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Sterilisation—snatching the right to choose

Forced sterilisation stopped women having children. Sarah Bates investigates how thousands of women, disproportionately black, were mutilated by the US state
Issue 2813
A vaginal hysterectomy being performed on a woman

Woman would undergo forced sterilisation during operations without their knowledge (Picture: Wellcome Collection)

Demanding the right to choose has always been about more than access to abortion. It also has to include the right to be a parent. The brutal history of forced sterilisations sits at the sharpest point of racism, sexism and class violence. In the US, this horrific act crossed state lines and was passed down through generations.

Thousands of people, ­disproportionately black, were forcibly sterilised in the US throughout the 20th century. Exact figures are hard to come by, but it is at least 60,000. Some were told the ­operation was temporary. Others were coerced into signing consent forms they couldn’t read, or only gave the go-ahead while in the throes of labour pains.

Many were told their ­welfare payments would stop unless they agreed to the procedure. Some women weren’t even informed that tubal ligation had occurred, as doctors performed the procedure during other operations. At one point, so common was the procedure across the US South, it was colloquially known as a “Mississippi appendectomy”.

But this wasn’t a result of dodgy doctors. Forced sterilisations were organised, funded and driven from the top of government into the medical establishment. At the turn of the 20th century birth rates were dropping as industrial capitalism became more established and people moved from rural to urban areas. 

As a result, people had less children. Alongside this was the deeply racist view that black people, seen as animalistic, may overtake the white population. In 1905 president Theodore Roosevelt ended his Lincoln Day speech by declaring that “race purity must be maintained.” This drove the “science” of eugenics that was used to justify the programme of forced sterilisation.

Eugenics is the idea that a population can be genetically purified by removing certain “inferior” groups from the gene pool. In 1907, the first eugenics legislation was passed in Indiana. Over the next twenty years, some 31 other states followed suit. These states maintained a federally funded eugenics board.

Doctors could sterilise people virtually at will. Sometimes their families would object, but it rarely made a difference. Their targets were clear—immigrants, black people, Indigenous Americans, poor white people and people with disabilities.

It was an inspiration to some. The 1933 ruling “Law for the Prevention of Offspring with Hereditary Diseases” in Nazi Germany was modelled on similar legislation in Indiana and California. Using this law, the Nazis sterilised around 400,000 children and adults. Back in the US, laws were designed to target people deemed “mentally defective,” “feebleminded” or just plain “undesirable”.

One such person was Carrie Buck. Carrie was imprisoned in 1924 in the Virginia State Colony for Epileptics and Feeble-Minded. Her crime? Bearing a child as a result of being raped by her foster parents’ nephew. Just 20 years old, Carrie was picked out to test the law on implementing Virginia’s eugenicist policy. Supreme Court Justice Oliver Wendell Holmes said in black and white why the state didn’t want her to have children.

He said, “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. Three generations of imbeciles are enough.” Following the Second World War there was a change in the way sterilisation was used—it became a specific tool of racism. The shift was damning for black women. 

In North Carolina, for instance, it’s estimated that black women were sterilised at three times the rate of white women between 1950 to 1966. It was more than 12 times the rate of white men. Why? Because racists in the state and medical ­establishments thought black people couldn’t be good parents, and wanted to stop poor children being born.

It was treated as a public health intervention to keep welfare payments low and the general population “healthy”. Puerto Rico is one harrowing example. Between the 1930s and 70s around a third of women there were sterilised by the US government, and abortion was illegal. Activists demanded, “End all genocide. Abortion under community control”.

In the 1970s somewhere between 25 and 42 percent of Indigenous American women were forcibly sterilised by the US government. But a number of legal cases, driven by a sense of injustice from below, highlighted the abhorrent practice affecting women and children. The landmark case was of Minnie Lee and Mary Alice Relf from North Carolina in 1973.

Revolutionary writer Angela Davis explained forced sterilisation simply as “a racist form of mass ‘birth control’.” She said the Relf case meant “the Pandora’s box of sterilization abuse was finally flung open”. “The urgent need for mass opposition to sterilization abuse became tragically clear. The facts surrounding the Relf sisters’ story were horrifyingly simple.”

The sisters were sterilised at just 14 and 12 years old. Their mother, who was illiterate, signed the consent forms she couldn’t read with an X. She thought she was ­signing a form for birth control ­injections that the girls had ­previously received. These Depo-Provera shots had been administered to the girls under the assumption that they were sexually active. 

Their social worker Jessie Bly found the two sisters post operation, terrified and alone, huddled together in cotton surgical gowns. “I just hurt so bad,” said Mary Alice. “I just hurt so bad, Miss Bly.” A third Relf sister, Katie, narrowly avoided sterilisation by locking herself in her bedroom when the nurses came to her house to collect her.

Madrigal v Quilligan is another example. Here, ten women of Mexican origin took the County Hospital to court for tricking them into tubal ligations. Dr James Quilligan was open about the reasons. One key witness testified that he had said that “poor minority women in LA County were having too many babies, that it was a strain on society, and that it was good to be sterilised”. 

The judge ruled in the hospital’s favour, claiming the women were at fault. He assumed their ­breakdowns after sterilisation were caused by their inability to raise a big family, which was important in Latina culture. He said it was their cultural background that heightened their trauma—not the ­procedure itself. Although they didn’t win, the case led to more stringent guidelines around informed consent.

But despite the best efforts of activists, the practice isn’t in the dim and distant past. Forced sterilisation is as much a part of the modern-day US as McDonalds and mass shootings. An investigation in 2013 found that at least 148 women inmates in two California prisons were sterilised in just four years. 

Many of the women say they were coerced into it. Unsurprisingly, the majority were black and Latina. In Valley State Prison in California, bosses spent over £123,000 of public money to perform tubal ligations on women.  

Its gynaecologist Dr James Heinrich defended it. “Over a 10-year period, that isn’t a huge amount of money,” he said. “Compared to what you save in welfare paying for these unwanted children—as they procreate more.” In 2017, Judge Sam Benningfield was found to be offering 30-day sentence reductions for prisoners who agreed to vasectomies or birth control implants. 

And two years ago, a whistleblower alleged that imprisoned migrant women were given hysterectomies without their knowledge. Nurse Dawn Wooten said the facilities’ gynaecologist was known as the “uterus collector” among staff. “Everybody he sees, he’s taking all their uteruses out or he’s taken their tubes out. What in the world,” she said.

It’s hard to imagine what sort of impact such a vile injustice has on a person. Certainly for the Relf sisters it is something that has stayed with them in the intervening five decades. “It might have happened a long time ago, but it still brings back memories. We’re still ­thinking about it,” said Minnie Lee. “I know I can’t have kids, and it gets to me sometimes.

“Every time I see somebody like my cousin or my niece Debbie with their child, I think about it. Seeing these little pretty babies, I wish that was me.” There are many, many, more people like Minnie Lee and Mary Alice Relf. Too many women to count. Too many lives ripped apart by racist laws and too many bodies ripped open by racist doctors. The fight for real bodily autonomy—in its every expression—has to be a central plank of the wider battle for reproductive justice.

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