without a uterus. She called that surgical bait and switch “the Mississippi appendectomy” and alleged that as many as 60% of women in the Black Belt’s northern Sunflower County had their uteruses stolen in a genocidal medical campaign.

Puerto Ricans also had a name for sterilization, whether it was getting a woman’s Fallopian tubes “tied” or outright hysterectomy. They simply called it la operación, a linguistic clue to how widespread “the” operation was. In 1949, Puerto Rico’s health commissioner told a Spanish-language newspaper that the U.S. territory’s district hospitals could be used once or twice a week for clinics that would sterilize up to 50 people a day. Studies from the 1940s to the 1960s routinely found that a third of Puerto Rican mothers had undergone the procedure after previous births. Health clinics, reproductive health research, and government-approved mass sterilization were largely bankrolled by the Rockefeller Foundation and global population control advocates who believed that lowering the population would mitigate the island’s unemployment crisis (and sometimes believed that Puerto Ricans were a different “breed”).

But it would be the 1974 case of 14-year-old Minnie and 12-year-old Mary Alice Relf that would catalyze policy change. The Alabama sisters lived in public housing, and Mary Alice had a cognitive disability. They were taken to a Montgomery family planning clinic to get long-lasting birth control shots, an option peddled to parents of pubescent children with developmental conditions. Their mother, who was unable to read, signed a consent form with an “X.” Their older sister, Katie, just missed the operation by hiding when social workers visited their home. But the Relfs’ nonconsensual sterilization sparked a ban on federal funding for coerced sterilization and eventually led to federal standards that mandate special consent forms and a waiting period for procedures paid for by Medicaid.

Unfortunately, red tape and existing policies around consent, when they existed, often failed to protect many women. In the 1960s and 1970s, Los Angeles County General Hospital sterilized Spanish-speaking Mexican American women who were working class but not welfare recipients, often pushing them to decide during difficult births or promising access to other medical services if they agreed. Eventually, some of the women unsuccessfully sued the doctors, the hospital, and the state of California. Native and Indigenous women who had no or limited access to medical services outside the Indian Health Service (IHS) have been particularly vulnerable. While a General Accounting Office report found only 3,400 IHS sterilizations from 1973 to 1976, the study focused only on four IHS areas in Arizona, Oklahoma, New Mexico, and South Dakota. It found “no evidence” of a sterilization without a consent form but admitted to “several weaknesses,” including the illegal sterilization of people under age 21, inadequate documentation of what Native patients were told before procedures, and that doctors themselves didn’t understand the federal sterilization regulations.

In one much-quoted and egregious example, two Northern Cheyenne 15-year-olds showed up to get their tonsils out and got tubal ligations instead, which became fodder for yet another court case in 1977. And for some women, forced sterilization went hand in hand with child protection agencies seizing custody of the offspring they already had.

Narratives that women of color, the poor, the incarcerated, or immigrants are a drain or a danger to society — and their own children — persist. And so too does involuntary or coerced sterilization.

A 2013 investigation by Reveal News found the California corrections department sterilized 150 women without heeding proper protocol between 2006 and 2010, and women who were giving birth while incarcerated or already had multiple children reported feeling pressure to agree to procedures. The obstetrician-gynecologist who approved the surgeries trotted out familiar justifications: “Over a 10-year period, [the $147,000 spent on the surgeries] isn’t a huge amount of money,” [James] Heinrich said, “compared to what you save in welfare paying for these unwanted children — as they procreated more.”

Virginia Espino, a historian who produced the film No Más Bebés about the women sterilized by Los Angeles County General and the resulting Madrigal v. Quilligan case, is used to these echoes from the past ricocheting into treatment of present-day women. “We’ve seen women being sent back to their home countries in active labor, denied abortions in detention, giving birth alone in custody. It’s the culture within these institutions that allows these abuses to dehumanize people — and get away with it.”

Writer. Historian. Thinker.

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