by Rallie Murray
In California, policy-driven sterilization programs have reared their ugly head once again. Women prisoners in the care of the California Department of Corrections and Rehabilitation (CDCR) have been confronted with coerced sterilization, according to a report released last July by the Center for Investigative Reporting.
Nearly 150 women prisoners were sterilized between 2005 and 2013 without the necessary state approvals. Women were targeted based on repeat offender status and likelihood to return to prison, as well as the number of children they had.
Prisoners who were pregnant at the time of their incarceration report having been pressured to consider sterilization, some made to feel as though it were a matter of course when giving birth in a prison, others made to feel as if they were bad mothers if they did not go through with it, and others coerced while still in the delivery room.
On June 19, the California State Auditor released an initial report, an official examination of the claims made by these women and by the coalitions and agencies working with them. The report found that among the 144 cases reviewed, at least 39 sterilizations were carried out without the inmate’s lawful consent.
Twenty-seven cases showed no physician signature on forms confirming two key components of consent in voluntary sterilization procedures: mental competence and full understanding of the lasting effects of the procedure and that the required waiting period – minimum of 30 days, maximum of 80 days – had been fulfilled. Free, prior and informed consent are vital components of medical ethics, and the lack of paperwork in these 27 cases is suspicious if not outright disturbing.
Despite the women participating in this dispute stating that they were repeatedly asked whether they had decided to undergo sterilization, sometimes without even being told why the physician felt it was medically necessary, Dr. James Heinreich of Valley State Prison, one of the institutions held accountable for the sterilization campaign, has made statements that he feels as though the outcry against his services are unfair.
It has been suggested by the implicated physicians as well as some of those responding in the news and in social media that the women complaining about this are just seeking a handout from the state. In regards to the $147,460 spent by the State of California on sterilization from 1997 to 2010, Heinreich stated, “Over a 10-year period, that isn’t a huge amount of money … compared to what you save in welfare paying for those unwanted children – as they procreated more.”
Nearly 150 women prisoners were sterilized between 2005 and 2013 without the necessary state approvals.
Crucial for the ongoing movements for prisoner justice, the audit also criticized the CDCR as well as the federal receiver for allowing such abuses of medical ethics and practice to take place. Liz Gransee, a spokesperson from the federal receiver’s office, has acknowledged their fault in failing to ensure that free, prior and informed consent was obtained.
She stated that the federal receiver would be complying with the audit’s recommendation to report the physicians involved to the California Department of Public Health, a critical step in ensuring that such abuses are less likely to happen in the future. At the same time, members of the state Senate Health Committee voted unanimously to approve SB 1135, a bill which would ban the sterilization of women prisoners in all cases except medical emergencies.
The overwhelming public response, both when this story first broke last summer and now as the state audit has been released, has fallen to two sides – one, the side which seemingly agrees with people like Dr. Heinreich in thinking that women prisoners would irresponsibly have more children who would be a further drain on the system; and two, those driven by the righteous indignation that something like this could happen here, could happen now.
Surely coerced sterilizations must be some legacy of a dark fascistic past or a different sort of place. All of which is a convenient way to forget the lineage of coerced sterilization in the United States over the past several decades.
The United States and California especially has a long and storied past when it comes to compulsory and coerced sterilization. The Eugenics Movement began here – the initial targets principally amongst those with disabilities but branching out to encompass all the “undesirables”: the poor, the remaining Indigenous populations and people of color.
California sterilized more people than any other state in the country by a wide margin – at least a third of all sterilization procedures. Information on the California eugenics operation was of key importance to Nazi Germany in undertaking its own eugenics movement.
But since World War II the word “eugenics” has carried the lingering stench of the charnel houses of the Holocaust, and so coerced sterilization protocols have needed to operate under an unspoken agreement that what they are doing is not anything quite so awful as “eugenics,” but is simply a means of ensuring the greater good.
Managing “undesirable” populations has been an easily forgotten undercurrent in U.S. policy, one that has not received much ongoing media attention despite its history and the outcries against its continued use. The reproductive choices of women of color – especially poor women of color – have been a target of population management throughout U.S. history. People of color have long been seen as “surplus” populations in danger of overwhelming the United States.
The United States and California especially has a long and storied past when it comes to compulsory and coerced sterilization. The Eugenics Movement began here.
Poor communities, especially communities of color, were held to be incapable of raising children “correctly.” All that was necessary was to point to the government assistance they might be receiving to illustrate how they were not teaching their children to be good, productive citizens but instead to be reliant on the state. This sort of language masked the racist undertone of such claims.
Children of color were dangerous because through them communities of color could persist. Women of color raising children in poverty were accused of being irresponsible mothers for a variety of reasons, such as having too many children so that they could receive more benefits from the state.
This myth grew during the post-war period. It demeaned women of color for daring to have families, for trying to provide for those families even in the absence of a male head of household, and for refusing to tailor their reproductive choices to the desires of the white majority.
Because the fertility “problem” of the woman of color was presented as a concern for public safety and welfare, it became a problem that could be tackled by bureaucratic policy. Starting in 1970, the Department of Health, Education, and Welfare ramped up programs which covered the majority of sterilization costs for willing Medicaid recipients.
By the end of the decade, seven out of the ten U.S. hospitals performing voluntary sterilization treatments for women receiving Medicaid support had violated federal guidelines in their disregard for informed consent procedures for elective hysterectomies.
Indigenous women bore the brunt of this policy. As members of a community robbed of political power, of a community which had been targeted for eradication in the previous century and who relied upon government assistance for health care, they were perhaps seen as a good place to start; the Indian Health Services authorized fully-funded sterilization in 1970.
While findings from state-sponsored research differ from those of independent activists, it is difficult to argue that a deliberate policy of eugenics was not being enacted against poor Indigenous women. According to a 1976 report by the General Accounting Office (GAO), approximately 5 percent of Indigenous women of childbearing age receiving services at clinics and hospitals in the reporting area had been sterilized. Indigenous activists, however, report numbers as high as 25 percent.
At a Claremont, Okla., facility, one woman was sterilized of every seven who gave birth at the hospital. Many women were in their 20s; 38 of those identified in the GAO report were under the age of 21. These women were sterilized because they were believed to be “unfit mothers,” because they had “too many” children or simply as a matter of policy.
Women were pressured to give children who had already been born up to foster care because their quality of life would be better outside the poor Indigenous community they had been born into.
In 1976, the GAO released the statement that it would not be productive to seek free, prior and informed consent from Indigenous women being sterilized. A bureaucratic hassle, perhaps? Unnecessary in the face of the immense public good that was being provided? Decisions made to manipulate and deceive Indigenous women into giving up their reproductive agency were based on the belief that any future children would have lives not worth living and that the population of the U.S. would benefit from their removal.
Watching the responses to this report and the other articles it has spawned across the web, one thing has been abundantly clear: For far too many people, far too many women and reproductive health activists, the history of eugenics within the United States has been forgotten or completely ignored. There is a degree of privilege at play here in that white activists have not faced the same history of reproductive oppression as women of color.
Campaigns for reproductive agency overwhelmingly target the language of choice as it predominantly affects white women: the choice whether to terminate or keep a pregnancy. They rarely if ever discuss the kind of choice being robbed by people like Dr. Heinreich and his fellow physicians that limits a woman’s ability to have a family in the first place and to determine how many children she wishes to have, not just how few.
In order to confront the issues faced by women prisoners today, we need to also consider the ways in which the state has actively employed such procedures in the past. The secret history of reproductive agency is too often forgotten or ignored in political debate, but somehow they still manage to find a way to say that providing for large, low-income families is a burden on the state and that the lives of poor children of color aren’t worth living anyway.
What you can do
Those interested in taking further action can write directly to their state representative regarding SB 1153 or sign the petition at MoveOn.org urging the California legislature to immediately pass the bill.
Rallie Murray is a doctoral student at the California Institute of Integral Studies in San Francisco, where she works with prisoners in long-term solitary confinement and with the larger community to build awareness about current issues stemming from the criminal (in)justice system. She can be contacted at email@example.com.