Sterilization and Women of Color

In the late 1960s and through the 1970s, activists and academics noticed a widespread trend among women of color: sterilization. The particular type of sterilization is medically referred to as “tubal ligation” and commonly known as getting one’s tubes tied. It permanently terminates a woman’s ability to have children. Concern over widespread abuse emerged in the late 1960s and 1970s when it was found that disproportionate numbers of African American, American Indian, Puerto Rican, and Mexican origin women were undergoing the surgery compared to European American women. One of the cases that brought racially-targeted sterilization abuse to national attention was the 1973 case of the Relf sisters—two African American early adolescent-aged sisters who were sterilized at an Alabama family planning clinic that received federal funds.

The sterilizations of Minnie Lee and Mary Alice Relf were performed by the Family Planning Clinic of the Montgomery Community Action Committee which was funded and controlled, at the federal level, by the Office of Economic Opportunity (OEO). This case is often cited as an exemplar of sterilization abuse in the form of surgical sterilization, but the case involved other dimensions of reproductive abuse such as the use of the Relf sisters (including Minnie Lee and Mary Alice’s older sister Katie, aged 17) as guinea pigs for “investigational drugs” (i.e., Depo-Provera injections twenty years prior to their approval by the Food and Drug Administration).

Parental permission for the administration of these shots was never sought nor obtained. In early March 1973, Katie Relf was taken to the Family Planning Clinic for insertion of a dangerous IUD (intra-uterine device) without permission sought from parents. Katie, as a minor, acquiesced at the urging of clinic staff to accept insertion of the device. Several months later, a clinic Nurse picked up Mrs. Relf and her two youngest daughters and drove them to a physician’s office. Mrs. Relf thought the girls were being taken for the shots that they had been receiving. From the doctor’s office, and having not spoken with anyone, Mrs. Relf and her daughters were then transported to the local hospital where the girls were assigned a room. Hospital staff asked Mrs. Relf, unable to read or write, to put an ‘X’ on a consent form authorizing tubal sterilization for her youngest daughters. No informed consent was sought nor were details on the nature of the surgical procedure provided. After signing, Mrs. Relf was driven home.
Minnie Lee and Mary Alice were left alone in the hospital ward where a nurse came in and had Minnie Lee sign a false document indicating that she was over age twenty-one (she was in fact fourteen years old). Minnie Lee did not understand what the document meant or authorized. At this point, neither the parents nor the daughters met the physician who was going to perform the operation nor were the two young adolescents or parents aware of what was going to happen to them. Before the operation, Minnie Lee borrowed change from another patient in the ward, called her mother, and asked her mother to take her and her sister home. However, Mrs. Relf did not have any means of getting to the hospital. The next morning, both sisters were placed under an anesthetic and surgically sterilized. A little known fact is that on the same day the nurse picked up Minnie Lee and Mary Alice, and brought them to the clinic, she returned to the Relf home and attempted to pick up Katie, the eldest sister, to go to the hospital for sterilization. Katie locked herself in her room, refusing to go.

The complaint filed by the Southern Poverty Law Center (SPLC) indicated that this was abusive and coercive because 1) neither the mother nor her daughters ever sought to for the two young women to be surgically sterilized, 2) prior to the operation neither the mother nor daughters met the physician who would perform the operation, and 3) before the operation no physician or other healthcare provider discussed the consequences of tubal sterilization with either the mother or the daughters (Relf vs. Weinberger 1974). During the trial one of the sisters was asked if she planned to have children and she answered “yes”, which indicates she was never made aware of the consequences of the surgery. Furthermore, as noted in the legal complaint filed by the SPLC:

When Community Action moved the Relfs to a public housing project in 1971, the Family Planning Service began the unsolicited administration of experimental birth control injections to Katie. No parental permission was sought or given. Indeed, the agency sought out the Relf children as good experimental subjects for their family planning program. The F.D.A. approved this experimental drug for use by the Family Planning Service of the Montgomery Community Action Committee (p. 9).

In addition to the use of the daughters as unwilling test subjects for Depo-Provera, the clinic used federal funds to pay for the surgery. The main reason the clinic stopped injecting the girls with Depo-Provera shots is because it was found to cause cancer in lab animals and thus it was decided that sterilization would be an appropriate substitute for the shots. Not long after the Relf case, many other African American, Native American, and Latina women came forth with similar stories. This case is illustrative of a larger pattern of reproductive abuse targeted at women of color. While many cite it as a case of sterilization abuse, the case has greater significance because the it touches upon all elements of racially targeted reproductive abuse: coercive surgical sterilization, assumptions about the sexual behavior of two young women of color, use of a dangerous unapproved sub-permanent sterilizing drug (Depo-Provera), coercing “consent” to have an IUD inserted (Katie), and manipulating parents through the welfare system to allow their children to be used as a ‘test case’ for the state to see if it could limit the reproductive abilities of women of color. In the end, two young women, at the age of 12 and 14 were robbed of their ability to have children thereby stripping them of their human right to procreate.

In the early 1970s, Dr. Connie Pinkerton-Uri, an American Indian physician, began looking into the sterilization of American Indian women after a twenty-six year old patient walked into her Los Angeles clinic and asked for a “womb transplant”. The patient was told by the doctor, who had performed a complete hysterectomy on her, that the surgery was reversible. The woman left the clinic in tears. Dr. Pinkerton-Uri then performed her own investigation and found that nearly 1 in 4 (or 25 percent) of American Indian women had been sterilized. Her research indicated that Indian Health Services (IHS) facilities “…singled out full-blooded Indian women for sterilization procedures.” The Government Accounting Office performed a study to refute Dr. Pinkerton-Uri’s allegations that only studied four of the twelve IHS facilities. However, their findings were consistent with Pinkerton-Uri’s conclusions.

The extremely high rate of sterilization, many scholars contend, fits within the parameters of the United Nations’ definition of genocide which includes acts that specifically limit the number of births within a group.

Recent data show widespread racialized variation in sterilization. For example, my tabulation of the 2002 Behavioral Risk Factor Surveillance Survey data indicate that African American, American Indian, and Latin American women (age 18-44) have a very high rate of tubal sterilization compared to European American women. In 2002, 32.9 percent of American Indian women, 26.2 percent of African American women, and 25.5 percent of Latinas reported having a tubal ligation compared to 18.9 percent of European American women. Given the past history of sterilization abuse in the United States directed at women of color, the current extremely high disparities suggest that similar such practices may have continued into the twenty-first century.

Women of color have actively fought against abuses against reproductive rights since slavery. Two contemporary organizations fighting for the reproductive rights of all women include: SisterSong, INCITE! Women of Color Against Violence