Editor's note: This is the third story in a three-part series about the American eugenics movement after World War II. The series focuses on the wealthy benefactors and various promoters of eugenics, including ministers, bankers, journalists and politicians (part 1); the advertising and public relations machine behind the movement (part 2); and the racial aspects of eugenics (part 3, below).
When Fannie Lou Hamer tried to organize black voters in her home state of Mississippi, she was savagely beaten. As she campaigned for civil rights, Hamer became one of the first to acknowledge another hidden abuse—forcible sterilization of minorities.
"Six out of every ten Negro women were taken to the Sunflower City Hospital to be sterilized for no reason at all," Hamer said in a 1965 speech at the nation's Capitol, according to a Washington Post article. "Often the women were not told that they had been sterilized until they were released from the hospital."
Hamer's accusation received attention but also raised questions. Some wondered if her numbers were accurate. They were, according to a 1965 letter from the National Council of Churches. A young law student had been sent to investigate, and "He concluded, after diligent research, that the charges were indeed true but that all those involved were too frightened to make an affidavit to that effect."
The letter was one of many collected by Dr. Julius Paul, a researcher at Walter Reed Army Medical Center. Americans had supposedly rejected eugenics after World War II and the Nazi horrors, but Paul saw an opposite trend. At the very moment when compulsory sterilization in most states was fading to a fraction of levels of prewar eugenics programs, many of the same economic, racial and moral justifications of the practice had returned. "The superficially moralistic overtones of these proposals should not blind us to the similarity of the current attacks on the recipients of welfare assistance and the poor ... to the earlier attacks on the masses of foreign immigrants coming to America," Paul wrote.
In many cases race was at the center of the new debate over sterilization. In 1964, Mississippi lawmakers argued whether the state should arrest parents of illegitimate children and offer them a choice of prison or sterilization. "When the cutting starts, they'll head for Chicago," state Rep. Stone Barefield said, referring to sterilization and black people.
As lawmakers began debating the issue, Mississippi newspapers described the mood in the state Capitol as "boisterous." But the jokes didn't go over well with Mrs. Gordon White, who admonished her colleagues. "This is no laughing matter. We have a welfare problem that is hurting our state. We are trying to let people know that we do not approve and we are not going to continue to pay for it. I very much favor this bill," according to the pamphlet "Genocide in Mississippi," issued by the Student Nonviolent Coordinating Committee.
Another supporter of the legislation taught Sunday school at his Baptist Church. All but one of the original bill sponsors was in his 20s or 30s, and Newsweek quoted one saying the law was "morally sound." There was clearly broad support for the involuntary sterilization law, and it wasn't coming from the old guard of the eugenics movement who had formed their beliefs before World War II.
The South wasn't the only region with a renewed interest in involuntary sterilization. In Pasadena, Calif., in 1963, a man was granted probation in a child support case after "consenting" to a vasectomy. In Santa Barbara County in 1965, two women were given reduced sentences and probation after they submitted to sterilization. In 1966, a single mother with no prior criminal record or history of misusing welfare funds was convicted of a misdemeanor for being in a house where marijuana was being used. Municipal Court Judge Frank Kearney offered a suspended sentence and probation—if Mrs. Nancy Hernandez agreed to be sterilized. Kearney said that Hernandez "should not have more children because of her propensity to live an immoral life," and added that his probation deal was "nothing novel—legally, medically, or sociologically." Hernandez initially agreed to the operation, then reconsidered, and the American Civil Liberties Union supported her. A Superior Court judge struck down Kearney's sterilization order.
In many cases, people who were involuntarily sterilized had little or no idea what was happening to them. "They asked me if I wanted my appendix out. I was so dumb then. I said sure. When I woke up I saw this big scar across my stomach," said Carolyn Wade, a young white woman who was ordered sterilized in 1966, at age 17, by Judge William Gary of Ohio. Gary had ordered sterilizations in previous cases, and he made no apologies in a 1962 letter to Julius Paul. "... We would try to get consent in each case, but if consent were not given, it would be proper to proceed with the order, provided due service had been given to the next of kin," Gary wrote.
During the 1960s and '70s, the media and government focused on poverty among black Americans. Daniel Patrick Moynihan, the U.S. assistant secretary of labor, wanted to stop a centuries-long cycle of discrimination and help black Americans prosper. But parts of his 1965 report weren't that different from the sentiments voiced by Mississippi lawmakers the year before: Black people were having too many children. "Negro families in the cities are more frequently headed by a woman than those in the country. Negro women not only have more children, but have them earlier ... The Negro fertility rate overall is now 1.4 times the white," Moynihan wrote in The Negro Family: The Case For National Action.
The report was a key part of President Lyndon Johnson's War on Poverty, and it stated that "The evidence—not final, but powerfully persuasive—is that the Negro family in the urban ghettos is crumbling. A middle-class group has managed to save itself, but for vast numbers of the unskilled, poorly educated city working class, the fabric of conventional social relationships has all but disintegrated. So long as this situation persists, the cycle of poverty and disadvantage will continue to repeat itself."
And in a little-noticed point, one of the most important bureaucrats in the War on Poverty had a long history of supporting eugenics. Dr. Ellen Winston, whom John F. Kennedy appointed as the first U.S. Commissioner of Welfare in 1963, stayed in that position until 1967. Winston, a North Carolina native, had served on that state's eugenics board for almost 20 years before moving to Washington. In North Carolina she approved measures to track both black and white children for future sterilization, as well as a radical expansion of the N.C. eugenics program in 1961, as noted by the secretary:
"I now propose to have as my objective ... to work to promote earlier use of the program; that is, after the first rather than third or fourth child. ... I plan a tickler (sic) file on all persons whose names reach me regardless of age in order that they may be picked up as they reach child bearing age ... I also plan to look carefully at people who live in dreadful living conditions (substandard housing, crowded families, etc., where poor standard of conduct may flourish) to determine if sterilization of the family members would help to prevent the situation from worsening."
By the mid-1960s the stage had been set. Both liberals and conservatives were questioning minority birth rates. Add to that the growing discussion about world population growth, and the result was that people who coerced or forced minorities into sterilization operations could easily justify their actions.
Greed among doctors may have been a factor, too, according to H. Curtis Wood, a Philadelphia OB/GYN and longtime president of the Human Betterment Association. As sterilizations surged in the 1960s, he noted that "the urologists have finally gotten on the bandwagon, and I think primarily, not because they got concerned about population problems but because there's so much easy money in it. They can concentrate and have Saturday mornings, let's say, be vasectomy day, and they can do 10 in a morning with no problem at all and charge $150 and make $1,500 in a morning," according to an interview done by William van Essendelft.
Operations and experiments took place even in states where there were no laws allowing eugenic sterilization. A 1963 letter from a director at Creedmoor Psychiatric Hospital in New York noted that, "greatly to our surprise, there have been at least 85 sterilizations reported for this disease, and 131 consultations for the possibility of sterilization." A 1960 letter from Mount Sinai Hospital in New York City said that "extensive toxicity studies on male prisoners elsewhere have established the safety and reliability" of a compound designed to cause male infertility, and sought new men for further tests.
The shift in public attitudes toward involuntary sterilization came as some supporters of eugenics tried to distance themselves from public policy with racial overtones. The Human Betterment Association, a New York City group, opposed legislation in Mississippi and other states that targeted unwed mothers on welfare. But the protests came too late, for in some ways the group helped create the environment that fueled the Mississippi bill. Founded in 1937 as the Sterilization League of New Jersey, the Human Betterment Association mailed more than a million pieces of sterilization literature in the 1940s and 1950s, and directed a massive campaign promoting sterilization to social workers and doctors all over the nation.
And while many doctors acknowledged the scientific and medical flaws of eugenics, the pattern of imposing sterilization under questionable conditions persisted after World War II. "Consent is not considered necessary since this is a public health problem. If the family objects, the Superintendent may or may not accede to their wishes, depending on the urgency of the case," the Superintendent of Delaware State Hospital at Farnhurst wrote in 1964.
A county attorney in Kentucky commented that even doctors ignored court rulings. "The matter was held in the Whitley Circuit Court, which turned down the request for permission to sterilize the woman ... even after permission was denied, a surgeon in our county performed the sterilization operation upon this woman. Probably, nothing will come of it, because no one will sign a complaint about it, since the parents of the woman gave their permission," the attorney wrote in 1969.
Finally, in the late 1960s, another financial decision cleared the way for more widespread sterilization abuse. Since few among the poor or in institutions could afford the procedure, paying for operations had long been a challenge for the eugenics movement. But in 1969, the federal government began to fund operations under Medicaid.
Along with the surge of new money, two professors at Stanford University propelled the discussion of eugenics back into the mass media. Nobel Prize winner William Shockley argued that African-Americans are genetically less intelligent than whites (though few noticed that he had no training in genetics; his Nobel was for work on inventing the transistor). Shockley suggested that society pay cash bonuses to less intelligent people who agreed to be sterilized. Newsweek titled a story on racial differences "Born Dumb?" An article on race and intelligence that took up almost an entire issue of the Harvard Educational Review suggested "eugenic foresight" was the best—and perhaps only —way to deal with blacks who scored low on IQ tests.
Around the same time, Shockley's fellow Stanford professor Paul Ehrlich advocated compulsory sterilization in the best-selling The Population Bomb, claiming that 65 million Americans would die of starvation between 1980 and 1989. Ehrlich added he "would take even money that England will not exist in the year 2000," because of the coming anarchy.
In academic journals, Shockley and Ehrlich could argue that they were just being scientists analyzing data and suggesting possible solutions to society's problems. But when the public saw that the face of eugenic sterilization included a pair of 12- and 14-year-old sisters in Alabama, the tone of the debate finally changed to outrage. Mary Alice and Minne Lee Relf were sterilized at a federally funded clinic in 1973, and that led Sen. Edward Kennedy to hold hearings on sterilization abuse. "The nurse came and told me she was going to give them shots," said the girls' mother. The Department of Health, Education and Welfare quickly ordered a halt to federally funded sterilizations as experts started to probe why such abuses had happened.
The Women's Brigade of the Weather Underground bombed the San Francisco office of the U.S. Department of Health, Education and Welfare in 1974, and the group's list of complaints about bias against women said the action was "especially for" the Relf sisters.
Part of the problem was purely political. Dr. Warren Hern told a Senate committee that federal officials had developed guidelines to protect against sterilization abuse in 1971, and 25,000 copies of them were printed the next year—and then locked in a warehouse. Hern said he was told that aides in the Nixon White House stopped the release of the guidelines because they felt the issue was too controversial for an election year.
The FBI also monitored protests by the National Organization of Women, noting in a memo that some signs read "Free Abortion – No Forced Sterilization."
In the summer of 1973, the Southern Poverty Law Center sued the federal government over sterilization abuse. The next year, a ruling by District Court Judge Gerhard Gesell finally put numbers to the problem. "Over the last few years, an estimated 100,000 to 150,000 low-income persons have been sterilized annually under federally funded programs," Gesell wrote, adding that about 2,000 to 3,000 per year were under age 21, and about 300 younger than 18.
"There is uncontroverted evidence in the record that minors and other incompetents have been sterilized with federal funds and that an indefinite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that various federally supported welfare benefits would be withdrawn unless they submitted," Gesell added. "The dividing line between family planning and eugenics is murky."
With that lawsuit and others, people around the nation began speaking out. "I was sterilized during the operation without my knowledge and without my agreement. What could I say and do? It was already too late," said Barbara Moore, a South Dakota Native American woman sterilized as she gave birth. A Cheyenne woman, Bertha Medicine Bull, said "two girls had been sterilized at age 15 before they had any children. Both were having appendectomies when the doctors sterilized them without their knowledge or consent" at Indian Health Service hospitals.
Complaints from tribes all over the nation prompted an investigation by Sen. James Abourezk of South Dakota and a report by the U.S. Government Accountability Office. The report found that more than 3,400 sterilizations had been performed between 1973 and 1976 at just a portion of the Native American hospitals in the system. Most records suggested that basic rules about informed consent hadn't been followed.
Around the same time, women founded the Committee to End Sterilization Abuse (CESA), with chapters in New York and Chicago, and Hispanic women sued Los Angeles County General Hospital, citing a pattern of coercion. A CESA report noted that in 1975 the acting director of a municipal hospital in New York City told the group that "in most major teaching hospitals in New York City, it is the unwritten policy to do elective hysterectomies on poor, Black, and Puerto Rican women with minimal indications, to train residents ... at least 10% of gynecological surgery in New York is done on this basis. And 99% of this is done on Blacks and Puerto Rican women."
Yet today much of this history is forgotten, and the thousands of victims in the late 1960s and early 1970s are literally counted as a zero by most scholars and journalists. The Human Betterment Association stopped tracking sterilizations in 1963. The final number it issued was 63,678—the source for the oft-repeated statement that 60,000 to 65,000 Americans were victims of the eugenics movement.
Paul Lombardo, a professor at the Georgia State University College of Law who has studied eugenics in America for 30 years, says that the 1960s and 1970s "probably generated more sterilizations than any of the eugenics laws—and they weren't called eugenic sterilization. That is just women going into county hospitals, being pregnant and being told either after the fact or just before it happened they were going to be sterilized, because they were on welfare or they had too many babies, according to someone's opinion." And such abuses were still happening in Washington, D.C., as late as the 1990s—and probably elsewhere. "It was told to me by people who practiced in those hospitals," Lombardo says.
But the old narratives die hard. Many still suggest that eugenics ended after World War II, ignoring not just sterilization abuse but the challenges and threats that exist side by side with the power of new genetic testing. Others blame the Nazis for eugenics, or Planned Parenthood founder Margaret Sanger, or certain scientists. Yet as I read over tens of thousands of documents over the last nine years, many helpers emerged, but no single villain. Eugenics may be more of a mirror than we care to acknowledge, reflecting both the urge to improve society and the danger of scapegoating the poor and powerless, even today.
She worked her whole life, never breaking the law or causing trouble in her community. When the North Carolina Eugenics Board ordered her to have an operation, she tried to run away, but they caught her. And so the young mother died on a cold day in early March, in a little town in eastern North Carolina. State officials sent a brief letter of consolation—to the social worker involved. "I believe that you need feel no responsibility for the results," they wrote.
The nights were still below freezing as local doctors finally scheduled the operation on Donna (not her real name). It was the depths of the Great Depression, and under "Occupation" on the Eugenics Board form it listed "House & field work" at 50 cents per day. Under "Duration" it noted simply "All life." Donna, who was white, could read and write, and had left school after the sixth grade—not unusual for a young girl in a farming community during that era.
Her father had recently burned to death in a fire, and her mother was dead too. She was married, with a 9-year-old child, and the section that asked for "any evidence of abnormal or antisocial behavior or harmful habits" was hardly convincing:
"Has never violated law or caused trouble in her family or community. Is quiet and harmless, but incapable of the care of children. The two that died of pneumonia were not properly nursed."
Under "Previous Institutional Record" was written "none."
The Eugenics Board had ordered the operation on Nov. 27, adding to the standard form that at the hearing the "patient not being represented or represented by counsel." But in late January the social worker on the case asked for an extension.
"Three times I have had (Donna) over here to go to the hospital for the operation and every time she alluded (sic) us and slipped back home. Her childish mind dreaded the operation and we could not impress her with the importance of time or time limit. Unless you can extend the time for 30 days I cannot have Donna's operation."
The Eugenics Board approved the extension, and the secretary added, "If necessary I think she could be taken into custody by the Sheriff, but of course it will be much better if you can persuade her to submit to the operation." Call it premonition or fate, but Donna was right to fear her sterilization. The doctor reported that problems developed immediately.
"She gave a history of having had a slight cough a week prior to her admission to the hospital. I could find nothing in her chest suggestive of any recent, or old, infection. She gave a history of having had pellagra (a severe vitamin deficiency) but I could see no active symptoms of this condition. She did not take her anesthesia well ... and her respirations became moist shortly after the ether had been started. The operation was completed within an hour. She developed respiratory symptoms a few hours after her operation and died on 3-4-34 of bronchial pneumonia. I regret Mrs. _______ death exceedingly. The cause of her death was not due to the operation per se but to the above mentioned post-operative complication."
Five days later, the secretary of the Eugenics Board responded.
"I wish to thank you for your letter of April 4th in regard to the death of Mrs. _____.
There has been no suggestion of criticism in this case and the Board feels it would be wise to have a definitive statement as to the cause of death, on file. Thanking you for your interest and cooperation, I am, Sincerely yours."
And with that, the Eugenics Board closed the case file.