By Gabriela Salas

On September 15, 2020, a whistle-blower complaint alleged that immigrant women in a privately-run Immigration and Customs Enforcement (ICE) detention center in Ocilla, Georgia were being coerced into unnecessary sterilization and subjected to medical neglect.

In light of this horrific news, the NWHN wanted to present a brief history of sterilization and reproductive abuse in the U.S. and to make clear that this is an on-going issue for the reproductive rights of marginalized communities. The NWHN also seeks to make clear that REPRODUCTIVE RIGHTS ARE IMMIGRANT RIGHTS!

What Is a Hysterectomy?

First, a bit of background on the procedure. A hysterectomy involves surgically removing a person’s uterus; afterward, they cannot become pregnant. 

Hysterectomy is the second-most frequently performed surgical procedure among U.S. women of reproductive age. On average, about 600,000 hysterectomies are performed in the U.S. every year. One-third of all U.S. women will have a hysterectomy by age 60. According to the Centers for Disease Control and Prevention (CDC), 3.2 percent of all women of reproductive age (15-44), and 10.6 percent of women aged 40-44 have had a hysterectomy. There are several reasons women choose to have a hysterectomy, as shown in the table below. 

Reason for Hysterectomy (2011 – 2015)		Percentage of Women (15-44 years old)
Medical reasons (e.g., uterine fibroids, endometriosis, cancer)		89.6%
No more children desired (a chosen family planning method)		5.3%
Other reasons (not detailed by CDC)		1.7%

A hysterectomy is deemed to be “major surgery” by the Mayo Clinic and should be taken extremely seriously, due to the risk of complications.  In addition, it has significant outcomes that women should consider before having the procedure, including starting menopause early, and an inability to become pregnant. Like any medical procedure, hysterectomy should only be performed with the patient’s full and informed consent. 

Sterilization Abuse in the U.S. 

Throughout history, women in the U.S. have been subjected to coordinated efforts to control their fertility, including through abusive and non-consensual sterilization. The concept of “full consent” and patients having a “full understanding” when they consent to a procedure is critical. According to the whistle-blower’s complaint, coercive hysterectomies are being performed at the Ocilla ICE detention center.  

There is a long and extensive history of reproductive abuse of Black, Indigenous, and people of color (BIPOC) prior to the 20th century. As just one example, in the 19th century, the “Father of Modern Gynecology,” James Morion Sims, developed many reproductive health practices based on experiments he conducted on enslaved Black women, without anesthesia. Sims’ decision to not use anesthesia was based on his false and racist belief that Black people didn’t experience pain as white people did—a belief that still affects the treatment quality and pain management received by Black people in hospitals and clinics today. Today, people are starting to give credit for these medical advancements to the Black women who endured excruciating pain during Sims’ experimentations. To this day, however, we only know the names of three of these women from Sims’ records: Lucy, Anarcha, and Betsey. 

Sterilization abuse gained a false patina of scientific legitimacy during the height of the eugenics movement that began in the 1920s and continued well into the 1960s. During these decades, racism was fully integrated into U.S. public health, immigration, and segregation policies, as eugenicists applied emerging theories of biology and genetics to human reproduction. White supremacists embraced eugenics and sought to “improve” U.S. society by expanding white reproduction and limiting reproduction on the part of those deemed to be “unfit.” Sterilization was used to uphold white supremacy and limit the reproductive futures of BIPOC communities, as well as people with physical and/or mental health challenges. In the early 20th century, more than 60,000 people were sterilized in 32 states based on the “science” of eugenics.

State-sanctioned sterilizations reached their peak in the 1930s and 1940s but continued throughout the 20th century. In the 1960s and 1970s, federal programs started funding non-consensual sterilizations, which ultimately affected more than 100,000 BIPOC women. For example: 

• Poor and Black women in the South were so frequently victimized by non-consensual sterilizations that civil rights activist Fannie Lou Hammer coined the term “Mississippi Appendectomy” to raise awareness about the experiences of women who, like her, went to hospitals for medical treatments and were sterilized without their consent. 
• From 1950-1966, Black women in North Carolina were sterilized at more than three times the rate of white women and more than 12 times the rate of white men. 
• In 1965, the U.S. Public Health Service began providing family planning services to Native American and Indigenous families; by the 1970s, as many as 25 percent of Native American and Indigenous women of reproductive age had been sterilized. 
• Puerto Rican women were subjected to aggressive population control measures by the federal government, which promoted and conducted sterilization through coercive institutionalized pressure, such as by door-to-door visits by health workers, financial subsidies for sterilization, and employer favoritism toward sterilized women. A 1965 survey found that about one-third of all Puerto Rican mothers aged 20 – 49 had been sterilized. A 1968 study found that more than one-third of sterilized women did not fully understand that tubal ligation (a form of sterilization also called “tying the tubes”) was permanent; many of these women believed the procedure to be reversible and were not directly told otherwise by medical professionals. 

The NWHN Fights Back

In 1975, the newly formed National Women’s Health Network testified at nationwide hearings on proposed federal sterilization guidelines. In support of safeguards proposed by Black and Latina activists, we called for a 30-day waiting period for procedures, a minimum age of 21 years old, detailed informed consent requirements, and a moratorium on government funding for the sterilization of institutionalized women and those deemed “incompetent.” 

By 1979, the NWHN was taking on the National Organization for Women (NOW), asking our members to speak at their local NOW chapter in response to its position on sterilization, which opposed any waiting period and disregarded what women of color (and poor white women) were experiencing. In March of that year, federal regulations went into effect restricting federal funds for sterilization to when patients give their voluntary and informed consent for the procedure.

In 1981, as part of its Sterilization Abuse Monitoring Project, the NWHN organized with member groups in New York City and elsewhere to develop an in-depth manual to help local groups monitor hospitals and clinics for cases of forced sterilization. This manual was a first-of-its kind guide.

That same year, the NWHN sent a letter to OB/GYN departments at all major teaching hospitals in the U.S, asking for chairpersons to confirm in writing whether that hospital is complying with federal sterilization regulations and requested copies of each hospital’s memo to staff explaining the regulations. One-third, or the 350, hospitals responded. 

The medical establishment deeply resisted these rules protecting against abuse, but they were ultimately implemented and, in many cases, remain in effect today.  But that doesn’t mean that sterilization abuse was no longer a concern.

Throughout this period and into the present day, our work has been deeply shaped by NWHN charter member and long-time board member Dr. Helen Rodriguez-Trias, M.D., a leader in the fight against sterilization abuse in Puerto Rico, New York, and nationwide. Helen was a founding member of the Committee to End Sterilization Abuse (CESA), the first grassroots organization developed to combat forced sterilization.  CESA, a multiethnic organization, was responsible for crafting protective guidelines and leading a multipronged campaign to demonstrate community support for government action to end abuse. Read more about Dr. Rodriguez-Trias and her work to end reproductive coercion HERE and HERE.

Sterilization Abuse Continued Where Women Weren’t Free  

Women who are incarcerated or otherwise detained by the state appear to be at highest risk these days. For example, a 2013 audit of state and federal prisons in California found that 144 tubal ligations had been performed on inmates, and that at least 25 percent were performed without legal consent. These data are, alarmingly, only from the time periods of 2005-2006, and 2012-2013, so the numbers are likely to be even higher. 

The most recent case of sterilization abuse comes from September 2020. A whistle-blower who works in an ICE detention center filed a complaint citing concerns about the apparently high number of hysterectomies being performed on immigrants who are detained at the facility. Since then, multiple women have come forward to share their firsthand account of having been subjected to sterilization, including a former detainee who says she was sterilized without providing consent. As NWHN Policy Director Sarah Christopherson noted on behalf of the organization, these allegations must be viewed in the larger context of the U.S.’s shameful history of sterilization abuse, which has always been genocidal in its motivation. The NWHN strongly supports the congressional investigation into mass hysterectomies and medical neglect in ICE detention centers.

These are just a few of the myriad of stories and experiences of sterilization abuse suffered by marginalized peoples in the U.S. 

Conclusion 

The NWHN firmly believes that reproductive autonomy — the right to control when and whether to become pregnant, seek abortion care, and have a child — is a human right. According to an interagency statement published in 2014 by the World Health Organization, “Sterilization without full, free and informed consent has been variously described by international, regional and national human rights bodies as an involuntary, coercive and/or forced practice, and as a violation of fundamental human rights, including the right to health, the right to information, the right to privacy, the right to decide on the number and spacing of children, the rights to found a family and the right to be free from discrimination…Human rights bodies have also recognized that forced sterilization is a violation of the right to be free from torture and other cruel, inhuman or degrading treatment or punishment”.

The immigrant women in detention centers deserve autonomy over their bodies and reproductive choices, just like everyone else. This right does not depend upon a person’s race, ethnicity, gender, sexuality, religion, creed, or immigration status

The NWHN is also committed to ensuring that people have the most accurate information and high-quality health care in order to make their own decisions about what is best for their bodies and their health. We strongly support access to all contraceptive options, including fully informed and consented hysterectomies and sterilizations, and we reject any effort to direct or coerce women into using any specific method. We caution providers, public health officials, and policy-makers against assuming one method is better or worse for any individual based on his or her race, ethnicity, age, ability, economic status, sexual orientation, or gender identity and expression. Read more about the NWHN’s work on reproductive coercion, including our Statement of Principles on Long-Acting Reversible Contraception coauthored with SisterSong and signed by hundreds of organizations and individuals.

It is essential that we continue fighting and advocating for the rights of all individuals, including those who are marginalized and oppressed. If you want to get involved, contact your member of Congress and express your support for a full investigation of sterilization abuses in detention facilities. You can also ask your member of Congress to support the Dignity for Detained Immigrants Act, which supports immigrant rights. 

Gabriela Salas is the NWHN Policy Fellow

Additional Resources

Fit to Be Tied:  Sterilization and Reproductive Rights in America 1950-1980 by Rebecca M. Kluchin, 2009, Rutgers University Press, New Brunswick, New Jersey.

Landmark court cases related to sterilization abuse:

1. Buck v. Bell (1927): Carrie Buck, a poor white woman who was assumed to have inherited “feeblemindedness” and “promiscuity” from her institutionalized mother, was sterilized after giving birth to an “illegitimate child”. The suit, filed by Buck and her guardian, made it to the Supreme Court where the Virginia law, which allowed for individuals labeled as “feeble-minded” to be sterilized, was upheld in the interest of “public welfare.” As a result of this case, thousands of Americans with mental illness or developmental disabilities were sterilized throughout the 20th century. 
2. Relf v. Weinberger (1973): Mary Alice and Minnie Relf, poor Black sisters, were sterilized at the ages of 14 and 12 for being “mentally disabled.” Their illiterate mother had signed an “X” on a piece of paper that she believed had provided consent for the young women to receive birth control. The case exposed the wide-spread sterilization abuse that had been funded by the federal government for decades. The District Court found that an estimated 100,000 – 150,000 low-income people had been sterilized annually under federally-funded programs. It also found that countless numbers were coerced into agreeing to be sterilized by doctors who threatened to terminate their welfare benefits unless they “consented” to the procedures. The case resulted in the requirement that doctors obtain informed consent before performing sterilization procedures, prohibited the use of federal dollars for involuntary sterilizations, and prohibited the practice of threatening women with the loss of their benefits and welfare.
3. Madrigal v. Quilligan (1975): Ten Mexican and Mexican-American women filed a lawsuit alleging that they had been systematically coerced by medical personnel to be sterilized while giving birth at Los Angeles County-USC Medical Center. Seven out of the ten signed consent forms, the other three did not. All of the women who “consented” were in labor; many said that they were told they could not be attended until they signed the consent form; some did not read English, and therefore had no way to understand of what they were signing, and at least one woman said that a nurse took her hand and signed an “X” for her. The women did not win their case but, because of this court case consent forms must be printed in both English and Spanish. 

Additional recent publications related to sterilization abuse in the U.S.

1. Union of Concerned Scientists – “Hysterectomies at an ICE Facility and the Complicity of Science in Reproductive Rights Violations”
2. National Partnership for Women & Families – “Past as Present: America’s Sordid History of Medical Reproductive Abuse and Experimentation”

Organizations that work on immigrant rights, including providing crucial legal aid:

1. American Civil Liberties Union (ACLU) 
2. National Immigrant Justice Center 
3. Interfaith Community for Detained Immigrants
4. Immigration Justice Campaign
5. National Coalition for Immigrant Women’s Rights