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Article: Eugenics in the United States

Eugenics, the set of beliefs and practices which aims at improving the genetic quality of the human population, played a significant role in the history and culture of the United States during the Progressive Era, from the late 19th century until US involvement in World War II.

Eugenics was practiced in the United States many years before eugenics programs in Nazi Germany, which were largely inspired by the previous American work. Stefan Kühl has documented the consensus between Nazi race policies and those of eugenicists in other countries, including the United States, and points out that eugenicists understood Nazi policies and measures as the realization of their goals and demands.

While ostensibly about improving genetic quality, it has been argued that eugenics was more about preserving the position of the dominant groups in the population. Progressive-era US eugenics is now generally associated with racist and nativist elements, as the movement was to some extent a reaction to a change in emigration from Europe, rather than scientific genetics.

Early proponents
The American eugenics movement was rooted in the biological determinist ideas of Sir Francis Galton, which originated in the 1880s. In 1883, Sir Francis Galton first used the word eugenics to describe scientifically, the biological improvement of genes in human races and the concept of being "well-born". He believed that differences in a person's ability were acquired primarily through genetics and that eugenics could be implemented through selective breeding in order for the human race to improve in its overall quality, therefore allowing for humans to direct their own evolution. In the US, eugenics was largely supported after the discovery of Mendel's law lead to a widespread interest in the idea of breeding for specific traits. Galton studied the upper classes of Britain, and arrived at the conclusion that their social positions could be attributed to a superior genetic makeup. They tended to believe in the genetic superiority of Nordic, Germanic and Anglo-Saxon peoples; supported strict immigration and anti-miscegenation laws; and supported the forcible sterilization of the poor, disabled and "immoral." Eugenics was also supported by African American intellectuals such as W. E. B. Du Bois, Thomas Wyatt Turner, and many academics at Tuskegee University, Howard University, and Hampton University; however, they believed the best blacks were as good as the best whites and "The Talented Tenth" of all races should mix. W. E. B. Du Bois believed "only fit blacks should procreate to eradicate the race's heritage of moral iniquity."

The American eugenics movement received extensive funding from various corporate foundations including the Carnegie Institution, Rockefeller Foundation, and the Harriman railroad fortune. In 1906 J.H. Kellogg provided funding to help found the Race Betterment Foundation in Battle Creek, Michigan. The Eugenics Record Office (ERO) was founded in Cold Spring Harbor, New York in 1911 by the renowned biologist Charles B. Davenport, using money from both the Harriman railroad fortune and the Carnegie Institution. As late as the 1920s, the ERO was one of the leading organizations in the American eugenics movement. In years to come, the ERO collected a mass of family pedigrees and provided training for eugenics field workers who were sent to analyze individuals at various institutions, such as mental hospitals and orphanage institutions, across the United States. Eugenicists such as Davenport, the psychologist Henry H. Goddard, Harry H. Laughlin, and the conservationist Madison Grant (all of whom were well-respected during their time) began to lobby for various solutions to the problem of the "unfit." Davenport favored immigration restriction and sterilization as primary methods; Goddard favored segregation in his The Kallikak Family; Grant favored all of the above and more, even entertaining the idea of extermination. The Eugenics Record Office later became the Cold Spring Harbor Laboratory until its closure in 1971.

As students began to label themselves as “Eugenists”, Professor Karl Pearson can be seen as their director in the field. As the foundation of the Eugenic structure, he states 3 claims, (1) “We depart from the old sociology, in that we dessert verbal discussion for statistical facts.” (2) Shall apply new methods of statistics, creating a new calculus. (3) three fundamental biological ideas (a)relative weight of nature and nurture must be scientifically measured therefore inheritance is more vital than environment. (b) no demonstrable inheritance of acquired characters exist. Environment can modify the bodily characters of an existing generation but not the germ plasm of the next generation. (c) all human qualities are inherited in a marked and probably equal degree. These ideas created a lot of controversy at the time.

Eugenics was widely accepted in the U.S. academic community. By 1928, there were 376 separate university courses in some of the United States' leading schools, enrolling more than 20,000 students, which included eugenics in the curriculum. It did, however, have scientific detractors (notably, Thomas Hunt Morgan, one of the few Mendelians to explicitly criticize eugenics), though most of these focused more on what they considered the crude methodology of eugenicists, and the characterization of almost every human characteristic as being hereditary, rather than the idea of eugenics itself.

By 1910, there was a large and dynamic network of scientists, reformers, and professionals engaged in national eugenics projects and actively promoting eugenic legislation. The American Breeder's Association was the first eugenic body in the U.S., expanded in 1906 to include a specific eugenics committee under the direction of Charles B. Davenport. The ABA was formed specifically to "investigate and report on heredity in the human race, and emphasize the value of superior blood and the menace to society of inferior blood." Membership included Alexander Graham Bell, Stanford president David Starr Jordan and Luther Burbank. The American Association for the Study and Prevention of Infant Mortality was one of the first organizations to begin investigating infant mortality rates in terms of eugenics. They promoted government intervention in attempts to promote the health of future citizens.

Several feminist reformers advocated an agenda of eugenic legal reform. The National Federation of Women's Clubs, the Woman's Christian Temperance Union, and the National League of Women Voters were among the variety of state and local feminist organization that at some point lobbied for eugenic reforms.

One of the most prominent feminists to champion the eugenic agenda was Margaret Sanger, the leader of the American birth control movement. Margaret Sanger saw birth control as a means to prevent unwanted children from being born into a disadvantaged life, and incorporated the language of eugenics to advance the movement. Sanger also sought to discourage the reproduction of persons who, it was believed, would pass on mental disease or serious physical defects. In these cases, she approved of the use of sterilization. She rejected euthanasia. In Sanger's opinion, it was individual women (if able-bodied) and not the state who should determine whether or not to have a child.

In the Deep South, women's associations played an important role in rallying support for eugenic legal reform. Eugenicists recognized the political and social influence of southern clubwomen in their communities, and used them to help implement eugenics across the region. Between 1915 and 1920, federated women's clubs in every state of the Deep South had a critical role in establishing public eugenic institutions that were segregated by sex. For example, the Legislative Committee of the Florida State Federation of Women's Clubs successfully lobbied to institute a eugenic institution for the mentally retarded that was segregated by sex. Their aim was to separate mentally retarded men and women in order to prevent them from breeding more "feebleminded" individuals.

Public acceptance in the U.S. lead to the passing of eugenic legislation. Almost 19 million people attended the Panama–Pacific International Exposition in San Francisco, open for 10 months from 20 February to 4 December 1915. The PPIE was a fair devoted to extolling the virtues of a rapidly progressing nation, featuring new developments in science, agriculture, manufacturing and technology. A subject that received a large amount of time and space was that of the developments concerning health and disease, particularly the areas of tropical medicine and race betterment (tropical medicine being the combined study of bacteriology, parasitology and entomology while racial betterment being the promotion of eugenic studies). Having these areas so closely intertwined and presented at the PPIE, it seemed that they were both categorized in the main theme of the fair, which was the advancement of civilization. Thus in the public eye, the areas of study were both represented under progressive banners of improvement and were made to seem like plausible courses of action to better American society.

Beginning with Connecticut in 1896, many states enacted marriage laws with eugenic criteria, prohibiting anyone who was "epileptic, imbecile or feeble-minded" from marrying.

W. E. B. Du Bois maintained the basic principle of eugenics: that different persons have different inborn characteristics that make them more or less suited for specific kinds of employment, and that by encouraging the most talented members of all races to procreate would better the "stocks" of humanity.

The first state to introduce a compulsory sterilization bill was Michigan in 1897 - although the proposed law failed to garner enough votes by legislators to be adopted, it did set the stage for other sterilization bills. Eight years later, Pennsylvania's state legislators passed a sterilization bill that was vetoed by the governor. Indiana became the first state to enact sterilization legislation in 1907, followed closely by Washington, California, and Connecticut in 1909. Sterilization rates across the country were relatively low (California being the sole exception) until the 1927 Supreme Court case Buck v. Bell which legitimized the forced sterilization of patients at a Virginia home for the mentally retarded. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma, 1942, complicated the legal situation by ruling against sterilization of criminals if the equal protection clause of the constitution was violated. That is, if sterilization was to be performed, then it could not exempt white-collar criminals. The state of California was at the vanguard of the American eugenics movement, performing about 20,000 sterilizations or one third of the 60,000 nationwide from 1909 up until the 1960s.

While California had the highest number of sterilizations, North Carolina's eugenics program which operated from 1933 to 1977, was the most aggressive of the 32 states that had eugenics programs. An IQ of 70 or lower meant sterilization was appropriate in North Carolina. The North Carolina Eugenics Board almost always approved proposals brought before them by local welfare boards. Of all states, only North Carolina gave social workers the power to designate people for sterilization. "Here, at last, was a method of preventing unwanted pregnancies by an acceptable, practical, and inexpensive method," wrote Wallace Kuralt in the March 1967 journal of the N.C. Board of Public Welfare, "The poor readily adopted the new techniques for birth control."

Immigration restrictions
In the late 19th century, many scientists became concerned about the population leaning too far away from the favored "Anglo-Saxon superiority" due to a rise in immigration from Europe and partnered with other interest groups to implement immigration laws that could be justified on a genetical basis. This led to the recruitment of Dr. Charles B. Davenport, who was involved with the Eugenics Record Office, to weigh in on the Congressional debates surrounding immigration and distribute surveys to American prisons, mental hospitals, and other institutions in order to determine and keep track of their genetic origins. This program, deemed "research" at the time, was passed to Harry Laughlin for management.

In 1921, a temporary measure was passed to slowdown the open door on immigration. The Immigration Restriction League was the first American entity to be closely associated with eugenics and was founded in 1894 by three recent Harvard University graduates. The overall goal of the League was to prevent what they perceived as inferior races from diluting "the superior American racial stock" (those who were of the upper-class Anglo-Saxon heritage), and they began working to have stricter anti-immigration laws in the United States. The League lobbied for a literacy test for immigrants as they attempted to enter the United States, based on the belief that literacy rates were low among "inferior races". Henry Laughlin played a large role in this, as he had an appointment at the House Committee on Immigration and Naturalization as the lead agent in eugenics. They stated that immigrants were often degenerate, had low IQs, and displayed shiftlessness, alcoholism and insubordination. According to Eugenicists, all of these qualities were transmitted through genes. After Laughlin's speech, Herbert Spencer Jennings was supposed to rebut but was only given five minutes and was largely unable to discredit Laughlin's remarks. Literacy test bills were vetoed by Presidents in 1897, 1913 and 1915; eventually, President Wilson's second veto was overruled by Congress in 1917. Membership in the League included: A. Lawrence Lowell, president of Harvard, William DeWitt Hyde, president of Bowdoin College, James T. Young, director of Wharton School and David Starr Jordan, president of Stanford University.

The League allied itself with the American Breeder's Association to gain influence and further its goals and in 1909 established a Committee on Eugenics chaired by David Starr Jordan with members Charles Davenport, Alexander Graham Bell, Vernon Kellogg, Luther Burbank, William Ernest Castle, Adolf Meyer, H. J. Webber and Friedrich Woods. The ABA's immigration legislation committee, formed in 1911 and headed by League's founder Prescott F. Hall, formalized the committee's already strong relationship with the Immigration Restriction League. They also founded the Eugenics Record Office, which was headed by Harry H. Laughlin. In their mission statement, they wrote: "Society must protect itself; as it claims the right to deprive the murderer of his life so it may also annihilate the hideous serpent of hopelessly vicious protoplasm. Here is where appropriate legislation will aid in eugenics and creating a healthier, saner society in the future."

There was much debate on immigration and eventually it was decided through the 1890 census that immigrants who were of Nordic or Anglo-Saxon stock showed qualities that were greatly favored over those found in immigrants from southern and eastern Europe, and specifically in Jews. According to Laughlin, Jews were genetically inferior and a racial mix of a Jew with an Anglo-Saxon would be a degenerate.

Eugenics and Puoney from the Harriman railroad fortune was also given to local charities, in order to find immigrants from specific ethnic groups and deport, confine, or forcibly sterilize them.

With the passage of the Immigration Act of 1924, eugenicists for the first time played an important role in the Congressional debate as expert advisers on the threat of "inferior stock" from eastern and southern Europe. The new act, inspired by the eugenic belief in the racial superiority of "old stock" white Americans as members of the "Nordic race" (a form of white supremacy), strengthened the position of existing laws prohibiting race-mixing. Eugenic considerations also lay behind the adoption of incest laws in much of the U.S. and were used to justify many anti-miscegenation laws.

Stephen Jay Gould asserted that restrictions on immigration passed in the United States during the 1920s (and overhauled in 1965 with the Immigration and Nationality Act) were motivated by the goals of eugenics. During the early 20th century, the United States and Canada began to receive far higher numbers of Southern and Eastern European immigrants. Influential eugenicists like Lothrop Stoddard and Harry Laughlin (who was appointed as an expert witness for the House Committee on Immigration and Naturalization in 1920) presented arguments they would pollute the national gene pool if their numbers went unrestricted. It has been argued that this stirred both Canada and the United States into passing laws creating a hierarchy of nationalities, rating them from the most desirable Anglo-Saxon and Nordic peoples to the Chinese and Japanese immigrants, who were almost completely banned from entering the country.

Unfit vs. fit individuals
Both class and race factored into the eugenic definitions of "fit" and "unfit." By using intelligence testing, American eugenicists asserted that social mobility was indicative of one's genetic fitness. This reaffirmed the existing class and racial hierarchies and explained why the upper-to-middle class was predominantly white. Middle-to-upper class status was a marker of "superior strains." In contrast, eugenicists believed poverty to be a characteristic of genetic inferiority, which meant that those deemed "unfit" were predominantly of the lower classes.

Because class status designated some more fit than others, eugenicists treated upper and lower-class women differently. Positive eugenicists, who promoted procreation among the fittest in society, encouraged middle-class women to bear more children. Between 1900 and 1960, Eugenicists appealed to middle class white women to become more "family minded," and to help better the race. To this end, eugenicists often denied middle and upper-class women sterilization and birth control.

Since poverty was associated with prostitution and "mental idiocy," women of the lower classes were the first to be deemed "unfit" and "promiscuous."

A Racial Hygiene movement started in Germany in the late 19th century started by Drs. Wilhelm Schallmayer and Alfred Ploetz. The concerns in racial hygiene grew high from industrialization growth and the concepts of social Darwinism being expressed. In 1908, in the Germany Colony of Southwest Africa, all mixed marriages were annulled and forbidden. In 1936, the German Ministry of the Interior stated that there would be a system of records set up to record hereditary-biological data on patients within mental hospitals and institutions. This was a way to see hereditary traits that should or should not be bred. RuSHA, the Race Bureau and the Marriage Bureau was set in place to judge the “Aryan Qualities” within an individual.

Eugenics and Public Health
In the 19th century, based on a Lamarckian view, it was believed that the damage done to people by diseases could be inherited and therefore through eugenics they could banish diseases. This was believed well on into the 20th century. Through this belief, public health measures were promoted to improve health that could hopefully be inherited in future generations.

However, in the 1910s, August Weismans theory became more popular, environmentally caused changes in the body could not cause corresponding changes in the “germ plasm.” However, even believers of this theory still understood that the symptoms of some diseases in a pregnant woman could lead to birth defects for the child. Through these beliefs, it was decided that fighting infections would still lower hereditary issues and therefore improve the genetics of successive generations.

Compulsory sterilization
In 1907, Indiana passed the first eugenics-based compulsory sterilization law in the world. Thirty U.S. states would soon follow their lead. Although the law was overturned by the Indiana Supreme Court in 1921, the U.S. Supreme Court, in Buck v. Bell, upheld the constitutionality of the Virginia Sterilization Act of 1924, allowing for the compulsory sterilization of patients of state mental institutions in 1927.

Some states sterilized "imbeciles" for much of the 20th century. Although compulsory sterilization is now considered an abuse of human rights, Buck v. Bell was never overturned, and Virginia did not repeal its sterilization law until 1974. The most significant era of eugenic sterilization was between 1907 and 1963, when over 64,000 individuals were forcibly sterilized under eugenic legislation in the United States. Beginning around 1930, there was a steady increase in the percentage of women sterilized, and in a few states only young women were sterilized. From 1930 to the 1960s, sterilizations were performed on many more institutionalized women than men. By 1961, 61 percent of the 62,162 total eugenic sterilizations in the United States were performed on women. A favorable report on the results of sterilization in California, the state with the most sterilizations by far, was published in book form by the biologist Paul Popenoe and was widely cited by the Nazi government as evidence that wide-reaching sterilization programs were feasible and humane.

Men and women were compulsorily sterilized for different reasons. Men were sterilized to treat their aggression and to eliminate their criminal behavior, while women were sterilized to control the results of their sexuality. Since women bore children, eugenicists held women more accountable than men for the reproduction of the less "desirable" members of society. Eugenicists therefore predominantly targeted women in their efforts to regulate the birth rate, to "protect" white racial health, and weed out the "defectives" of society.

A 1937 Fortune magazine poll found that 2/3 of respondents supported eugenic sterilization of "mental defectives", 63% supported sterilization of criminals, and only 15% opposed both.

In the 1970s, several activists and women's rights groups discovered several physicians to be performing coerced sterilizations of specific ethnic groups of society. All were abuses of poor, nonwhite, or mentally retarded women, while no abuses against white or middle-class women were recorded. Several court cases such as Madrigal v. Quilligan, a class action suit regarding forced or coerced postpartum sterilization of Latina women following cesarean sections, and Relf v. Weinberger, the sterilization of two young black girls by tricking their illiterate mother into signing a waiver, helped bring to light some of the widespread abuses of sterilization supported by federal funds.

After World War II, Dr. Clarence Gamble revived the eugenics movement in the United States through sterilization. Gamble supported the eugenics movement throughout his life. He worked as a researcher at Harvard Medical school and was well-off financially, as the inheritor of the Procter and Gamble fortune. Gamble, a proponent of birth control, contributed to the founding of public birth control clinics. These were the first public clinics in the United States. Until the 1960s and 1970s, Gamble's ideal form of eugenics, sterilization, was seen in various cases. Doctors told mothers that their daughters needed shots, but they were actually sterilizing them. Hispanic women were often sterilized due to the fact that they could not read the consent forms that doctors had given them. Poorer white people, African Americans, and Native American people were also targeted for forced sterilization.

The number of eugenic sterilizations is agreed upon by most scholars and journalists. They claim that there were 64,000 cases of eugenic sterilization in the United States, but this number does not take into account the sterilizations that took place after 1963. Around this time was when women from different minority groups were singled out for sterilization. If the sterilizations after 1963 are taken into account, the number of eugenic sterilizations in the United States increases to 80,000. Half of these sterilizations took place after World War II. Sterilization still occurs today - in some states, it is legal for drug addicts to be paid to be voluntarily sterilized. Eugenic sterilization programs before World War II were mostly conducted on prisoners, or people in mental hospitals. After the war, eugenic sterilization was aimed more towards poor people and minorities. There were even judges who would force people on parole to be sterilized. People supported this revival of eugenic sterilizations because they thought it would help bring an end to some issues, like poverty and mental illness. Supporters also thought that these programs would save taxpayer money and boost the economy.

In 1972, United States Senate committee testimony brought to light that at least 2,000 involuntary sterilizations had been performed on poor black women without their consent or knowledge. An investigation revealed that the surgeries were all performed in the South, and were all performed on black women with multiple children who were receiving welfare. Testimony revealed that many of these women were threatened with an end to their welfare benefits unless they consented to sterilization. These surgeries were instances of sterilization abuse, a term applied to any sterilization performed without the consent or knowledge of the recipient, or in which the recipient is pressured into accepting the surgery. Because the funds used to carry out the surgeries came from the U.S. Office of Economic Opportunity, the sterilization abuse raised other, older suspicions, especially amongst the black community, that "federal programs were underwriting eugenicists who wanted to impose their views about population quality on minorities and poor women."

Native American women were also victims of sterilization abuse up into the 1970s. The organization WARN (Women of All Red Nations) publicized that Native American women were threatened that, if they had more children, they would be denied welfare benefits. The Indian Health Service also repeatedly refused to deliver Native American babies until their mothers, in labor, consented to sterilization. Many Native American women unknowingly gave consent, since directions were not given in their native language. According to the General Accounting Office, an estimate of 3,406 Indian women were sterilized. The General Accounting Office stated that the Indian Health Service had not followed the necessary regulations, and that the "informed consent forms did not adhere to the standards set by the United States Department of Health, Education, and Welfare (HEW)."

In 2013, it was reported that 148 female prisoners in two California prisons were sterilized between 2006 and 2010 in a supposedly voluntary program, but it was determined that the prisoners did not give consent to the procedures. In September 2014, California enacted Bill SB1135 that bans sterilization in correctional facilities, unless the procedure is required to save an inmate's life.

Euthanasia programs
Edwin Black wrote that one of the methods that was suggested to get rid of "defective germ-plasm in the human population" was euthanasia. A 1911 Carnegie Institute report explored eighteen methods for removing defective genetic attributes, and method number eight was euthanasia. The most commonly suggested method of euthanasia was to set up local gas chambers. However, many in the eugenics movement did not believe that Americans were ready to implement a large-scale euthanasia program, so many doctors had to find clever ways of subtly implementing eugenic euthanasia in various medical institutions. For example, a mental institution in Lincoln, Illinois fed its incoming patients milk infected with tuberculosis (reasoning that genetically fit individuals would be resistant), resulting in 30–40% annual death rates. Other doctors practiced euthanasia through various forms of lethal neglect.

In the 1930s, there was a wave of portrayals of eugenic "mercy killings" in American film, newspapers, and magazines. In 1931, the Illinois Homeopathic Medicine Association began lobbying for the right to euthanize "imbeciles" and other defectives. The Euthanasia Society of America was founded in 1938.

Overall, however, euthanasia was marginalized in the U.S., motivating people to turn to forced segregation and sterilization programs as a means for keeping the "unfit" from reproducing.

Better baby contests
Mary deGormo, a former teacher, was the first person to combine ideas about health and intelligence standards with competitions at state fairs, in the form of baby contests. She developed the first such contest, the "Scientific Baby Contest" for the Louisiana State Fair in Shreveport, in 1908. She saw these contests as a contribution to the "social efficiency" movement, which was advocating for the standardization of all aspects of American life as a means of increasing efficiency. DeGarmo was assisted by Doctor Jacob Bodenheimer, a pediatrician who helped her develop grading sheets for contestants, which combined physical measurements with standardized measurements of intelligence.

The contest spread to other U.S. states in the early twentieth century. In Indiana, for example, Ada Estelle Schweitzer, a eugenics advocate and director of the Indiana State Board of Health's Division of Child and Infant Hygiene, organized and supervised the state's Better Baby contests at the Indiana State Fair from 1920 to 1932. It was among the fair's most popular events. During the contest's first year at the fair, a total of 78 babies were examined; in 1925 the total reached 885. Contestants peaked at 1,301 infants in 1930, and the following year the number of entrants was capped at 1,200. Although the specific impact of the contests was difficult to assess, statistics helped to support Schweitzer's claims that the contests helped reduce infant mortality.

The intent of the contest was to educate the public about raising healthier children as during the time period, it was approximated that 100 infants out of every 1000 births passed away prior to their first birthday. However, its exclusionary practices reinforced social class and racial discrimination. In Indiana, for example, the contestants were limited to white infants; African American and immigrant children were barred from the competition for ribbons and cash prizes. In addition, the scoring was biased toward white, middle-class babies. The contest procedure included recording each child's health history, as well as evaluations of each contestant's physical and mental health and overall development using medical professionals. Using a process similar to the one introduced at the Louisiana State Fair, and contest guidelines that the AMA and U.S. Children's Bureau recommended, scoring for each contestant began with 1,000 points. Deductions were made for defects, including a child's measurements below a designated average. The contestant with the most points was declared the winner.

Standardization through scientific judgment was a topic that was very serious in the eyes of the scientific community, but has often been downplayed as just a popular fad or trend. Nevertheless, a lot of time, effort, and money was put into these contests and their scientific backing, which would influence cultural ideas as well as local and state government practices.

The National Association for the Advancement of Colored People promoted eugenics by hosting "Better Baby" contests and the proceeds would go to its anti-lynching campaign.

Fitter families
First appearing in 1920 at the Kansas Free Fair, "Fitter Families for Future Firesides" competitions continued all the way up to World War II. Mary T. Watts and Dr. Florence Brown Sherbon, both initiators of the Better Baby Contests in Iowa, took the idea of positive eugenics for babies and combined it with a determinist concept of biology to come up with fitter family competitions.

There were several different categories that families were judged in: size of the family, overall attractiveness, and health of the family, all of which helped to determine the likelihood of having healthy children. These competitions were simply a continuation of the Better Baby contests that promoted certain physical and mental qualities. At the time, it was believed that certain behavioral qualities were inherited from one's parents. This led to the addition of several judging categories including: generosity, self-sacrificing, and quality of familial bonds. Additionally, there were negative features that were judged: selfishness, jealousy, suspiciousness, high-temperedness, and cruelty. Feeblemindedness, alcoholism, and paralysis were few among other traits that were included as physical traits to be judged when looking at family lineage.

Doctors and specialists from the community would offer their time to judge these competitions, which were originally sponsored by the Red Cross. The winners of these competitions were given a Bronze Medal as well as champion cups called "Capper Medals." The cups were named after then-Governor and Senator, Arthur Capper and he would present them to "Grade A individuals".

The perks of entering into the contests were that the competitions provided a way for families to get a free health check-up by a doctor as well as some of the pride and prestige that came from winning the competitions.

By 1925 the Eugenics Records Office was distributing standardized forms for judging eugenically fit families, which were used in contests in several U.S. states.

Planned Parenthood and the African American community
Concerns about eugenics arose in the African American community after the implementation of the Negro Project of 1939, which was proposed by Margaret Sanger who was the founder of Planned Parenthood. In this plan, Sanger offered birth control to Black families in the United States to give them the chance to have a better life than what the group had been experiencing in the United States. She also noted that the project was proposed to empower women. The Project often sought after prominent African American leaders to spread knowledge regarding birth control and the perceived positive effects it would have on the African American community, such as poverty and the lack of education. Because of this, Sanger believed that African American ministers in the South would be useful to gain the trust of people within disadvantaged, African American communities as the Church was a pillar within the community. Also, political leaders such as W.E.B. Dubois were quoted in the Project proposal criticizing Black people in the United States for having many children and for being less intelligent than their white counterparts:"... the mass of ignorant Negroes still breed carelessly and disastrously, so that the increase among Negroes, even more than the increase among Whites, is from that part of the population least intelligent and fit, and least able to rear their children properly."Even though The Negro Project received a lot of praise from white leaders and eugenicists of the time, it is important to note that Margaret Sanger wanted to clear concerns that this was not a project to terminate African Americans. To add to the clarification, she received support from prominent African American leaders such as Mary McLeod Bethune and Adam Clayton Powell Jr. These leaders and many more would later serve on the Negro National Advisory Council of Planned Parenthood Federation of America in 1942.

African-American support of eugenics
Some African-Americans were proponents of eugenics. Thomas Wyatt Turner, a professor at Howard University and a well-respected scientist, incorporated eugenics into his classes. The NAACP founder asked his students how eugenics can affect society in a good way in 1915. W.E.B DuBois, a historian and civil rights leader had some beliefs that lined up with eugenics. He believed in developing the best versions of African Americans in order for his race to succeed.

Influence on Nazi Germany
After the eugenics movement was well established in the United States, it spread to Germany. California eugenicists began producing literature promoting eugenics and sterilization and sending it overseas to German scientists and medical professionals. By 1933, California had subjected more people to forceful sterilization than all other U.S. states combined. The forced sterilization program engineered by the Nazis was partly inspired by California's.

The Rockefeller Foundation helped develop and fund various German eugenics programs, including the one that Josef Mengele worked in before he went to Auschwitz.

Upon returning from Germany in 1934, where more than 5,000 people per month were being forcibly sterilized, the California eugenics leader C. M. Goethe bragged to a colleague: "You will be interested to know that your work has played a powerful part in shaping the opinions of the group of intellectuals who are behind Hitler in this epoch-making program. Everywhere I sensed that their opinions have been tremendously stimulated by American thought ... I want you, my dear friend, to carry this thought with you for the rest of your life, that you have really jolted into action a great government of 60 million people."

Eugenics researcher Harry H. Laughlin often bragged that his Model Eugenic Sterilization laws had been implemented in the 1935 Nuremberg racial hygiene laws. In 1936, Laughlin was invited to an award ceremony at Heidelberg University in Germany (scheduled on the anniversary of Hitler's 1934 purge of Jews from the Heidelberg faculty), to receive an honorary doctorate for his work on the "science of racial cleansing". Due to financial limitations, Laughlin was unable to attend the ceremony and had to pick it up from the Rockefeller Institute. Afterward, he proudly shared the award with his colleagues, remarking that he felt that it symbolized the "common understanding of German and American scientists of the nature of eugenics."

Henry Friedlander wrote that although the German and American eugenics movements were similar, the U.S. did not follow the same slippery slope as Nazi eugenics because American "federalism and political heterogeneity encouraged diversity even with a single movement." In contrast, the German eugenics movement was more centralized and had fewer diverse ideas. Unlike the American movement, one publication and one society, the German Society for Racial Hygiene, represented all German eugenicists in the early 20th century.

After 1945, however, historians began to try to portray the U.S. eugenics movement as distinct and distant from Nazi eugenics. Jon Entine wrote that eugenics simply means "good genes" and using it as synonym for genocide is an "all-too-common distortion of the social history of genetics policy in the United States." According to Entine, eugenics developed out of the Progressive Era and not "Hitler's twisted Final Solution."

Genetic engineering
After Hitler's advanced idea of eugenics, the movement lost its place in society for a bit of time. Although eugenics was not thought about much, aspects like sterilization were still taking place, just not at such a public level. As technology developed, the field of genetic engineering emerged. Instead of sterilizing people to ultimately get rid of "undesirable" people, genetic engineering "changes or removes genes to prevent disease or improve the body in some significant way."

Proponents of genetic engineering cite its ability to cure and prevent life-threatening diseases. Genetic engineering began in the 1970s when scientists began to clone and alter genes. From this, scientists were able to create life-saving health interventions such as human insulin, the first-ever genetically-engineered drug. Because of this development, over the years scientists were able to create new drugs to treat devastating diseases. For example, in the early 1990s, a group of scientists were able to use a gene-drug to treat severe combined immunodeficiency in a young girl.

However, genetic engineering also further allows for the practice of eliminating "undesirable traits" within humans and other organisms - for example, with current genetic tests, parents are able to test a fetus for any life-threatening diseases that may impact the child's life and then choose to abort the baby. Some fear that this will could lead to ethnic cleansing, or alternative form of eugenics. The ethical implications of genetic engineering were heavily considered by scientists at the time, and the Asilomar Conference was held in 1975 to discuss these concerns and set reasonable, voluntary guidelines that researchers would follow while using DNA technologies.

Compulsory sterilization prevention
The 1978 Federal Sterilization Regulations, created by the United States Department of Health, Education and Welfare or HEW, (now the United States Department of Health and Human Services) outline a variety of prohibited sterilization practices that were often used previously to coerce or force women into sterilization. These were intended to prevent such eugenics and neo-eugenics as resulted in the involuntary sterilization of large groups of poor and minority women. Such practices include: not conveying to patients that sterilization is permanent and irreversible, in their own language (including the option to end the process or procedure at any time without conceding any future medical attention or federal benefits, the ability to ask any and all questions about the procedure and its ramifications, the requirement that the consent seeker describes the procedure fully including any and all possible discomforts and/or side-effects and any and all benefits of sterilization); failing to provide alternative information about methods of contraception, family planning, or pregnancy termination that are nonpermanent and/or irreversible (this includes abortion); conditioning receiving welfare and/or Medicaid benefits by the individual or his/her children on the individuals "consenting" to permanent sterilization; tying elected abortion to compulsory sterilization (cannot receive a sought out abortion without "consenting" to sterilization); using hysterectomy as sterilization; and subjecting minors and the mentally incompetent to sterilization. The regulations also include an extension of the informed consent waiting period from 72 hours to 30 days (with a maximum of 180 days between informed consent and the sterilization procedure).

However, several studies have indicated that the forms are often dense and complex and beyond the literacy aptitude of the average American, and those seeking publicly funded sterilization are more likely to possess below-average literacy skills. High levels of misinformation concerning sterilization still exist among individuals who have already undergone sterilization procedures, with permanence being one of the most common gray factors. Additionally, federal enforcement of the requirements of the 1978 Federal Sterilization Regulation is inconsistent and some of the prohibited abuses continue to be pervasive, particularly in underfunded hospitals and lower income patient hospitals and care centers.

Eugenics, Sterilization, and the African American Community [Omi]
Early proponents of the eugenics movement did not only include influential white Americans but also several proponent African American intellectuals such as W. E. B. Du Bois, Thomas Wyatt Turner, and many academics at Tuskegee University, Howard University, and Hampton University. However, unlike many white eugenicists, these black intellectuals believed the best African Americans were as good as the best White Americans, and "The Talented Tenth" of all races should mix. Indeed, Du Bois believed "only fit blacks should procreate to eradicate the race's heritage of moral iniquity."

With the support of leaders like Du Bois, efforts were made in the early 20th century to control the reproduction of the country's black population; one of the most visible initiatives was Margaret Sanger's 1939 proposal, The Negro Project. That year, Sanger, Florence Rose, her assistant, and Mary Woodward Reinhardt, then secretary of the new Birth Control Federation of America (BCFA), drafted a report on "Birth Control and the Negro." In this report, they stated that African Americans were the group with "the greatest economic, health and social problems," were largely illiterate and "still breed carelessly and disastrously," a line taken from W.E.B. DuBois' article in the June 1932 Birth Control Review. The Project often sought after prominent African American leaders to spread knowledge regarding birth control and the perceived positive effects it would have on the African American community, such as poverty and the lack of education. Sanger particularly sought out black ministers from the South to serve as leaders in the Project in the hopes of countering any ideas that the project was a strategic attempt to eradicate the black population. However, despite Sanger's best efforts, white medical scientists took control over the initiative, and with the Negro Project receiving praise from white leaders and eugenicists, many of Sanger's opponents, both during the creation of the Project and years after, saw her work as an attempt to terminate African Americans.

Opposition to initiatives to control reproduction within the African American community grew in the 1960s, particularly after President Lyndon B. Johnson, in 1965, announced the establishment of federal funding of birth control used on the poor. In the 1960s, many African Americans throughout the country took the government's decision to fund birth control clinics as an attempt to limit the growth of the black population and along with it, the increase political power that black Americans were fighting to acquire. Scholars have stated that African Americans' fear about their reproductive health and ability was rooted in history as under U.S. slavery, enslaved women were often coerced or forced to have children to increase a plantation owner's wealth. Therefore, many African Americans, particularly those in the Black Power Movement, saw birth control, and federal support of the Pill, as equivalent to black genocide, declaring it as such at the 1967 Black Power Conference.

Federal funding for birth control went alongside family planning initiatives that were a part of state welfare programs. These initiatives, in addition to advocating the use of the Pill, supported sterilization as a means of curbing the number of people receiving welfare and control the reproduction of 'unfit' women. The 1950s and 1960s were the height of the sterilization abuse that African American women as a group experienced at the hands of the white medical establishment. During this period, the sterilization of African American women largely took place in the South and assumed two forms: the sterilization of poor unwed black mothers, and "Mississippi appendectomies." Under these "Mississippi appendectomies," women who went to the hospital to give birth, or for some other medical treatment, often found themselves incapable of having more children upon leaving the hospital due to unnecessary hysterectomies performed on them by southern medical students. By the 1970s, the coerced sterilization of women of color spread from the South to the rest of the country through federal family planning and under the guise of voluntary contraceptive surgery as physicians began to require their patients to sign consent forms to surgeries they did not want or understand.

Though it is unknown the exact number of African American women who were sterilized throughout the country in the 20th century, records from a few states offer some estimates. In the state of North Carolina, which was seen as having the most aggressive eugenics program out of the 32 states that had one, during the 45-year reign of the North Carolina Eugenics Board, from 1929 to 1974, a disproportionate number of those who were targeted for forced or coerced sterilization were black and female, with almost all being poor. Of the 7,600 women who were sterilized by the state between the years of 1933 and 1973, about 5,000 were African American. In light of this history, North Carolina became the first state to offer compensation to surviving victims of compulsory sterilization. Additionally, whereas African Americans made up just over 1% of California's population, they accounted for at least 4% of the total number of sterilization operations conducted by the state between 1909 and 1979. Overall, according to one 1989 study, 31.6% of African American women without a high school diploma were sterilized while only 14.5% of white women of the same educational status were sterilized.

In 1972, United States Senate committee testimony brought to light that at least 2,000 involuntary sterilizations had been performed on poor black women without their consent or knowledge. An investigation revealed that the surgeries were all performed in the South, and were all performed on black women with multiple children who were receiving welfare. Testimony revealed that many of these women were threatened with an end to their welfare benefits unless they consented to sterilization. These surgeries were instances of sterilization abuse, a term applied to any sterilization performed without the consent or knowledge of the recipient, or in which the recipient is pressured into accepting the surgery. Because the funds used to carry out the surgeries came from the U.S. Office of Economic Opportunity, the sterilization abuse raised suspicions, especially among members of the black community, that "federal programs were underwriting eugenicists who wanted to impose their views about population quality on minorities and poor women."

Despite this investigation, it was not until 1973 that the issue of sterilization abuse was brought to media attention. On June 14, 1973, two black girls, Minnie Lee and Mary Alice Relf, ages fourteen and twelve, respectively, were sterilized without their knowledge in Alabama by the Montgomery Community Action Committee, an OEO-financed organization. The summer of that year, the Relf girls sued the government agencies and individuals responsible for their sterilization. As the case was being pursued, it was discovered that the girls' mother, who could not read, unwittingly approved the operations, signing an 'X' on the release forms; Mrs. Relf had believed that she was signing a form authorizing her daughters to receive Depo-Provera injections, a form of birth control. In light of the 1974 case of Relf v. Weinberger, named after Minnie Lee and Mary Alice's older sister, Katie, who had narrowly escaped also being sterilized, the Department of Health, Education, and Welfare (HEW) were ordered to establish new guidelines for its government sterilization policy. By 1979, the new guidelines finally addressed the concern over informed consent, determined that minors under the age of 21 and those with severe mentally impairments who could not give consent would not be sterilized, and articulated the provision that doctors could no longer claim that a woman's refusal to be sterilized would result in her being denied welfare benefits.

The Sterilization of Latina Women [Morgan]

The 20th century demarcated a time in which compulsory sterilization heavily navigated its way into primarily Latinx communities. Locations such as Puerto Rico and Los Angeles, California were found to have had large amounts of their female population coerced into sterilization procedures without a the necessary informed consent or awareness of procedure. Between the span of the 1930's to the 1970's, nearly one-third of the female population in Puerto Rico was sterilized; at the time, this was the highest rate of sterilization in the world. Arguments stand that sterilization was in an effort to rectify the country's poverty and unemployment rates, even so that sterilization became legal in the eyes of the government in 1937. The procedure was so common that is was often referred to solely as “la operación." This intentional targeting of Latinx communities exemplify the strategic placement of racial eugenics in modern history. This targeting is also inclusive of those with disabilities and those from marginalized populations.

Eugenics did not serve as the only reason for the disproportionate rates of sterilization in the Puerto Rican community. Contraceptive trials were inducted in the 1950's towards Puerto Rican women. John Rock and Gregory Pincus were the two men spearheading the human trials of oral contraceptive. In 1954, the decision was made to conduct the clinical experiment in Puerto Rico, citing the island's large network of birth control clinics and lack of anti-birth control laws, which was in contrast to the United States' thorough cultural and religious opposition to the reproductive service. The decision to conduct the trials in this community was also motivated by the structural implications of supremacy and colonialism. Rock and Pincus monopolized off of the primarily poor and uneducated background of these women, countering that if they "could follow the Pill regimen, then women anywhere in the world could too." These women were purposely ill-informed of the oral contraceptives presence; the researchers only reported that the drug, which was administered at a much higher dosage than what birth control is prescribed at today, was to prevent pregnancy, not that it was tied to a clinical trial in order to jump start oral contraceptive access in America through FDA approval.

In California, by the year 1964, a total of 20,108 people were sterilized, making that the largest amount in all of the United States. It is an important note that during this period in California's population demographic, the total individuals sterilized was disproportionately inclusive of Mexican and Chicana women. Andrea Estrada, a UC Santa Barbara affiliate, said:"Beginning in 1909 and continuing for 70 years, California led the country in the number of sterilization procedures performed on men and women, often without their full knowledge and consent. Approximately 20,000 sterilizations took place in state institutions, comprising one-third of the total number performed in the 32 states where such action was legal."Cases such as Madrigal v. Quilligan, a class action suit regarding forced or coerced postpartum sterilization of Latina women following cesarean sections, helped bring to light some of the widespread abuses of sterilization supported by federal funds. Furthermore, attempts to successfully narrate the experiences of sterilized Latina women, which have often been silenced through history, have taken up space within media. Films such as No más bebés and La Operación offer emotional and candid storytelling on behalf Latina women directly affected by the coerced sterilization of their communities. These stories, among many others, serve as backbones for the reproductive justice movement that we see today.

Sterilization of Native American Women [Kalina]

An estimated 40% of Native American women (60,000-70,000 women) and 10% of Native American men in the United States underwent sterilization in the 1970s. A General Accounting Office (GAO) report in 1976 found that 3,406 Native American women, 3,000 of which were of childbearing age, were sterilized by the Indian Health Service (IHS) in Arizona, Oklahoma, New Mexico, and South Dakota from 1973 to 1976. The GAO report did not conclude any instances of coerced sterilization, but called for the reform of IHS and contract doctors' processes of obtaining informed consent for sterilization procedures. The IHS informed consent processes examined by the GAO did not comply with a 1974 ruling of the U.S. District Court that "any individual contemplating sterilization should be advised orally at the outset that at no time could federal benefits be withdrawn because of failure to agree to sterilization."

In examining individual cases and testimonies of Native American women, scholars have found that IHS and contract physicians recommended sterilization to Native American women as the appropriate form of birth control, failing to present potential alternatives and to explain the irreversible nature of sterilization, and threatened that refusal of the procedure would result in the women losing their children and/or federal benefits. Scholars also identified language barriers in informed consent processes as the absence of interpreters for Native American women hindered them from fully understanding the sterilization procedure and its implications, in some cases. Scholars have cited physicians' individual paternalism and beliefs about the population control of poor communities and welfare recipients and the opportunity for financial gain as possible motivations for performing sterilizations on Native American women.

Native American women and activists mobilized in the 1970s across the United States to combat the coerced sterilization of Native American women and advocate for their reproductive rights, alongside tribal sovereignty, in the Red Power movement. Some of the most prominent activist organizations established in this decade and active in the Red Power movement and the resistance against coerced sterilization were the American Indian Movement (AIM), United Native Americans, Women of all Red Nations (WARN), the International Indian Treaty Council (IITC), and Indian Women United for Justice, founded by Dr. Constance Redbird Pinkerton Uri, a Cherokee-Choctaw physician. Some Native American activists have deemed the coerced sterilization of Native American women a "modern form of genocide," and view these sterilizations as a violation of the rights of tribes as sovereign nations. Others argue that the sterilization of Native American women is interconnected with colonialist and capitalist motives of corporations and the federal government to acquire land and natural resources, including oil, natural gas, and coal, currently located on Native American reservations. Scholars and Native American activists have situated the forced sterilizations of Native American women within broader histories of colonialism, violations of Native American tribal sovereignty by the federal government, including a long history of the removal of children from Native American women and families, and population control efforts in the United States.

The 1970s brought new federal legislation enacted by the United States government which addressed issues of informed consent, sterilization, and the treatment of Native American children. The U.S. Department of Health, Education, and Welfare released new regulations in 1979 on informed consent processes for sterilization procedures, including a longer waiting period of 30 days before the procedure, the presentation of alternative methods of birth control to the patient, and clear verbal affirmation that the patient's access to federal benefits or welfare programs would not be revoked if the procedure were refused. The Indian Child Welfare Act of 1978 officially recognized the significance and value of the extended family in Native American culture, adopting "minimum federal standards for the removal of Indian children to foster or adoptive homes," and the central importance of the sovereign tribal governments in decision-making processes surrounding the welfare of Native children.

Bibliography:


 * "Forced Sterilization of Native Americans: Later Twentieth Century Physician Cooperation with National Eugenics Policies?," Rutecki
 * United Nations Resolution 96 - definition of genocide
 * Prevention of birth in specific group
 * Eugenics policy
 * Indian Health Service (IHS)
 * Government Accounting Office (GAO) investigation HRD-77-3 - November 6, 1976
 * From 1973-1976 "the IHS performed 3,406 sterilizations"
 * "as many as 25-50% of the Native American women of that era were sterilized between 1970 and 1976."
 * Informed consent not mandatory for "contract physicians" -- lack of information, coercion
 * Culpability of IHS medical professionals and "contract physicians"
 * Broader national/governmental efforts of physician/medical intervention in marginalized communities
 * Motivations/justifications of physicians performing sterilization procedures/abortions
 * Salaried IHS physicians -- individual beliefs about poor communities/welfare recipients
 * Private 'contractors' -- financial reimbursement for procedures
 * Centrality of "technique" - bypass ethical concerns
 * Indian Child Welfare Act of 1978
 * "Legalised non-consensual sterilization - eugenics put into practice before 1945, and the aftermath. Part 1: USA, Japan, Canada, and Mexico," Amy and Rowlands
 * 1970s: sterilization of 40% of Native American women - 60-70,000 women; 10% of Native American men
 * Vulnerable communities - smaller populations, minority, marginalized
 * Coercion - lack of informed consent
 * "threatening her with losing her children to social welfare agencies in case of refusal" (126)
 * "Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s," Torpy
 * Particularly vulnerable situation of Native American women: "tribal dependence on the federal government" (1)
 * General Accounting Office (GAO) 1976
 * "between 1973 and 1976 IHS facilities sterilized 3,406 Native American women. Of these, 3,001 involved women of childbearing age (between fifteen and forty-four). Of these, 1,024 were performed at IHS contract facilities." (4)
 * "given the fact of the small population of Native Americans, 3,406 Indian sterilizations would be comparable to 452,000 non-Indian women." (4)
 * informed consent procedures of IHS went against a 1974 ruling from the US District Court that "any individual contemplating sterilization should be advised orally at the outset that at no time could federal benefits be withdrawn because of failure to agree to sterilization." (5)
 * Role of individual beliefs of IHS medical officials
 * Joint Committee on Accreditation of Hospitals' 1975 study: "over two-thirds of the IHS' fifty-one hospitals were 'obsolete and in need of complete replacement.' Only twenty-four, less than half, met the committee's standards, and just twelve of the fifty-one hospitals met the fire and safety codes." (6)
 * "In 1974 there was only one doctor for every 1,700 reservation Indians." (7)
 * 1977 - "For every seven babies born, one Indian women was sterilized." (7)
 * Presented sterilization as appropriate method of birth control, failed to present/explain alternatives
 * Informed consent processes -- absence of interpreter for Native American women to fully understand the procedure and its implications --> language
 * Doctors <> social workers
 * History of Native American women losing their children
 * Native American resistance, reproductive rights movements in the 1960s and 70s
 * 'Red Power'
 * United Native Americans, Women of All Red Nations (WARN), International Indian Treaty Council (IITC)
 * American Indian Movement (AIM)
 * Interconnection of land ownership issues and reproductive rights/population control
 * Indian Child Welfare Act 1978
 * "established the extended family as the primary means by which Native Americans maintain their complex culture" (11)
 * "gave back parental and some tribal authority in regard to Native children's welfare" (11)




 * "Informing Red Power and Transforming the Second Wave: Native American women and the struggle against coerced sterilization in the 1970s," O'Sullivan
 * https://doi.org/10.1080/09612025.2015.1083229
 * Federally-funded forced sterilization as violation of rights of tribes as sovereign nations
 * "Native American women contributed to an interpretation of reproductive rights that transitioned from a framework of personal choice to one focused on justice" (966)
 * Mainstream feminist movement for reproductive rights
 * Activism of Native American women - "important influences on the larger movement for the termination of sterilization abuse" (966)
 * Population control efforts in the mid-20th century
 * "By the late twentieth century, concerns about overpopulation justified the sterilization of women authorities considered a social burden." (967)
 * "Native American women emerged as accessible candidates for sterilization because of the contractual nature of healthcare between the federal government and Native nations." (968)
 * "a service historically provided in exchange for land"
 * "Wealthier Native Americans frequently sought treatment elsewhere."
 * "In 1973, 40% of Native Americans lived in poverty." (968)
 * "possible motivation of financial gain" (969) for sterilization procedures
 * "unequal political relationships between Native nations and the federal government" (970) - sterilization as part of broader power structures, context of colonialism
 * Dr. Constance Redbird Pinkerton Uri (Cherokee-Choctaw) - founder of Indian Women United for Justice
 * 1976 GAO report - sterilizations of Native women at IHS facilities in "Aberdeen, South Dakota; Albuquerque, New Mexico; Oklahoma City, Oklahoma; and Phoenix, Arizona."
 * Did not conclude there was coerced sterilization but called for improved informed consent processes - largely unmonitored/unregulated
 * Some thought procedure would be reversible
 * Red Power - coerced sterilization of Native American women as "modern form of genocide" (973)
 * "AIM acknowledged coerced sterilization as a problem but by no means advanced it as a central concern." (974)
 * New HEW regulations 1979 - "clarified the terms of informed consent and the protocol involved in obtaining it" (976)


 * "Better Dead than Pregnant: The Colonization of Native Women's Reproductive Health," Smith