Analysis Human Rights

From Coercive Prisoner Sterilizations to State Abortion Restrictions: How Reproductive Justice Eludes Women of Color

Sheila Bapat

Aggressive attempts to restrict women's health-care options, which range from shutting down abortion clinics to coercing women inmates to become sterilized, reveal the long, seemingly unattainable arc toward reproductive justice for women of color.

In the 1950s, John Rock and Gregory Pincus, the inventors of the birth control pill, sought a place where they could test the drug among a large population of women so that it could be approved by the Food and Drug Administration. They visited Puerto Rico and decided it would be the perfect place, because if they could demonstrate that “poor, uneducated … women of Puerto Rico could follow the Pill regimen, then women anywhere in the world could too,” according to a PBS American Experience write-up about the Puerto Rico trials.

Many women in Puerto Rico were eager to use birth control, but “[t]he women had only been told that they were taking a drug that prevented pregnancy, not that this was a clinical trial, that the Pill was experimental or that there was a chance of potentially dangerous side effects.” Three of the women “guinea pigs” died.

The physicians viewed these women as “ideal” subjects because they were poor and uneducated, and they in turn gave the women half-truths and false information. This weekend, we learned that in at least one prison, a somewhat similar situation has been unfolding in the United States.

The Center for Investigative Reporting (CIR) broke the news on Sunday that some women inmates in California felt pressured by their prison’s physician to get tubal ligations. The physicians, under contract with the California Department of Corrections and Rehabilitation, also reportedly failed to obtain required state approvals before performing sterilizations on 148 women inmates in the state between 2006 and 2010, according to the CIR report.

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This story, and the extreme abortion restrictions that continue to be introduced and passed in Texas, North Carolina, Wisconsin, and elsewhere, reveal how reproductive justice eludes so many women in the United States, and how policies and practices can disproportionately affect women of color.

CIR reporter Corey Johnson’s sources told him they felt pressured by Dr. James Heinrich, the OB-GYN at Valley State Prison for Women in Chowchilla, California, to undergo tubal ligations. “Dr. Heinrich’s role was central in that when the pregnant women came to the prison, they all saw him; he was the prison OB-GYN. … And it was him and his staff that would pitch the women on getting a tubal ligation,” Johnson told Rewire Sunday evening. “[Heinrich] maintains he did not coerce anyone,” Johnson said, but “the women I spoke with told me that the message they heard was, ‘You need to get this tubal ligation or you risk dying.’ I could easily see how that could be very persuasive to anyone, when a doctor is telling you you could possibly die if you don’t undergo a procedure.”

Johnson told Rewire that the four women inmates included in his story are women of color; two are Hispanic and two African-American, ranging in age from their late 20s to their early 40s.

Johnson does not yet have data about the racial breakdown of the 148 women who underwent tubal ligations in the 2006-to-2010 period. Women of color are overrepresented in the U.S. prison system generally. According to 2007 data from Sentencing Project, African-American women are three times more likely than white women to be incarcerated, while Hispanic women are 69 percent more likely than white women to be incarcerated.

On Tuesday, Joyce Hayhoe, the director of the California Prison Health Care Receivership Corporation, the group charged with administering medical care issues in state prisons, said on a Los Angeles radio show that the details in Johnson’s story are accurate.

Valley State Prison for Women has not commented.

Meanwhile, anti-choice legislators in Texas—which is 773 miles wide and 790 miles long, and where nearly 40 percent of the population is Latino and over 12 percent is African-American—are fighting tooth-and-nail to restrict access to safe, legal abortion as much as possible, making it that much harder for Texans and citizens in neighboring states to make informed choices about their reproductive care.

These modern examples are linked to a deep history that goes back much further than Rock and Pincus’ testing of the birth control pill. In 2008, the Guttmacher Institute published a talk called “Medical Mistrust and Communities of Color,” in which Loretta Ross, co-founder of SisterSong, revealed examples in U.S. history of times when “the medical community was enlisted in the larger project” of coercive medical practices against women of color. She pointed out that much of what we’ve learned about OB-GYN technology in the United States has resulted from doctors experimenting on women slaves.

“Eugenical laws were not discredited until the Nazis took them to their logical conclusion … unfortunately the thinking behind the laws, the eugenical feelings, never went away, they just regrouped,” Ross said, arguing that justifications for “forced control of people’s populations” has revealed itself throughout history.

In Johnson’s CIR story, Dr. Heinrich argues that tubal ligations would save the state money in welfare costs—evidence that the “forced control” Ross speaks of is alive today.

“Over a 10-year period, [the money spent to perform tubal ligations] isn’t a huge amount of money,” Heinrich said, “compared to what you save in welfare paying for these unwanted children—as they procreated more.”

These aggressive attempts to restrict women’s health-care options, which range from shutting down abortion clinics to coercing women inmates to become sterilized, reveal the long, seemingly unattainable arc toward reproductive justice for women of color.

Commentary Human Rights

A Sterilized Peruvian Woman Seeks Justice From the Americas’ Highest Human Rights Court

Cynthia Soohoo & Suzannah Phillips

I.V.'s case, I.V. v. Bolivia, illustrates the all-too-common scenario of medical providers making decisions on behalf of women who are deemed unfit or unable to make their own choices.

In 2000, a Peruvian political refugee referred to by her initials, “I.V.,” went to a Bolivian public hospital to deliver her third child. According to court documents, the doctors decided during the cesarean section that a future pregnancy would be dangerous for I.V. and performed a tubal ligation—for which they claimed they had I.V.’s consent. When I.V. learned that she had been sterilized two days later, she said, she was devastated.

After her complaint against the surgeon who sterilized her was dismissed by Bolivian courts, I.V. brought her case to the Inter-American Court of Human Rights (IA Court), which heard oral arguments earlier this month. In a region where there are widespread reports of forced sterilization, the case is the first time the court will consider whether nonconsensual sterilization is a human rights violation.

The IA Court should hand down its decision in the coming months. A favorable ruling in this case by the IA Court—the highest human rights court in the Americas—could require Bolivia to, among other things, pay reparations to I.V., investigate and possibly punish the doctors who sterilized her, and take steps to prevent similar situations from occurring in the future. The decision will also have ramifications across the region, establishing a binding legal precedent for the 25 countries that are party to the American Convention on Human Rights.

I.V. v. Bolivia provides an important opportunity for the IA Court to condemn forced sterilization and to adopt clear standards concerning informed consent. It would also be joining U.N. human rights bodies and the European Court of Human Rights in recognizing that forced sterilization violates fundamental human rights to personal integrity and autonomy, to be free from gender discrimination and violence, to privacy and family life, and, as CUNY Law School’s Human Rights and Gender Justice Clinic and Women Enabled International recently argued in our amicus brief to the IA Court, to be free from cruel, inhuman, or degrading treatment or torture.

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Further, the European Court and U.N. experts recognize that possible health risk from a future pregnancy cannot justify nonconsensual sterilization because there are alternative contraceptive methods to prevent pregnancy and women must be given the time and information needed to make an informed choice about sterilization. The IA Court should make similar findings.

Unlike the sterilization of Mexican immigrant women in the United States in the 1970s, recently portrayed in the documentary No Más Bebés, I.V.’s case doesn’t appear to involve a broad governmental policy of sterilizing poor or immigrant women. But it illustrates the all-too-common scenario of medical providers making decisions on behalf of women who are deemed unfit or unable to make their own choices.

Indeed, forced and coerced sterilization is disproportionately perpetrated around the world against women in stigmatized groups, such as women living with HIV, poor women, ethnic or national minorities, or women with disabilities because some health-care providers believe that such women should not have children. Whether driven by animosity against certain women, stereotypes that these women are unfit to become parents, or a paternalistic notion that “doctor knows best,” the end result is the same: Women are permanently robbed of their capacity to have children without their consent.

The parties contest whether I.V. orally consented to sterilization during her c-section. But even if she did so, medical ethical standards and decisions from U.N. human rights bodies and the European Court make clear that consent obtained during labor or immediately preceding or after delivery cannot be valid because the circumstances surrounding delivery—due to pain, anesthesia, or other factors—are inherently inconsistent with voluntary patient choice.

I.V. delivered at a public hospital that predominantly treats indigent women, many of whom are indigenous or migrants. The Inter-American Commission on Human Rights—which effectively acts as a court of first instance for the IA Court—considered the case before it went to the IA Court and noted the special vulnerability of migrant women seeking health care in Bolivia, given their reliance on public services and the lack of care options. It found that I.V.’s medical team was influenced by “gender stereotypes on the inability of women to make autonomous” reproductive decisions. It further concluded that the decision to sterilize I.V. without proper consent reflected notions that the medical staff was “empowered to take better medical decisions than the woman concerned regarding control over reproduction.”

Sixteen years after her sterilization, I.V. still acutely feels the emotional and psychological toll of having been sterilized. Because of the severity of physical and mental harms that forced sterilization imposes upon women, the Inter-American Court should join the European Court of Human Rights and U.N. human rights experts in recognizing that forced sterilization constitutes cruel, inhuman, or degrading treatment and may constitute torture.

In addition to condemning forced sterilization, the IA Court should recognize the multiple human rights violations I.V. suffered. The Inter-American human rights system protects women from gender-based discrimination and violence and violations of the right to personal integrity, information, privacy, and family life, all of which are at issue in this case.

Culture & Conversation Media

A Conversation With ‘No Más Bebés’ Filmmakers Virginia Espino and Renee Tajima-Peña

Tina Vasquez

A new generation can now hear from some of the women coerced into sterilization at Los Angeles County General Hospital in the 1970s in the documentary No Más Bebés ("No More Babies"), airing on PBS tonight.

When Consuelo Hermosillo stands in front of audiences at colleges in Southern California and shares her story of being one of many immigrant women from Mexico coerced into sterilization at Los Angeles County General Hospital in the 1970s, she’s surprised by how quickly she’s transported back to being a scared 23-year-old giving birth to her third and final child.

“I still cry. Maybe I will always cry,” Hermosillo told Rewire. “I tell myself I should get over it, that a lot of time has passed, but it still hurts. I’m surprised it still hurts like this.”

While in labor, before being allowed to see a doctor, Hermosillo was asked by a woman who worked at the hospital to sign papers consenting to sterilization. The woman told Hermosillo that if she didn’t sign the papers, her baby would die. To this day, Hermosillo does not recall signing the papers.

Countless women have come forward with different variations of the same experience at the Los Angeles County General Hospital. In 1975, ten of those women, including Hermosillo, filed Madrigal v. Quilligan, a class action lawsuit against hospital doctors, the state, and the federal government for coercing them into tubal ligation, often while they were under duress. The women eventually lost their case, and despite making front-page news at the time, their experiences have largely been forgotten—until now.

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A new generation can now hear their stories in the documentary No Más Bebés (“No More Babies”), directed by Academy Award-nominated filmmaker Renee Tajima-Peña and produced by historian Virginia Espino, airing tonight on PBS.

Hermosillo said her reasons for participating in the documentary were the same as her reasons for participating in the court case: She wanted to remind everyone of what happened in hopes that it wouldn’t continue happening to “younger generations.”

“I just wanted to remind people that women in delivery rooms need support because there will be people who try to deny them rights,” Hermosillo said.

“I still wish I could know why doctors did this to us,” she added. “Did the doctors think this wasn’t wrong? Were they being paid per patient? Did they not even think about it? I don’t know. Only God knows.”

What happened to Hermosillo in California happened to women nationwide. As the Los Angeles Times reported, in the 1900s, “thousands of poor women in at least 30 states were unknowingly sterilized after giving birth as part of a federally funded program aimed at population control.” The bulk of the women sterilized in California, which accounted for a significant number of the sterilizations, were Spanish-speaking immigrants.

No Más Bebés documents the experiences of some of the Mexican immigrant women who were sterilized in the Los Angeles area. RH Reality Check recently spoke with director Tajima-Peña and producer Espino about the film, including what brought them to the subject matter and what they hope audiences will take away from the documentary.

Rewire: What was your entry point for learning about coercive sterilization, especially what happened to Mexican immigrant women in Los Angeles in the 1970s?

Virginia Espino: I grew up in Los Angeles around the L.A. County Hospitalmy grandmother lived five minutes from the hospital—so it was a big, looming figure in my childhood and my adolescence. It was never a place that people wanted to go for medical care; it was a place you had to [because you were poor], otherwise you stayed away from it. I never heard of the history of sterilization until a Chicano Studies class in graduate school. My professor, at the time, was one of the few Chicana historians in the country. It was her task to recover these stories and train young students to take on these topics. I decided this was something I wanted to investigate even further because it was so outrageous and unbelievable I almost didn’t believe it. I couldn’t believe it was true that women were coercively sterilized at a time when I was a kid growing up in Los Angeles. I had to go home and research it.

Renee Tajima-Peña: I first heard about it from Virginia. We both had toddlers and would have playdates, and that’s when she told me about her research. I was a new mother, in that blissful state of new motherhood, and [the history] felt very profound. I couldn’t imagine being denied the right to have a child. Like a lot of other middle-class women, the question for me when it came to reproductive rights had always been: Do we have access to safe and legal abortion? Reproductive justice was a new idea to me. It addresses how poor women, immigrant women, and other women who are marginalized have to worry about the right to, and the access to, safe and healthy childbirth and the ability to raise those children safely. I’d been around issues of race, feminism, and activism for many years, but it never struck me quite like that. What happened to women like Mrs. Hermosillo is one of the many untold stories of reproductive rights. What we don’t talk about enough is that women also have a constitutional protection to give birth, and that some women have that right taken from them.

Rewire: It took six years to make the documentary happen. Why did you remain so committed to making it, and did anything about how you initially set out to tell this story change?

VE: I don’t think anything changed. For me, I was just amazed at how well the mothers remembered what happened. The way they told their stories in the 2000s was the same way they told it in the 1970s, based on court records. They didn’t stray from their original memories. They still remembered the details 40 years later. The thing that was up in the air for me was how the defendants would respond after all of this time. I didn’t have a chance to interview them; Renee did. Their memories, their perspectives on what went on in the maternity ward, were so strikingly different from the plaintiffs’. But even if they didn’t think they were responsible, were they sorry that the women felt this happened? Maybe they feel they didn’t do anything wrong, but look: Something happened at that hospital. Something went wrong in the way they were administering what they considered “good medical practice.”

RTP: I was committed to telling the story because I wanted something to “click” for people the way reproductive justice clicked for me. Reproductive rights was my framework—this idea of reproductive autonomythe mainstream, traditional framework. I was a teenager during Roe v. Wade. I had an abortion myself and that was my frame of reference. I think it was for a lot of women. Through Virginia and Elena Gutiérrez, who was one of our advisors, and through talking to people about this case, I was introduced to the reproductive justice framework. For me, it wasn’t easy to understand, but after meeting these women and understanding how the case related to women’s reproductive autonomy and women who are incarcerated in California prisons today, it really clicked. Hopefully the film will help that idea click for the audience.

Rewire: The documentary touches on the nationwide program under which the sterilizations in Los Angeles happened. Because of demographics in California, it primarily affected immigrant women. In other parts of the country, it affected poor Black and white women. Do you think this had more to do with race or socioeconomics?

VE: It’s a combination of a lot of things. This didn’t just happen to Mexican Americans. Poor people of color are not valued and poverty is criminalized. You are demonized for your economic status, which is why in Alabama, you had 12-year-olds being sterilized. In Puerto Rico, you had many, many women who underwent coercive sterilizations. It happened on reservations and in Indian health centers in urban areas. We don’t even know how many women were sterilized with these funds. We tried, but it was almost impossible to pinpoint where the money came from, who did the sterilizations, and how many women were impacted. There were millions of dollars poured into public hospitals in the United States. Often, they were teaching hospitals, so the people who used those services were primarily people of color and poor people, and they became the victims of these coercive tactics.

RTP: It’s easy to say it’s just about class, and it was very much about that, impacting poor women across the country. But it’s equally about race, culture, and gender.

Rewire: Many people were shocked to learn what was happening to women in California prisons. Are you shocked this is still happening?

VE: It’s always outrageous when it happens. It’s outrageous when conservative politicians want to bargain with the judicial system to implement laws where women agree to sterilization for a reduced sentence or to see their children again. Sterilization has become a bargaining chip.

Rewire: Virginia, you were so close to these stories for so long, first as a historian conducting oral histories with these women when you were at the University of California, Los Angeles, and then during the years it took to make this documentary. What does it mean to you that the documentary is being embraced by so many people and that it will air February 1 on PBS?

VE: It has had such an impact on me as a Mexican American in the United States, who comes from a community that is viewed as a burden to society. I grew up in a time when we didn’t have the representation we do today. People in my community are often robbed of so much, denied opportunities because of their race or color or ethnicity. They’re never allowed to believe they could have anything different. The women these sterilizations happened to were robbed too; they were robbed of what they wanted for their future and for many of them, that included the opportunity to have more children. I’ve had three children and each time I deliver in a hospital, I remember the women’s stories and I remember what it was like for them being approached for sterilization when they were in the middle of childbirth. But I have to say, it has been a beautiful experience to bring these everyday women, who for 40 years have been living their everyday lives after this horrible thing happened to them, on a stage and let them tell their stories. They have been so courageous, every step of the way, and they are becoming heroes for a new generation of Chicanas.

RTP: [The women behind Madrigal v. Quilligan] are not everyday activists or everyday heroes. These aren’t women we recognize during Hispanic Heritage Month. They have not lived their lives as activists. When history called them, they stood up. They didn’t even think about it. The women are so amazing, like Mrs. Hurtado, for example, who was featured in the documentary. She really owns her sexuality and for a little while, we didn’t know how much of that to convey. We were worried about these stereotypes about Latina sexuality, especially given the subject matter of the film. But, finally, we realized this is just who she is and how she is and she was simply ahead of her time. That’s important to showcase.

Rewire: Have you been surprised to learn anything during the course of making the film or in its aftermath?

RTP: I guess I’ve been surprised by some reactions. The most uncomfortable thing that comes up is that people who I wouldn’t think would say something like this, say, “Well, they didn’t really need to be having more children.” That has come up a lot from otherwise very liberal people. I know I’ve made judgments like that in the past, but I’ve learned not to. When my grandfather came here, he had five kids and my grandparents wanted more. He raised them during the Depression. Years before he was able to naturalize, he didn’t have immigration status; he was poor. Everything was against my grandparents. Why should he have more children? Thank God he had those kids, or I wouldn’t be here! The point is, it was their choice. They were able to figure it out. Letting people decide how many kids they want, even if you disagree with it, is part of letting people have reproductive autonomy. We don’t get to pick and choose how that takes shape.

This interview has been edited for length and clarity.