Between 1929 and 1975, the North Carolina Eugenics Board authorized over eight thousand eugenic sterilizations. By stressing the irreversible and permanent effects of sterilization, historians have emphasized the involuntary character of sterilization for poor and minority women. They have associated sterilization with coercion and abortion and birth control with women's liberation, thus situating them at opposite poles. Yet the eugenic sterilization program ironically offered rare access to a form of birth control women desired. Given the absence of adequate health and welfare services for poor women, the program was often the only means by which they could control their reproduction. This article demonstrates that sterilization sometimes enhanced and sometimes limited women's reproductive autonomy. It highlights that women were not merely victims of state sterilization policies, but tried to control their reproduction even if it meant taking advantage of less-than-perfect programs.