 Johanna Schoen is professor of history at Rutgers University with an affiliation at the Institute for Health. She is the author of two books, Choice and Coercion, Birth Controls, Sterilization, and Abortion in Public Health and Welfare in the 20th Century and Abortion After Row, which won the Welsh Medal of the American Association for the History of Medicine. In her presentation, Race and Reproduction, North Carolina Story, she will detail the internal deliberations of the North Carolina eugenics sterilization program, stressing how social workers and members of the eugenic board justified sterilization. Equally important in Professor Schoen's discussion is how sterilization candidates as well as their families resisted the state's efforts to sterilize. She ends with a detailed discussion of how race played an important role in the state's sterilization deliberations, particularly after World War II. On April 20, 1938, the North Carolina eugenics board considered the sterilization of 13-year-old Kim Miller. Miss Ruth Wexler, a child welfare worker with a Durham County Welfare Department, had suggested Kim for eugenic sterilization after removing her and her younger sister from their father's home, where Kim had received a beating that left her with bruises all over her body. Kim's mother was an inmate in a state mental institution. Lacking any other option, Miss Wexler placed her in the county home. There, Kim spent her days locked in a room to prevent her from interacting with the prisoners and workmen in the vicinity. This situation was far from ideal, and after five months, Wexler finally decided to return Kim to her father, fearing that Kim might be cursed into having sexual relations and become pregnant. However, she sought Kim's sterilization before her return. Kim's father objected and came to Raleigh to voice his objections to the members of the North Carolina eugenics board. He argued that Kim was not feeble-minded. If she's insane, it is from being locked up five months. It would run anybody crazy. He charged the eugenics board members with wanting to butcher her up and experiment when she's innocent and complained that the social worker should leave him and his children alone and turn her attention to a neighborhood boy, Charlie, whom he charged with picking on his daughters, pushing Kim down, pulling her under a building and threatening her with a knife. Board members, however, failed to address the issue of Charlie and worried instead about Mr. Miller's alcohol consumption and his inability to either control his children or provide for them. Mr. Miller explained that he drank once in a while, but that he had never been drunk or been in court. Asked how he earned his living, Mr. Miller responded, I'm not doing anything. Neighbors give me something to eat, but added that he would go to work to provide for his daughters. At the center of the hearing, however, was the issue of parental discipline. Board members were worried about Mr. Miller's apparent inability to control his daughters. Alluding to Mr. Miller's complaints about Charlie, one board member warned, if you continue to object to the sterilization and if we do not go ahead, you're going to have trouble all the time. You know you can't afford that. Mr. Miller defended himself. I have tried to train them right. I whipped them for disobeying. This thing started because I was correcting my own child. But board members remained unconvinced that Mr. Miller could provide for his children and protect them from the advances of neighborhood boys. Kim was one of about 7,000 people sterilized between 1929 and 1975 under the authority of the North Carolina Eugenics Board. Eugenic science gained the ear of policymakers in the last quarter of the 19th century. During the 1910s and 20s, Eugenicists helped to shape legislation that aimed to sterilize members of the community whose offspring they considered undesirable. By 1929, 30 states, including North Carolina, had passed sterilization laws inspired by Eugenic science. Between the passage of the first sterilization law until the mid-1970s when the last states seized operating their sterilization programs, over 63,000 people nationwide received Eugenic sterilizations. California led the way with almost 20,000 sterilizations between 1909 and 1953, followed by North Carolina and Virginia with close to 7,000 Eugenic sterilizations each. While inmates of state mental institutions comprise a significant portion of sterilization candidates in the early decades, with the expansion of the welfare state in the post-war period, the Eugenics Board turned its attention to the non-institutional poor. 60% of those sterilized during the 1930s and 40s had been inmates of state mental institutions. The remaining 40% were non-institutional poor. By the 1950s, psychiatrists began to express open doubt about the efficacy of Eugenic sterilization and the number of institutional petitions plummeted drastically. In its stead, the percentage of those sterilized outside institutions rose to over 70% in the 1950s and 60s. Overall, 40% of those sterilized were inmates of state mental institutions, 60% were non-institutional poor. State-sponsored sterilizations were a national, indeed an international phenomenon, yet the events that led to the passage of individual sterilization laws and to each individual state authorization of Eugenic sterilization occurred at the local level. Many states sought to control public expenditures by limiting the reproduction of welfare recipients. North Carolina's Eugenic sterilization law fits squarely with state public welfare policies and the desire to save public funds. The law was introduced by a former member of the Burke County Board of Public Welfare and permitted the sterilization of individuals who were mentally diseased, feeble-minded or epileptic and whose sterilization was considered to be in the best interest of the mental, moral or physical improvement of the patient or inmate or for the public good. In the early 1930s, North Carolina established a state eugenics board to consider petitions for eugenic sterilization. The board had five members, the commissioner of public welfare, the secretary of the state board of health, the chief medical officers of the state hospital in Raleigh, and of an institution of the feeble-minded or insane and the attorney general of North Carolina. The program itself was housed within the Department of Public Welfare. The board received sterilization petitions from physicians, public health nurses and social workers. At monthly board meetings, eugenic board members reviewed petitions and voted on sterilization decisions. Once the board authorized a sterilization petition, the case was assigned to the hospital closest to the patient where staff surgeons performed the sterilization. While discriminatory welfare practices of the 1930s and 40s had excluded African-Americans from welfare programs and left them largely outside social workers sphere of influence, federal pressure and a series of new requirements relating to the implementation of age to dependent children resulted in black women's inclusion in social service programs, bringing them into closer contact with social workers and thus with state supported sterilization. Nationwide, the percentage of welfare recipients who were African-American rose from 31% in 1950 to 48% in 1961. As a result, the proportion of African-Americans sterilized under the auspices of North Carolina's eugenics board rose from 23% in the 1930s and 40s to 45% between 1950 and 1968. Overall, 61% of sterilization candidates were white and 39% were African-American. The interplay of race, class and gender in the implementation of reproductive policies in North Carolina married tensions across the country. Stalization candidates or their legal guardians had to consent to the sterilization. If they failed to do so, the eugenics board called a hearing case at which family members could voice their opposition to the procedure. If after the hearing, board members still believed that sterilization was advisable, they could authorize surgery over the patients or their guardians objections. Only a very few family members actually attended eugenics board hearings. Most were too intimidated by legal formalities and the sensitive nature of cases to make the journey to Raleigh where they would have to face members of the eugenics board. Many probably also found it difficult to travel all the way to Raleigh. In that sense, Kim Miller's father was an exception. He appeared at two hearings before the board in April of 1938 and then again in June. In April, he brought a lawyer. In June, he appeared by himself. Stalization candidates and their family members had numerous reasons to object to eugenic sterilization. Most objected that sterilization violated their religious beliefs. I think it is a sin and Christ never meant for that to be done, Mr. Miller explained his opposition. Many wanted to have more children. Others dreaded the experience of surgery. Still others feared the impact of sterilization on sexual behavior. Husbands worried that the operation might reduce their wife's desire for sex while parents worried that sterilization might give their daughters license to be sexually promiscuous. Many also questioned the diagnosis of feeble-mindedness. She's not more feeble-minded than anyone in this building one mother protested the diagnosis of her daughter. While Mr. Miller conceded that his wife was mentally ill and that Kim's younger sister seemed to be a little feeble-minded, he noted that the younger sister was born after his wife went bad. But he stated, Kim is not feeble-minded, nervous and broken down from being locked up. With the passage of the state's eugenic sterilization law, health and welfare officials implementing the program brought their own policy goals to the table. These goals could range from controlling welfare spending to improving the health of sterilization candidates, to easing institutional overcrowding by sterilizing and then releasing inmates from the state's training schools, Caswell and Samarkand. Health and welfare authorities hoped that eugenic sterilization could aid in the fight against social ills. Social and economic factors took center stage in the implementation of eugenic sterilization. Class background played an important role in identifying the mentally defective. Poverty pointed to the existence of feeble-mindedness and receiving financial aid from the state provided the state with a financial interest in the eugenic sterilization and further helped officials to identify potential sterilization candidates. A study of mental illness and mental deficiency and epilepsy conducted in the late 1940s found that most of those classified as mentally deficient had received some type of financial assistance from the state. This has been in the form of general assistance, old age assistance, ADC, boarding home placement, institutional care in homes for children, free medical care and hospitalization and employment on the projects of the WPA and in civilian conservation core camps. In addition to this, there's the cost of court hearings, sentences served in the county jail, training schools, state prison and the road camps. To convince family members of the desirability of surgery, board members frequently stated that they wanted to prevent the birth of children who might be financially dependent on the family or the welfare department. They inquired about family's financial resources, the kind of work they did, how much they earned, whether they had ever received relief payments or help through the WPA and how high such relief payments had been. State board member, the state board members emphasized, had a financial interest in the sterilization. As one board member argued, patient is a state charge and to protect herself and the state, we feel that this operation would be for the best. Indeed, board members claimed that the real or potential financial dependence of patients gave the state a right to consider sterilization and asked family members to prove that a patient is perfectly capable of taking care of herself or of any children she might have or that any children she might have would be able to take care of themselves. Such proof, of course, was impossible for anyone to render. Many sterilization candidates and family members resented social workers for meddling in their personal affairs and suspected that sterilization petitions resulted from social workers' personal malfeasance. Referring to the Durham County superintendent of public welfare, W.E. Stanley, Mr. Miller protested that he has got no right to do that, initiate a sterilization petition. Stanley hasn't been a friend of me for three or four years, he charged. One Christmas, I didn't have any funds to buy presents for the children and I went down there and asked them to help me some. Mr. Stanley laughed. Mr. Miller's suspicion of county welfare authorities was likely shared by his neighbors. Neighbors think it should not be done, he protested the petition of Kim sterilization, told me to fight it if anything happened they would come to my rescue. Patient sexual behavior provided another indication of mental disease or deficiency. One eugenic board member explained that the operation could be performed when people are mentally disordered, mentally defective or promiscuous sexually. The same 1948 study quoted above of 40 persons sterilized under North Carolina's eugenic sterilization program concluded that 22 of the 40 persons were known to be sex offenders. 19 had been diagnosed as sexually promiscuous. Other sexual delinquencies in this group included incest, trespassing, including being a peeping tom, abduction, adultery, bastardy, crime against nature, indecent exposure, prostitution, seduction, using a hotel room for immoral purposes and uncontrolled sexual desire. Of the case histories with information on patients sexual history, 80% were considered promiscuous. Since sexual activity outside marriage was particularly disturbing in women, they became the main target of sterilization programs. 61% of eugenic sterilizations nationwide and 84% of sterilizations in North Carolina were performed on women. To be sure, eugenic board members encountered sterilization candidates who suffered from serious mental illness or retardation. 23% of sterilization candidates had been diagnosed with some form of mental illness. Many of them suffered from auditory and visual hallucinations, delusions, or depression. A number of them had also threatened their children's safety or severely neglected or abused them, sometimes causing the death of a child. Ethel, a 40-year-old mother of seven who suffered from depression killed her two youngest children and 21-year-old Bertha, diagnosed with mental retardation, was the mother of a four-month-old and a four-year-old. After her younger child died as a result of neglect, the Department of Public Welfare explained that Bertha herself was a half-grown child and needed someone responsible to care for and guide her. The department petitioned for her sterilization. I am not suggesting that eugenic sterilization was appropriate in these cases while it might not have been in others. The cases illustrate, however, that as far as the law was concerned, some of those sterilized did indeed suffer from severe mental illness and retardation. But cases such as these constituted the exception in a program where most sterilization candidates were neither inmates in state mental institutions nor threatened the lives and physical safety of their children. Most sterilization candidates came to this attention of county health or welfare officials because they or their relatives received some form of welfare benefits and officials feared that pregnancy would add yet another child to the welfare roles. In case files, descriptions of poverty were accompanied by observations about sexual behavior. Ella May's social worker sought sterilization for the 29-year-old mother of four because Ella May seems determined to be promiscuous. Pearl's social worker argued for the sterilization of Pearl at 21-year-old mother of six because Pearl made no effort to curb her sexual desires and is very promiscuous with numerous suitors. And Ruby, a 32-year-old single woman without children was simply deemed oversexed. Most troubling, however, was the sterilization of rape and incest victims, the majority of whom were teenage girls like Kim. The petition for Bula, a 16-year-old white girl, noted that Bula was pregnant. When Bula was 12, the petition observed, her father began to rape her. The man responsible for Bula's pregnancy was a friend of Bula's mother who had gotten the mother's permission to have sexual relations with Bula. The social worker suggested sterilization. Bula's father concurred and signed the petition. Leora, in 18-year-old black single girl, was also pregnant. Her petition noted that Leora had an incestuous relationship with her father at age 14, but because she and her mother would not testify in court against him, he was found not guilty. She is now far advanced in pregnancy and her parents refused to attempt to establish paternity as they don't want to get messed up in that. Her father had signed the consent form and Goldie, a 13-year-old white girl, was pregnant by her brother. The social worker suggesting sterilization wrote, her brother is the alleged father of her child and has been committed to training school. There's also a feeling in the community that the father has had relations with her, but no proof of this has been secured. According to the brother, Goldie would make an attempt to resist him what would give in each time. The parents sought sterilization and signed the consent form. Also common was the sterilization of girls like Kim who had not yet become pregnant as a result of rape, but who were likely to become victims in months and years to come. Mr. Miller's repeated attempts to alert authorities to the neighborhood boy Charlie were met with an unsympathetic ear. When he told members of the eugenics board that he wanted something done with Charlie, one of the members responded, we have nothing to do with Charlie and insinuated that if Mr. Miller was unable to control Kim in light of the Charlie's in this world, sterilization would be the best response. In July 1938, a month after the second eugenics board hearing, Mr. Miller decided to withdraw his objection and signed the consent form for Kim's sterilization. The record suggests that he had had health troubles and needed Kim at home to help him. Kim was sterilized a couple of months later, a precondition for her release from the county home and return to her father. Lest anyone think that cases like these were rare, the youngest person sterilized under the eugenics sterilization program was nine years old. There were three 10-year-olds, 31 11-year-olds, 67 12-year-olds, 116 13-year-olds, 226 14-year-olds, 335 15-year-olds, 406 16-year-olds, and so on. More than one third of those sterilized were not even of legal age to buy a drink or vote, let alone give consent to their sterilization. It is unclear what social workers and eugenic board members thought when they looked to eugenics sterilization as a solution to these problems. Careful attention to the words of former eugenic board members and social work professionals indicates that they were genuinely concerned with their clients and desire to help improve their lives. Several health and social work professionals expressed deep ambivalence about the program when I contacted them in the 1990s. One former eugenics board member claimed to be so haunted by his role that he refused to talk to me. Others conceded that the program sometimes carried negative association. It isn't something we would have volunteered to do. Jacob Kuhn, a former board member explained, we did it because the law obligated us to. Board members questioned whether authorizing sterilization was a function of the state. Was this a right thing to do? Did we really have all the data at hand? Despite such doubts, however, eugenic board members were firmly convinced that eugenic sterilization constituted an important social policy intervention. The eugenic sterilization program seemed to offer an opportunity to make things better for the flow of illegitimate children and the circumstances in which they were brought up, Kuhn explained. I think our major concern was that here was a mother who has already demonstrated to be incompetent for the raising of children who was having yet another child and who because of her community behavior was likely to have several more. That it was an illegitimate birth was of much less concern than the fact that it was an incompetent mother. Social workers recalled in vivid detail the grinding poverty of clients if combined with mental illness or mental retardation they explained the situation could spell disaster. Kuhn concluded, I never for a moment felt that anyone on this board was doing this as a matter of punitiveness or vindictiveness or this is what these people deserve, never, never or a matter of discrimination of any kind. Most of us felt it was a very sad situation, felt knew that there were hundreds and hundreds and hundreds of others just like this that never came to our attention. We were sometimes thanked for having done this. Parents were glad. The impersonal nature of the process masked the fact that eugenic board members were making decisions about the most intimate aspects of sterilization candidates' lives. Since board members rarely faced sterilization candidates in person, they were assessing abilities at a distance in the abstract. Clients' abilities were expressed in an IQ rating and brief descriptions of a client's social and economic background. The presence of some severely developmentally disabled or mentally ill individuals among sterilization candidates most likely camouflaged the fact that the majority were primarily poor and lacking education. Indeed, the social distance between sterilization candidates and eugenic board members further eased the decision-making process. Board members were all heads of state agencies and of similar age and academic background. They shared a sense of purpose and competency central to the decision-making process. We would usually have a brisk discussion. Think about our own background, Jacob Kuhmann explained about the preparation for voting on a case. Even with the best of intentions, however, social workers and eugenic board members acknowledged that the eugenic sterilization program was far from flawless. We may well have sterilized some folks who weren't that much retarded, Kuhmann admitted. Systemic problems further contributed to abuse. A lack of oversight on the county level meant that some social workers overstepped their boundaries with impunity. One retired social worker recalled a colleague who sterilized his entire caseload. Others misrepresented the nature of the procedure when securing consent. They claimed that sterilization was reversible or coerced clients into signing consent forms by threatening the withdrawal of welfare payments. Sometimes social workers asked relatives to sign the consent form, even if those relatives lacked the legal authority to do so. Board members too were not above reproach. They disregarded evidence that clients had indeed been coerced and ignored details suggesting that sterilization candidates were merely victims of unwanted sexual attention. And they gave little thought to the fact that sterilization might further harm rape and incest victims. Moreover, those board members who were directors of state mental institutions frequently voted on petitions they themselves had submitted for their institution. They did so with the acquiescence of the state attorney general's office which also had a member on the board. Finally, while some board members in the 1950s began to have doubts about the program, they preferred to stay away from board meetings rather than challenge the program itself. This is true both for several of the psychiatrists who sat on the board as well as for several representatives from the state attorney general's office. Indeed, in its heyday, the program was run by three individuals, typically the director of the state board of public welfare, Ellen Winston or her representative, R. Eugene Brown, R. D. Higgins from the state board of health and W. R. Pierce from the state attorney general's office. It took until the 1960s for North Carolina's sterilization rates to decline. Changes during that decade laid the groundwork for the dismantling of state-supported sterilization, the development of more reliable contraceptives, the onset of the civil rights and women's rights movements, and a better understanding of mental disease and developmental disability all contributed to a significant shift in board members' perception of eugenic sterilization. In 1974, North Carolina and Virginia finally repealed their eugenic sterilization laws. That same year, the Office of Economic Opportunity formulated and distributed sterilization guidelines to ensure that patients would receive adequate counseling and be given informed consent to further safeguard the poor against the possibility of sterilization abuse. Clearly, the history of eugenic sterilization is a history of misguided governmental policy that we do not want to see repeated. By thwarting the most intimate interests of sterilization victims in their own physical and mental health, the state did wrong as well as harm. State sterilization disappointed the most natural and realistic hopes and expectations an individual might hold, the ability to determine the size of one's family. Moreover, as victims testified to a lifetime of depression, distrust, and feelings of worthlessness as a result of sterilization, the surgery left them worse off than they had been prior to the surgery. By infringing on the victim's interests in their own health and the normal functioning of their bodies, the state violated the most important interests a person has. Let me close by noting that the ability of poor women to exercise their reproductive rights remates under constant attack. As shocking as last year's story about the forced hysterectomies in the eyes detention center was, it was not surprising. Whether through deliberate act or willful oversight and neglect, our government on all levels continues to demonstrate that women's reproductive health and choices are of no importance. Moreover, reproductive policies indicate that many policymakers feel women's reproductive choices cannot be trusted, that women lack the moral capacity to make the right decisions. This is most obvious in the politics surrounding abortion, a procedure that came under attack almost as soon as it was legalized. Is the mismanagement of a miscarriage on the schedule really a miscarriage? Is the patient's choice to end an unwanted pregnancy really the right decision? And the suspicion extends beyond abortion care to healthcare workers providing other reproductive healthcare services. We deny women decision-making capacity and second guess the healthcare providers who take care of them with the prohibition of abortion in Texas after six weeks gestation, most people in Texas are already left without a choice. And if you think that abortion care and forced sterilization have nothing to do with each other, you are mistaken. North Carolina sterilization victims lacked access to sexual education and reproductive health services. During the time of the eugenics sterilization program, abortion was illegal. The program drew to an end after abortion became legal with the 1973 Roe decision. And when women finally gained contraceptive choices, the pill and the IUD and were no longer forced to rely on condoms and the diaphragm, two forms of contraception that don't work for many couples. Indeed, it is the very restriction of the services or the lack of them that made it possible to curse women into unwanted sterilizations. To assure full reproductive autonomy, we have to ensure that all access to education about birth control, sterilization and abortion, regardless of their race, class, age and marital status. Finally, we have to understand that women and men have the right to decide to use or not to use such services even if we disagree with their choices. Rights are only as strong as our willingness to tolerate the decisions of others. A full acknowledgement of the suffering of the women and men sterilized under the state eugenics programs must include a fair to defense of the reproductive rights of all. Thank you.