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

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

In 2003, North Carolina became the third U.S. state to apologize for state-ordered sterilizations, carried out between 1929 and 1975, and the first to call for compensation to victims. This action was prompted by a series of newspaper stories based on 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 7,500 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 in compensation. The restitution proposal requires legislative approval before funds can be dispersed.

In this UNC Press Short, excerpted from Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare, 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 victims how the state was able, in multiple ways, to deny reproductive autonomy to women who were poor, uneducated, African American, or promiscuous.

Johanna Schoen is associate professor of history at Rutgers, the State University of New Jersey.

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. Produced exclusively in ebook format, these shorts present essential concepts, defining moments, and concise introductions to topics. They are intended to stir the imagination and encourage further exploration of the topic. For in-depth analysis, contextualization, and perspective, we invite readers to turn to the original publications from which these works are drawn.

Women and the Politics of Sterilization consists of the introduction, chapter 2, and the epilogue from Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare, by Johanna Schoen. © 2005 The University of North Carolina Press. All rights reserved. Originally published as part of the Gender and American Culture series, Thadious M. Davis and Linda K. Kerber, coeditors.

www.uncpress.unc.edu

The Library of Congress has cataloged the original edition of this book as follows:

Schoen, Johanna.

Choice and coercion: birth control, sterilization, and

abortion in public health and welfare / Johanna Schoen.

p. cm.—(Gender and American culture)

Includes bibliographical references and index.

ISBN 0-8078-2919-6 (cloth: alk. paper)

ISBN 0-8078-5585-5 (pbk.: alk. paper)

1. Birth control—Government policy—North Carolina—

History. 2. Sterilization, Eugenic—North Carolina—History.

3. Abortion—Government policy—North Carolina—History.

I. Title. II. Gender & American culture.

HQ766.5.U5S36    2005

363.9′6′09756—dc22

2004017632

UNC Press Shorts ebook edition published in 2012

ISBN: 978-0-8078-3759-7

For more information on UNC Press ebook shorts, visit www.uncpressebookshorts.com.

Contents

Abbreviations

INTRODUCTION

A Great Thing for Poor Folks

CHAPTER TWO

Nothing Is Removed Except the Possibility of Parenthood: Women and the Politics of Sterilization

EPILOGUE

From the Footnotes to the Headlines: Sterilization Apologies and Their Lessons

Notes

Bibliography

Gender & American Culture

COEDITORS

Thadious M. Davis

Linda K. Kerber

EDITORIAL ADVISORY BOARD

Nancy Cott

Cathy N. Davidson

Jane Sherron De Hart

Sara Evans

Mary Kelley

Annette Kolodny

Wendy Martin

Nell Irvin Painter

Janice Radway

Barbara Sicherman

Abbreviations

ABCL American Birth Control League ADC Aid to Dependent Children AFDC Aid to Families with Dependent Children AID Agency for International Development ALI American Law Institute BCFA Birth Control Federation of America D&C dilation and curettage DNS Division of Negro Services EMIC Emergency Maternal and Infant Care program FDA Food and Drug Administration FPI Family Planning Incorporated FSA Farm Security Administration IPPF International Planned Parenthood Federation IQ intelligence quotient IUD intrauterine device NAACP National Association for the Advancement of Colored People NCMH National Committee for Maternal Health PPFA Planned Parenthood Federation of America Rs rupees WMS Women’s Medical Service

INTRODUCTION

A Great Thing for Poor Folks

In 1948, Estelle, a twelve-year-old African American girl from Pittsburgh, had her first encounter with abortion.¹ Without examining her, a physician had concluded that she was four months pregnant. An irregular period and, most likely, Estelle’s race had been enough evidence for him to diagnose pregnancy. Actually, Estelle had not been pregnant, and eventually she began menstruating again. Her first real pregnancy occurred in 1957, and at the age of twenty-one Estelle gave birth to her first baby. After the delivery, she tried to obtain contraceptives but found that as a single woman she was ineligible. Her second baby followed in 1958, and her third in 1959. In 1961, when she discovered that she was pregnant for the fourth time, she tried to secure an abortion. It took her a while to find an abortionist, and when she finally located one, the abortionist informed her that her pregnancy was too far along. Estelle had no choice but to have another baby.

After the delivery, Estelle married and again tried to obtain contraceptives. This time, however, she met the resistance of her husband, who refused to sign the required form. Within four months, Estelle was once again pregnant. Right away, she contacted her abortionist and terminated the pregnancy, only to find herself pregnant for the sixth time in 1962. Her husband had just lost his job, and there was no money for another abortion. Estelle tried a number of home remedies to terminate the pregnancy but was unsuccessful, and she had another child. Sick of her frequent pregnancies and overburdened with five children, a rocky marriage, and no money, Estelle sought sterilization. Her physician, however, refused to perform the operation.

Estelle concluded that she had no other option but to forge her husband’s signature to get a diaphragm. But using the diaphragm was nearly impossible. Her husband objected and beat her whenever he noticed that she was using the device, and in 1963 Estelle found herself with a tubal pregnancy. When her physician removed her ovary, Estelle begged him for a sterilization—without success.² Her sixth baby was born in 1964, and one year later she was pregnant again. After Estelle received a particularly severe beating from her husband in her seventh month of pregnancy, her seventh baby was born prematurely.

Estelle had had enough. For the second time, she forged her husband’s signature, this time to obtain birth control pills. Then she bought a gun and practiced shooting in the basement to keep her husband away from the pills. With this safeguard in place, she was able to protect her birth control pills from her husband and herself from pregnancy for the next seven years. By 1970, however, Estelle had become a diabetic, and she had to stop taking the pill. Instead, she got an intrauterine device (IUD), which gave her a severe infection. After the removal of the IUD, she was again without contraceptives, and she promptly found herself pregnant. Fortunately, by this time she could get a legal abortion for medical reasons. The following year, she had another abortion—her last. Shortly afterward, her husband divorced her.

Estelle’s story poignantly demonstrates women’s struggle for reproductive control. While she turned to birth control, sterilization, and abortion in an attempt to control her reproduction, Estelle found that she was largely unable to prevent unwanted pregnancies. Her husband and her health professionals repeatedly denied Estelle what we have come to understand as her reproductive rights—her ability to control when and under what conditions to become pregnant and bear children. Poor and black, Estelle frequently lacked the resources that might have allowed her to gain access to birth control, sterilization, and abortion. This book is about women like Estelle. The state, I demonstrate, alternately offered and denied poor women access to birth control, sterilization, and abortion, and women negotiated with their physicians as well as with health and welfare officials in their attempts to control their reproduction.

Access to birth control, sterilization, and abortion was, as one African American woman commented after her sterilization surgery, a great thing for poor folks.³ But poor women were rarely able to gain access to these technologies on their own terms. Other groups—philanthropists, policy makers, health and welfare professionals—also had an interest in the control of poor women’s reproductive capacities and thought reproductive technologies a great thing for poor folks. But the terms under which they offered poor women access to them frequently kept control in the hands of health and welfare officials. The title of the introduction thus alludes to the double-edged application of reproductive technologies: they could extend reproductive control to women, or they could be used to control women’s reproduction.

Health and welfare officials regulated poor women’s access to birth control, sterilization, and abortion for most of the twentieth century. Concerned about maternal and infant mortality and convinced that alcoholism, sexual promiscuity, and poverty were hereditary, officials across the country began in the 1920s and 1930s to offer access to reproductive technologies through public health and welfare programs. Women sought reproductive control, but did so within clear limits. Sometimes, methods of reproductive control could offer women greater autonomy. Women gained reproductive control, for example, when state officials began to offer birth control through North Carolina’s public health clinics and when, several decades later, state legislators enacted a voluntary sterilization law and liberalized North Carolina’s abortion law. But birth control, sterilization, and abortion found legislative support partly because supporters used eugenic rhetoric and arguments for population control to promote them. Women lost reproductive autonomy when social workers threatened pregnant women on welfare with sterilization and attempted to tie offers of financial help to the use of contraceptives. North Carolina’s record on reproductive health evokes the Jekyll-and-Hyde nature of state involvement in such matters. The operation (sterilization) that violated a young girl in the name of eugenics brought relief to her overburdened mother; the jellies and foam powder that visiting nurses offered may have aided family limitation, but they hardly substituted for a broader public commitment to women’s health and to their reproductive control. The state of North Carolina presents an exemplary case study of what Rosalind Petchesky has called the tension between the principles of individual control and collective responsibility over reproduction.⁴

Four groups of people influenced the nature and delivery of reproductive policies throughout the twentieth century. First, medical and social scientists offered theories about the origins and characteristics of poverty and proposed solutions that involved the control of reproduction. Birth control and sterilization, concluded University of North Carolina professor of social work George H. Lawrence after an investigation of poverty in Orange County, North Carolina, were crucial to eliminating the state’s health and social problems. Second, leading health and welfare professionals as well as financial sponsors shaped public policy and influenced the nature of reproductive services. Clarence J. Gamble, heir of the soap firm Procter and Gamble, distributed and tested cheap birth control methods in North Carolina’s public health clinics and elsewhere and advocated eugenic sterilization. Third, the state and county officials who implemented public health and welfare policies shaped the delivery of reproductive services. George H. Cooper, director in the 1930s of maternal and child health programs in North Carolina, took Gamble’s offer of free contraceptive sponges and foam powders and tried to convince his county health officers to distribute the devices. He and his colleagues in the health and welfare professions influenced the accessibility of birth control, sterilization, and abortion and shaped the character of women’s reproductive health services. Finally, the poor and minority women targeted by the programs responded to them. Edith Turner, for instance, wrote to the North Carolina State Board of Health to ask for contraceptive information. Her interest in birth control and the responses of other poor and minority women to the programs, in turn, influenced the programs’ implementation, the policy-making process, and theories about the causes of and treatments for poverty.

While all four groups shared the goals of improving infant and maternal health and reducing poverty, they disagreed about women’s ability to control their reproduction and the desirability of giving reproductive control to women. Moreover, none of the groups’ members held a unified position. Philanthropists and policy makers argued with each other about the precise goals of reproductive policies. Some held that poor and uneducated women lacked both the motivation and the intelligence to use contraceptives and argued that resources should be channeled into the development of a birth control method geared specifically for the poor. Others felt that women merely lacked access to good contraceptives and health care and would frequent birth control clinics if such services were available. Health professionals also disagreed about the details of policy implementation and about the desirability of extending full reproductive control to women. They argued, for instance, over whether any woman requesting birth control should be given access to contraceptives or whether women needed to be married and to already have several children before they could get access to contraceptive advice. Women, too, lacked a unified response to, or experience with, reproductive technologies. Some sought sterilization, others did not. Some volunteered for contraceptive trials to gain access to birth control, while others objected to being the subjects of what they felt was medical experimentation.

As a result, policy implementation lacked cohesion, leading to the creation of a patchwork of programs with great disparities and contradictions between them. While health professionals might have coerced women to use IUDs, for instance, they barred women’s access to both abortion and elective sterilization. Women at times used the programs for their own purposes and in ways that contradicted the intentions of policy makers and health professionals. Lacking access to elective sterilization, for example, some women applied for eugenic sterilization through the North Carolina Eugenics Board, even though this necessitated that they be diagnosed as feebleminded.

Sexual, class, and racial conflicts shaped negotiations over reproductive control. Women’s ability to control their sexuality and the terms and conditions of motherhood stood at the center of debates about birth control, sterilization, and abortion. Class and race background determined whether women had access to reproductive health care, whether they came into contact with state sterilization and birth control programs, how they were treated by the representatives of these programs, and how they experienced sexuality and reproduction. Assumptions about the links between sexuality, class, and race shaped public perceptions of women’s sexual behavior, policy debates surrounding issues of sexuality and reproduction, the formulation of reproductive policies, and the delivery of services to patients. Policy makers and health and welfare professionals frequently assumed that poor single mothers—particularly if they were African American, Hispanic, or Native American—lacked the ability to function properly as mothers and that they should be discouraged from further childbearing. Middle-class white physicians and female social workers based decisions concerning women’s reproductive futures on middle-class assumptions about working-class and black women’s sexuality. Many white, male researchers and health professionals assumed that poor and minority women were unable or unmotivated to use contraceptives properly and encouraged the development and testing of cheaper contraceptives and contraceptives that were outside the control of female patients. Women negotiated with an overwhelmingly male medical profession, while an overwhelmingly male legislature regulated access to reproductive technologies. But gender, race, and class were not clear dividing lines in these debates, as any individual could be found on either side of a particular discussion.

Finally, concerns about racial discrimination shaped both the contemporary discourse about women’s reproductive experiences and the historical understanding of those experiences. Black nationalists frequently voiced suspicions that birth control for African Americans was equivalent to race genocide. Such allegations raised legitimate concerns. Critics pointed to the real abuse and coercion perpetrated by some family planning programs that targeted minorities for involuntary sterilization. They criticized persistent racial discrimination in access to health care, disapproved of the lack of minority representation on family planning boards, and expressed wariness about the attraction that family planning programs held for many racists. And they found an echo in academic circles in the 1970s, as mainland socialist