California Coercively Sterilized Over 100 Inmates. In This Century.

The Mississippi appendectomy lives on, although usually it occurs in concert with a C-section, when it’s relatively easy to access the fallopian tubes for a quick sterilization procedure while the patient is unconscious or sedated.

The news is exploding this week with a Center for Investigative Reporting piece by Corey G. Johnson on the coerced sterilization of 148 inmates in California prisons between 2006 and 2010. Already, California’s legislators are making noise about a possible investigation, and no wonder, given the state’s long and very ugly history when it comes to forcible and coerced sterilization. California was the most prolific forcible sterilizer in US history, rendering 20,000 people infertile between 1909 and 1964.

As a writer covering reproductive justice in marginalized communities, I often encounter surprise when I bring up forcible sterilization. “That’s in the past,” people say, referring to the height of the eugenics era, when thousands of people across the US were sterilized for being too poor, too disabled, too Black -- forcible sterilization targeted women of color and others the state deemed “unfit to reproduce.”

In many cases, people were sterilized not just without consent, but without knowledge. In the infamous Mississippi appendectomy, women would go to the doctor for a routine surgical procedure and only discover that they were sterile years later, when they were struggling with fertility. In other cases, the illusion of choice may have been provided, but patients were clearly coerced.

People generally seem to recognize that this era in US history was a horrific one, and that states involved in forcible sterilization need to start compensating their victims and making good on their crimes. In North Carolina, for example, there’s been a very vocal movement to address the long-term consequences of sterilization, primarily among women of color.

What they seem less aware of is the fact that coerced and forcible sterilization are ongoing issues not just worldwide for marginalized women but in the US itself, where people, usually women, are pushed into getting sterilized for much the same reasons they were in the eugenics area. They’re too poor, they’re disabled and shouldn’t be allowed to reproduce, they have too many children, they’re women of color and thus undesirable as parents, or they have other “flaws” doctors believe make them good candidates for sterilization.

In strict point of fact, it is not legal to coerce people into sterilization (surprise! coercing people into doing things usually isn't legal!). Doctors are only supposed to provide sterilizations to patients who request them, and those patients must be fully informed and consenting. As I know from my own experiences with sterilization last year, when doctors follow requirements, it’s a lengthy process that requires repeated statements from the patient indicating comprehension of the fact that sterilization is an irreversible procedure that will lead to infertility, along with statements indicating that the patient actively consents to the procedure and is not being coerced into it.

However, not all doctors follow the law. The Mississippi appendectomy lives on, although usually it occurs in concert with a C-section, when it’s relatively easy to access the fallopian tubes for a quick sterilization procedure while the patient is unconscious or sedated. And doctors routinely coerce patients into receiving sterilizations; in a common example, a woman may be repeatedly asked about the procedure during prenatal appointments, with the implication that the doctor assumes she’ll eventually “consent” to it. Women have also been asked while in labor and delivery, despite the fact that they are not legally in a state to give informed consent.

Which brings us back to California, a state with an extremely troubled prison system. After being chastised by the Supreme Court, the state is participating in a “voluntary” realignment program that involves large-scale prisoner release, referral of prisoners to regional jails, and other measures to bring the population down. Meanwhile, the health care system of California prisons remains in receivership because it was deemed of such low quality that the state was unfit to continue running it.

When it comes to women in California prisons, there are significant racial disparities. Women of color are far more likely to be imprisoned than white women in California, and they’re more likely to serve longer sentences. Incidentally, California leads the nation on the incarceration of women, with more women in prison than any other state, most of whom are overseen by male guards in facilities rife with sexual assault, abuse and inadequate medical care.

Many of the women in California’s prisons come from low-income backgrounds, are mothers, and have spent time in the foster or juvenile system. California’s justice system, like that in other states, is focused on corrective and retributive justice, not rehabilitation, and that extends to women prisoners.

These conditions created a perfect storm for pressuring women into unwanted surgical procedures, and encouraging them to stay silent about it afterwards.

While demographics are not yet available on the women victimized by forcible sterilization from 2006 to 2010, it is highly likely that many of them were women of color who came from particularly marginalized social backgrounds. All of the women profiled in Johnson's feature were women of color, and while they represent only a small sampling of the women involved, they definitely provide a striking picture. It's also entirely possible that more victims will come forward as the news spreads, making the list of victims even longer.

Doctor James Heinrich, an OB-GYN who worked at Valley State Prison for Women in Chowchilla, had this to say about the sterilizations:

He described the $147,460 total [spent on sterilizations] as minimal. ‘Over a 10-year period, that 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.’ The top medical manager at Valley State Prison from 2005 to 2008 characterized the surgeries as an empowerment issue for female inmates, providing them the same options as women on the outside. (Johnson)

His evidently enlightened colleagues agreed. Psychologist Daun Martin played upon the myth than women would seek opportunities to go to prison for health care: “[he] claimed that some pregnant women, particularly those on drugs or who were homeless, would commit crimes so they could return to prison for better health care,” wrote Johnson. Johnson added that Martin said: “Do I criticize those women for manipulating the system because they’re pregnant? Absolutely not. But I don’t think it should happen. And I’d like to find ways to decrease that.”

These attitudes about the standard of health care in prison are rather eyebrow-raising. While it’s true that California’s dysfunctional public health system creates limited options on the outside, pregnant women in California correctional facilities are not treated well. It’s highly unlikely women were “manipulating the system” so they could have the privilege of being shackled during labor, a practice that was only banned last year in California.

In addition to violating standards and practices on handling sterilizations, these procedures also violated California’s law, which requires that any inmate sterilizations be approved by an outside board. One reason why this was required, of course, was to reduce the risk of coerced sterilizations.

Revoltingly, the receiver responsible for overseeing California’s prison health care was aware of the sterilizations and chose not to act. What ultimately tipped the scales was a complaint to the office of state Senator Carol Liu of Glendale. The Democrat investigated and her staffers called the receiver's office for an explanation, triggering a larger investigation.

Why did the sterilizations go on as long as they did? A lack of awareness, and a lack of outcry. Prisoners started connecting with rights groups in 2008, but it took another two years for rights groups to be able to apply pressure to lawmakers and trigger a real investigation. The slow pace of reform for women in California prisons reflects a larger lack of interest in prisoner welfare and the rights of prisoners in the state -- remember, this is a state where prisoners are on hunger strike again for basic rights.

And, predictably, Dr. Heinrich told the CIR that: “They all wanted it done. If they come a year or two later saying, ‘Somebody forced me to have this done,’ that’s a lie. That’s somebody looking for the state to give them a handout.”