A Brief History of Reproductive Coercion

It’s not possible to understand present-day reproductive coercion, or its lasting impact on marginalized communities, without understanding the United States' long history of sterilization abuse. From our nation’s founding, controlling Black women’s fertility was a cornerstone of slavery while exterminating Native women and their children was an explicit part of our frontier policy. Throughout the 19th and 20th centuries, the dehumanization of Black, Indigenous, immigrant, and poor communities, as well as LGBTQ people and people with physical and/or mental health challenges, was an integral part of public health.

In the 19th century, for example, the so-called “Father of Modern Gynecology,” James Morion Sims, conducted torturous experiments without anesthesia on enslaved Black women Lucy, Anarcha, Betsey and many others. His false and racist belief that Black people don’t experience pain as white people do still affects the treatment quality and pain management received by Black patients in hospitals and clinics today.

Throughout the 20th century, 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. In 1927, involuntary sterilization received the blessing of the US Supreme Court in the infamous Buck vs Bell decision. 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 other groups.

By 1965, one-third of all Puerto Rican mothers aged 20-49 were sterilized, many without their knowledge or consent. The procedure was so common on the island that it was simply called “la operacíon.” In the South, poor and Black women 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 against their will. By the 1970s, as many as 25 percent of Native American and Indigenous women of reproductive age had been sterilized. All told, more than 60,000 people were sterilized in 32 states during this time period based on the “science” of eugenics. To learn more about the history of this pernicious practice and its connection to current events, read “A Brief History of Sterilization Abuse in the U.S. and its Connection to ICE Mass Hysterectomies in Georgia,” found below.

The NWHN Fights Back Against Reproductive Coercion

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, detailed informed consent requirements, and a moratorium on government funding for the sterilization of institutionalized women and those deemed “incompetent.”

By 1979, the young NWHN was taking on the long-established National Organization for Women (NOW), asking our members to speak up at their local NOW chapter in opposition to NOW's disregard for 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 was complying with federal sterilization regulations and requested copies of each hospital’s memo to staff explaining the regulations.

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. Dr. Rodriguez-Trias 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. To learn more about this titan of advocacy, read “Dr. Helen Rodriguez-Trias: A Warrior in the Struggle for Reproductive Rights," found below.

Reproductive Coercion Today

While the medical establishment in the 1970s and '80s deeply resisted rules protecting against sterilization abuse, they were ultimately implemented and, in many cases, remain in effect today. But that doesn’t mean that sterilization abuse is no longer a concern. Officials in the California prison system were caught coercing female inmates into sterilization against their will as recently as 2010. And in 2020, immigrant women held in U.S. detention facilities accused ICE officials of conducting involuntary sterilizations when the women required other medical care.

But more commonly, reproductive abuse in recent decades has appeared in the form of contraceptive coercion targeted to these same communities. The parallels between sterilization abuse and coercion related to long-acting reversible contraception (LARC) became clear within days of FDA approval in 1990 of the first LARC, the implant Norplant. Immediately following approval, the Philadelphia Inquirer asked, “Poverty and Norplant—Can Contraception Reduce the Underclass?” while state legislators around the country pushed legislation to make Norplant mandatory for low-income women receiving public benefits or making it a part of court sentences.

Meanwhile, more subtle forms of contraceptive coercion play out in clinics around the country, when women are pushed to choose a LARC method, no matter what their true reproductive priorities might be, and then given little opportunity to have their LARC removed. In an effort to elevate and combat LARC coercion, SisterSong and the NHWN partnered to draft our LARC Statement of Principles (found below), which rejects efforts to push patients toward any particular method and cautions providers and public health officials against making dubious assumptions based on patient identity.