The latest attempt to sink health care reform bills under consideration in Congress comes as no surprise. Anti-abortion advocates are pressuring the administration to exclude one of America's most controversial surgical procedures from the federal plan. At the same time as this story broke, another White House related reproductive rights issue was also hitting the news: Obama's appointed Science Czar, John Holdren, wrote a book in support of forced sterilization as a means of population control. Which story do you think has received more press? Abortion, of course.
Both issues are critically important to discuss. Rebecca Kluchin's new book, Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980, explores a thirty year period of US history in which eugenic and neo-eugenic ideas were used to justify forced, coerced, and freely chosen sterilization, providing much-needed historical context for a topic that is still alive. In it, Kluchin shines a light on why it's high time to make room at the reproductive rights table for more than one conversation.
Mandy Van Deven: Sterilization isn't the most popular reproductive health topic. How did you come to write this book?
RK: As a graduate student studying American women's history, I studied the history of abortion and birth control. I shifted my research focus from abortion to sterilization because so little had been written about the latter in the post-World War II period, and I was interested in understanding the ways social engineering continued to shape sterilization policy and practice even after the formal eugenics movement concluded. I was also very interested in the gendered power dynamics between patients and healthcare providers, and the ways in which race, ethnicity, and class shaped women's access to reproductive health services.
MVD: Why did these three decades stand out as important for sterilization and reproductive rights?
RK: The 1960s and 1970s represented an era of social and political change, and to some extent, the law changed with the times. The Supreme Court legalized contraception for married couples in 1965, and for singles and minors in 1972. The following year, it legalized abortion in the first two trimesters with Roe v. Wade. The new freedoms women gained through these decisions led some women who were denied voluntary sterilization to challenge restrictions on their desired surgeries. If birth control and abortion were legal, they wondered, why was tubal ligation still restricted? Voluntary sterilization policy, specifically the overturning of hospital codes that restricted women's access to tubal ligation, followed the precedents set by Supreme Court decisions that legalized birth control and abortion.
MVD: What kinds of hospital policies did women find problematic?
RK: Most hospitals restrict women's access to tubal ligation through age/parity policies. The most common policy is called the 120 rule, and said a woman's age multiplied with the number of children she had (her parity) had to equal or exceed 120 in order for her to eligible for sterilization. Birth rates were declining and many women - especially white women, as hospital administrators did not always employ such policies in minority communities - could not meet the criteria. Using recent precedents in birth control and abortion policy, voluntary sterilization plaintiffs successfully argued that the hospitals that refused their requests for tubal ligation had violated their newly established reproductive rights.
MVD: What influenced your decision to use legal sources as your primary research material?
RK: My reliance on lawsuits to tell the stories of the forcibly sterilized and those seeking sterilization was dictated largely by the sources available to me. I lacked access to most medical records, but I did have access to court cases and, in some instances, trial transcripts and affidavits, which provided me with direct access to my subjects. Whenever possible, I supplemented these sources with popular literature and letters written by women and men seeking sterilization that I found in the archives.
Historians can never be totally objective, but when researching and writing this book, I tried to listen to the women whose voices I located and represent them in the most authentic terms possible. I am keenly aware that most women do not describe their reproductive experiences in political terms, which meant that I could not rely on institutional records (e.g. NOW, NARAL, Planned Parenthood, the Association for Voluntary Sterilization) to represent those sterilized or seeking to be sterilized. I studied the records of these organizations, but they did not offer the direct access to the subjects of my study like legal records did.
MVD: How did the battle for the right of sterilization differ from the battle against forced sterilization?
RK: Victims of sterilization abuse proved less successful in their efforts to sue the hospitals and physicians that were responsible for their loss of fertility. This is largely because the precedents set in birth control, abortion, and voluntary sterilization cases defined reproductive rights as access to reproductive health services. Victims of forced sterilization attempted to broaden this framework by arguing that they possessed the right to be free from coercion and should be compensated for the abuse they suffered. Only one of the thirty-three lawsuits I found was decided in favor of sterilization abuse victims. As a result, current policy defines reproductive freedom narrowly, as access to reproductive health services, which ignores the ways in which poverty and race continue to shape women's reproductive experiences and options.
MVD: To some degree this book re-centers women of color in an historical viewing of reproductive rights struggles. How did sterilization practices and policies effect women of color's participation in the movement for reproductive rights?
RK: Fit to Be Tied builds on the work of scholars like Jennifer Nelson, Elena Gutierrez, Loretta Ross, and Angela Davis, among others, who not only pointed out the white middle class biases of feminist organizing around reproductive rights issues, but revealed a rich organizing tradition of women of color around reproductive rights. The reproductive choices that women confront are shaped by race, class, and ethnicity; thus, for many women of color, reproductive freedom was part of their struggle for racial equality and economic justice.
In 1961, civil rights activist Fannie Lou Hamer was sterilized via hysterectomy when she entered Sunflower County Hospital in Alabama to have a uterine tumor removed. The operating physician performed a "Mississippi appendectomy." He removed her uterus without her knowledge during abdominal surgery. White physicians practiced "Mississippi appendectomies" in Southern black communities in the 1950s and early 1960s, particularly communities with active civil rights traditions. For black women in the South, sterilization abuse was a civil rights issue.
While white feminists organized around abortion, many Chicana and Native American activists organized around the issue of ending sterilization abuse. Chicanas in western states and Native American women on reservations experienced forced sterilization in the late 1960s and early 1970s that involved white physicians targeting them for "elective" tubal ligation when they entered hospitals in labor. As with black women, Chicanas and Native American women were targeted because of their race and class status.
MVD: You write about the fissures between white women and WOC who were advocating two very different, and at times conflicting, positions on reproductive rights. Can you talk about why there was divergence in the movement?
RK: Women are not a unified group. Because race, ethnicity, and class play such a critical role in determining the reproductive choices available, women define reproductive rights differently. Most women of color did not join mainstream white feminist organizations because groups like NOW, NARAL, and Planned Parenthood constructed a reproductive rights agenda based upon a white, middle-class experience that focused nearly exclusively on abortion rights and did not address the other reproductive offenses through the medical racism women of color, especially poor women of color, experienced - sterilization abuse being just one form. Women of color advocated a broader definition of reproductive freedom that went beyond unrestricted access to legal abortion and included the right to determine when and under what conditions to become pregnant and the right of all women to bear and raise children with dignity.
Feminists of color leveled many criticisms against white feminists during the late 1960s and early 1970s. Radical white feminists listened to charges that they ignored issues of race and class, and adopted the expanded definition of reproductive freedom held by feminists of color. Together these groups formed an anti-sterilization abuse movement that made sterilization abuse a national issue. Their efforts led the Department of Health, Education and Welfare (DHEW) to develop sterilization guidelines for public patients designed to prevent coercion. White "mainstream" feminists and anti-sterilization abuse activists found themselves on opposite sides of the debate that ensued over how to prevent abuse via public policy.
MVD: What is interesting is that both camps literally had opposing positions.
RK: All feminists opposed forced sterilization, but Planned Parenthood, NARAL, and NOW rejected the waiting periods (thirty days between time of consent and surgery) and age minimums (21-years-old) that DHEW proposed on the grounds that they impeded women's access to sterilization. Anti-sterilization abuse activists, however, argued in favor of these safeguards, and insisted that forced sterilization constituted a far greater violation of rights than did lack of immediate access to services. Herein lay the conflict: in order to protect one group of women from forced sterilization, DHEW had to restrict another group of women's access to tubal ligation. In this instance, women's reproductive rights were in irreconcilable conflict.
MVD: You're keen to point out in the book that many of the women who filed suit against unfair sterilization practices were not, in fact, feminists. Why was it important to make this distinction?
RK: Scholars and journalists tend to define reproductive rights as a feminist issue, but women who did not identify as feminist challenged public policy too. Before Roe v. Wade, hundreds of thousands of women underwent illegal abortions every year. Their defiance of the law, at great risk to their lives and health, should be read as a challenge to public policy, even though it was covert. The voluntary and forced sterilization lawsuits I examine reveal the extent to which feminist ideas about reproductive freedom made their way into mainstream culture in the 1970s. They show how quickly many American women adopted feminist ideas about the right to control their reproductive decisions without medical or legal interference even as many of these women went out of their way to separate themselves from organized feminism. Reproductive rights activism can assume many forms and one does not have to define oneself as a feminist to take action.
MVD: A continuous struggle regarding sterilization is one between individual freedoms and the "collective good," both sides which have merit and serious problems. Do you see these positions as reconcilable?
RK: I think it depends on who gets to define what the "collective good" is and whether or not those whose interests conflict with the "collective good" have the ability to resist attempts to control their reproduction. Too often those in power use the interest of the "collective good" to justify the violation of individual rights of those who lack power. I think in a pluralistic society like ours where we theoretically all have equal rights, but in practice racism, sexism, and class disparities continue to shape our ability to exercise such rights, these positions cannot be reconciled.
MVD: Fit to be Tied is primarily interested in the sterilization of women, but you do write about men's sterilization as well. In what ways were men impacted by sterilization?
RK: Not surprisingly, physicians and hospitals did not place the same restrictions on vasectomy as they did tubal ligation. The 120 rule governed women's access to contraceptive sterilization, but not such policy existed for men. This is partially because, until the early 1970s when laparoscopic methods were introduced, tubal ligations were performed in hospitals whereas vasectomies were performed in urologists' offices and therefore not subject to oversight. But sexism also played a role. When a New Jersey woman denied tubal ligation by Riverview Hospital in 1971 asked an administrator why vasectomy was not regulated like tubal ligation, he replied, "It's nobody's business what a man does."
MVD: The Association for Voluntary Sterilization (AVS) is prominent in this book, and seems to be the only organization that was able to change with the times in order to put forth its agenda. Why do you think they were able to maintain this level of success in pushing their agenda?
RK: I think the AVS (which is now called EngenderHealth) endured for so long because it was willing to change its strategies and philosophies in order to meet its end goal of legitimizing contraceptive sterilization and making sure that all those who wanted - and some more eugenically-minded members would argue needed - sterilization had access to surgery. The formal eugenics movement concluded around the 1950s, but AVS placed itself at the forefront of what I term a "neo-eugenics" movement around this time by casting sterilization as a solution to contemporary social "problems" like an expanding welfare system, concerns about overpopulation, and rising rates of unwed motherhood. Its leaders tapped into conservative Cold War anxieties and marketed the benefits of contraceptive sterilization effectively.
MVD: You link sterilization to many other social and political issues: fear of communism, immigration, genocide, and informed consent, to name a few. Can you give an example of the way these issues intersect?
RK: The stereotype of the "welfare queen" is a good example. This myth is neo-eugenic in nature because it is based on the idea that "defective" traits like poverty and illegitimacy are reproduced via culture. Opponents to welfare and other social services attack the reproductive fitness of poor women, especially women of color, and reinforce a common notion that women who receive public assistance should relinquish some of their reproductive rights in exchange for aid because white, middle class tax payers have a right to dictate the reproductive decisions of poor women in the interest of society, on behalf of the "collective good" you mentioned earlier.
MVD: The irony of this idea is that the same social stratification which allows for abusive reproductive policies and practices creates the systemic oppressions that put people in disadvantaged situations. What groups attempt to address the underlying issues of racism, poverty, and gender norms instead of writing individuals off as "unfit"?
RK: Welfare rights activists certainly framed their opposition to forced sterilization in terms of abuse being caused by racism, poverty, and sexism. Feminists of color, radical white feminists, and groups like the Young Lords did the same. Despite their efforts for change, though, the systems that perpetuate economic inequalities, racism, and sexism remain in place, in part because neo-eugenic attitudes perpetuated them and did so in a way that effectively removing systemic oppressions from the discussion by blaming individual women for their status in society.
MVD: The reproductive rights movement is currently undergoing a serious overhaul away from "white women's issues," like abortion, and toward a philosophy of reproductive justice that takes a more complex look at how systemic oppression influences reproduction. It seems like you agree this is a positive development.
RK: I think the white feminist community is more aware of a broader philosophy of reproductive justice than it has been in the past, in larger part because of organizations like SisterSong and New Voices Pittsburgh. White radical feminists "got it" in the 1970s and were the only group to advance a political agenda that did not foreground their race and class interests. They were willing to accept restrictions on voluntary sterilization in order to protect poor women of color from sterilization abuse. Abortion is one of many reproductive rights, not the reproductive right. Abortion rights meant little to women forcibly sterilized. Sterilization is not as controversial as abortion, but it carries the same potential to be life changing.
