Coercive Sterilization Isn’t A Matter of the Past

A Call to Action for Medical Providers


Mahika Ahluwalia, MBE

Publish date

Coercive Sterilization Isn’t A Matter of the Past: A Call to Action for Medical Providers
Tag(s): Editor's pick
Topic(s): Reproductive Ethics


Reproductive coercion is alive and well in the United States, violently robbing women of their ability to build families. 

Sterilization procedures, like hysterectomies and tubal ligations, permanently prevent pregnancies. When considering sterilization, patients are entitled to be fully informed and freely consent, rather than coerced or forced. Contraception without consent violates human rights. 

Physicians need to understand the history behind social control through coercive sterilization, how sterilization still occurs today, and work towards preventing the practice. 

The Persistent Impact of Eugenics 

American eugenicists believed that white “elite” individuals could breed individuals with higher IQ levels to benefit American society. Recognizing this “better breeding” would never eradicate those deemed unfit, Eugenicists turned to sterilizing “undesirables.” These beliefs led to a long history of coercively sterilizing Black, Latina, and Indigenous women in the United States, and people with disabilities.

Laws and practices reflected eugenics thinking, resulting in state-sanctioned sterilizations peaking in the 1930s-40s, affecting more than 100,000 women. But the practice didn’t end with WWII. In 1961, famed civil rights activist Fannie Lou Hamer suffered a hysterectomy without her consent. Her white physician claimed it was to remove a uterine tumor. The involuntary sterilization of lower-income Black women became so common that women referred to it as a Mississippi Appendectomy. Through the 1960s, US governmental campaigns led Puerto Rican women to believe tubal ligation was their only contraception option but did not necessarily disclose that it was permanent. Similarly, after the passage of the Family Planning Services and Population Research Act of 1970, 25% of Native American women of childbearing age underwent sterilization procedures under pressure, sometimes without their knowledge. The impact of the forced loss of fertility continues to impact these communities today.

Coercive Sterilization Never Left Us

Although coercive sterilization may seem like a matter of the past, today, laws in 31 states allow coercive sterilization of people with disabilities and survivors of California’s prison system reveal reproductive prejudice among physicians. While incarcerated in California, Kelli Dillon consented to a biopsy to work up an abnormal pap smear at age 26. After developing sudden symptoms of menopause and requesting her medical records, her lawyer informed her that the prison physician removed both of her ovaries without her permission and lied to her about her ability to have children. In 2013, The Centre for Investigative Reporting (CFIR) exposed the forced sterilization of 148 women without consent between 2006-2010. One hundred forty-four previously incarcerated survivors have spoken up about being forcibly sterilized and stripped of their reproductive capacity. The documentary Belly of the Beast follows Dillon and other survivors in their fight against reproductive injustice at the California Department of Corrections. 

A Nashville District Attorney made sterilization part of plea negotiations. In one instance, he told a woman with a history of mental illness that she must undergo sterilization to avoid prison charges. Defense attorneys further claimed these practices are more common and can occur without court approval. Ongoing forced and coerced sterilization in the present environment raises ethical concerns for the reproductive autonomy of incarcerated women and women with disabilities. 

Medical providers still impose the prejudiced beliefs of previous federal and state-level programs that aimed to limit the fertility of Black women. US institutions lack accountability for treating the Black, Latina, and Indigenous populations, and people with disabilities. 

I propose the following recommendations for medical providers to eradicate the practice of coercive sterilization and maximize the patient’s autonomy. 

Actively Learn the History of Reproductive Injustice

Teaching hospitals, grand rounds programs, and continuing medical education programs should include the history of reproductive injustice in their curriculum. They must offer training to doctors on best practices for voluntary sterilization, with a strong emphasis on defining what informed consent looks like. Promoting diversity among physicians and eliminating bias through training is crucial to ensure equitable treatment and prevent discriminatory practices against Black, Latina, and Indigenous patients and people with disabilities. To eradicate eugenicist practices, clinicians need enhanced education about forced/coerced sterilization within current medical practices.

Better Communication With Patients 

The first step in improving communication between patients and providers is addressing explicit biases that providers may hold against lower-income, incarcerated, or minoritized women. Teaching programs should incorporate education on recognizing and addressing discrimination and skills training to mitigate the tendency to stereotype patients. Helping providers identify bias is essential to preventing them from coercively sterilizing patients. Additionally, medical providers must respect patients’ autonomy by honoring their right to make reproductive decisions, including the right to refuse interventions the clinician believes are indicated.

Providers should communicate with patients to educate them about contraception methods and associated risks. Explicitly inform patients that permanent infertility due to sterilization is expected. Providing patients with clear consent documents in plain language and the language patients speak/read ensures they understand the consequences. When an agreement is unclear, providers should recommend further counseling to confirm patients willingly consent to the procedure. 

Furthermore, delivering tailored information based on each patient’s medical history and specific needs regarding contraceptive methods is crucial in preventing coerced sterilizations. For example, inaccurate information about HIV transmission contributes to coercive sterilization. Medical providers can prevent such cases by accurately disclosing medical history and dispelling misinformation about individual risks. By doing so, physicians actively resist the practice of coercive sterilization.

Form a Taskforce to Safeguard Against Coercive Sterilization 

Hospital systems should always promote non-discrimination in family planning and sterilization procedures through their policies. If assessment of the organization’s protection and promotion of patients is lacking, launching a Reproductive Justice Taskforce will ensure that women have the tools and support needed to comprehend the implications of sterilization and the significance of consenting to the procedure. Furthermore, a Taskforce must incorporate interdisciplinary perspectives, including those of physicians, nurses, bioethicists and lawyers, to form these tools. Most importantly, input from women sterilized without consent must be included. This approach helps to provide patients with practical treatment suggestions and prevents coercive sterilization practices. 

All women, regardless of race, ethnicity, ability, or class, possess the right to bear children. Coercive sterilization violates a woman’s right to bodily autonomy and reproductive justice. To combat ongoing coercive sterilization in the United States, physicians must ensure reproductive freedom of patients by educating themselves about effective informed consent and removing harmful biases against patients. More work must continue in the legal arena, including initiatives to promote non-discrimination in family planning and safeguard women from unjust practices in hospitals and state and federal facilities.

Mahika Ahluwalia, MBE (@ahluwm92) is a bioethicist, JD Candidate at the University of Western Ontario, Faculty of Law, and alum of the Yale Bioethics Institute. She completed her MBE degree at the Perelman School of Medicine at the University of Pennsylvania.  

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