What my Black mother’s involuntary sterilization in 1965 reveals about America today

This piece is adapted from Holy Ground: On Activism, Environmental Justice, and Finding Hope by Catherine Coleman Flowers, published by Spiegel & Grau on January 28, 2025.

Just before Christmas in 1965, my mother was recovering from the birth of her fifth child, David, at the John A. Andrew Memorial Hospital, on the campus of the Tuskegee Institute in Alabama. She was twenty-six years old. By all measures it should have been a very happy holiday season for my parents—not just because of the arrival of the baby, but also because this was the year that the Voting Rights Act was signed into law by President Lyndon Johnson, one year after the 1964 Civil Rights Act was passed. Two momentous markers for those who had devoted so much of their lives to the Civil Rights Movement. Deep systemic racism remained, but there must have been a feeling of real hope for Black parents all over the South. Hope that their children would be safer, better educated, and have more economic and social possibilities because they would grow up in a world that was free, or maybe just freer, from the Jim Crow horrors that had scarred their lives.

And yet, while my mother was in the hospital, physicians had decided that her reproductive life should end. While she was in labor, she was told that she had to consent to tubal ligation in order for the doctor to deliver her baby. Tubal ligation, what is casually called “having your tubes tied,” was part of a national program, sanctioned by state governments, that sterilized women. That the hospital was for poor women without insurance was another way that the medical establishment preyed on low-income people.

This process of forced and involuntary sterilization was referred to by activist Fannie Lou Hamer, with the mordant humor that emerges from righteous fury, as “Mississippi appendectomies.” In Hamer’s case, she had gone to the hospital to have a uterine tumor removed in 1961, and while she was thoroughly sedated, the doctors decided her reproductive organs should go as well. Why not? Hamer was poor and Black and likely fertile. As a Mississippi congressman had reportedly said, forced sterilization was designed to “stop this black tide which threatens to engulf us.”

It is impossible to quantify how many mostly poor and mostly Black women were sterilized at the same time as my mother and Hamer. Each state had its own programs, and, even then, individual doctors could improvise with few consequences. But in 1970, during the height of the Nixon administration, when both the House and the Senate were controlled by the Democrats, Congress passed the Family Planning Services and Population Research Act. It sounds quite innocuous, doesn’t it? But, in fact, in what can only be described as eugenics, the act sanctioned and subsidized sterilizations of Medicaid recipients and Indian Health Service patients. The grim numbers demonstrate its efficiency: 100,000 to 150,000 poor and mostly Black and Native women were sterilized every year until 1979, when federal sterilization guidelines were enacted to protect women from the procedure.

The John A. Andrew Memorial Hospital was founded in 1892 as Alabama’s only hospital for Black people. It was one part of the compound created by Booker T. Washington that included a prestigious university, all designed to educate and support the Black community. In 1913, the hospital was renamed in honor of Andrew, the former governor of Massachusetts, an abolitionist who advocated for the inclusion of Black troops not just in the Union forces but in the US military. But in 1965, while my mother was in the maternity ward, in another area of the hospital, immoral experiments conducted by the US Public Health Service and the Communicable Disease Center on almost four hundred Black men who suffered from syphilis were entering their thirty-third year. The project would continue for another seven years before the practice was exposed to the press and finally ended in 1972. Not before an appalling human cost: 128 patients died of syphilis or related complications, forty wives were infected, and nineteen children were born with congenital syphilis.

But this was not yet revealed in the Christmas season of 1965. Since 1919, Alabama had led the way among states in forcing the sterilization of people who were considered by racist and eugenicist state legislators to have demonstrated their unfitness to be a part of society. Sterilization was mandatory for people who were in hospitals, prisons, or orphanages or who were considered to be intellectually disabled, or “feebleminded,” as they disparagingly said back then. The revelations from Hitler’s eugenicist Germany—which engaged in similar practices—slowed the enthusiasm in the US, but it was revived again in the 1950s, continued, and then was further supported by the government act through the 1970s. In some teaching hospitals, poor Black women were not told what was taking place. They were used by medical students to perfect their technique in performing sterilizations, much like cadavers. This was the case for my mother.

The assault on the human rights of women was federally sanctioned and federally funded through a program in which doctors had carte blanche to sterilize women and adolescent girls and others they deemed unworthy of becoming parents. On the occasions that they actually did inform these women of what was going to happen, doctors quashed any protest by threatening to cut off welfare support or refusing medical services—delivering their children in a hospital, for instance. This violent act on women’s bodies gained some of its diabolical power from the secrecy surrounding the most intimate aspects of women’s lives. Yes, people knew that it was going on, but what leverage did they have?

Finally, they found recourse in the justice system. After decades, this degrading and inhumane practice emerged from the shadows on July 17, 1973, when the Southern Poverty Law Center filed a lawsuit on behalf of two mentally disabled sisters, Mary Alice and Minnie Lee Relf. Mary and Minnie were the youngest of six children in a Montgomery family. Their parents were illiterate, and their father had been injured in an accident and unable to work. Oh, yes, and of course they were African American. In other words, they were perfect victims in an unjust system. The girls were twelve and fourteen years old, and boys had begun visiting them. One day, city social workers picked the girls up, told their mother that they were going to a family planning clinic to receive birth control shots (which, by the way, had not yet been tested on humans), and instead were taken to a hospital.

Minnie Lee, also illiterate, was the older sister and was given a consent form that she signed with an X. Informed consent technically granted, both girls were given tubal ligations.

Their parents were not permitted to visit them for three days. When they returned home, their father saw the scars on Minnie Lee’s body. Jessie Bly, a Black social worker in the hospital, found out what had happened and told the girls’ parents, which in turn led their father to demand answers. He was told they had been sterilized because they had “signed” the consent form. Bly then took the family to the Southern Poverty Law Center, which had been aware of the practice but had not yet found a suitable case to file. This one fit the bill, and the organization sued the federal government and brought the story to public attention. Senator Edward Kennedy from Massachusetts even invited the girls’ parents to testify in Congress.

Between the congressional hearings and the wide publicity the Relf case received, my parents had heard of the case—as had everyone in Alabama. But for my mother, this was personal in more ways than one. At the time, she was an organizer for the National Welfare Rights Organization, a nonprofit group that fought for women’s and children’s dignity, justice, democratic participation, and income equality. It was founded in 1966, when a group of welfare activists met and decided that a grassroots organization for poor people all across the country was necessary in order to galvanize their power within the broad framework of the Civil Rights Movement.

My mother became involved in the Alabama branch of the organization a few years later, working in the community to reach out to poor women and families to help them with their benefits and inspire them to get involved politically. In this position, when news of the Relf case broke in March 1973, she was tasked with finding and talking to women who had been sterilized, just as she had been. That part wasn’t hard. Within the informal networks that existed at the time, women all over the community spoke to each other about the case and urged their sisters and friends to step forward if they too had suffered this terrible treatment.

A new dimension of my mother was revealed to me. In her quiet way, even with her sunny disposition, she carried with her the dignified but burning rage of Black women who had been grievously wronged for their entire lives. Then, when the time was right—and the story of Mary Alice and Minnie Lee made the time right—she deployed that rage for the good of others.

When my mother was sterilized, I was seven years old and, of course, I didn’t know anything about it. After all, as the oldest child, I was a seasoned veteran of my mother being pregnant, leaving for a few days, and returning with a squalling baby. I seem to remember that it felt as if she was gone for a longer time when she gave birth to my youngest brother, but I didn’t think twice about that. In 1973, when I was fifteen, the word spread about her work with the National Welfare Rights Organization. I will never fully know the backstory, but I assume that journalists were in touch with the Alabama branch of the ACLU, which was in touch with the National Welfare Rights Organization, who identified my mother as a good source for a story about the issue, as she was both a victim and an advocate.

A television reporter from Montgomery, a lawyer from the American Civil Liberties Union, a local reporter from the NBC affiliate in Montgomery, and a reporter and crew from the BBC appeared at our house in Lowndes County. My brothers were wearing their ironed white shirts, my sister and I wore nice dresses, and we all quietly watched the proceedings in our front yard as the BBC reporter interviewed my mother, who shared her story.

My parents got married a year after I was born, but their devotion had long preceded my birth. They met in Birmingham in 1957, and when my father saw young Mattie Debardelaben walking down the street, he smiled and said to his friends, “Here comes my wife.” He must have been struck by her serene manner, her caring expression, and her quiet elegance. I always thought that my mother was tall—she had a bearing that made her appear to be—but in fact, she was only five feet two inches, just like me. She was dark-skinned with wide-set, heavy-lidded eyes, and when she smiled her dimples were revealed. She was a proper lady, who always wore lipstick and nail polish. And when it was time for church, my mother chose from a vivid collection of hats.

My father was about five feet nine inches and usually dressed in the gray or blue work clothes that were basically his uniform—except when he went to church, or when he was being interviewed with my mother by the BBC. They were both very community-oriented. My mother was more of a teacher, thoughtful, soft-spoken, providing guidance to young women who sought her out. Most of her jobs were as an organizer or an advocate. Her mother had died when she was fifteen years old, leaving eight motherless children behind. My mother was the youngest, and she had five siblings who lived in Detroit, a brother who lived in Birmingham, a brother in New Jersey, and her oldest sister, Eula, whom we affectionately called Aunt Honey, who stayed in the family’s hometown in Autauga County.

My father was an only child, but most of the people in Lowndes County were in some way related to him. He treasured being part of a big family. That was one of the things that led to my interest in genealogy: I could not understand how someone with no siblings could have so many cousins. When I heard my father speak—many people said he had the voice and the measured, articulate style of Dr. King—he reminded me of a preacher. Folks would ask him where his church was because of his powerful, charismatic presence.

And so, as the cameras rolled and the reporter took notes, the two of them spoke about what had happened to my mother. What struck me as I listened to them were the years of pain that my mother had never shared, the suffering I had never known about, and the injustice that was never addressed. As children, we didn’t really have access to the intimacy our parents shared as a couple, but during this interview, the love, care, and profound mutual respect that bound them for more than four decades was undeniable. In speaking out that day, my mother was encouraging other women to tell their stories and share them publicly. Much like during the wastewater crisis many years later, people were ashamed of their circumstances, locked in their need for privacy. When she spoke that day, she referred to other women who had undergone the same experience in Tuskegee and showed the world that one didn’t need to have been young or developmentally disabled or impoverished to have been violated. You could be articulate, married, and respectable and still have been victimized by a brutal system.

In 1974, the girls finally won their lawsuit, Relf v. Weinberger (Caspar Weinberger was the head of the Department of Health and Human Services at the time). Judge Gerhard Gesell, a judge in the powerful United States District Court for the District of Columbia, wrote in his decision, “The dividing line between family planning and eugenics is murky.” He described the forced sterilizations in the 1970s as having “improperly coerced” poor women and banned the use of federal funds for any sterilization that was performed without informed consent. He also made sure that local welfare departments could no longer threaten poor women with the loss of their public assistance if they refused to submit to being sterilized. This abominable program was finally shut down in 1979 when federal guidelines outlined very clear protections, even for people who might have sought the end of their reproductive lives.

In December 2015, when these women were well past middle age, the US Senate passed a measure to address the horrors that had been inflicted, but only three states—Virginia, North Carolina, and California—created programs to compensate victims. North Carolina set up a $10 million fund for victims, though only a limited number of women were deemed eligible. Two hundred twenty women in North Carolina received about $45,000. In Virginia, the victims were given $25,000. In California, an unknown number of women, many of them Hispanic, were sterilized in the LA County General Hospital. In 2022, the state legislature created the California Forced or Involuntary Sterilized Compensation Program, and it included both an awareness campaign and funds for survivors from state hospitals or prisons. Finding the victims, however, after so much time has passed, has proven difficult.

 As for the Relf sisters, they received nothing. No damages, no financial compensation. Alabama offered nothing to those who had been sterilized, and the federal government has not intervened. Minnie Lee and Mary Alice, now in their sixties, survive on their Social Security checks.

We never saw the BBC documentary. We never spoke much about what my mother had endured. Life, of course, goes on, and ten years later, in 1983, I visited friends in Chattanooga, Tennessee. I left Atlanta, where I lived at the time, to go on the trip, even though I wasn’t feeling very well. Once I arrived in Chattanooga, I started experiencing extreme bouts of nausea and had a sharp pain in my right side. Alarmed, I called the physician I had been seeing in Atlanta to ask for guidance. “When you come to see me,” he said dismissively, “I am going to remove your uterus because it is rotten anyway.” He suggested some aspirin and went no further. His nurse overheard the conversation, called me back, and said her sister worked for a doctor in Chattanooga. She asked for my permission to put her sister in touch with me, which of course gave. She offered a final bit of advice before hanging up: she told me never to see the Atlanta doctor again.

I was really getting concerned at this point. The pain grew more intense, and I thought that maybe the source was my appendix. I spoke to the nurse’s sister, and she immediately got me an appointment with the Chattanooga physician. He had a kind bedside manner, suspected I had an infection, ordered a pregnancy test, and sent me to the hospital across the street for further tests.

A short time later, I lay on a gurney, sedated but aware of what was going on around me. I was in the hospital’s operating room and faced emergency surgery. as he entered, I overheard the anesthesiologist say, “I can’t give her this medication—she’s pregnant.” There I was, in a twilight state of consciousness, and I felt a burst of excitement at the thought that I was carrying a child. Only a moment later, I learned that I could not carry this pregnancy to term. The pregnancy was irrelevant, my doctor said, because it was an ectopic pregnancy, which is to say it was a nonviable pregnancy located in a fallopian tube.

Helpless and unable to speak, I learned they were going to perform surgery to try to save the tube where the embryo had implanted. When an embryo implants in a fallopian tube, surgery is essential to prevent the tube from rupturing and creating life-threatening internal bleeding. Was this some kind of nightmarish replication of what doctors had inflicted on my mother and so many other Black women? I trusted these doctors; it was clear that they had located the cause of my discomfort. And yet, rationally and irrationally, I felt the danger of becoming another link in the long chain of victimized, experimented-on, mutilated Black women. Times have changed, I thought. It is a thing of the past. But the horrifying question was impossible to ignore: Would they sterilize me too?

That did not happen. But a quieter lack of respect did. I consented to the surgery generally but without being told that I was pregnant and that the surgery involved resectioning my tube—removing the embryo and then reconnecting the fallopian tube to my ovary. I would have liked to have been told that I was pregnant. I would have liked to have known that they had to resection the tube in order to save my life. At no moment did anyone say to me, “Catherine, you are pregnant. But the pregnancy is complicated and cannot be carried to term.” That would have made a world of difference. My demeaning treatment notwithstanding, the operation saved my life. And yet, I had always longed to be a mother, so when I recovered from this ordeal, I grieved.

I write this after the Supreme Court Dobbs decision overturned the constitutional right to an abortion and antiabortion legislatures all over the country have engaged in an orgy of restrictions on basic health care for women. I know that had I been in exactly the same situation in, say, Ohio, or Texas, or Louisiana today, the doctors might have been unsure of what to do. Not because they were not trained to recognize a life-threatening pregnancy gone awry, but because if they intervened medically, they could face criminal charges.

What had implanted in my fallopian tube was not a viable embryo at all, but tell that to Representative John Becker from Ohio. He had authored legislation in which surgery for abortion services would be covered by health insurance only to save a woman’s life—a standard that is almost impossible to regulate—or in the case of an ectopic pregnancy. But he had a unique approach to the latter that had nothing to do with best practices developed over decades. Under his plan, the physician would be required “to re-implant the fertilized ovum into the pregnant woman’s uterus.” This is medically impossible, just to be clear. And, depending on the state, this could have happened to me—not during the Jim Crow era, but in the twenty-first century in the richest country on the planet. I would have been left to suffer, possibly go septic, with the threat of death before my situation would be deemed a sufficient emergency to require help.

Because of my ectopic pregnancy and the effects of the surgery, becoming pregnant without medical intervention was impossible for me. Yet I longed to be a mother, so I looked into vitro fertilization, a procedure known as IVF. My partner would have to inject hormones into my body so my egg production could be stimulated, and then some would be extracted and fertilized with my partner’s sperm. Then, if successful, the embryo would be implanted in my womb. For some IVF patients, those embryos would be frozen and stored, so parents could have the potential for larger families in the future. IVF has been performed millions of times; about 2 percent of all babies in the US, or more than eight million, are the result of IVF. It was a process that seemed thankfully distant from the hideous abortion wars.

Until the Alabama Supreme Court made sure it wasn’t.

When some frozen embryos in a reproductive-medicine clinic in Mobile were mistakenly destroyed, the couples insisted that these were not mere embryos but actual children and sued the hospital under a state law, the Wrongful Death of a Minor Act. On February 16, 2024, the court ruled, in an 8–1 decision, that the embryos were minors and, as Justice Tom Parker wrote in his concurring opinion, “Human life cannot be wrongfully destroyed without incurring the wrath of a holy God.” The majority opinion asserted that there was no “unwritten exception to that rule for unborn children who are not physically located ‘in utero’—that is inside a biological uterus—at the time they are killed.”

This ruling seemed to panic even conservative lawmakers, and our Republican-dominated state legislature immediately passed a law that offered “civil and criminal immunity for death or damage to an embryo to any individual or entity when providing or receiving goods or services related to in vitro fertilization,” including retroactively.

Indeed, it appears that the court this time had gone too far, and it is heartening to see the enraged response. But this is a costly procedure, with a single IVF cycle running about $23,000; many patients require more than one cycle. FertilityIQ, an information service, notes that the average patient will spend close to $50,000 in treatment, much of which is not covered by insurance. I am happy about the outrage. Relieved to see the pushback. But I am acutely aware that when middle-class and wealthy women’s bodies are the issue, the constituency representing them is robust. For poor women, not so much.

And so, over these many years, Black and Indigenous and Hispanic and white women, barely adolescent girls and older women, have all had the agency of their bodies seized by others with the explicit goal of controlling their reproductive lives. I think of enslaved women—my great-great-grandmothers, their sisters and friends, and other enslaved women whose bodies were trafficked and raped on the plantations of my home state. Whose children were seized and sold like animals. Whose capacity to bear children was considered either an asset or a liability but rarely something deeply personal, something that demanded autonomy.

Yes, I know that we have made great progress since the time when plantations dominated our economy. And yet, as we see too often with our justice system, with our economic system, with our political system, and with our medical system, the plantation mentality endures.