Demanding the Right to Reproduce: Voluntary and Forced Sterilization in America


The latest attempt to sink health care reform bills under consideration in Congress comes as no surprise. Anti-abortion advocates are pressuring
the administration to exclude one of America’s most controversial
surgical procedures from the federal plan. At the same time as this
story broke, another White House related reproductive rights issue was
also hitting the news: Obama’s appointed Science Czar, John Holdren,
wrote a book in support of forced sterilization as a means of population
control. Which story
do you think has received more press? Abortion, of course.

Both issues are critically important
to discuss.  Rebecca Kluchin’s new book, Fit to Be Tied: Sterilization
and Reproductive Rights in America, 1950-1980
, explores a thirty
year period of US history in which eugenic and neo-eugenic ideas were
used to justify forced, coerced, and freely chosen sterilization, providing much-needed historical context for a topic that is still alive. In
it, Kluchin shines a light on why it’s high time to make room at the
reproductive rights table for more than one conversation.

Mandy Van Deven: Sterilization isn’t the most popular
reproductive health topic. How did you come to write this book?

RK: As a graduate student studying American
women’s history, I studied the history of abortion and birth control.
I shifted my research focus from abortion to sterilization because so
little had been written about the latter in the post-World War II period,
and I was interested in understanding the ways social engineering continued
to shape sterilization policy and practice even after the formal eugenics
movement concluded. I was also very interested in the gendered power
dynamics between patients and healthcare providers, and the ways in
which race, ethnicity, and class shaped women’s access to reproductive
health services.

MVD: Why
did these three decades stand out as important for sterilization and
reproductive rights?

RK: The 1960s and 1970s represented an era
of social and political change, and to some extent, the law changed
with the times. The Supreme Court legalized contraception for married
couples in 1965, and for singles and minors in 1972. The following year,
it legalized abortion in the first two trimesters with Roe v. Wade.
The new freedoms women gained through these decisions led some women
who were denied voluntary sterilization to challenge restrictions on
their desired surgeries. If birth control and abortion were legal, they
wondered, why was tubal ligation still restricted? Voluntary sterilization
policy, specifically the overturning of hospital codes that restricted
women’s access to tubal ligation, followed the precedents set by Supreme
Court decisions that legalized birth control and abortion.

MVD: What kinds of hospital policies did
women find problematic?

RK: Most hospitals restrict women’s access
to tubal ligation through age/parity policies. The most common policy
is called the 120 rule, and said a woman’s age multiplied with the
number of children she had (her parity) had to equal or exceed 120 in
order for her to eligible for sterilization. Birth rates were declining
and many women – especially white women, as hospital administrators
did not always employ such policies in minority communities – could
not meet the criteria. Using recent precedents in birth control and
abortion policy, voluntary sterilization plaintiffs successfully argued
that the hospitals that refused their requests for tubal ligation had
violated their newly established reproductive rights.

MVD: What influenced your decision to use
legal sources as your primary research material?

RK: My reliance on lawsuits to tell the stories
of the forcibly sterilized and those seeking sterilization was dictated
largely by the sources available to me. I lacked access to most medical
records, but I did have access to court cases and, in some instances,
trial transcripts and affidavits, which provided me with direct access
to my subjects. Whenever possible, I supplemented these sources with
popular literature and letters written by women and men seeking sterilization
that I found in the archives.

Historians can never be totally objective,
but when researching and writing this book, I tried to listen to the
women whose voices I located and represent them in the most authentic
terms possible. I am keenly aware that most women do not describe their
reproductive experiences in political terms, which meant that I could
not rely on institutional records (e.g. NOW, NARAL, Planned Parenthood,
the Association for Voluntary Sterilization) to represent those sterilized
or seeking to be sterilized. I studied the records of these organizations,
but they did not offer the direct access to the subjects of my study
like legal records did.

MVD: How did the battle for the right of
sterilization differ from the battle against forced sterilization?

RK: Victims of sterilization abuse proved
less successful in their efforts to sue the hospitals and physicians
that were responsible for their loss of fertility. This is largely because
the precedents set in birth control, abortion, and voluntary sterilization
cases defined reproductive rights as access to reproductive health services.
Victims of forced sterilization attempted to broaden this framework
by arguing that they possessed the right to be free from coercion and
should be compensated for the abuse they suffered. Only one of the thirty-three
lawsuits I found was decided in favor of sterilization abuse victims.
As a result, current policy defines reproductive freedom narrowly, as
access to reproductive health services, which ignores the ways in which
poverty and race continue to shape women’s reproductive experiences
and options.

MVD: To some degree this book re-centers women of color in an historical viewing of reproductive rights struggles. How did
sterilization practices and policies effect
women of color’s participation in the movement for
reproductive rights? 

RK: Fit to Be Tied builds on the work
of scholars like Jennifer Nelson, Elena Gutierrez, Loretta Ross, and
Angela Davis, among others, who not only pointed out the white middle
class biases of feminist organizing around reproductive rights issues,
but revealed a rich organizing tradition of women of color around reproductive
rights. The reproductive choices that women confront are shaped by race,
class, and ethnicity; thus, for many women of color, reproductive freedom
was part of their struggle for racial equality and economic justice.

In 1961, civil rights activist Fannie
Lou Hamer was sterilized via hysterectomy when she entered Sunflower
County Hospital in Alabama to have a uterine tumor removed. The operating
physician performed a "Mississippi appendectomy." He removed her
uterus without her knowledge during abdominal surgery. White physicians
practiced "Mississippi appendectomies" in Southern black communities
in the 1950s and early 1960s, particularly communities with active civil
rights traditions. For black women in the South, sterilization abuse
was a civil rights issue.

While white feminists organized around
abortion, many Chicana and Native American activists organized around
the issue of ending sterilization abuse. Chicanas in western states
and Native American women on reservations experienced forced sterilization
in the late 1960s and early 1970s that involved white physicians targeting
them for "elective" tubal ligation when they entered hospitals in
labor. As with black women, Chicanas and Native American women were
targeted because of their race and class status.

MVD: You write about the fissures between
white women and WOC who were advocating two very different, and at times
conflicting, positions on reproductive rights. Can
you talk about why there was divergence in the movement?

RK: Women are not a unified group. Because
race, ethnicity, and class play such a critical role in determining
the reproductive choices available, women define reproductive rights
differently. Most women of color did not join mainstream white feminist
organizations because groups like NOW, NARAL, and Planned Parenthood
constructed a reproductive rights agenda based upon a white, middle-class experience that focused nearly exclusively on abortion rights
and did not address the other reproductive offenses through the medical
racism women of color, especially poor women of color, experienced – sterilization
abuse being just one form. Women of color advocated a broader definition
of reproductive freedom that went beyond unrestricted access to legal
abortion and included the right to determine when and under what conditions
to become pregnant and the right of all women to bear and raise children
with dignity.

Feminists of color leveled many criticisms
against white feminists during the late 1960s and early 1970s. Radical
white feminists listened to charges that they ignored issues of race
and class, and adopted the expanded definition of reproductive freedom
held by feminists of color. Together these groups formed an anti-sterilization
abuse movement that made sterilization abuse a national issue. Their
efforts led the Department of Health, Education and Welfare (DHEW) to
develop sterilization guidelines for public patients designed to prevent
coercion. White "mainstream" feminists and anti-sterilization abuse
activists found themselves on opposite sides of the debate that ensued
over how to prevent abuse via public policy.

MVD: What is interesting is that both camps
literally had opposing positions.

RK: All feminists opposed forced sterilization,
but Planned Parenthood, NARAL, and NOW rejected the waiting periods
(thirty days between time of consent and surgery) and age minimums (21-years-old)
that DHEW proposed on the grounds that they impeded women’s access
to sterilization. Anti-sterilization abuse activists, however, argued
in favor of these safeguards, and insisted that forced sterilization
constituted a far greater violation of rights than did lack of immediate
access to services. Herein lay the conflict: in order to protect one
group of women from forced sterilization, DHEW had to restrict another
group of women’s access to tubal ligation. In this instance, women’s
reproductive rights were in irreconcilable conflict.

MVD: You’re
keen to point out in the book that many of the women who
filed suit against unfair sterilization practices were not, in fact,
feminists. Why was it important to make this distinction? 

RK: Scholars and journalists tend to define
reproductive rights as a feminist issue, but women who did not identify
as feminist challenged public policy too. Before Roe v. Wade, hundreds
of thousands of women underwent illegal abortions every year. Their
defiance of the law, at great risk to their lives and health, should
be read as a challenge to public policy, even though it was covert.
The voluntary and forced sterilization lawsuits I examine reveal the
extent to which feminist ideas about reproductive freedom made their
way into mainstream culture in the 1970s. They show how quickly many
American women adopted feminist ideas about the right to control their
reproductive decisions without medical or legal interference even as
many of these women went out of their way to separate themselves from
organized feminism. Reproductive rights activism can assume many forms
and one does not have to define oneself as a feminist to take action.

MVD: A continuous struggle regarding sterilization
is one between individual freedoms and the "collective good,"
both sides which have merit and serious
problems. Do you see these positions as
reconcilable?

RK: I think it depends on who gets to define
what the "collective good" is and whether or not those whose interests
conflict with the "collective good" have the ability to resist attempts
to control their reproduction. Too often those in power use the interest
of the "collective good" to justify the violation of individual
rights of those who lack power. I think in a pluralistic society like
ours where we theoretically all have equal rights, but in practice racism,
sexism, and class disparities continue to shape our ability to exercise
such rights, these positions cannot be reconciled.

MVD: Fit to be Tied
is primarily interested in the sterilization of women, but you do
write about men’s sterilization as well.
In what ways were men impacted by sterilization?

RK: Not surprisingly, physicians and hospitals
did not place the same restrictions on vasectomy as they did tubal ligation.
The 120 rule governed women’s access to contraceptive sterilization,
but not such policy existed for men. This is partially because, until
the early 1970s when laparoscopic methods were introduced, tubal ligations
were performed in hospitals whereas vasectomies were performed in urologists’
offices and therefore not subject to oversight. But sexism also played
a role. When a New Jersey woman denied tubal ligation by Riverview Hospital
in 1971 asked an administrator why vasectomy was not regulated like
tubal ligation, he replied, "It’s nobody’s business what a man
does."

MVD: The
Association for Voluntary Sterilization (AVS) is prominent in this book,
and seems to be the only organization that was
able to change with the times in order to put forth its
agenda. Why do you think they were able to maintain
this level of success in pushing their agenda?

RK: I think the AVS (which is now called
EngenderHealth) endured for so long because it was willing to change
its strategies and philosophies in order to meet its end goal of legitimizing
contraceptive sterilization and making sure that all those who wanted – and
some more eugenically-minded members would argue needed – sterilization
had access to surgery. The formal eugenics movement concluded around
the 1950s, but AVS placed itself at the forefront of what I term a "neo-eugenics"
movement around this time by casting sterilization as a solution to
contemporary social "problems" like an expanding welfare system,
concerns about overpopulation, and rising rates of unwed motherhood. Its
leaders tapped into conservative Cold War anxieties and marketed the
benefits of contraceptive sterilization effectively.

MVD: You link sterilization to many other
social and political issues: fear of communism, immigration,
genocide, and informed consent, to name a few. Can you give an example
of the way these issues intersect?

RK: The stereotype of the "welfare queen"
is a good example. This myth is neo-eugenic in nature because it is
based on the idea that "defective" traits like poverty and illegitimacy
are reproduced via culture. Opponents to welfare and other social services
attack the reproductive fitness of poor women, especially women of color,
and reinforce a common notion that women who receive public assistance
should relinquish some of their reproductive rights in exchange for
aid because white, middle class tax payers have a right to dictate the
reproductive decisions of poor women in the interest of society, on
behalf of the "collective good" you mentioned earlier.

MVD: The irony of
this idea is that the same social stratification which allows for abusive
reproductive policies and practices creates the systemic oppressions
that put people in disadvantaged situations. What groups attempt to
address the underlying issues of racism,
poverty, and gender norms instead of writing
individuals off as "unfit"?

RK: Welfare rights activists certainly framed
their opposition to forced sterilization in terms of abuse being caused
by racism, poverty, and sexism. Feminists of color, radical white feminists,
and groups like the Young Lords did the same. Despite their efforts
for change, though, the systems that perpetuate economic inequalities,
racism, and sexism remain in place, in part because neo-eugenic attitudes
perpetuated them and did so in a way that effectively removing systemic
oppressions from the discussion by blaming individual women for their
status in society.

MVD: The reproductive rights movement
is currently undergoing a serious overhaul
away from "white women’s issues," like abortion, and toward
a philosophy of reproductive justice that takes a more complex look
at how systemic oppression influences reproduction.
It seems like you agree this is a positive development.

RK: I think the white feminist community
is more aware of a broader philosophy of reproductive justice than it
has been in the past, in larger part because of organizations like SisterSong and New Voices Pittsburgh. White radical feminists "got it" in
the 1970s and were the only group to advance a political agenda that
did not foreground their race and class interests. They were willing
to accept restrictions on voluntary sterilization in order to protect
poor women of color from sterilization abuse. Abortion is one of many
reproductive rights, not the reproductive right. Abortion rights
meant little to women forcibly sterilized. Sterilization is not as controversial
as abortion, but it carries the same potential to be life changing.

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  • crowepps

    This sounds like a very informative book — will be looking for it.

  • invalid-0

    I am intrigued and am ordering this book but I am a little concerned about some things I read in this intervriew.

    first, I wonder why the author focused on lawsuits, lawsuits will present as much of a bias as the records of the organizations she mentions. this time period was less than 60 years ago so I am sure many of these people are still alive and could be interviewed.

    second, sterilization is not inherantly bad, it is fine as long as it is voluntary, for example my brother-in-law has enough kids and is getting a vasectomy.

    third, I personaly support some of the organizations mentioned here, especially Engender health. I do not know what they might have been doing 50 years ago, but today they are clearly not a “eugenics” organization, they are really involved in things like HIV prevention, obstretic fistula, reducing gender linked violence, and more. they still support sterilization as part of their family planning work but I want to make it clear that Engender health is not a eugenics organization, even though you might get that impresion from this interview and maybe from the book (which I am ordering now).

    fourth, having said all that, it is always important to keep eugenics in mind when studying sterilization, because it is always a potential issue. but supporting sterilization does not mean you support eugenics

    thank you.

  • invalid-0

    Brave, resource-filled analysis and book. I can’t wait to order it. I love books that provide multi-faceted perspectives on complex issues and don’t reduce subjects to black & white (pun intended). This probably should be required reading in every women’s studies or women’s health class and included in medical school curriculum.

  • http://www.powell.com invalid-0

    The Cluetrain Manifesto wasnt the biggest nonfiction book to come along in early 2000. That would be Who Moved My Cheese. I never read that, but I did read what was probably the second-biggest: Malcolm Gladwells The Tipping Point. Like Cheese, Tipping is about change. Unpacking one chapter in the book, Malcolm writes, I think

  • rachel-walden

    Thanks for doing this interview; I hadn’t heard of this book yet, and definitely need to add it to my massive to-read list.

  • invalid-0

    Coerced sterilization and sterilization done without the patients knowledge by the US government was not done for eugenics, but as a form of poverty control.
    It was done to whites, blacks, and most recently in the 1970s to Native Americans.

    They are obviously thinking of conducting coerced and uninformed sterilization again of whites and latinos if they gain control of people through government health care again, or there would not be people advising the writing of the current health care plans such as Peter Singer, Holdren, and Van Jones.

    It shows that the Dutch option of private health insurance should be the plan, and that government health care should always be avoided as much as possible.

  • nicole-r

    While it’s true that sterilization has been badly misused in the past, when it’s voluntary and with informed consent, sterilization is an essential option for women and couples who don’t want to have more children: Unfortunately, because of past abuses, this very good and important method is often maligned, and sidelined. As a feminist, I believe it all comes down to reproductive rights. Women must be able to make free and voluntary choices and access sterilization if they seek it. And, as with any medical procedure, patients must be able to make informed decisions about services that directly impact their health and lives. Thinking globally, we need to be sure that standards of care are uniform and that women receive all of the information they need before making the decision to be sterilized. Ultimately, we have to remember the many benefits of sterilization. In poorer countries—where the nearest hospital or health center is miles and hours away and regular visits to a health provider for short-term methods like the pill or the injection are not possible—permanent contraception can be a lifesaver. With sterilization, women who don’t want children no longer have to worry, or risk their life in childbirth for an unwanted pregnancy. Voluntary sterilization should be available to anyone who wants it—wherever they live. Helping to expand access to the method, improving the quality of services, and most importantly, ensuring informed choice, are critical.