[Eugenic sterilization] prevents the birth of children who would probably have a bad heredity, who could not be cared for properly, by their parents, and who would be likely to become state charges…Conservatively and sympathetically administered, it is a practical, humane, and necessary step to prevent race deterioration.

Human Betterment Foundation

In January 2016, the ACLU of California released a report and policy reform tool that highlight barriers to reproductive health care in county jails in California. The report discusses, among many other topics, coerced sterilization and the need for strict enforcement of laws banning jail officials from carrying out sterilization procedures for purposes of birth control, and why health professionals must know their legal obligations.

The need for these measures was brought into sharp focus in a 2013 project by the Center for Investigative Reporting, supported by the work of Justice Now, which revealed that doctors under contract with the California prison system had sterilized nearly 150 incarcerated women without their permission or required state approvals. Since then, California has enacted a law that explicitly prohibits prisons and jails from performing sterilization procedures for the purpose of birth control (SB 1135).

The forced sterilizations were yet another chapter in a long and sordid history that goes back more than a century in California. Each chapter is rife with justifications from immoral social engineers who stripped unwitting and unwilling Californians of their rights and agency in family planning.

For example, between 1909 and 1964, about 20,000 women and men were sterilized in California, making up a staggering third of all sterilizations nationwide. Many were patients in state mental institutions; others were vaguely deemed to be a drain on society.

Another insidious element was added as race-based theories of human worth gained adherents, as illustrated by the opening quote from an early 20th Century Human Betterment Foundation leaflet. Back then, the victimizers used the pseudoscience of eugenics to promulgate sterilization techniques that were later praised by and adopted in Nazi Germany. Decades later, when the story about sterilizations of California prisoners broke, a prison system OB-GYN, Dr. James Heinrich, told the Center for Investigative Reporting that the $147,460 the prison system paid doctors from 1997 to 2010 to perform sterilization procedures was minimal “compared to what you save in welfare paying for these unwanted children – as they procreated more.”

Then there’s the heartbreaking tale told in the powerful 2015 documentary No Más Bebés (No More Babies), directed by Oscar nominee Renee Tajima-Peña. The film takes us back to the mid-1970s, when working-class women of Mexican origin were systematically sterilized at Los Angeles County-USC Medical Center (LAC-USC). The sterilizations led to a class-action lawsuit, Madrigal v. Quilligan, which challenged the coerced postpartum tubal ligation (also known as “having your tubes tied”) of these women.

No Más Bebés explores the careers of five of the original 10 named plaintiffs, their attorney, Antonia Hernández, and Dr. Bernard Rosenfeld, who exposed the coerced or forced sterilizations that took place during his residency at LAC-USC. It was yet another example of a system which decided that an “undesirable” segment of society was unworthy of reproduction.

“[P]oor minority women in L.A. County were having too many babies…it was a strain on society…it was good that they be sterilized.”

So declared Dr. James Quilligan, head of Obstetrics and Gynecology at LAC-USC, according to Karen Benker, a former medical student and technician at LAC-USC who was a key witness in Madrigal v. Quilligan. Recalling a federal family planning initiative funded by President Lyndon B. Johnson’s 1964 War on Poverty family planning initiative, Benker recounts in the film that Dr. Quilligan said he intended to use the hospital’s share of a $2 billion dollar federal grant to “cut the birth rate of the Negro and Mexican populations in Los Angeles County.”

Under Dr. Quilligan’s guidance, LAC-USC took advantage of the lack of legal, social and educational resources for low-income people. The film notes that among the Mexican-American victims, many were not proficient in English and were unable to give informed consent because they could not understand the medical terminology and legal language in documents they were forced to sign. Some were under major distress while in labor and couldn’t recall having signed any documents. These women valued being able to plan the size of their family along with their partner, but were ultimately deprived of this choice.

Worse still, the court system engaged in victim-blaming when it found in favor of the doctors. In his decision, Judge Jesse W. Curtis wrote:

“One predominant trait of the Mexican culture is extreme dependence upon the family...the status of the woman in the family is determined by her ability to reproduce, rendering the sterilization decision more .”

In other words, the doctors were justified in coercing sterilization because the victims were somehow compromised by their own culture. The consequences of that attitude were dire. In one case told in No Más Bebés, a woman named Maria Figueroa saw her marriage deteriorate because of her husband’s discomfort after she was sterilized. Maria suffered a mental breakdown and attempted suicide.

All of these horrific incidents underscore the need for everyone to remain vigilant about their rights and responsibilities. The ACLU has published a Know Your Rights document that includes information on rights to reproductive health care and sterilization for incarcerated people -- a population particularly vulnerable to these rights violations. The ACLU’s report and toolkit discuss how jails must and can create clear rules to prohibit injustices such as coerced sterilization.

Download the report and toolkit (.pdf).

Diana González is paralegal at the ACLU of Southern California.