Fatima Rahman, MPH, M1, Class of 2023
‘Female sterilization’ refers to a procedure that permanently prevents women from becoming pregnant. Historically, sterilization has been used by females and on females to prevent pregnancies, as a form of both female empowerment and a form of oppression. The history of sterilization in America built the foundation for one of the most controversial topics in public health today: reproductive rights.
On August 22nd, 1974, Ms. Nial Ruth Cox sued the Eugenics Board of North Carolina for a sterilization procedure that was conducted on her in 1968. The details of the case are shocking to the modern ear. In 1965, Nial was an 18-year-old unmarried woman living with her welfare-assisted mother. Nial was forced to endure sterilization (which she believed to be temporary at the time) at the behest of the social workers that were supposed to be helping her mother. Those same social workers subjected her mother to physical harassment until she signed off on the sterilization. Unbelievably, this eugenic program was created by the State of North Carolina, with the purpose of stopping those with inferior genes procreate. Undoubtedly, several principles of bioethics were violated. However, the Federal Courts decided to dismiss the case under the pretense that, according to North Carolina law, the three-year period between when she found out about the permanence of the procedure (1970) and when she filed the lawsuit, had run out (Cox v. Stanton, 1975).
You would think that this Eugenics program, created by the State of North Carolina, would be an anomaly in the history of the United States. You would be dead wrong. There were numerous other similar laws and regulations that have surfaced throughout American history. In 1907, Indiana passed the first forced sterilization law. California, in 1909, also passed a law that legalized nonconsensual sterilization of 20,000 women within the prison system of California. In total, 30 states passed some sort of compulsory sterilization law. These laws unfairly subjugated women, particularly minorities, to physical torture and violated their rights to procreate (Stern, 2005). The laws and regulations were sponsored by both state federal agencies, as the practice of forcibly sterilizing women was both legal and acceptable in society – not much different from the laws today in Alabama, Missouri, and Mississippi, that require women to give birth to children they cannot financially or emotionally care for.
Sterilization was also a tool for American activists to practice utilitarianism, always in pursuit of the ‘greatest good for the greatest number of people’. In the 1927 Supreme Court case, Buck v. Bell, the Supreme Court upheld a Virginia law which legalized “sexual sterilization of inmates of institutions supported by the State who shall be found to be afflicted with a hereditary form of insanity or imbecility” – forced sterilization of mentally unstable patients without their consent (Buck v. Bell, 1927). Supreme Court Justice Oliver Wendell Holmes’ comment in the ruling has become part of the lore surrounding the Eugenics movement in America:
“Three generations of imbeciles are enough.”
Although the Virginia law was repealed in 1974, it paints the struggle of reproductive rights that even the Planned Parenthood founder Margaret Sanger struggled with herself at one point: “the most urgent problem today is how to limit and discourage the over-fertility of the mentally and physically defective” (Sanger, 1921). It is disturbing that Margaret Sanger, a pioneer for the birth control pill and an activist for reproductive rights, was a eugenicist. Female sterilization certainly blurs the lines between reproductive rights and outright human rights violations.
While sterilization was a tool for oppression for many American citizens, it was also a source of freedom for others. In the 1950s and 1960s, there was much furor surrounding sterilization of Puerto Rican women. For the forced sterilization to be legal, it had to be established that:
1) it is for the best interest of the mental, moral, and physical improvement of the patient that he (she) undergo an operation for sterilization or asexualization; 2) that it is for the public good that such patient undergo such operation; or 3) that said patient would be likely to procreate a child or children who would have a tendency to serious physical, mental, or nervous disease or deficiency; (Operation Of Sterilization, 1973).
Though the laws were passed in an immoral and punitive manner, Puerto Rican women were able to find a source of social mobility in these laws. In a time when poverty and “population control” were pressing issues, Puerto Rican women found solace in the opportunity to permanently restrict their ability to procreate, with or without the approval of their male partners (Hansen & King, 2001). The newfound control over their bodies became widely accepted and sought after by Puerto Rican women. Sterilization provided a different type of control over the bodies of women that was previously not available. Similarly, in the mainland U.S., sterilization was a more reliable method of birth control than other types of contraceptives, even after the 1960 creation of the birth control pill (Schoen, 2005). American women were just as eager to participate in sterilization as Puerto Rican women.
Sterilization as a function of women’s rights sets the playing field to discuss the reproductive rights of women over their bodies. American Public Health Association reports on their website that “access to the full range of reproductive health services is a fundamental right and integral to the health and well-being of individual women and to the broader public health” (American Public Health Association, n.d.). The choice to sterilize, or use of any other contraceptives for that matter, is solely the decisions of females, while also the responsibility of society to make the multiple options available.
As health professionals, our duty lies in ensuring that all women have the choice and opportunity to use the contraceptives that they need – to assure reproductive justice in our populations. “A reproductive justice approach means reducing barriers to accessing long acting contraceptives [and other contraceptives] and making them readily available to all fully informed people who want them. However, it also means respecting the decision not to use these methods [ie nonconsensual uses of sterilization or other contraceptives] or to have these methods removed when they wish.” (Gubrium et al., 2016). With the wave of laws illegalizing abortions across America, and the debate on what forms of contraceptives should be available, it is more important now than ever to re-visit and evaluate the total effect of the players in the eugenics movement in shaping the culture around sterilization, birth control, and abortions in America today.
Birth Control Review, Oct. 1921, p. 5 , Margaret Sanger Microfilm S70:913
Buck v. Bell, 274 U.S. 200 (1927)
Cox v. Stanton, 529 F.2d 47 (4th Cir. 1975).
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