 Professor Alexandra Mina Stern is the Carol Smith Rosenberg Collegiate Professor of American Culture, History and Women's Studies at the University of Michigan. Much of her research has focused on the uses and misuses of genetics in the United States and Latin America. She is the principal investigator of the sterilization and social justice lab, which uses mixed methods to study patterns and experiences of eugenic sterilization in the 20th century United States. This research has informed policy efforts to provide redress to survivors of compulsory sterilization. In her lecture, she will discuss the formation of the sterilization and social justice lab, an ELSI-supported research project at the University of Michigan, highlighting how mixed methods analysis can help us understand patterns and experiences of eugenics and sterilization in the 20th century United States. Greetings. My name is Alexandra Mina Stern or Alex for short. I'm a white woman with brown hair and dark rim glasses. I am wearing a black blazer and a multicolored scarf. I am in my faculty office at the University of Michigan where I will be presenting this talk. This talk actually begins in Sacramento in 2007. I had written a book on the history of eugenics in California, but I was very frustrated because I knew little about the history of sterilizations in that state. I knew about the basic contours, but I really didn't know what happened behind the walls of institutions. I didn't know who was sterilized, what their demographic makeup was or what their stories were. I had spent a lot of time in a range of archives digging for these materials and I decided on a fateful day in July, 2007, to go to the department, the California Department of Mental Health and to ask them if they had any available records from the 20th century. I was fortunate that I happened upon an administrator there who helped me and pointed me to a file cabinet. In that file cabinet, after looking through various boxes, I found 19 microphone reels. I pulled one of the reels out, looked at its contents using just the desk lamp that they had nearby and I saw the words sterilization recommendation. And I knew I had found really important materials related to the history of eugenics and the history of sterilization in California. Thus began a whole range of projects, both individual and collaborative that I'm going to be discussing in greater length today. First off, I knew that when I having found these records, I would be able to expand on the first edition of my book, Eugenic Nation, Faults and Frontiers of Better Breeding in Modern America, to really dive into the institutions and to understand what happened in the multiple institutions in California where thousands of people were sterilized. You see on this slide, both the first and the second editions of my book, the most recent one is blue, as well as postcards of the institutions where thousands of people were institutionalized and many were sterilized. So let's take a brief detour and discuss what is eugenics. We've covered some of this ground in this symposium already. However, just as a reminder, this is a term that was coined in 1883 by Sir Francis Galton and was really focused on this idea of improving the quote, human stock, better breeding of populations, improving society through applying theories of biology and heredity. And it really gravitated towards two categories of people, those deemed fit and those deemed unfit. You can tell from the slide that who was deciding who was fit and unfit were primarily elite white men who liked to look at themselves in the mirror and wanted to reproduce their kind. To do that, they had to classify and they sought to control. There were a spectrum of activities and policies that unfolded as part of eugenics. On one side of that spectrum was positive eugenics. So this included manners and measures taken to incentivize the breeding of the so-called fit, such as better babies contests, better families contests, marriage counseling, metals and certificates given to those typically white middle-class Americans who were viewed as fit and in need of having more children. On the other side of this continuum was negative eugenics, which was focused on controlling the reproduction of the unfit, really crafting the body politic along the lines of what eugenicists viewed as ideal American society. This society in its most idealized form would be Nordic and Anglo-Saxon and include large broods of white families. In the images here, you see some of the tropes that were popular and that helped to popularize eugenics in the early 20th century, which were ideas about healthy seed being sown and the financial and biological cost of so-called feeble-minded people and mentally deficient people on society. Negative eugenics sought to impede both the arrival of supposedly biologically unfit peoples to US shores, typically through immigration laws and through marriage restrictions and most pointedly through eugenics sterilization. This slide, which was produced by Harry Loughlin, who was the superintendent of the eugenics records office from 1910 to the late 1930s, captures the different policies and approaches associated with eugenics and across the continuum, moving from segregation to controlling matings to sterilization and more. Under this banner of negative eugenics, 32 states passed eugenics sterilization laws starting in Indiana in 1907 and finishing with Georgia in 1937. It is quite striking to reflect on the fact that two thirds of US states at the time had eugenics sterilization laws on the books and these were not repealed until the 1970s and 1980s. Under these laws, over 60,000 people were sterilized in the 20th century. A key component of these sterilization laws was that they focused on categories and people who ostensibly had disabilities. Disability served as an ideological lynchpin in all of the states and all of their sterilization laws. And my colleague Natalie Leera, who is a co-director of the sterilization and social justice lab with me, will be addressing this in greater depth. Suffice it to say that if you look at the key diagnostic criteria as they saw them at the time for rationalizing sterilization, it almost always included the term feeble-minded as well as terms such as degeneracy, perversion, epilepsy and deficiency. Thus sterilization was not written primarily in racial or religious terms. However, how it played out, it exacerbated existing racism and one could argue expanded on racism and xenophobia at the time. So back to that fateful day in July 2007 when I found the microfilm reels and those materials on them, those would allow us and allow me to really delve into California's eugenics history. As you see in this slide, California surpassed all other states when it came to eugenic sterilization, sterilizing more than 20,000 people or more than one third of all sterilizations in the U.S. Virginia, North Carolina and Michigan come behind California, but they don't even match half of the operations that were performed there. These sterilizations took place in about 10 different mental institutions, some of which were founded in the late 19th century and others were founded in the mid 20th century. They, as you see from this slide, they really spread across the state from the Southland and the Patent State Hospital and Pacific Colony up to Northern California, including Sonoma and Mendocino. So in terms of the records that I found, those microfilm reels had over 50,000 discreet documents and over 20,000 patient records and forms dating from the years 1919 to 1952. Here are some samples redacted of what those forms look like. You see the forms are really basically intake and justification forms for sterilization procedures. They capture personal history, family history, clinical history and include actually language taken verbatim from the state sterilization law to justify the procedure. Here is the text that's included in the recommendation forms, which includes four boxes, beginning with this patient is afflicted with a set of four options. You'll notice that the top box is checked, although typically the most commonly checked box was feeble mindedness in any of its various grades, which could include just feeble mindedness, being a moron, being an imbecile. Those were scientific terms at the time that were used by this medical superintendents and the psychologists who administered IQ tests in order to ostensibly rank people's intelligence. Seeing feeble mindedness on this form also reminds us that feeble mindedness was a key criteria in all the sterilization laws that were passed in the United States and indeed in other parts of the world in the 20th century. So I found these records and began to work with them. Natalie Lira, who I already mentioned, began to work with me as well at the beginning of her very impressive career and she's been working on these questions in the context specifically of Pacific Colony, one of the institutions I already mentioned. But one of the things we realized is with these records, an Excel spreadsheet was not going to cut it. We needed to actually develop a data capture system and we needed one that was HIPAA compliant and that would allow us to capture key variables from the forms I showed you before and be able to digest them so that we could use them to explore patterns and look at experiences. With that in mind, and by the way, this is a short interlude in this slide to say, thank you very much NHGRI for support and funding of our quantitative and mixed methods research for this project, as well as thank you to the NEH for the digital archive that we're developing as part of this. So we knew that we needed to create these data sets and we turned to REDCAP, which is a HIPAA compliant data capture system and spent a great deal of time developing these data sets, pre-populating them with as many categories as we could. And in the end, the data set for California includes 212 unique variables and we had a little over 20,000 forms. It took about two years to enter all of this data with a robust and engaged team of undergraduates and graduate students into the data sets. And once we had done that, we were able to carry out our analytical work. We found along the way stories of resistance, stories of mothers who refused the sterilization of their children, of fathers who refused the sterilization of their children, of patients who did not want the procedure. Those stories, I've explored them as have other colleagues and historians and other venues and would be happy to take questions about them in the Q&A. We also found in the records, the routinization of sterilization and the way in which consent was really a farcical process. We looked closely at these records to see how language in them was changed. If going back to that slide quickly, it's interesting to note that the form originally said the form used for intake and patients at the institution who were recommended for sterilization. It said, who is now an inmate? They changed it to just by hand writing who is to be an inmate. And then later that was codified in the form to give them as much latitude as possible. When I say them, I mean the medical superintendents and other health authorities who are making decisions about sterilization who is now or may become an inmate. So anyone who was sent to one of these institutions I showed you before was held in these carceral spaces could be subjected to sterilization as shown in these forms. Another interesting aspect of this is something that Johanna Schoen found in the case of North Carolina is that it's important to remember that even as the state was coercibly performing sterilizations, birth control and sterilization itself as a form of permanent birth control was illegal and inaccessible for many women. So for those women who wanted to actually be sterilized and exercise their reproductive rights, we found that about 5% of the cases were women who committed themselves to institutions so they could be sterilized. These are just interesting facets of the records. They tell us about the experiences and the patterns. We have an excellent team at the sterilization and social justice lab. And one of the first papers that we published was an estimate of the likely number of sterilization survivors in California. If you remember, the total number sterilized was over 20,000. Most of them were sterilized from the period 1919 to 1952. So by the time many of them are sadly no longer with us. When we published this in 2017, we estimated, and this is where Nicole Novak, who's our demographer on the team, used our data set that I told you about how we created the data set with life tables to do this estimate. And we estimated at that time that about 850 survivors, there were 850 survivors. Fast forward to today, that number sadly has dwindled each year by about 100. And we estimate now and kind of looking towards 2022 that there were are likely about 350 survivors from the eugenic sterilization era. In any case, we published this paper in the American Journal of Public Health. It garnered a great deal of media attention and helped to inform efforts on the parts of advocates to pass a compensation law. Our second paper was also published in AJPH and it shows the way in which the disability discourse and discrimination of California sterilization law merged with racism that was enacted disproportionately on Latinos, notably on young Latina patients. So using regression analysis, using census data using our data set, our team was able to show that during the height of the program, women and girls were 14% more likely to be sterilized than their male counterparts. Male Latino patients were 23% more likely to be sterilized than non Latino patients. And female Latina patients were 59% more likely to be sterilized. So that's quite a striking finding and it drives home the ways in which eugenics enacted racism and reproductive injustice. In California, most notably against Latinx communities and Latinx families and Latinx women. So since our work on California, we've developed pretty sturdy and reliable methods that are able to tell us a great deal about demographic patterns and experiences of sterilization. Because of that, we decided to expand the project to include additional states. Initially, we added Iowa and North Carolina. Johanna Schoen contributed the records from North Carolina. Nicole Novak based in Iowa was able to lead a team to go to the Des Moines archives where they obtained the records. A graduate student working in the lab brought in the records from Michigan the following year. And we're now working with Jim Tabary at the University of Utah who has accessed working with the appropriate institutions and agencies, de-identified data from Utah. So at this point, we have five states that are part of our work at the lab and taken together, this consists of, they consist of more than 35,000 records related to eugenics sterilization in the United States. And I would argue cover a pretty good demographic variety and we'll be able to tell us a great deal about patterns of sterilization and eugenics across the United States by combining the data sets from these five states in terms of race, in terms of gender, in terms of nativity and ethnicity, in terms of diagnosis. And we're doing that in concert with looking at contextual factors such as laws and institutions, economic situations and a range of other important factors. This is a slide here that is interesting because it shows how across the different states and this includes three states, California, North Carolina and Iowa, how the patterns in terms of actually the numerical number, the number of sterilizations varied across time. So you see in California how dramatic the sterilization rates were from 1920 to 1950, they dramatically declined after 1950. Whereas in North Carolina and Iowa, they were fairly steady and even increased and peaked in the 1950s and 1960s. We know in North Carolina that this rise in the 1960s was associated with increased sterilizations of black women and a disproportionate targeting of black women who often had several children already who were on welfare and were seen as not only biologically unfit to reproduce, but also unfit to parent. And that's an important part of the eugenics story in the second half of the 20th century. At the lab, we are involved in, we have many balls in the air, so to speak. We're continuing to do our mixed method analysis and exploring new areas of research. As I mentioned, we're looking at cross-state comparisons, doing demographic analysis. We have a researcher working on the question of consent and I put that in scare quotes in California. She's been using in vivo software to look at 400 cases where consent was refused and trying to understand what that means in a context where it was already impossible to provide true bioethical consent in places with asymmetrical power relationships and essentially the carceral spaces of institutions. We have a paper under review that looks at the disproportionate sterilizations of people of Asian nativity in California. I'm working with a researcher in the lab on a paper that shows that about 40 incarcerated Japanese-Americans were transferred from the camps in places like Manzanar to institutions to be sterilized in California and sometimes sent back and sometimes not. This is very important because to date, we had not seen much interaction between state authorities and federal authorities when it came to this type of reproductive control and this is going to give us a better sense of that in the context of wartime during World War II. Our team is also working on a sterilization survivor estimate for Iowa akin to what we did for California. So I've told you about patterns. I've told you about some experiences. I'd like to wrap up this talk by addressing legacies. There are many legacies of eugenics that we live with every day and there are eugenic overtones to some of genomic technologies as well. One of the most notable legacies is really addressing the wrongs of the past through compensation programs. Earlier in the 21st century, North Carolina and Virginia passed compensation programs really that aim to compensate usually in the amount of 20 to $25,000 individuals who were involuntarily sterilized by the state. California followed suit after four tries in the legislature and passed the Involuntary Sterilization Compensation Bill and will be launching the compensation program in January, 2022. For me, it's really a source of pride that the dataset that we created in the lab and as our kind of original centerpiece of this work is going to be consulted. We're going to be working with the Victims Compensation Board to look for forms and materials and documents and help them in their verification process. Finally, I'm working with a colleague at Dartmouth, Jackie Wernemont, who's a digital humanist to build a digital archive that is going to, that both will curate and showcase stories related to sterilization and eugenics in North Carolina, Iowa and California. We're calling it eugenic states, a contextual archive and we plan for a soft launch of this digital archive in spring of 2022. So please stay tuned for that. Thank you.