The “Good” Mother

Magazine cover with photo of young girl pulling small shopping cart with baby, text reads "Birth Rights"

This article originally appeared in Southern Exposure Vol. 18 No. 2, "Birth Rights." Find more from that issue here.

Nearly half of the 2,300 women who give birth in Gaston County, North Carolina each year cannot afford to pay for their own obstetric care. When local doctors threatened to stop deliveries last September unless the county paid the bills, County Commissioner Porter McAteer proposed a final solution to the problem: Women who live in poverty and can’t pay for their own prenatal care and delivery should be forcibly sterilized.

“If I lose the election by saying that, then fine,” McAteer said. “You can laugh, but most ofthe public feels that way.”

Although McAteer stated that he didn’t think such forced sterilizations would ever happen, history suggests otherwise. His words echo over a century of societal efforts to promote compulsory or coercive sterilization and limit the reproductive freedom of poor or otherwise disenfranchised women.

His words also reflect the stark reality of national policy. If Gaston County did actively promote sterilization, the federal Medicaid program would currently pay for 90 percent of the cost. When a poor woman in Gaston County seeks health care for her children, however, Medicaid picks up only 50 percent of the bill.

These funding policies belie current pro-family rhetoric. Although the Bush administration argues that it has a legitimate interest in outlawing abortion to promote childbirth, history shows that for the past century the state has generally played a much more active role in defining who should be prohibited from bearing society’s children.


Genetic Superiority

Forcible sterilization has been practiced in this country since at least 1889, initially for the purpose of ending the hereditary lines of retarded people or others presumed to be somehow “unfit” to reproduce. At that time, feeblemindedness, mental illness, and “moral degeneracy” were commonly thought to be hereditary conditions, and preventing procreation was viewed as an appropriate social “cure.”

Around the same time the eugenics movement began to flourish. Eugenics basically posits that some people are innately superior to others, and proponents advocated measures to “improve” the human race by encouraging procreation among persons with “good” genes and by legally proscribing procreation of persons with “inferior” genes.

The movement pushed for legislation to restrict immigration and marriage and to segregate or sterilize “mental defectives.” The theory of eugenics was promoted by many prominent Americans, including Theodore Roosevelt and birth control advocate Margaret Sanger.

In 1914 a “Model Eugenical Sterilization Law” drafted by Harry Laughlin, who later became the Expert Eugenics Agent of the U.S. House of Representatives, called for compulsory sterilization of all “social inadequates.” By 1932, 32 of the 48 states had passed compulsory sterilization laws —including Alabama, Georgia, Mississippi, North Carolina, South Carolina, Virginia, and West Virginia.

The laws generally provided for sterilization of inmates of state hospitals and prisons, and some made it mandatory before discharge. Over 30 different categories justifying sterilization were listed, from insanity and idiocy to epileptics, drug fiends, moral and sexual perverts, and persons with “criminal tendencies.”

The list left a lot of room for interpretation. Even a superficially medical diagnosis such as idiocy in practice reflected a judgment against individuals who, in the eyes of more powerful members of society, were unable to perform as economically self-sufficient citizens. From the beginning, state-sanctioned restrictions of reproductive freedom were conceived of as a punitive solution to a wide array of social problems.

The new laws did not go unchallenged, and the major test came in the South. In 1927, Dr. A.S. Priddy, superintendent of the State Colony for the Feebleminded in Lynchburg, Virginia, tried to sterilize Carrie Buck, the 18-year-old-child of a poor single mother and a single mother herself. Her lawyer fought the sterilization all the way to the U.S. Supreme Court. In the now infamous decision of Buck v. Bell, Justice Oliver Wendell Holmes upheld the Virginia statute.

“It is better for the whole world . . . [if] society can prevent those who are manifestly unfit from continuing their kind,” Holmes wrote. “The principle that sustains compulsory vaccination is broad enough to cover cutting of the Fallopian tubes. . . . Three generations of imbeciles are enough.”


Holmes and Hitler

Records of state institutions indicate that between 1907 and 1963, nearly 70,000 people were forcibly sterilized — one out of five in either Virginia or North Carolina. Many were never told what had been done to them. Carrie Buck’s 16-year-old half-sister Doris was told she was having an appendectomy and only found out the true nature of her operation 50 years later.

These practices found a powerful admirer in Adolf Hitler. In 1933, the Nazi regime passed a sterilization statute that was based in part on the U.S. model. Abortion, however, was outlawed, effectively forbidding women from making individual decisions about motherhood. “Good” women were supposed to bear children; “bad” women were sterilized. During the Nuremburg trials, the Holmes decision in Bell v. Buck was cited in the defense of Nazi atrocities.

After the horror of the Holocaust became clear, the theory of eugenics began to fall into disrepute. Sterilization declined nationwide, but continued at high rates in Georgia and Virginia through the 1950s and in North Carolina into the 1960s. In 1963, more than half of the 467 forcible sterilizations in the U.S. were performed in North Carolina.

Many of those sterilized in the postwar period were poor teenage girls. Of the 1,620 people sterilized by state statute between 1960 and 1968 in North Carolina, 1,583 were female, 1,023 were black, and 907 were teenagers.


Felony Childbirth

The eventual repeal of many eugenic sterilization statutes, however, did not diminish the social acceptance of efforts to restrict the reproductive autonomy of disenfranchised members of society. During the late ’50s and early ’60s, some states considered forcibly sterilizing unmarried women who bore children — especially if they were welfare recipients. Such proposals were generally justified using a category of “fitness for parenthood,” with fitness determined by marital and economic status.

One Mississippi proposal suggested that having a child out of wedlock be considered a felony and that a three-year minimum sentence be imposed for second “offenses.” Most proposals for criminalizing unwed motherhood contained clauses allowing for a sentence reduction after sterilization or marriage.

Although only Louisiana and Mississippi actually made unwed parenthood a crime, the pervasive attitude that society can legitimately dictate who should be parents created a climate which fostered coercive and punitive sterilization practices in government-funded social services. Coercion often came in the form of a threat: submit to surgical sterilization or lose your welfare benefits and medical care.

Once again, poor women and minorities were the most frequent targets of abuse. In 1970, when access to abortion usually required approval by a hospital board, many teaching hospitals had a policy called the “Package Deal” that approved abortions on the condition that women also submit to sterilization.

In 1972, a survey of obstetricians found that six percent favored sterilization for private patients, 14 percent favored it for welfare patients, and 97 percent favored it for unwed mothers on welfare. The following year, three obstetricians in Aiken County, South Carolina refused to care for pregnant women on Medicaid who had two or more children unless they agreed to be sterilized.

The extent of abusive practices came to national attention in 1974 through the case of Relf v. Weinberger. At the age of 12 and 14, two black sisters were sterilized at an Alabama hospital through a federally funded program without their or their parents’ knowledge or consent. At least 11 minors were sterilized at the clinic, 10 of whom were black.

“Over the past few years, an estimated 100,000 to 150,000 low-income persons have been sterilized under federally funded programs,” concluded Judge Gerhard Gesell. “There is uncontroverted evidence in the record that minors and other incompetents have been sterilized with federal funds and that an indefinite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that various welfare benefits would be withdrawn unless they submitted to irreversible sterilization.”


Who Decides

Although such blatantly abusive practices have diminished over the past 15 years, the attitude that forcible sterilization is an appropriate remedy for social problems remains strongly rooted in our society. A regional task force considering the “problem” of teenage pregnancy recently suggested that retributional policies — including sterilization — might need to be considered.

In some states, lawmakers even seem to view state-funded abortion as a useful tool to implement a de facto eugenics policy. Whenever the state abortion fund in North Carolina is threatened, funding is usually won not only by arguing that poor women deserve equal access to health care, but also by convincing legislators that it is cheaper to abort a poor woman than to provide her and her child with medical care and social services.

The connection between sterilization abuse and access to abortion is more than superficial. When courts accept the argument that it serves the national interest to ban abortion and force women to give birth, they justify government efforts to narrow the range of reproductive options, opening the door to further limits on reproductive freedoms. If a state can define legitimate reasons for promoting childbirth, it can also define legitimate reasons for promoting sterility.

Whenever government steps in to limit reproductive autonomy, we need to remember that the theme of “Who Decides” has a very long and unpleasant history. In the past, we have been only too ready to define who is “good enough” to become a parent — and to allow the state to rob disenfranchised women of the possibility of motherhood.