Women and the Politics of Sterilization

A UNC Press Short, Excerpted from Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare

Johanna Schoen

• Publisher: The University of North Carolina Press
• Year: 2012
• eBook ISBN: 9780807837597
• Topic: Social Sciences
• Subtopic: Social Policy
• Index: Social Sciences

In 2003, North Carolina became the third U.S. state to apologize and the first to call for compensation to victims of state-ordered sterilizations carried out between 1929 and 1975. The decision was prompted largely by a series of articles in the Winston-Salem Journal. The stories were inspired in part by the meticulous research of Johanna Schoen, who was granted unique access to the papers of the North Carolina Eugenics Board and to summaries of the case histories of nearly 7600 victims — men, women, and children as young as ten years old — most of whom had been sterilized without their consent. In 2011, a gubernatorial task force held public hearings to gather testimony from the victims and their families before recommending in early 2012 that each living victim be granted $50,000 compensation. The restitution proposal requires legislative approval before funds can be dispersed.

In this UNC Press Short, excerpted from Choice and Coercion, Schoen explains the legal construction of North Carolina’s sterilization program, which lasted far longer than similar programs in other states, and demonstrates through the stories of several women how the state was able to deny women who were poor, uneducated, African American, or “promiscuous” reproductive autonomy in multiple ways.

UNC Press Shorts excerpt compelling, shorter narratives from selected best-selling books published by the University of North Carolina Press and present them as engaging, quick reads. Presented exclusively as e-books, these shorts present essential concepts, defining moments, and concise introductions to topics. They are intended to stir the imagination and courage exploration of the original publications from which they are drawn.

CHAPTER TWO
Nothing Is Removed Except the Possibility of Parenthood

Women and the Politics of Sterilization

On February 10, 1965, Nial Cox, an eighteen-year-old black unwed mother, was subjected to a tubal ligation under a North Carolina statute providing for the sterilization of the mentally diseased, the feebleminded, and the epileptic. Although she had never been tested for any of these afflictions, her surgeon’s discharge summary described Cox, who would later become a nurse, as an “eighteen-year old mentally deficient Negro girl.”¹ Three months prior to the surgery, Cox had given birth to a daughter. She and her daughter lived with her siblings and their mother, Devora. While Nial Cox received no welfare benefits for her daughter, Devora did receive benefits for herself and for Nial’s brothers and sisters, which meant that she was in regular contact with the local welfare department. For several months before and after Nial gave birth, Devora’s social worker, Shelton Howland, had insisted that Nial would have to be sterilized. If Nial and her mother refused, Howland threatened, Devora and Nial’s siblings would all be stricken from the welfare rolls. Faced with the loss of her entire income, Devora finally consented. The local social service agency petitioned the North Carolina Eugenics Board for the operation, and three months after her baby was born Nial was sterilized. It was Nial’s nonmarital pregnancy and her mother’s welfare dependency rather than Nial’s intellectual capacities—or even her own dependency—that earned her the label of “feebleminded” and made her one of over eight thousand people sterilized between 1929 and 1975 under the authority of the North Carolina Eugenics Board.

Historians and social scientists, stressing the operation’s irreversible and permanent effects, have emphasized the coercive nature of the sterilization of poor and minority women.² Throughout the late 1960s and the 1970s, the publicity given to cases of sterilization abuse raised awareness of its prevalence in the United States and in Puerto Rico, India, Bangladesh, Brazil, and elsewhere.³ By the late 1970s, a number of political organizations lobbied against sterilization abuse in legislatures and contributed to the passage of federal sterilization guidelines in 1978 that recognized involuntary sterilization as a violation of civil and human rights.⁴

The case of Nial Cox demonstrates how sterilization could restrict women’s reproductive autonomy and underscores its peculiarly sexist, classist, racist, and coercive character. Sexual behavior, race, and class background constituted major factors in the identification of the so-called feebleminded. A concern with sexual behavior led social workers to focus on those whose deviation from the desired norm was particularly obvious and disturbing: sexually active single women. Eighty-five percent of those sterilized in North Carolina were women, and half of them were single and had given birth to one or more children outside of marriage. Class and race were critical factors in the identification of potential sterilization cases: the members of poor and rural families were particularly likely to be perceived as feebleminded. The link between mental deficiency and sexual immorality seemed especially close in the case of African American welfare recipients. In the eyes of those who implemented the sterilization program, the presence of children outside marriage served as an indication of women’s emotional immaturity and mental retardation even when—as in Nial Cox’s case—the woman was able to take care of her children. Given changing attitudes toward sterilization in the late 1960s and the 1970s, however, and given the circumstances of Cox’s case, it is no surprise that Cox’s sterilization became part of a lawsuit that focused on the question of whether the sterilization program in North Carolina constituted an attempt at “racial genocide.”⁵

The eugenic sterilization program did not function only as an assault on women’s reproductive autonomy. Ironically, it also offered access to a form of birth control that women desired. One woman who eagerly sought a contraceptive sterilization was Shirley, a white woman who was thirty-six when she petitioned to be sterilized.⁶ Shirley had met her first husband in 1950, when she was twenty. In the early 1950s, she gave birth to two children. But her husband was an alcoholic and a poor provider, and Shirley, engaged in a fifteen-year battle against schizophrenia, put her children up for adoption and eventually left the marriage. After her divorce, she became pregnant for the third time. She gave this child, too, up for adoption. In November 1957, she married a marine. Although Shirley did not want to have more children, her second husband pressured her to become pregnant again. By the time her fourth and last child was born, her husband was stationed overseas. Shirley tried to juggle the demands of motherhood with her mental illness but was only able to care for her child when her husband was around to offer help. In May 1963, she attempted suicide and was committed to a psychiatric hospital. She was released in July, just as her husband was leaving for Okinawa, Japan. Overwhelmed with the responsibility of caring for her son, Shirley gave the child to a friend and committed herself to a psychiatric hospital in February 1964. Her child was placed in foster care, and during the next two and a half years, which Shirley spent at the hospital, she had little contact with either her husband or her son. Her husband rarely wrote and only visited a couple of times. Once or twice he took Shirley to see the children, but each such visit precipitated a deterioration in Shirley’s mental condition.

At the hospital, Shirley learned about the possibility of sterilization. Eager to end her constant fear of pregnancy and to aid her recovery, she sought the operation prior to her release from the hospital. In the summer of 1966, Shirley and her physician petitioned the North Carolina Eugenics Board for Shirley’s eugenic sterilization. The board, however, refused to authorize Shirley’s sterilization on the ground that her husband objected to the procedure. Although he had been conspicuously absent during her two and a half years at the hospital, although Shirley’s history of mental illness was clearly connected to her inability to cope with the responsibilities of parenthood, although she had proven unable to care for her children, although she was likely to become pregnant again once she was released from the hospital, and although she urgently desired the operation, the Eugenics Board turned down Shirley’s petition. To the board members, the factors in favor of an operation did not outweigh Shirley’s husband’s desire to have more children and his hope that his wife might someday be “cured of not wanting children,” allowing him to reestablish his family. In the deliberations of the Eugenics Board, the patriarchal prerogative of a husband who misunderstood his wife’s mental illness as a lack of interest in her role as wife and mother outweighed his wife’s desire for reproductive control.⁷

As Shirley’s eagerness for the operation demonstrates, while sterilization could threaten women’s reproductive autonomy, some women very much desired this form of birth control. Until the 1960s, contraceptives were largely limited to diaphragms, douches, foam powders, and condoms. While the diaphragm was considered the most reliable, women had to be fitted for diaphragms, to be taught how to use them, and to have the privacy and the necessary sanitary conditions to feel comfortable with them. Douches and foam powders were less reliable, and men frequently objected to using condoms. Only with the introduction of the birth control pill and the IUD in the 1960s did women gain access to contraceptives that separated the use of birth control from the act of sexual intercourse, making successful contraception much easier for women who found it hard to plan ahead or whose partners were uncooperative. But birth control pills had to be taken every day, and both the pill and the IUD could have serious side effects. Although the risks of major surgery accompanied female sterilization, the unreliability of other contraceptives and the inaccessibility of abortion made sterilization an attractive option for women from all class and ethnic backgrounds. State restrictions on access to sterilization were thus as disempowering for those women denied access to the operation as state promotion of the operation was to women coerced or pressured into sterilization.

Until the 1960s, sterilizations for reasons other than eugenics were not governed by law. The decision whether or not to perform the operation was left to the discretion of individual physicians, who often considered sterilization to be an operation of convenience, mistrusted women’s ability to decide responsibly when to cease childbearing, and felt that husbands should ultimately decide whether and when their wives should become pregnant. As the former chairman of the Department of Obstetrics and Gynecology at the University of North Carolina facetiously noted, “The [fallopian] tubes belong to the husband, both the left and the right.”⁸ Most physicians established complicated parity formulas to govern access to the operation, requiring, for instance, that women have already given birth to four children by the age of thirty in order to qualify for sterilization. While privileged women could seek sterilization from the private physicians of their choice, poor women were forced to seek help from public health and welfare departments. In North Carolina, this meant that poor women who wished to be sterilized had to bargain with welfare officials and petition the members of the Eugenics Board, the same people who sought out “undesirables” for eugenic sterilizations whose voluntary nature was at best questionable.

The history of sterilization, then, reminds us not only that the same operation could both restrict and enhance women’s reproductive control but also that the restriction of women’s reproductive control could take many forms. As the contrast between Nial Cox and Shirley demonstrates, it was not the technology of sterilization itself that determined whether women saw the operation as repressive or liberating but the context in which the technology was embedded.⁹ The state of North Carolina restricted Nial Cox’s reproductive autonomy by denying her the opportunity to bear children; it restricted Shirley’s reproductive autonomy by denying her the opportunity to cease bearing children. I have chosen the term “opportunity” here to emphasize that women did not have a legally codified right to control their reproductive capacity in general or to choose sterilization in particular. In fact, Nial Cox and Shirley sought control over their reproductive capacities during the mid-1960s, at least a decade before the notion that women have reproductive rights was fully articulated in the United States. In emphasizing the importance of reproductive rights for all women, I would argue that the state denied both women the “right” to reproductive autonomy. However, my goal here is to analyze Cox’s and Shirley’s situations within their historical context, a context in which such rights had not yet been articulated.

While poor and minority women were more susceptible to coercive sterilization and more likely as a group to suffer from sterilization abuse, women’s race and class background alone did not determine the meaning sterilization held for them. Poor and minority women did not share one outlook or one experience in regard to the surgery. Some poor women and women of color actively sought sterilization. Rather than being the victims of coercive eugenic policies, they used those policies and programs for their own ends. Those ends, however, were hardly unrelated to race or to class. The fact that some women could only gain access to sterilization through the eugenic sterilization program speaks to their lack of resources. As the case of Shirley demonstrates, moreover, gender relations further complicated this picture. Given poor women’s vulnerable position and the history of racism, class bias, and coercive practices in sterilization programs, the self-determination of women who turned to the eugenic sterilization program is all the more remarkable.

A certain flexibility in the meaning of sterilization could ease women’s access to the surgery. While women might be unable to obtain an “elective” sterilization for contraceptive reasons, physicians were sometimes willing to perform the surgery if serious health problems justified a “therapeutic” sterilization. Similarly, welfare officials unable to provide clients with elective or therapeutic sterilizations could petition the state’s Eugenics Board for “eugenic” sterilizations. Just as women’s access to abortion could depend on whether the procedure was classified as elective or therapeutic, access to sterilization could change as the definition of the surgery changed.

State-sponsored sterilizations were a national, indeed an international, phenomenon. Yet the events that led to each individual sterilization occurred at the local level. An in-depth analysis of North Carolina’s sterilization program allows us to understand these local events. In some ways, North Carolina’s history with birth control, sterilization, and abortion is unusual. Not only did the state introduce the nation’s first state-supported birth control program, it initiated more state-sponsored sterilizations per capita than any other state, and it was among the first states to pass a voluntary sterilization law and to reform its abortion law in the 1960s. Moreover, its sterilization law was the only one in the country that permitted welfare officials to petition for the sterilization of their clients, and the state greatly expanded its sterilization program in the 1950s and 1960s, when eugenic sterilization programs in most states ceased.

Despite the unique attributes of its reproductive policies, however, many of their features could be seen in other states. Many states attempted to control public expenditures by limiting the reproduction of welfare recipients. The interplay of race, class, and gender in the implementation of reproductive policies in North Carolina mirrored tensions in other locations. Across the country, public health and welfare officials, medical professionals, and research scientists were intimately involved in reproductive policies, and several other states expanded eugenic sterilization after 1950.¹⁰

His excitement about the promise of eugenic sterilization moved Clarence J. Gamble to write a poem on the topic. The poem celebrated North Carolina’s eugenic sterilization program by contrasting the fate of a happy sterilized “moron” couple with that of a “moron” couple fated to give birth to generations of feebleminded children, grandchildren, and great-grandchildren. Gamble intended the North Carolina Human Betterment League to use the poem, which he wrote in the mid-1940s, in its promotional materials. League members, however, found the piece in poor taste and worried about the public backlash it might produce. They quietly ignored it. When the Department of Social Services donated its papers to the North Carolina State Archives, the poem went along. I have used it to introduce this chapter’s subsections.

Eugenic Science and the Making of Eugenic Sterilization Laws

Once there was a MORON, that means / A person who wasn’t very bright. / He couldn’...

Table of contents

• Cover Page
• Title Page
• Introduction
• Copyright
• Table of Contents
• Abbreviations
• INTRODUCTION A Great Thing for Poor Folks
• CHAPTER TWO Nothing Is Removed Except the Possibility of Parenthood
• EPILOGUE From the Footnotes to the Headlines
• Notes
• Bibliography