Eugenic Nation

by Stern, Alexandra Minna

  The plaintiffs in Madrigal v. Quilligan were neither welfare recipients nor on trial for illegitimacy; instead, they were working-class migrant women sterilized in a county hospital where obstetric residents were pressured to meet a quota of tubal ligations to adequately complete their training, and the physicians at the top of the chain of command were partisan to racially slanted ideas about population control. In 1973, appalled by the unethical medical behavior he witnessed during his residency at County Hospital, Dr. Bernard Rosenfeld coauthored a Health Research Group report on sterilization abuse. He and his collaborators identified three hospitals, each of which had been heavily swayed by family planning and overpopulation concerns and received HEW monies, as the gravest offenders: County Hospital, Boston City Hospital, and Baltimore City Hospital. At County Hospital, Rosenfeld documented a 742 percent increase in elective hysterectomies, a 470 percent increase in elective tubal ligations, and a 151 percent increase in postdelivery tubal ligations.108 Moreover, he described a situation in which there was “little evidence of informed consent by the patient,” and doctors were “selling” sterilizations “in a manner not unlike many other deceptive marketing practices.”109 According to Rosenfeld, County Hospital obstetricians instructed residents to strong-arm patients who were at the peak of labor into tubal ligations, often packaging the operation as an opportunity to gain needed surgical experience (“Remember everyone you get to get her tubes tied means two tubes for some resident or intern”).110

  Cognizant of what was transpiring at County Hospital, Los Angeles Chicanas began to organize and investigate, eventually locating 140 women who claimed that they had been forcibly sterilized in medically unnecessary surgeries.111 As with Puerto Ricans on the East Coast, the sterilization cases galvanized Chicana feminists, who distinguished themselves from both white feminists, whose quest for abortion rights often made them oblivious to reproductive abuse, and male Chicano nationalists, who frequently cast birth control as either superfluous to race and class or, more stridently, as treason against the perpetuation of the Chicano family and nation.112 Chicanas mobilized demonstrations against County Hospital and formed the Committee to Stop Forced Sterilization, which linked sterilization to federal antipoverty programs, the greed of big international corporations, and the oppression of poor people worldwide, declaring, “we believe that the purpose of birth control is to given [sic] women more choice about how we will live our lives.”113

  Figure 10. Protest in Los Angeles against forced sterilizations at County–USC Medical Center, 1974. Los Angeles Times photo, used with permission.

  The Madrigal v. Quilligan trial, which in the end pitted the ten sterilized women against County Hospital obstetricians, began in May 1978. The plaintiffs charged that their civil and constitutional rights to bear children had been violated, and that between 1971 and 1974 they had been forcibly sterilized by obstetricians at County Hospital, specifically, they had signed consent forms under duress, hours or minutes before or after labor, or had never been informed, or had been misinformed, that their tubes would be “tied.”114 Antonia Hernández and Charles Nabarette of the Los Angeles Center for Law and Justice represented the plaintiffs, all of whom were low-income monolingual Spanish speakers who had migrated to California in their teens from rural areas in Mexico in search of economic opportunity or to join relatives. Although they varied in age, occupation, and number of children, their stories were strikingly similar. All of them had been approached about sterilization after having been in labor for several hours and had endured complicated and difficult deliveries, which were ultimately performed by cesarean section.115 Their lawyers asserted that “these women were in such a state of mind that any consent which they may have signed was not informed,” and that in three cases, no consent was obtained.116 Rebecca Figueroa was falsely given the impression that she was submitting to a reversible procedure. Elena Orozco was told that her hernia would be repaired only if she agreed to be sterilized, which she refused repeatedly “until almost the very last minute when she was taken to be delivered.”117 At no point after being admitted to County Hospital in 1973 did Guadalupe Acosta sign a consent form.118 Dolores Madrigal did so after a medical assistant told her that her husband had already offered his signature, something that was deliberately untrue. Their accusations were supported by the affidavits of seven additional women, one of whom stated that a County Hospital doctor told her after her cesarean that “I had too many children” and that “having future children would be dangerous for me.”119 Another was pressured by a doctor who told her that birth control pills and contraceptive foam were unreliable methods of birth control and only sterilization was guaranteed to be effective; en route to the operating room, “confused and tired,” and “frightened by what the doctor had told me,” she signed a release handed to her by a Spanish-speaking nurse.120 And yet another woman who provided a supporting affidavit was led to believe that she had offered her signature for the cesarean, not for a tubal ligation.121

  Despite commanding and corroborated testimony about sterilization abuse at County Hospital, the judge ruled against the plaintiffs and for the defendants, who, he determined, had acted in good faith and intended no harm. During the hearing several patterns emerged that presaged the final outcome. First, only one key witness, Karen Benker, spoke out against the doctors. Then a medical student and technician, Benker related an entrenched system of forced sterilization based on stereotypes of Mexicans as hyperbreeders and Mexican women as welfare mothers in waiting. She recalled conversations in which Dr. Edward James Quilligan, the lead defendant and the head of obstetrics and gynecology at County Hospital since 1969, stated that “poor minority women in L.A. County were having too many babies; that it was a strain on society; and that it was good that they be sterilized.”122 She also testified that he boasted about receiving a federal grant for a substantial sum that he intended to use to show, in his words, “how low we can cut the birth rate of the Negro and Mexican populations in Los Angeles County.”123 According to Benker, sterilizations were particularly pushed on women with two or more children who underwent C-sections. Facing the animosity of the judge, Benker’s testimony was curtailed and then drowned out against the voices of the preponderantly male experts heard in the courtroom.

  Second, the anthropologist Carlos Vélez-Ibañez, who threw himself into the case and sought with much passion and professionalism to make a compelling argument on behalf of the women, did so in a manner that ended up partially reinscribing problematic stereotypes of Mexican women. Drawing primarily from structural anthropology, Vélez contended that the essence of Mexican women’s identity, particularly this “subgroup” of working-class mestizas from rural backgrounds, was motherhood. Not only that, the plaintiffs were naturally predisposed to wanting a large brood of children, and hence forced sterilization even after the fifth or sixth child was an affront to the ingrained values of Mexicans and constituted a violent kind of “cultural sterilization.”124 Vélez’s character study of poor rural Mexican women helped to emphasize national difference and make the plaintiffs “other,” a conundrum that distracted from and undermined their most promising avenue: that the legal standards for informed consent had not been met and that the abrogation of individual, civil, and constitutional rights outweighed the medical judgment of the doctors.

  Finally, Hernández and Nabarette waived the option of a jury trial, a decision that placed the adjudication in the hands of one man, Judge Jesse Curtis. Although Curtis recognized that the women had “suffered severe emotional and physical stress because of these operations,” he refused to blame County Hospital physicians for what he called “a breakdown in communication between the patients and the doctors.”125 At the conclusion of a two-and-a-half week trial that produced a transcript of more than fifteen hundred pages, Curtis ruled that he had found “no evidence of concerted or conspiratorial action” and stated that he had been persuaded by the defendant physicians’ claim that they “would not perform the operation unl
ess they were certain in their own mind that the patient understood the nature of the operation and was requesting the procedure.”126 Although Curtis did not explicitly endorse the neo-Malthusianism expressed by the physicians, he conveyed that it was not objectionable if a physician believed that a tubal ligation could improve a perceived overpopulation problem, as long as said physician did not try to “overpower the will of his patients.”127 Curtis described the case as a “clash of cultures,” and in a damning reversal invoked Vélez’s arguments about Mexican culture to suggest that if the plaintiffs had not been inclined toward wanting such large families, then their postpartum sterilizations would never have resulted in a class action lawsuit.

  Less than two weeks after the ruling, the Center for Law and Justice announced that it would appeal and harshly criticized the court’s neglect of Benker’s testimony as well as that of an obstetrician called as an expert witness who contended that a woman in labor was not in a position to give what qualified as genuine informed consent.128 Even though this legal action seems to have fizzled out, Madrigal v. Quilligan did have major consequences for the elaboration of sterilization stipulations, especially by securing a clause that consent forms be bilingual.129 Now under many watchful eyes, County Hospital began to comply with federal sterilization guidelines, which included a seventy-two-hour waiting period between consent and operation, a near moratorium on sterilization of persons younger than twenty-one, and a written and signed statement of consent, preceded by a clear explanation that welfare benefits would not be terminated if the patient declined the procedure. These guidelines officially took effect in 1974, although persistent violations and inconsistencies in hospitals across the country spurred more than fifty organizations to meet in Washington, D.C., in 1977 to push for stricter enforcement and oversight by HEW, and noncompliance was repeatedly reported at many hospitals into the 1980s.130

  The sterilization of Mexican-origin women in Los Angeles unfolded alongside related abuse throughout the South and Southwest in the early 1970s and cannot be comprehended without attention to the confluence of forces—enlarged federal family planning initiatives, a county hospital with residents eager for obstetric training, the penetration of population planning into federal policy and some medical fields, and the rising availability and use of contraceptive methods—that facilitated these forced operations. Nevertheless, the rationale used to disparage these women, indeed to deprive them of their human rights, had a much older provenance. As early as the 1920s, California eugenicists such as Goethe, David Starr Jordan, and Samuel J. Holmes claimed that Mexicans were irresponsible breeders, flooded over the border in “hordes,” and undeservingly sapped fiscal resources. In 1935, for example, Goethe wrote to Laughlin, “It is this high birthrate that makes Mexican peon immigration such a menace. Peons multiply like rabbits.”131 In editorials, pamphlets, and personal correspondence, prominent eugenicists foregrounded the “Mexican problem” as a danger to every facet of the state’s health. The sterilizations at County Hospital were not under the purview of the Department of Institutions, like the twenty thousand that occurred from 1909 into the 1960s, but they cannot be extracted from the history of sterilization in California, particularly because they occurred in Los Angeles, which after the dissolution of the Eugenics Section of the Commonwealth Club of California in 1935 overtook San Francisco as the Pacific West’s eugenic epicenter.132 Los Angeles was home to several prominent groups, such as the Human Betterment Foundation, the California Division of the AES, and the AIFR, that were active into the 1950s and 1960s and that included as members several physicians affiliated with the University of Southern California hospitals.

  With the repeal of state sterilization statutes, the demise of national origins quotas, and the overturning of marriage bans, Americans exited an era of eugenics in which the state played a principal role in instituting and upholding hereditarian ideas and practices. From the early twentieth century to the 1960s, key state agencies, usually working in concert with private organizations and individuals, often made better breeding a guiding principle of social and health programs. There were differing permutations of eugenics across the country, depending on regional variations in race relations, gender dynamics, environmental policy, professional networks, and patterns of state governance and administration. The 1960s and 1970s saw the popular contestation of a eugenic nation through street protests, legislative reform, and lawsuits. Activists condemned practices they associated with racism, sexism, oppression, and exploitation and regularly expressed their moral outrage with terms such as imperialism, fascism, and genocide. References to and representations of Hitler, Nazis, and extermination were ubiquitous during the 1960s, expressed in the maxim “question authority.” This discourse resonated powerfully in a country with profound medical inequities, where medical and human subject abuse was not uncommon, and where reproductive health was suffused with tenets of selective breeding.

  Just as the transformations of the 1960s helped to usher us out of an era of coercion, this decade was instrumental to the crystallization of many of the keywords and conceptual frameworks we have employed since to understand eugenics in America. Quite ironically, the discursive bundling of eugenics, biological determinism, and scientific racism with Nazism and the Holocaust, which coalesced in American historical memory in the 1970s, has often helped to obfuscate the long chronology of better breeding across the twentieth century.133 It has made it more difficult to capture nuances, appreciate gray areas, and analyze the complicated interactions of various social actors.

  In the end, there are many more stories to be told about how Americans challenged, embraced, and navigated hereditarianism. Eugenics took hold in states as diverse as Indiana, Vermont, and Virginia, providing a scientific framework to interpret and address perceived social problems. More than just a top-down affair, better breeding was often popular among working-class and middle-class Americans. In rural parts of the country many people extrapolated from the experience of crop cultivation and animal husbandry to human improvement. In the 1920s, for example, parents flocked to better babies contests to compare their children to their neighbors’ and to learn scientific motherhood. In midcentury, women in Puerto Rico, Minnesota, and North Carolina solicited sterilizations through eugenics boards because they were desirous of permanent birth control, even when that meant being labeled feebleminded or mentally retarded. Although this book has concentrated on how European Americans and those who imagined themselves white or Anglo pursued eugenics, African Americans intent on racial uplift and “righteous propagation” cultivated their own oppositional forms of better breeding.134 In short, there are many more faces of eugenics in modern America that remain to be explored. Uncovering further aspects of hereditarianism can enhance our understanding of subjects and processes as varied as the family, the state, sexuality, and race relations, especially in the period after 1940, when eugenic trajectories receded, continued forward, and splintered in competing directions. Finally, further excavating this history can point out new and challenging questions and concerns related to the implications and social uses of genetic and reproductive technologies in the twenty-first century.

  Epilogue

  In March 2003, following a senate hearing in the state capitol in Sacramento, Governor Gray Davis apologized for California’s sterilization program. Speaking for the “people of California,” he conveyed his message to the “victims and their families of this past injustice,” lamenting, “our hearts are heavy for the pain caused by eugenics. It was a sad and regrettable chapter—one that must never be repeated.”1 There was one glaring absence however: someone on the receiving end to accept this official expression of regret. Unlike in Virginia, Oregon, and North Carolina, where those sterilized unveiled plaques, crowded into the government buildings to listen, and related their stories in newspaper features, the response in California was deafening silence.2 Six months later, after the Department of Health and the Senate Select Committee on Genetics, Genetic Techno
logies, and Public Policy had searched for victims through press announcements and institutional channels, only one person, a seventy-three-year-old man named Charlie Follett, living out of his Cadillac in the small town of Lodi, had come forward publicly.3 Sterilized at the Sonoma State Home in 1945 at the age of fifteen, Follett felt entitled to some form of compensation for his suffering and shame, describing his life as “miserable.”4

  How is it possible that in California, where more than twenty thousand sterilizations were performed, there is virtually nobody willing or able to tell her or his story, something that could attach a human face to the statistics, legislative files, and unnamed patient records that sit in boxes in the archives? In large part, the answer has to do with timing. Whereas in several other states, persons classified as mentally retarded or unfit to bear or rear children were sterilized, sometimes at increasing rates, into the 1960s, California’s program slowed considerably in the early 1950s. As of 2005, only about a dozen of the fifty patients interviewed in the 1960s by Robert Edgerton, a psychiatric anthropologist based at the University of California at Los Angeles, for a study of the psychological and emotional impact of the sterilizations carried out at what was once called the Pacific Colony, are still alive.5 These individuals, along with a tiny handful who contacted the state in late 2003, are emphatically not interested in sharing their personal experiences with journalists or historians.