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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.