A closer look

Involuntary Female Sterilization in the Twentieth Century

How did activists oppose government sterilization programs and fight for reproductive justice in the 1970s?

by Chloe Stoia, CUNY Graduate Center

Origins of Female Sterilization in the United States

In the 1960s, women of color and reproductive justice activists mobilized against government-sanctioned practices of sterilizing women and girls who were unable to provide their informed consent. African American, Latinx, Indigenous, and low-income women and girls were most vulnerable, particularly those whose families received federal welfare benefits, relied on public health care facilities, or were labeled physically, intellectually, or morally unfit. By calling public attention to this abuse, activists (including some who had undergone such procedures themselves) and some healthcare providers helped highlight the long history of coerced or forcible sterilization practices in the United States. 
State-sanctioned forcible sterilization dated back to at least the early twentieth century when reformers, politicians, and medical professionals responded to social and economic changes resulting from the end of slavery, imperialist expansion, demands for women’s rights, immigration, and other forces. The movement to empower state and federal agencies to deny women and girls the right to reproduce was led by proponents of eugenics, who believed that their wealth, intelligence, and whiteness made them more desirable to reproduce than immigrants, people of color, and poor people. Prominent eugenicists—including President Woodrow Wilson, the wealthy industrialist John D. Rockefeller Jr., and Margaret Sanger, founder of Planned Parenthood—argued that sterilizing women, even without their consent, would save public monies and serve the public good by preventing children they feared would weaken society. Similarly, as medical advances increased longevity, population control advocates argued that population growth caused poverty and that the nation should reduce birth rates, particularly among groups they considered unlikely to contribute to society or likely to drain public resources. Other reformers saw sterilization as the solution to rising immigration rates and the country’s growing non-white population after the end of slavery and the incorporation of Hawaii, Puerto Rico, and other territories. In Puerto Rico, for example, the fear of overpopulation and poverty led the U.S.-controlled government to legalize sterilization for eugenic purposes on the island in 1937. Thirty states passed similar laws.

Mechanisms of Coercion

In June 1973, workers from a federally funded family planning clinic in Montgomery, Alabama, informed Mrs. Minnie Relf, an African American woman and welfare recipient, that her daughters required some injections. Relf was unable to read the documents they provided, and unknowingly authorized the surgical sterilization of 14-year-old Mary Alice and 12-year-old Minnie Lee. Along with the Relfs, about 100,000-150,000 low-income women and girls were involuntarily sterilized each year, including approximately 2,000–3,000 minors. Coercion took many forms. Like the Relfs, many were pressured by public agencies that required sterilization as a condition for receiving public assistance. Other women were not offered non-permanent methods of birth control or warned of the operation's permanence and possible complications. Some patients in public hospitals gave birth, only to discover later that they had been unknowingly sterilized following the delivery. In some public hospitals, consent forms and medical information were only available in English, denying Spanish-speaking women the possibility of informed consent. 
Many employees of public agencies, including physicians and welfare caseworkers, believed that coercive and restrictive family planning practices were needed because low-income women of color could not care for their children adequately. Public policies and practices reinforced these views. For instance, the federal government created a monetary incentive for clinics to sterilize impoverished women: it provided states with 90 percent of the cost of sterilizations for women receiving government assistance but only 50 percent of the cost to provide abortions.
As a result of such funding, and because of the racist stereotypes on which funding for health and welfare programs were based, the impact on Black, Puerto Rican, and Indigenous women was widespread. Princeton University’s 1975 National Fertility Study, for example, found that 43 percent of the women sterilized in federally financed family planning programs were Black, although African American women represented only one-third of the patients seen at the facilities. Similarly, Indigenous women who sought medical care from Indian Health Service facilities suffered tremendously high rates of medically unnecessary sterilizations.

The impact was particularly severe for Puerto Rican women who lived on the mainland and on the island. During the 1950s, Puerto Rico was a test site for multiple contraceptives, including Enovid, the first birth control pill, and Emko spermicidal foam. Enovid frequently caused severe side effects and tests proved that other experimental forms of birth control were ineffective: deprived of good alternatives, many Puerto Rican women chose sterilization as the best contraceptive option. On the island, the Department of Health established a network of free sterilization clinics to serve low-income women. The Department’s clinics operated along with clinics overseen by the Family Planning Association of Puerto Rico, which received the majority of its budget from the federal Department of Health, Education, and Welfare (HEW). By 1968, the island had the world’s highest rate of sterilization: an estimated 35 percent of Puerto Rican women of childbearing age were sterilized, nearly all of them younger than 35 years.

Resistance and Reform

In the 1970s, women of color mobilized to end sterilization abuse and other coercive practices. After the Relfs learned of their daughters’ involuntary sterilization, the family worked with the Southern Poverty Law Center and the National Welfare Rights Organization to sue HEW. Relf v. Weinberger (1974) alleged that HEW, which funded the Alabama clinic, had violated the sisters’ right to have children. The suit disclosed that approximately 100,000–150,000 women were involuntarily sterilized each year through federal anti-poverty programs. Based on the evidence, the court ruled that HEW monies could no longer fund the sterilization of minors or people with disabilities. In addition, the agency was forced to adopt new guidelines, specifying that women had to be informed about and understand the possible side effects and consequences of sterilization in order to give their consent. 

Other activists focused on raising public awareness about the frequency of coercive sterilization and its broader impact. Iris Morales Luciano, a leader in New York’s Young Lords Party, a Puerto Rican civil rights group, wrote in the organization’s newspaper, Palante, about the mass sterilization of Puerto Rican women on the island and in the New York City diaspora. Similarly, Triple Jeopardy, published by the Third World Women’s Alliance, reported how Connie Uri, a Choctaw and Cherokee physician, had collected accounts of Indigenous women and men in Oklahoma who had been sterilized. Uri’s findings helped spur investigations of the Indian Health Service by the U.S. Senate and the Government Accounting Office (GAO). The investigation concluded that the Indian Health Service failed to follow the guidelines established after Relf v. Weinberger and did not have adequate consent procedures. The same year, Congress passed the Indian Health Care Improvement Act. The Act gave Indigenous people the right to manage Indian Health Service programs, which significantly decreased sterilization abuse in Native communities. Two other organizations, the Committee for Abortion Rights and Against Sterilization and the Committee to End Sterilization Abuse, also demanded greater legal protections against sterilization abuse. These groups proposed regulations for sterilization, such as a waiting period of 30 days, which HEW eventually adopted in 1979. 
Despite the successes of activists in the 1970s, sterilization abuse in the U.S. has not been completely eradicated. A 2020 report on health conditions within a U.S. Immigration and Customs Enforcement detention center alleged that medically unnecessary hysterectomies were performed on immigrant women without their consent. A nurse employed at the detention center stepped forward to expose the facility’s treatment of detainees: her action revealed the ongoing need for reform to stop abuses within settings where women have a limited ability to question the validity of their treatment or to assert their reproductive rights.

Reflection Questions

How did experiences with female sterilization differ between racial groups? How were they similar?
What policies and practices by state and federal agencies fostered sterilization abuses?
What arguments did supporters of female sterilization make to justify the practice?
How did activists resist coerced female sterilization?

Additional Readings

Briggs, Laura. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. Berkeley: University of California Press, 2002.
García, Ana María, director. La Operación. Brooklyn, New York: The Cinema Guild, 1982. https://video.alexanderstreet.com/watch/la-operacion.
Kluchin, Rebecca M. Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980. New Brunswick: Rutgers University Press, 2009.
Lawrence, Jane. “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly 24, no. 3 (2000): 400-419. http://www.jstor.org/stable/1185911.
López, Iris Ofelia. Matters of Choice: Puerto Rican Women’s Struggle for Reproductive Freedom. New Brunswick: Rutgers University Press, 2008.
Nelson, Jennifer. Women of Color and the Reproductive Rights Movement. New York: New York University Press, 2003.
Tajima-Peña, Renee, director.  No Más Bebés. Los Angeles: Moon Canyon Films, 2015.

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