It’s 2014. Why Do We Still Need Laws Banning Coerced Sterilization?

Last month, reproductive justice advocates and prisoner rights organizers won an important victory when California governor Jerry Brown signed SB 1135 into law. The new law, which takes effect on January 1, 2015, will ban sterilization as a form of birth control in the state’s women’s prisons. In the case of a life-threatening situation, the law requires a second medical opinion (a procedure that is pretty much unheard-of in prison health care) and counseling on the effects of the procedure, including the fact that sterilization is permanent.

It seems preposterous that California (or any state) needs a law making it illegal to coerce people in women’s prisons into sterilization. But recent history shows that California does need such a law: between 2006 and 2012, nearly 500 people in two of California’s women’s prisons were sterilized. Approximately 100 women had been pressured into agreeing to tubal ligations between 2006 and 2010. Although the law states that every in-prison tubal ligation must be approved by the State Medical Board, none of these surgeries were put before the board. In addition, another 378 women had been given hysterectomies, had their ovaries removed or underwent endometrial ablation (which destroys the uterus’ lining). Some had been given false information about their medical conditions — being told that they had fibroids, for instance — and that the only cure was to undergo a hysterectomy. In several cases, the woman did not have fibroids and the procedure proved to be medically unnecessary.

But SB 1135 didn’t come about by itself. It began in 2004 when advocacy group Justice Now began receiving letters from women in prison about their medical care. Through these letters, the group learned that hysterectomies and tubal ligations were happening frequently; some had even happened without the person’s consent or knowledge. The group began to try to find out more about what was happening inside — no easy task since not only are prisons not obliged to disclose information but, under privacy laws, are not allowed to talk about individual people’s medical issues. So Justice Now reached out to people incarcerated in these prisons directly.

In 2006, after a federal judge appointed a federal receiver to oversee California’s prison health care system, Justice Now asked the receiver’s office about prenatal care practices. Among their questions was whether tubal ligations were performed in prison. Two years later, they received their answer: more than 100 had occurred within a four-year time span.

Even then, it took years for a law that seems like common sense to be passed. This happened in large part because people inside women’s prisons spoke up repeatedly. They reached out to Justice Now, then helped break through the information barriers by letting others know that they should share their experiences and interviewing each other to present a clearer picture. People now out of prison came forward to share their stories publicly, putting a human face on the problem. Advocates continued to press the issue. In the meantime, at least one investigative journalist pursued the story, not only unearthing more information about these surgeries and the health care failures that enabled them, but also keeping the issue in the news for over a year.

California’s SB 1135 is not the only time women of color have fought sterilization abuses. Women both in and outside of state institutions have been threatened with and pressured into sterilization since the early 1900s. This has been particularly true for low-income women of color, who continue to face coercive sterilization practices today.

In her groundbreaking book Killing the Black Body: Race, Reproduction and the Meaning of Liberty, reproductive justice advocate and scholar Dorothy Roberts clearly maps out how the reproductive rights of women of color have been under assault since the abolition of slavery. Published in 1997, her work describes in great detail how women of color have been targeted by abusive sterilization practices. She also delves into ways that advocates, including women of color, have fought to end these abuses, a legacy often overlooked by today’s reproductive rights activists.

Some of these organizing histories have been nearly forgotten. For example, while the Student Nonviolent Coordinating Committee is best known for its sit-ins and desegregation campaigns, who remembers that, in the 1960s, they also organized to oppose a bill pushing for the sterilization of unwed mothers? When Mississippi representative David H. Glass introduced “An Act to Discourage Immorality of Unmarried Females by Providing for Sterilization of the Unwed Mother Under Conditions of the Act,” SNCC, realizing the disproportionate impact of the bill on black women, published and distributed a pamphlet entitled Genocide in Mississippi. The pamphlet spurred national outcry. Although the bill had passed in the House of Representatives by a vote of 72 to 37, the national outcry pushed the Senate to drop the bill.

But the act’s demise did not stop the targeting of women of color for sterilization. In Puerto Rico, public health officials pushed women into agreeing to sterilization that, with the support of federal funds, was offered at little to no cost. By 1968, more than one-third of women of childbearing age had been sterilized. On Native reservations on the continental United States, doctors performed more than 3,000 sterilizations between 1973 and 1976, many without adequate consent procedures. In 1973, the parents of 14-year-old Minnie Lee Relf and 12-year-old Mary Alice Relf, black sisters in Montgomery, Ala., approached the Southern Poverty Law Center after the girls had been sterilized. Health care workers had told their parents that the sisters would be given injections of the then-experimental contraceptive Depo-Provera. Instead, they were sterilized. The center filed suit, leading to the discovery that between 100,000 and 150,000 poor women had been sterilized each year under federally funded programs. Nearly half of these women (and children, like the Relf sisters) were black. In the meantime, white women during that period, particularly those who had private doctors, had the opposite experience: Those who sought sterilization were refused because they were either unmarried or their doctors felt that they had too few children.

In the late 1970s, women of color formed the Committee to End Sterilization Abuse. In New York City, the committee introduced guidelines into the City Council to prevent coerced sterilization. These guidelines included requiring informed consent in the patient’s preferred language, a 30-day waiting period between consent and the procedure, and a prohibition on obtaining consent during labor, after childbirth or an abortion, or under the threat of losing welfare benefits. They also included a ban on the sterilization of anyone under the age of 21, or people deemed mentally incompetent or institutionalized.

In 1978, the Department of Health Education and Welfare adopted these guidelines, creating new federal rules that tightened restrictions on sterilization under programs such as Medicaid and Aid to Families with Dependent Children. Many of these restrictions, including the right to informed consent, the 30-day waiting period, and a ban on threatening the loss of federal aid programs, remain in place today. While these laws prohibit forcible sterilization, Roberts pointed out that they did not prevent medical workers from pressuring women, especially low-income women whom they think have too many children, to agree to sterilization.

However, the ban on sterilizing institutionalized people has not always been heeded, as the nearly 500 recent sterilizations in California’s women’s prisons demonstrate. And, nearly 25 years later, these guidelines, especially Medicaid’s mandatory 30-day waiting period to deter pressure and coercion, are being challenged by some researchers and health care providers who argue that the waiting period provides an undue burden, raising the rate of unwanted pregnancies and abortions among low-income women. In response, women of color organizations and advocates, including Roberts, have pointed to the United States’ not-so-distant history of sterilization abuse and argued against the overturning of these fundamental safeguards.

SB 1135 passed because currently and formerly incarcerated people spoke up. It passed because advocates took their claims seriously, spending years investigating and pushing for change. It passed because journalists, such as Corey Johnson, not only released one damning report, but kept the story in the public consciousness for over a year. These combined efforts helped pass the bill and hopefully these efforts will ensure that no one in California ever has to go through something like this again.

But we have to ask ourselves, how do we know that reproductive injustices like these aren’t taking place behind prison walls elsewhere? No other state has banned prison sterilizations. In addition, many other states lack organizations such as Justice Now, which incarcerated people know they can turn to and which also have the resources, capacity and determination to pursue investigations and campaigns that can take up to 10 years. We need to learn from the historical examples of SNCC and the Southern Poverty Law Center, recognize that the fight for reproductive justice is also a fight for racial justice and social justice, and incorporate this into our own organizing.