Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980

Chapter 3: Sterilizing “Unfit” Women

The practice of involuntary sterilization existed throughout the twentieth century , but it changed over time, with a critical transition occurring in the late 1950s and early 1960s, during the shift from eugenics to neo-eugenics, and another occurring in the late 1960s concurrent with the development of federal family planning. In both moments of transition, region and race intersected to create distinct trends. First, physicians, social workers, and members of state eugenics boards exploited existing eugenic statutes to sterilize poor black women with the specific intention of reducing the number of blacks eligible to receive public assistance. Some southern physicians performed what black women colloquially referred to as “Mississippi appendectomies,” or the secret sterilization via hysterectomy of poor black women who entered hospitals for abdominal surgeries—like cesarean sections and appendectomies—and left, unknowingly, without their uteruses. Women of color in other regions came under scrutiny during the second transition. The establishment of federal family planning functioned as a catalyst for this change but was not the only factor responsible for it. Neo-eugenic attitudes and policies also contributed. Physicians who treated patients receiving government aid benefited from the legitimization of contraceptive sterilization and the absence of hospital policies governing informed consent. Physicians recorded forced sterilizations as voluntary, and rising rates of female sterilization in the 1960s and 1970s “hid” their coercion. As contraceptive sterilization gained legitimacy and as federal family planning brought together poor women, especially women of color, and physicians who sought to control their reproduction and funded these interactions, forced sterilization increasingly occurred during childbirth. Sterilizing “Unfit” Women Chapter 3 73 The exact number of women involuntarily sterilized between roughly 1950 and 1980 remains unknown. Neither medical institutions nor federal agencies collected the necessary statistics—perhaps an impossible task, as physicians recorded most coercive sterilizations as voluntary, and many women chose not to file formal complaints. Few sterilizations appear suspect when read through the official medical record. Consequently, the burden of verifying abuse fell to victims, an especially difficult task during a decade of rapidly evolving definitions of informed consent and consent policy. Many victims believed their coercive sterilizations to be isolated incidents, and cultural stigmas attached to infertility shamed other victims—especially Native American and Hispanic women—into secrecy.1 The threat of racial violence prevented still more victims from demanding recourse. “Me? Getting a white lawyer to go against a white doctor?” civil rights leader and sterilization abuse victim Fannie Lou Hamer exclaimed. “I would have been taking my hands and screwing tacks into my own casket.”2 Although exact statistics are not available, experts and contemporary activists have estimated that the total number of forced sterilizations ranged between a few thousand to several hundred thousand.3 Images of and Policies to Control the “Welfare Queen” In the first half of the century, racial segregation created a semiprotective barrier between many poor black women and eugenicists.4 Largely excluded from state and federal aid and institutions because of their race, many black women escaped eugenicists’ grasp. But once civil rights activists threatened to integrate state facilities and the law mandated the inclusion of minorities in the welfare state, some opponents of integration seized sterilization as a weapon to combat racial equality and drew upon neo-eugenic ideas to do so. Integration proved to be bittersweet for victims of sterilization abuse. The Civil Rights Act of 1964 granted people of color full access to federal programs and services such as welfare, public housing, and occupational training, but it also brought them into intimate contact with social workers, physicians, lawyers, welfare workers, and judges who provided family planning services, some of whom who took it upon themselves to sterilize “defective” women in order to reduce their dependence on welfare. As ideas about reproductive fitness changed, so, too, did images of the “unfit.” Women continued to receive the majority of attention because of their ability to bear children, but the ethnicity and race of those targeted changed as Cold War society struggled to accept civil rights, Mexican immigration, an expanding welfare system, and a rise in illegitimacy. Two new stereotypes directly linked ideas about reproductive fitness to poor women of color: the “welfare queen” and the “pregnant pilgrim.” Together, these images solidified 74 Fit to Be Tied links between women of color, dependency, lack of reproductive fitness, and single motherhood in the public mind. These stereotypes promoted and...