How Organizers Are Fighting an American Legacy of Forced Sterilization

Kelli Dillon was only 24 when a surgeon at the Central California Women’s Facility in Chowchilla decided that she was not fit to be a parent and intentionally sterilized her without her consent. Dillon had sought medical attention for an abnormal pap smear and told the doctor that should he find cancerous cells, he could operate. After the procedure, Dillon intuitively felt that something was wrong, but the surgical team didn’t tell her she had been sterilized. Dillon fought the prison staff for over a year to gain access to her medical records, and only when a lawyer from Justice Now, an Oakland-based social justice legal advocacy organization, requested the records did Dillon learn the truth. 

In 2001, Dillon was one of 148 women incarcerated and living inside California’s state prisons who experienced medical abuse in the form of forced tubal ligations or total hysterectomies without their knowledge or consent and without required state approvals. A 2013 report by The Center for Investigative Reporting found that the state paid prison doctors $147,460 between 1997 and 2010 to sterilize incarcerated women, which one prison doctor said “isn’t a huge amount of money” when “compared to what you save in welfare paying for these unwanted children as they procreated more.”

Until 2014, medical teams inside California prisons could lawfully provide sterilizations that were deemed “medically necessary” and for the purposes of birth control if they received permission from the patient. But Dillon’s surgery, as well as dozens of others provided to young Black and Brown women, were not conducted with informed consent, according to a state audit. Dillon began to organize inside the women’s prison by collecting testimonials from other women the prison’s medical team had abused, and provided the personal accounts to staff at Justice Now that was laying the groundwork to petition for legislation that would ban the procedures in prisons.

Five years after she was forcibly sterilized, Dillon sued the state of California for damages, and her work helped to shape the scope of the Eugenics Sterilization Compensation Program Bill. “I felt like it was this time for these truths to be revealed … these hidden evils that had been happening behind prison walls and institutional walls,” Dillon says.

Dillon’s personal story and work, along with the efforts of Justice Now, were the subject of the 2020 film, Belly of the Beast. The documentary follows Dillon and the Justice Now team over a decade as they lobby lawmakers in Sacramento to prevent prison doctors from sterilizing and abusing more women. Belly of the Beast also chronicles the period of recovery, healing, and rebuilding Dillon navigated after she was allowed to return home. 

“It wasn’t until the making of the film and the showing of the film did my actual healing begin,” Dillon says. “Then I had to face what truly happened and the impact that it had on me and thousands of other women.” 

An American Legacy

Twenty years after she was forcibly sterilized, Dillon reflects that the government’s actions are fundamentally about control: deciding who lives and who dies, who’s worthy of creating community, and who deserves to build a family. “This is not just about the control of one’s body, but this is about people who are trying to control humanity,” Dillon says. “This is about people who are trying to control and determine the worth of a human life, and that is dangerous. And it’s diabolical.”

Sterilization was found to be constitutional in a 1927 Supreme Court case known as Buck v. Bell. The case has never been overturned, says Jasmine E. Harris, a professor of law at the University of California, Davis School of Law, though it’s not used as precedent. An 8-1 decision found that the institutionalization of Carrie Buck for “feeblemindedness” and her subsequent sterilization were both legal and justified. As Justice Oliver Wendell Holmes Jr. wrote in the majority opinion, “Three generations of imbeciles are enough.”

Though Buck was apparently institutionalized for an intellectual disability, Harris says that is false. Rather, Buck was a poor White woman—someone politically disempowered and simultaneously dependent on the state government for social support services. Buck’s sterilization was a political move and a policy prototype motivated by a desire to “prevent dependency on social welfare programs and draining of the public coffers,” Harris says. Carrie Buck’s sterilization, as is often the case, was carried out at a government-run facility. 

Once other states saw that they could justify the medical abuse of women with this legal precedent, sterilizations increased dramatically in the 20th century. Some estimates say that at least 70,000 women were forcibly sterilized because of state laws and other sources list the number of victims between 100,000 and 150,000. The uncertainty surrounding these totals is telling. “[Buck v. Bell] gave the green light to states to go ahead and actually create or incentivize sterilization of unwanted populations,” Harris says, referring to those whose bodies and lives exist outside the norm of able-bodied White men, namely Black and Brown women.

During the height of this wave of eugenics by means of sterilization in the U.S., forced hysterectomies were so common in the Deep South that activist Fannie Lou Hamer coined the term “Mississippi Appendectomy” to describe them. Thousands of poor Black women who had sought medical treatment at teaching hospitals, either because it cost less or because Jim Crow laws prevented them from accessing other facilities, were sterilized. 

It wasn’t limited to the South, either. Between 1958 and 1968, the Eugenics Board of North Carolina forcibly sterilized a documented 2,163 individuals, most of whom were Black. Scholars also documented a direct link between victimization and receipt of public welfare in the state. 

A 1970 federal law known as the Family Planning Services and Population Research Act allowed the Indian Health Service, which is run through the Department of Interior, to sterilize Native women and girls, often by means of coercion or deceit. Native activists and scholars estimate that the act paved the way for the IHS to sterilize 25% of Native women and girls between the ages of 15 and 44 in the 1970s. 

The longest running and most expansive eugenics policy was enacted in California, where between 1909 and 1979 at least 20,000 people were sterilized, most of them women. 

Organizing Against Medical Abuse 

The legacy of 20th century sterilizations continues today. In September 2020, The Intercept reported that the Irwin County Detention Center in Georgia had forcibly sterilized at least five women in the custody of Immigrations and Customs Enforcement, though the true number of women who have suffered this medical abuse is unknown. 

Project South, a Georgia-based grassroots organization working to eliminate poverty and genocide, filed a complaint on behalf of the detained individuals, arguing that the human rights abuses in the detention center range from the highly publicized hysterectomies to a lack of precautions to mitigate the spread of COVID-19. Since Project South filed the complaint, at least 57 women have come forward to say they experienced medical abuse, says Azadeh Shahshahani, Project South’s legal and advocacy director.  

In response, congressional legislators toured the Irwin facilities, called for an investigation, and suggested that the ICE detention facilities be reformed. “It’s good to see that the issue of medical abuse against women’s bodies is finally getting the attention that it deserves,” Shahshahani says. But she says that there’s a real danger in what will likely be a slow initiation of incremental change. “What [we] really need is for the facility to be shut down as soon as possible and for the women to be free,” Shahshahani says. “This place [cannot] be reformed.”

True to the legacy of Buck v. Bell, the medical abuse of Black and Brown immigrants is linked with the physicality of the institution itself and the federal government’s commitment to bureaucratic process over justice, Shahshahani says. The women represented in the complaint are “in U.S. government custody as well as the custody of these private prison corporations,” Shahshahani says, adding that the private corporation that owns the facility—LaSalle Corrections—makes money off of the incarceration of women who lack permanent residency status. “Women have been dehumanized,” Shahshahani says. “They’re being treated as tools in order for these private prison corporations to make profit.”

Each instance of medical abuse of women creates a new wave of awareness in the United States of the fact that Buck v. Bell was never overturned, further illustrating the need for legislative change and reparative policy, advocates say. 

On the West Coast, California Latinas for Reproductive Justice is working to secure legislative change for victims of the state’s sterilization efforts between 1909 and 1979. The reproductive justice organization is shepherding the proposed compensation program through the California legislature. If it passes, it will be the state’s first legislative motion to provide monetary compensation to victims of its long-standing eugenics practice, says Laura Jiménez, executive director of CLRJ. “We’re currently approaching the governor’s office and the heads of the budget on both sides of the house in California and requesting that they include this request into their next year budget proposals,” Jiménez says. In stewarding this legislation, California Latinas for Reproductive Justice is following the lead of North Carolina and Virginia, which established their own compensation programs in 2013 and 2015, respectively. 

Many victims of California’s unjust practices have died, but those who are eligible will receive the state’s first financial compensation for this kind of medical abuse. Thus far, the apologies have not carried this kind of weight. In 2003, around the same time that California’s prisons sterilized women like Dillon, then-Gov. Gray Davis issued a formal apology to the 20th century victims of sterilization and their family members. 

Jiménez says that no financial payment could ever compensate holistically for medical abuse, but she says that “our systems talk to each other in money,” and that the “symbolic gesture of regret from the state” would mark a first step in addressing California’s problematic history. “I think that putting money behind it makes it sincere,” Jiménez says. “It makes it more likely that the state will think twice about violating the human rights of people that are vulnerable and within its care.”

CORRECTION: This article was updated at 8:17p.m. on Feb. 24, 2021, to clarify that sterilization is still considered constitutional, rather than legal. Read our corrections policy here.