Get it Out: Investigating the history of hysterectomy

Get It Out is published by New York University Press

SW: You weave together historical research and interviews into a shocking and necessary book. I was really surprised to read how many hysterectomies are performed—did that prompt you to write the book?

I decided to write the book when I was working as a reproductive rights researcher. I stumbled on the number of women having hysterectomies—it was one in three. The figure is now around one in five.

But hysterectomies were almost entirely absent from the conversations I was having. 

There was one sociology book that focused on hysterectomies, and it was 20 years out of date. 

Apart from caesarean sections, hysterectomies are the most common surgical procedure among people assigned female at birth.

Your book really brings out the inequalities women face in relation to hysterectomies. How does this “social stratification” work?

Who you are, what you look like, what race you are, where you live—all these aspects of your personal identity determine how you access healthcare.

Hysterectomies are part of a broader inequality. 

Choices around hysterectomies are all shaped by social stratification, by racism and whether you are trans+ or non-binary. 

I found many white women dealing with conditions like endometriosis and fibroids were told they were too young to have a hysterectomy. 

They were told “you’ll regret this later” or “what about your husband?”

But young black and Hispanic women with exactly the same symptoms were told the only option for their problems was a hysterectomy. 

Trans+ and non-binary people’s reproductive capacity is often forgotten altogether. But the more masculine a trans man appears, the easier it is for them to access a hysterectomy. 

A cis woman might have a uterus that is tormenting her and causing chaos over her body. 

But she is seen as someone who is, if not pregnant, then is getting ready to be pregnant. 

I borrowed the phrase “zero trimester” from sociologist Miranda Waggoner to describe how some women are seen as constantly preparing for pregnancy.

Your book exposes the role of slavery and colonialism in the development of gynaecology—and how it still shapes gynaecology today.

When you look at the development of gynaecology you see how it is haunted by the exploitation of black and brown women. 

Dr Marion Sims is known as the “father of gynaecology”. He conducted horrific experiments on enslaved women in Alabama from the 1830s to his death in the early 1880s. The women involved, Betsey, Anarcha and Lucy, had no choice about what was done to them. Now we call them the “mothers of gynaecology”. 

All gynaecology, not just hysterectomies, was based on exploiting women’s bodies. 

The pill is seen as a turning point in women’s liberation, allowing women to time their pregnancies, to have sex for pleasure not just for procreation. 

But the pill was developed through trials in Puerto Rico where large doses were given to women who weren’t warned of the side effects or even told the pills would prevent pregnancy. 

These trials were carried out by Harvard doctors who exploited racism and colonialism—they experimented on women because they could get away with it.

The development of Depo-Provera, a contraceptive injection, depended on clinical trials carried out on low-income black women in Atlanta. They were used as guinea pigs.

And this continues today. We don’t have formal eugenics boards and we don’t have forced sterilisation campaigns but forced sterilisation continues through the carceral system.

A doctor in an Immigration and Customs Enforcement detention centre in Georgia performed forced and coerced hysterectomies on detained migrant women. 

He was reportedly known as the “uterus collector”.

In a neighbouring state, hysterectomies performed on black women were so common they were known as the “Mississippi appendectomies”.

Black and brown women often see birth control as dangerous and are accused of “conspiracy thinking”. But that thinking is rooted in their real experiences.

Why is women’s pain still dismissed as normal?

We are still in the dark ages of understanding women’s organs, the vagina, the uterus, the clitoris. 

There is far too little research on how to diagnose illnesses and how to treat them. It is normalised that a woman’s body means being in pain. 

So many aspects of gynaecological care assume a woman will be in pain. Childbirth is painful, so that justifies everything else being painful. 

That’s what doctors tell women, it’s even what mothers tell their daughters, so women end up thinking they’re just being weak. 

Endometriosis just doesn’t show up on scans. We have known about endometriosis for at least 100 years. But the only way you can diagnose it is through surgery. A woman doctor is developing a way to identify bio markers in menstrual blood—but it still hasn’t been done. 

You write about the impact of biomedics on perceptions of healthcare—can you explain what biomedics is about?

Medicine used to be about identifying and curing disease. There have been major advances in medicine that have enabled us to customise and perfect our bodies. 

For instance, think about robotic limbs, cosmetic surgery and corneal implants. 

And this changes social categories, you can become a hearing person, a “beautiful” person—so it’s not just about preventing illness anymore. 

We are in an age of “biohacking”—this is big in Silicon Valley. This is about finding nutritional supplements, cosmetic surgeries and lifestyle changes and constantly tracking our bodily data with Fitbits and Apple watches. 

Abortion rights and trans+ rights are being attacked. Is this a dangerous moment?

This is a very dangerous moment. The last time there was a major assault on trans+ lives and women’s reproductive autonomy, you arrived at the rise of Adolf Hitler.

Dr Magnus Hirschfeld produced an annual publication on same sex desire and gender diversity. 

Starting in 1899, his publication ran for 25 years, and he started a clinic which began offering medical surgeries and hormones for patients who wanted to change their sex. Hitler labelled Hirschfeld “The most dangerous Jew in Germany”. He was forced into exile. 

It is really hard not to see parallels with today, when abortion is impossible in half the states in the United States, when there is an overwhelming wave of anti-trans legislation. 

These are accompanied by a pro-natalist movement that wants to prescribe what it is to be a woman.

Abortion is a lifesaving procedure, but now doctors are scared of being sued or being criminalised. 

Women are forced to go home and get sicker, and then they need an emergency hysterectomy—so once again it has been chosen for them. 

What impact do you want your book to have?

I hope this book shows how much we have left people with uteruses behind, and how much more we can do too. 

Women’s pain is not taken seriously, but when you introduce race it’s even worse—black women’s pain is taken less seriously.

The National Institute of Child Health and Human Development in the US spends only 10 percent of its budget on “women’s health”. 

Yet some 80 percent goes to researching pregnancy and childbirth. 

We need to invest more in understanding women’s bodies beyond the realm of pregnancies.  

And we need to break taboos around menstruation and break the stigma around women’s bodies.