Available maternity leave options may also help lower the impact of children on career advancement, or the  motherhood penalty . There currently exists a "family gap" between the pay of mothers and nonmothers. In the United States prior to the passage of the FMLA, mothers typically earned 70% of men's wages while nonmothers earned 90%. [ 13 ]  These earning disparities partially stemmed from insecure employment return prospects. Women without maternity leave protection were often forced to start over with a new employer following their absence. [ 87 ]  This interrupted their career progression and burdened them with the additional task of seeking new employment. Such factors ultimately impeded equitable access to income and career opportunities. Women as a group notably experience increasing  income inequality  as they age illustrating the impact of motherhood on their wage prospects. However, the implementation of FMLA addressed some of these impediments through the introduction of mandatory maternity leave. Mothers now are more likely to return to their previous employer due to this increased legal protection. [ 88 ]  The policy minimizes some of the negative externalities of motherhood by maintaining women's employment options even following maternity leave. Many policy experts though suspect that the remaining gender imbalance is largely attributable to the dearth of paid leave options. [ 13 ]  Women who worked for companies that provided paid maternity leave before they gave birth are more likely to take such leave for up to 12 weeks, and more likely to return to work more quickly thereafter. [ 89 ]


Under the current FMLA system, approximately 40% of United States workers are ineligible for benefits due to the brevity of their tenure or the smallness of their firm. [ 35 ]  These excluded populations are often low-waged and minority women thus furthering their already present disadvantage. In 2016, 38% of white working mothers qualified for and could afford to take unpaid leave under FMLA compared with 30% of African American women and 25% of Hispanic women. [ 34 ]  Moreover, the unpaid aspect of the current policy limits access to those who are economically well off. The United States Department of Labor reported that over a 22-month period in 1999 and 2000, 3.5 million people needed leave but were unable to take it due to affordability concerns. [ 90 ]  In the private sector, it was found that 12% of workers received paid paternity leave with 23% of workers in the highest-wage quartile receiving paid maternity leave versus 5% of workers in the lowest-wage quartile. [ 34 ]  The lack of monetary compensation may hinder the ability of women who are not as financially secure as others to balance employment with their family life. Upper-class women are more likely to take unpaid leave than lower-class women. In addition, more white women take unpaid maternity leave than black or Hispanic women. This imbalance contributes to the discrepancies in infant mortality between groups. [ 15 ]


Parental leave policy wordings may lead to lack of access for LGBTQ parents when there is a lack of gender neutral language and when the language in the policies emphasizes leave as available only for birth parents. [ 91 ]  Policies and researchers exploring parental leave policy may assume birth parents are female and non-birthing parents are male, which may exclude transgender and non-binary parents and lead to them being denied access to leave by not being written into the policy contracts themselves. [ 92 ]  This kind of language can exclude adoptive parents, non-biological mothers, and gay fathers. A report looking at the parental leave policies of the 44 largest companies in the US found that only a minority offered policies that were inclusive of LGBTQ families. [ 91 ] [ 93 ]  LGBTQ parents are also more likely to foster or adopt, two processes that often require longer time periods of parent-child bonding and can have uncertain timelines of care. [ 94 ]  These parents more than heterosexual ones are affected and denied important connection periods when there is a lack of inclusive parental leave policy. [ 91 ]  The decision for paid parental leave is left for approval from the organization, which may leave LGBTQ adoptive parents with limited or no formal leave. It is not common for there to be adoption benefits, in comparison with traditional birth leave. Paid parental leave may be more accessible by biological lesbian parents than by non-biological lesbian parents. [ 95 ]


Access to paid parental leave for LGBTQ people of color


From a more intersectional lens, lack of access to parental leave also harms LGBTQ parents that are also people of color. LGBTQ people of color face additional barriers to requesting leave, as a combination of anti-LGBTQ and racially motivated employment discrimination might lead them to feel less comfortable in requesting paid leave. [ 96 ]  According to a report by the Human Rights Foundation released in 2018, which included responses from 1,883 LGBTQ people that also identified as people of color, nearly 30 percent of respondents noted they were uncomfortable requesting paid leave, compared to 16 percent of white LGBTQ people. [ 96 ]  Additionally, only 40 percent of the survey respondents also reported that their company offers them paid parental leave. [ 96 ]  As LGBTQ parents of color are more likely to be in a lower socioeconomic status than white LGBTQ parents, lack of paid parental leave policies disproportionately impacts LGBTQ parents of color, that often cannot afford to unpaid leave. [ 96 ]


Access to paid parental leave for transgender parents


Transgender and non-binary parents face hurdles to paid parental leave due to the lack of gender-neutral language in their companies' paid leave policies. According to the Human Rights Campaign Foundation's 2018  Report on the Experiences of Transgender and Non-binary Respondents,  which surveyed 1,121 transgender and non-binary people in the United States, less than 40 percent of respondents say that their companies have inclusive paid family leave policies. [ 97 ]  Respondents also mentioned having less access in using sick leave in substitution for paid parental leave. [ 97 ]  Similar to LGBTQ people of color, non-cisgender parents are usually more likely to live in poverty and struggle more with taking unpaid leave in order to support their families after childbirth or adoption of a new child. [ 97 ]


California is the first state to offer paid paternity leave weeks (six weeks, partial payment). New Jersey, Rhode Island, [ 98 ]  and New York [ 99 ]  since passed laws for paid family leave. In the rest of the US, paternity pay weeks are not offered (therefore neither paternity paid leave weeks), but fathers have access to unpaid paternity leave to care for their newborns (without new income). [ 98 ] [ 100 ]  Often, fathers will take sick days or vacation time when they have newborns. There is also a growing number of fathers that go unpaid. Some employers are required by law to allow 12 weeks of unpaid family leave after the birth or adoption of a child. This law is under  FMLA  or Family Medical Leave Act. [ 98 ]  Fathers who have access to paid paternity leave give mothers the opportunity to engage in paid work, with a positive effect on female labor force participation and wages. [ 101 ]  In 2015, a larger proportion of working fathers than mothers who requested leave received paid leave. [ 102 ]


The United States military branches also show a minimal paternity leave. Although some branches give more time after the birth to take the leave, all branches give ten days. This type of leave is applicable to those who are married. [ 103 ]


Research shows longer paternity leave increases the father's engagement with a child, which leads to the child's improved cognitive and mental health outcomes and fewer behavior problems. [ 67 ] [ 101 ]  Studies have also found beneficial associations between paid paternal leave and mental health for first time parents. [ 104 ]


Paternity leave has also led to an increase of breastfeeding on behalf of the mother. Research has shown when fathers take paternity leave, the likelihood of mothers continuing to breastfeed increases. This is in relation to fathers providing help with everyday household chores while also providing direct support to the mother, reducing her stress levels and making breastfeeding easier. In return, the health benefits of the child also increase due to the advantages of breastfeeding. [ 105 ] [ 106 ]


The COVID-19 pandemic has greatly impacted families all across the United States. A survey from S&P Global and AARP conveyed how families are engaged with taking care of their children from home for more hours than they are accustomed to since the onset of the pandemic. [ 107 ]  The Families First Coronavirus Response Act, or the FFCRA, was implemented in order to allow parents or guardians to be able to look after their children due to COVID-19 related issues. [ 108 ]  This act will allow employees up to 80 hours of paid sick leave or 10 weeks of paid family and medical leave in order for parents to care for their children. [ 108 ]  This act does not affect the FMLA, which stipulates the 12 weeks of unpaid parental leave. Home family structures look differently due to the pandemic and policies are needed to reflect this change in society. The 12 weeks of parental leave may no longer be a good fit for some families and may increase financial strain individuals are already enduring due to the pandemic.


The United States is the only industrialized nation that does not offer paid  parental leave . [ 109 ]  Of countries in the United Nations only the United States, Suriname, Papua New Guinea, and a few Pacific island countries do not provide paid time off for new parents either through the employer's benefits or government paid maternity and parental benefits. [ 110 ]  A study of 168 countries found that 163 guarantee paid leave to women, and 45 guarantee paid paternity leave. [ 111 ]


The United States maternity leave policy is distinct for its relative scarcity of benefits in comparison to other industrialized countries. Thus, the legislation imposes relatively few restrictions on American firms and instead underscores employer discretion in the shaping of maternity leave policy. These firms are thus free to offer maternity leave policies on terms that are more aligned with  corporate interests . [ 35 ]   This United States policy differs greatly from most other western countries in terms of maternity leave provision. These stark maternity leave differentials are demonstrated in both the policy's length and compensation. The United States does not comply to international minimum standards. The  Maternity Protection Convention, 2000  requires at least 14 weeks of maternity leave. In the  European Union , the  Pregnant Workers Directive  requires at least 14 weeks of maternity leave; while the  Work–Life Balance Directive  requires at least 10 days of paternity leave, as well as at least 4 months of parental leave, with 2 months being non-transferable.


Studies show the current laws disproportionately impact minorities and low-income women, who are less likely to take unpaid leave. [ 34 ]  As of 2017, there had been no significant change in the proportion of women who received maternity leave in the past 20 years. [ 112 ]


Although the United States does not guarantee paid maternity leave, employers may provide paid leave if they choose. 11 states—California, Colorado, Connecticut, Delaware, Massachusetts, Maryland, New Jersey, New York, Oregon, Rhode Island, and Washington—and the District of Columbia currently offer paid family and medical leave. [ 113 ]


In the United States like other nations, child care is not always equally shared between mothers and fathers. In the United States, fathers can have some paid leaves if they live in California or other states with similar legislation (partial paid leave). In contrast, Slovenian fathers have 12 weeks of 100% paid paternity leave. In  Sweden , 480 days of 80% paid paternity leave weeks. In  Norway , 49 weeks of 100% paid paternity leave weeks or 59 weeks of 80% paid paternity leave. Finnish fathers have 11 partial paid leave weeks. [ 100 ] [ 114 ]


While no existing laws explicitly prohibit LGBTQ+ people from taking parental leave in the United States, critics have noted that the Family Medical Leave Act (FMLA) doesn't provide adequate substantial financial support to LGBTQ+ parents. However, The U.S. Department of Labor has explicitly advised employers to grant workers in  loco parentis  child-related FMLA leave. This allows non-biological LGBTQ+ parents to have legal parental rights to a child. Many LGBTQ+ family advocates have demonstrated how the act excludes many low-income workers. Those looking to take federal family leave are only eligible if they have been in the service of their employer for 12 months. For low-income LGBTQ+ families, taking 12 weeks of unpaid leave creates a massive financial burden. LGBTQ+ parents and social justice activists have advocated for stronger federal, state, and local policy on paid parental leave, as a result of the existing complications with FMLA. [ 18 ]


Pre-conception counseling in the United States  allows for optimization of  US prenatal care .  Pre-conception counseling  is a meeting with a health-care professional (generally a  physician  or  midwife ) by a woman  before  attempting to become  pregnant . It generally includes a  pre-conception risk assessment  for any potential  complications of pregnancy .


Obstacles to pre-conception counseling in the United States include:


Screening  and  monitoring  of women prior to conception is recommended to include the following: [ 4 ]


However, the overall lack of evidence precludes a recommendation for universal screening for  thyroid disease in pregnancy . [ 5 ]


Screening for rubella susceptibility by history of vaccination or by  serology  is recommended in the US for all women of childbearing age at their first  preconception counseling  visit to reduce incidence of  congenital rubella syndrome  (CRS). [ 4 ]  It is recommended that all susceptible non-pregnant women of childbearing age should be offered  rubella vaccination . [ 4 ]


Immunity status of varicella should be performed at the pre-conception counseling session, in order to prevent the occurrence of  congenital varicella syndrome  and other adverse effects of  varicella in pregnancy . [ 4 ]  Generally, a person with a positive  medical history  of varicella infection can be considered immune. [ 4 ]  Among adults in the United States having a negative or uncertain history of varicella, approximately 85%-90% will be immune. [ 4 ]  Therefore, an effective method is that people with a negative or uncertain history of varicella infection have a  serology  to check antibody production before receiving the vaccine. [ 4 ]  The  CDC  recommends that all adults be immunized if seronegative. [ 4 ]


It is recommended to screen for  domestic violence  at a preconception visit, because  domestic violence during pregnancy  a risk factor for  miscarriage , late entry into prenatal care,  stillbirth ,  premature labor  and  birth , fetal injury and  low birth weight , and detection can avail for specific counseling and intervention. [ 4 ]


There is evidence that direct interview screening result in a higher rate of reporting prenatal domestic abuse than a written, self-report questionnaire method. [ 4 ]


Education of women intending to be pregnant is recommended to include: [ 4 ]


Vaccination  and other prophylaxis of women intending to become pregnant is recommended to include: [ 4 ]


Pregnant patients' rights regarding medical care during the  pregnancy  and  childbirth [ 1 ]  are specifically a  patient 's rights within a medical setting and should not be confused with  pregnancy discrimination . A great deal of discussion regarding pregnant patients' rights has taken place in the  United States .


In Western countries, medical services used during labor and delivery have increased since the 1930s. Starting in the 1950s, with the  natural childbirth  movement gaining strength, concern increased over typical hospital practices during childbirth. These medical services included medications and procedures that were not always necessary –  some of which had potential to harm the mother, the baby, or both. Various health-related and  consumer  organization groups began to advocate for a pregnant woman's right to be informed about medical services related to pregnancy and childbirth and for her right to refuse such services. [ 1 ]


In the  United States , the  American College of Obstetricians and Gynecologists  (ACOG) acknowledged the legal obligation of physicians to obtain  informed consent  for procedures related to pregnancy and childbirth in 1974. [ 2 ]


A 1987 study found that, in the preceding decade, at least 22 hospitals in the United States sought direction from the courts regarding care for pregnant patients. Fifteen court orders were sought, all but one without careful study of the legal facts of the case. [ 3 ]


In re A.C. , 573  A.2d  1235 (1990), was a  District of Columbia Court of Appeals  case, that was the first American appellate court case decided against a forced  Caesarean section , although the decision was issued after the fatal procedure was performed. [ 4 ]  Physicians performed a  Caesarean section  upon patient Angela Carder (née Stoner) without informed consent in an unsuccessful attempt to save the life of her baby. [ 5 ]   The case stands as a landmark in United States  case law  establishing the rights of informed consent and bodily integrity for pregnant patients.


Advocates endorse a pregnant patient's right to participate in medical decisions that may affect her well-being and that of her child. Specifically, these include but are not limited to the right to know the effects and risks to both the woman and the child associated with a drug or procedure, as well as the right to know about additional and alternative treatments. [ 1 ] [ 2 ]


Some groups, such as the  American Hospital Association  in its "Patient's Bill of Rights", advocate additional rights, including rights to the following: [ 1 ] [ 2 ]


Slave breeding  was the practice in  slave states  of the United States of  slave owners  systematically forcing slaves to have children to increase their wealth. [ 1 ]  It included coerced  sexual relations  between enslaved men and women or girls,  forced pregnancies  of  enslaved women and girls due to forced inter inbreeding with fellow slaves in hopes of producing relatively stronger future slaves. [ 1 ]  The objective was for slave owners to increase the number of people they enslaved without incurring the cost of purchase, and to fill labor shortages caused by the  abolition of the Atlantic slave trade . [ 2 ]


The laws that ultimately abolished the  Atlantic slave trade  came about as a result of the efforts of  British abolitionist  Christian groups such as the  Society of Friends , known as Quakers, and  Evangelicals  led by  William Wilberforce , whose efforts through the  Committee for the Abolition of the Slave Trade  led to the passage of the  1807 Slave Trade Act  by the  British parliament  in 1807. [ 3 ]  This led to increased calls for  abolition in America , supported by members of the  U.S. Congress  from both the North and the South, as well as President  Thomas Jefferson . [ 4 ]


At the same time that the importation of enslaved Africans was being restricted or eliminated, the United States was undergoing a rapid expansion of  cotton ,  sugarcane , and  rice  production in the  Deep South  and the West. The invention of the  cotton gin  enabled the profitable cultivation of short-staple cotton, which could be produced more widely than other types; this led to  the economic preeminence of cotton  throughout the Deep South. Enslaved people were treated as a  commodity  by owners and traders alike, and were regarded as the crucial labor for the production of lucrative cash crops that fed the  triangular trade . [ 5 ] [ 6 ]


The enslaved people were treated as  chattel  assets, similar to the legal treatment of farm animals. Enslavers passed laws regulating slavery and the slave trade, designed to protect their financial investments. The enslaved workers had no more rights than a cow or a horse, or as infamously put by the  U.S. Supreme Court  in the case of  Dred Scott v. Sandford , "they had no rights which the white man was bound to respect". [ 7 ]  On large plantations, enslaved families were separated for different types of labor. Men tended to be assigned to large field gangs. Workers were assigned to the task for which they were best physically suited, in the judgment of the  overseer . [ 8 ] [ 9 ]


The  prohibition on the importation of slaves  into the United States after 1808 limited the supply of slaves in the United States. This came at a time when the invention of the cotton gin enabled the expansion of cultivation in the uplands of short-staple cotton, leading to clearing lands cultivating cotton through large areas of the Deep South, especially the  Black Belt . The demand for labor in the area increased sharply and led to an expansion of the internal slave market. At the same time, the  Upper South  had an excess number of enslaved people because of a shift to mixed-crops agriculture, which was less labor-intensive than tobacco. To add to the supply of enslaved people, enslavers looked at the fertility of enslaved women as part of their productivity, and intermittently forced the women to have large numbers of children. During this time period, the terms "breeders", "breeding slaves", "child bearing women", "breeding period", and "too old to breed" became familiar. [ 10 ]


Planters in the Upper South states started selling enslaved people to the Deep South, generally through slave traders such as  Franklin and Armfield . Louisville, Kentucky, on the  Ohio River  was a major slave market and port for shipping slaves downriver by the Mississippi to the South.  New Orleans  had the largest slave market in the country and became the fourth largest city in the US by 1840 and the wealthiest, mostly because of its slave trade and associated businesses. [ 11 ]


In the  antebellum  years, numerous individuals who escaped from slavery wrote about their experiences in books called slave narratives. Many recounted that at least a portion of enslavers continuously interfered in the sexual lives of the enslaved people, usually the women. The slave narratives also testified that enslaved women were subjected to rape; arranged marriages; forced intercourse and sexual violation by enslavers, their sons or overseers; and other forms of abuse.


The historian  E. Franklin Frazier , in his book  The Negro Family , stated that "there were masters who, without any regard for the preferences of their slaves, mated their human chattel as they did their stock." [ 12 ]  Ex-slave Maggie Stenhouse remarked, "Durin' slavery there were stockmen. They was weighed and tested. A man would rent the stockman and put him in a room with some young women he wanted to raise children from." [ 13 ]


Some experts suggest that there may have been several factors that coalesced to make the  forced reproduction  of enslaved people a common practice by the end of the 18th century, chief among them the enactment of laws and practices that transformed the view of enslaved people from "personhood" into "thinghood". In this way, enslaved people could be bought and sold as chattel without presenting a challenge to the  religious beliefs  and  social mores  of the society at large. All rights were to the enslaving owner, with the enslaved individual having no rights of  self-determination  either to their own person, spouse, or children.


Slaveholders began to assert that slavery was grounded in the  Bible . This view was inspired in part by an interpretation of the  Genesis passage  "And he said, Cursed be Canaan; a servant of servants shall he be unto his brethren." (Genesis 9);  Ham, son of Noah  and father of Canaan, was deemed the  antediluvian  progenitor of the African people. Some white people used the  Bible  to justify the economic use of slave labor. The subjugation of the enslaved person was taken as a natural right of the white enslavers. The second-class position of the enslaved person was not limited to the relationship with the enslaver but was to be in relation to all white people. Enslaved people were considered subject to white persons. [ 14 ]


In a study of 2,588 slaves in 1860 by the  economist  Richard Sutch, he found that on slave-holdings with at least one woman, the average ratio of women to men exceeded 2:1. The imbalance was greater in the "selling states", [ clarification needed ]  where the excess of women over men was 300 per thousand. [ clarification needed ] [ 15 ]


Ned Sublette , co-author of  The American Slave Coast , states that the reproductive worth of "breeding women" was essential to the young country's expansion not just for labor but as merchandise and  collateral  stemming from a shortage of  silver ,  gold , or sound  paper tender . He concluded that enslaved people and their descendants were used as human savings accounts, with newborns serving as  interest  that functioned as the basis of money and  credit  in a  market  premised on the continual expansion of slavery. [ 16 ]


Robert Fogel  and  Stanley Engerman  reject the idea that  systematic  forced reproduction was a major economic concern in their 1974 book  Time on the Cross: The Economics of American Negro Slavery . [ 17 ]  They argue that there is very meager evidence for the systematic breeding of slaves for sale in the market in the Upper South during the 19th century. They distinguish systematic "breeding"—the interference in normal sexual patterns—by enslavers with an aim to increase fertility or encourage desirable characteristics—from  pronatalist  policies, the generalized encouragement of large families through a combination of rewards, improved living and working conditions for fertile women and their children, and other policy changes by masters. They point out that the demographic evidence is subject to a number of interpretations. Fogel argues that when slave owners intervened in the private lives of slaves, it actually had a negative impact on population growth. [ 2 ]


Sterilization law  is the area of law, that concerns a person's purported  right  to choose or refuse  reproductive sterilization  and when a given government may limit it. In the United States, it is typically understood to touch on  federal  and  state   constitutional law ,  statutory law ,  administrative law , and  common law .
This article primarily focuses on laws concerning compulsory sterilization that have not been  repealed  or  abrogated , i.e. are still  good laws , in whole or in part, in each  jurisdiction .


"We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. [...] Three generations of imbeciles are enough."


In  Buck v. Bell , the  United States Supreme Court  ruled in a majority opinion written by Justice  Oliver Wendell Holmes Jr.  that a  state statute  that authorized  compulsory sterilization  of the unfit, including the  intellectually disabled , "for the protection and health of the state" did not violate the Due Process clause of the  Fourteenth Amendment to the United States Constitution .


In  Skinner v. State of Oklahoma , the  United States Supreme Court  ruled that an Oklahoma compulsory sterilization law that applied to "habitual criminals" but exempted those convicted of  white-collar crimes  violated the  Equal Protection Clause  of the  14th Amendment . [ 2 ] [ 3 ]


Stump v. Sparkman  (1978) is the leading  United States Supreme Court  decision on  judicial immunity . It involved an  Indiana  judge who was sued by a young woman who had been  sterilized  without her knowledge as a minor in accordance with the judge's order. The Supreme Court held that the judge was immune from being sued for issuing the order because it was issued as a judicial function. The case has been called one of the most controversial in recent Supreme Court history. [ 4 ]


In 2007 the  United States Court of Appeals for the District of Columbia Circuit  heard  Doe ex. rel. Tarlow v. District of Columbia . The Court upheld a 2003  District of Columbia  statute that stated the conditions for authorizing a non-emergency surgical procedure on a mentally incompetent person. [ 5 ]   Under the Appellate Court's interpretation of the statute, a court located in the District of Columbia, must apply the "best interest of the patient" standard to a person who was never competent, and the court must apply the "known wishes of the patient" standard to a person who was once competent.


In the 2001 case of  Vaughn v. Ruoff , a husband and wife sued three social workers for coercing his wife, "diagnosed as mildly retarded", into getting a sterilization as a condition for getting their children back from state custody. [ 6 ]  The  United States Court of Appeals for the Eighth Circuit  held that the social workers did not have  sovereign immunity  and could be sued for violating the couple's Fourteenth Amendment right because the procedural due process requirements for performing a sterilization are clearly established by  Buck v. Bell  and were not met in this case. [ 6 ]


In 1975, in Cox v. Stanton, the  United States Court of Appeals for the Fourth Circuit  decided the  statute of limitations  for a lawsuit challenging the legality of a sterilization begins to accrue when the plaintiff discovers the sterilization. [ 7 ]


Poe v. Lynchburg Training School & Hospital  concerned whether or not patients who had been  involuntarily sterilized  in  Lynchburg Training School and Hospital , a state mental institution in  Virginia , as part of a program of  eugenics  in the early and mid-20th century had their constitutional rights violated. [ 8 ]


Under 22  United States Code  section 2151b, foreign aid used for population planning and the combat of HIV, tuberculosis, and malaria may not be used to fund "a program of coercive abortion or involuntary sterilization. [ 9 ]


The  Veterans Health Administration  or V.A. permits the sterilization of a patient, who is unable to give informed consent, if the guardian of the patient gives consent to the procedure; a witness, not associated with the V.A., witnesses the guardian signing the consent form; a healthcare committee completes a finding on the need for the procedure; and the Director of the facility approves of the procedure. [ 10 ]


The Office of the Assistant Secretary for Health, Health Resources and Services Administration, National Institutes of Health, Centers for Disease Control, Alcohol, Drug Abuse and Mental Health Administration and all of their constituent agencies are only authorized to perform a sterilization on a patient if the individual is at least 21 years old, mentally competent, gave informed consent to the procedure, and at least 30 days but not more than 180 days passed since the individual gave consent to the procedure. [ 11 ]  "Programs or projects to which this subpart applies shall not perform or arrange for the performance of a sterilization of any mentally incompetent individual or institutionalized individual." [ 12 ]


Indian Health Service  (IHS) is an operating division within the  United States Department of Health and Human Services .  The IHS offers sterilization as a method of family planning.  Tubal ligation and vasectomy are the only procedures which may be performed for the primary purpose of sterilization.  The IHS requires for the patient to give informed consent to the operation, be at least 21 years of age, and not be institutionalized in a correctional or mental health facility. [ 13 ]


A state plan must provide that a  Medicaid  agency will pay for the sterilization procedure if the individual is at least 21 years old, mentally competent, voluntarily gave informed consent to the procedure, and must be done for a purpose other than for "rendering the individual permanently incapable of reproducing." [ 14 ]  Medicaid will not pay "for the sterilization of a mentally incompetent or institutionalized individual." [ 14 ]


State sterilization laws are required to be in compliance with the United States Constitution.


In 1935 Dr W. D. Partlow proposed a bill to sterilize those with hereditary " mental disease ". [ 15 ]


In 1981 the  Alaska Supreme Court  held that an  Alaskan Superior Court  has the authority to order the sterilization of a "mental incompetent" person upon petition by their legal guardian if it is proven with clear and convincing evidence that sterilization is in the intellectually disabled person's best interest. [ 16 ]


Arkansas Code section 20-49-101 to -207 provides the guidelines for sterilizing an incompetent patient. [ 17 ]


In 1991, the  Arkansas Supreme Court  held the part of the Arkansas sterilization statute that allowed sterilization of an incompetent through direct medical channels, rather than approval from a court, to be unconstitutional because it denied the patient procedural due process.
 [ 18 ]


In 2013, the  4th District Court of Appeal  held that a developmentally disabled adult with "mild mental retardation" may be reproductively sterilized if the court determines there is clear and convincing evidence that the procedure is medically necessary for the patient. [ 19 ]   The court held that Probate Code section 2357 regulated the patients court order for medical treatment because the sterilization was incidental to acquiring medical care and not the purpose of the medical treatment; alternatively, Probate Code section 1950 et seq. applies when the objective is to prevent the patient from bearing children. [ 19 ]


In 1978, a federal  class action  lawsuit was brought from  Los Angeles County, California , involving the sterilization of  Mexican American  women. Most of the women were monolingual Spanish speakers and testified that they did not understand that the procedures they were undergoing would affect their ability to become pregnant or sustain a pregnancy. [ 20 ]


In 1985, the  Supreme Court of California  held that a California statute that completely prohibits the sterilization of the developmentally disabled is overbroad and unconstitutional because a mentally incompetent person has a constitutional right to sterilization if a less intrusive method of birth control is not available. [ 21 ]


The California Penal Code prohibits inmates from being sterilized unless the procedure is required to protect the life of the inmate or the procedure is necessary for treating a diagnosed condition and the patient gave consent to the procedure. [ 22 ]


Colorado Revised Statutes section 25.5-10-233 governs court-ordered sterilizations. [ 23 ]


In 1981, the  Colorado Supreme Court  held that a district court may authorize the sterilization of a "mentally retarded person" if the court finds with clear and convincing evidence the procedure is medically essential. [ 24 ]   The Court defined "medically essential" as a procedure that is "clearly necessary, in the opinion of experts, to preserve the life or physical or mental health of the mentally retarded person. [ 24 ]


In 1990, the Colorado Supreme Court held that a person "mentally incompetent to make some decisions is not necessarily incompetent . . . to grant or withhold consent to sterilization." [ 25 ]   Three members of the Court dissented from the majority opinion and stated that the "individual’s capacity to understand the risks of pregnancy and childbirth [should also be part of] the test for determining one’s competence to make a decision regarding sterilization." [ 25 ]


A person unable to give informed consent may only be sterilized if a  Connecticut Probate Court  determines it is in the patient's best interest. [ 26 ] [ 27 ]


A person unable to give informed consent may only be sterilized or given an abortion with specific authority from the court. [ 28 ]  The court must find clear and convincing evidence the person is unable to give consent and the procedure is in the best interest of the individual. [ 29 ]  The statute expressly states that these requirements "are procedural and do not establish any new or independent right to or authority" over the individual regarding abortion or sterilization. [ 29 ]


A court may authorize for a surrogate to provide consent to the sterilization or abortion of another person, [ 30 ]  after the surrogate petitions the court, provides supporting documents on the intent of the patient, gives notice to all relevant parties, and a hearing is conducted to review the matter. [ 31 ]


Under Florida statute § 985.18, delinquent children ordered by the court to undergo psychological or physical health exams may not be given a "permanent sterilization" unless the procedure is medically necessary "to protect or preserve the life of the child." [ 32 ]


Under Georgia Code, an incompetent person may be sterilized after a petition requesting sterilization is brought by the parents or guardians, two physicians examine the patient, the hospital in which the sterilization is to be performed approves of the sterilization, and after a hearing the judge finds by clear and convincing evidence the patient is a person subject to this code. [ 33 ]


In 1983, the Supreme Court of Georgia held the Georgia sterilization code unconstitutional because it used the “preponderance of the evidence” standard, and a court order that permanently deprives a person of a fundamental right requires a judicial finding of “clear and convincing” evidence.
 [ 34 ]   Since this case, the Georgia legislature changed the code to require “clear and convincing” evidence in order to comply with the requirements of the Constitution. [ 33 ]


The beginning of the Eugenics movement in the islands of Hawaii have been traced back to the early 1900s when a plan to sterilize all persons that were deemed “unfit” for procreation was uncovered. The group of unfit peoples included those of low income, Native Americans, deadly criminals, and those diagnosed as criminally insane. In 1950, sterilization of women after they give birth, if considered unfit to procreate, was happening. This kind of sterilization was found to have been happening on plantations. [ 35 ]  Doctors would say it was necessary for the mothers to stay healthy. As of 2010 there was a movement to pay “former and current drug users” approximately $200 to voluntarily be sterilized. This movement was named “Project Prevention.” [ 36 ]  This was created in order to prevent “medical disabilities” from being passed down from generation to generation. Project Prevention was very controversial with people claiming was, “promoting stereotypes and prejudices against pregnant women.” [ 36 ]


In 2008 the  Illinois Appellate Court  held that in determining a petition for the sterilization of an incompetent ward, a court should apply the substituted consent standard if there is clear and convincing evidence regarding how the ward would decide if the ward were competent; however, the court should apply the best interest of the patient standard if the ward's substituted judgment cannot be proven by clear and convincing evidence. [ 37 ]


In 1907, Indiana enacted the first sterilization law. [ 38 ] [ 39 ]


In 1983, the  Indiana Supreme Court  authorized for the sterilization of a mentally ill twelve-year-old girl who engaged in self-destructive behavior such as pulling her hair, biting herself, banging her head, ripping her skin with her fingernails, and resisting the "restraints in order to hurt her own body." [ 40 ]   The patient's parents and her doctors were both in agreement that a hysterectomy was necessary in order to prevent "hemorrhaging and infection, and possibly death" because the patient's excitement with her own blood may cause her "to induce bleeding by poking into her vagina or abdomen in an attempt to keep the blood flowing" once she develops her menstruation cycle. [ 40 ]   The Court held that a specific Indiana statute authorizing sterilization was not necessary in order to authorize the sterilization, the juvenile court had the authority to authorize sterilizations if there was clear and convincing evidence that the medical procedure was necessary, and in this case there was overwhelming evidence that the sterilization was medically necessary. [ 40 ]


In 1990, the  Indiana Court of Appeals  held that an appointed guardian may consent to health care for an adult incapable of consenting if there is "clear and convincing evidence that the judicially appointed guardian brought the petition for sterilization in good faith and the sterilization is in the best interest of the incompetent adult." [ 41 ]  Judge Sullivan wrote a concurring opinion stating that he was not convinced that in this present case the sterilization was done for healthcare, and consequentially, the consent of the guardian is not a factor in considering the legality of the sterilization.  According to Sullivan a sterilization of an incompetent requires "an evidentiary hearing, following which the court finds clear and convincing evidence that sterilization is in the best interests of the individual concerned. [ 41 ]


In 2003, the Supreme Court of Indiana recognized the medical malpractice tort of " wrongful pregnancy " when a woman became pregnant after a failed sterilization procedure. The court decided that the damages may include the cost of the pregnancy but may not include the ordinary cost of raising the child. [ 42 ]


In 1988, the  Iowa Supreme Court  held that a district court has jurisdiction to authorize the sterilization of an incompetent person, even in the absence of an Iowa statute regulating sterilization. [ 43 ]


In 2014, the Iowa Supreme Court held that court approval is required for the sterilization of an incompetent person. [ 44 ]


Under Title 34 B Chapter 7 of the Maine Revised Statutes, also known as the "Due Process in Sterilization Act of 1982," a  hearing  and a  District Court  order authorizing the sterilization is required if the sterilization is sought for "A. Persons under age 18 years and not married or otherwise emancipated; B. Persons presently under public or private guardianship or conservatorship; C. Persons residing in a state institution providing care, treatment or security, or otherwise in state custody; or D. Persons from whom a physician could not obtain informed consent." [ 45 ]   The hearing to determine the patient's ability to give  informed consent  requires at least two disinterested experts in developmental disabilities or mental health, including at least one psychologist or psychiatrist to examine the person to determine competency.  If the court determines the person is not competent to give informed consent the court will appoint at least three disinterested experts to examine the person for the beneficial or detrimental effects of sterilization. [ 45 ]  The sterilization may be authorized if the court determines with  clear and convincing evidence  that the sterilization is in the  best interests  of the patient and other methods of contraception are inappropriate or unworkable for the person. [ 45 ]


In 1985, the  Maine Supreme Judicial Court  heard a petition from a mother requesting for the court to authorize the sterilization of her mentally incompetent daughter. [ 46 ]   The court held that it did have the authority to grant a petition for sterilization if it is proven with clear and convincing evidence the sterilization is in the best interest of the patient; however, in this case, the court did not grant the petition because the physicians did not state the patient was capable of reproducing. [ 46 ]


In 1982 the  Maryland Court of Appeals  held that circuit courts have the jurisdiction to hear a petition for the sterilization on an incompetent minor.  The court may only approve of the petition for sterilization if it is proven with clear and convincing evidence that the "procedure is medically necessary to preserve the life or physical or mental health of the incompetent minor." [ 47 ]


In Maryland, a minor has the same capacity as an adult to consent to the use of contraception other than sterilization. [ 48 ]


In 1982 the  Appeals Court of Massachusetts  held that a court of general jurisdiction has the authority to hear a petition to sterilize a mentally retarded person.  The court stated that the court must use substituted consent to determine if the sterilization should be authorized, and "no sterilization is to be compelled on the basis of any State or parental interest." [ 49 ]


In 1991 the Appeals Court affirmed the substituted consent standard and wrote that "the guardian's petition" to authorize an abortion for their borderline retarded daughter "should have been allowed." [ 50 ]


In 2012 the Appeals Court overturned a decision by a lower court requiring a sterilization and abortion on a woman with "schizophrenia and/or schizoaffective disorder and bipolar mood disorder."  The appellate court wrote that the lower court did not follow the due process requirements for a sterilization and the decision to require the abortion was not made using the substituted consent standard. [ 51 ]    The lower court judge later stated that she required the abortion because she believed that if the patient were healthy she "would elect to abort the pregnancy to protect her own well-being." [ 52 ]   Rima Kundnani wrote that this case shows how "proper standards must therefore be established to avoid judicial abuse and to protect the reproductive rights of mentally ill women." [ 53 ]


In 1998 the  Michigan Supreme Court  held that a probate court has jurisdiction to hear a petition by a guardian for authorization to consent to an extraordinary procedure, including sterilization, if the procedure is in the ward's best interest. [ 54 ]


In 2022, Michigan voters passed  Proposal 3 , which amended the  Constitution of Michigan  to establish an individual right to reproductive freedom. Proposal 3 defines the right to reproductive freedom to include the right to make decisions about sterilization. [ 55 ]


The sterilization law passed in Minnesota in 1925 stated that anyone of any age that was determined to be “feeble minded” was legally able to be sterilized, with or without permission. Around 1930, Minnesota began to be known as “the most feeble minded-conscious” state because of the way they care for the mentally disabled. Out of the population, around 2,350 people were victimized by this sterilization. 519 of these victims were men and 1,831 were women. Throughout the 1930s, sterilization rates were high, but as the war broke out, it became less of a priority and rates dropped tremendously.  [ 56 ]


As the 26th state to pass any kind of sterilization law, Mississippi began the first sterilization on an inmate. The people affected by this law were “persons who are afflicted with hereditary forms of insanity that are recurrent, idiocy, imbecility, feeble-mindedness or epilepsy.” Approximately three people every year from the year 1938 to the year 1941 were involuntarily sterilized. Mississippi is rated number eighteen for most sterilizations of all stated in the United States. [ 57 ]


Laws considering sterilization in Missouri began by targeting criminals and slowly began to include people with any incurable disease, epilepsy, and eventually all with mental disabilities. Currently, one must be at least 21 years of age in order to be sterilized. [ 58 ]


In total, 256 people were affected by sterilization in Montana. Around 74% of those people were women and 28% were men. These laws began in the early 1920s and peaked around the mid 1930s. They targeted the “idiots, feeble-minded, insane, and epileptics, who are inmates of state institutions.” [ 59 ]


More than half of all people who were sterilized were deemed to be "mentally deficient." This sterilization was ended in 1963 .  [ 60 ]


In the early 1900s, it was mandatory to sterilize all men by “means of vasectomy (but not castration)” if they were found to be guilty of child molestation. This law was not repealed until around 50 years later.  [ 61 ]


In 1980 the  New Hampshire Supreme Court  held that a probate court may approve a petition for the sterilization of an incompetent minor if a  guardian  ad litem  is appointed to represent the minor and the court finds with clear and convincing evidence that the sterilization is in the best interest of the patient. [ 62 ]


In 1980, the  New Jersey Supreme Court  held that a mentally disabled woman has the right to be sterilized under the privacy rights of both the New Jersey and Federal Constitutions; however, the incompetent must be represented by counsel and the court may only authorize the sterilization if there is clear and convincing evidence the sterilization is in the person's best interest. [ 63 ]


In 2011, the New Jersey Division of Mental Health and Guardianship Advocacy brought an appeal to challenge the procedures the court followed to authorize the sterilization of a severely mentally disabled girl for reasons of medical necessity. [ 64 ]  The Division recommended more stringent procedures; however, the Superior Court dismissed the issue as moot because the girl was already sterilized. [ 64 ]


In 1983, the  New York Supreme Court  authorized the sterilization of an incompetent person. [ 65 ]   In 2002, a New York County Court authorized the sterilization of a woman with an intellectual disability who gave informed consent to the procedure. [ 66 ]


Under North Carolina General Statutes § 35A-1245, a mentally ill or mentally retarded patient who is unable to give informed consent may be sterilized with an order of the  clerk or court  after the clerk appoints an attorney to represent the patient and the clerk determines the sterilization is "medically necessary and is not solely for the purpose of sterilization or for hygiene or convenience." [ 67 ]


In 1985, the  North Carolina Supreme Court  held that a court has authority to authorize the sterilization of an incompetent person if the sterilization is in the best interest of the patient. [ 68 ]


In 2013, the General Assembly of North Carolina passed an appropriations bill to give compensation, up to $50,000 per person, to individuals sterilized under the authority of the  Eugenics Board of North Carolina . [ 69 ] [ 70 ]   However, in 2016, a claimant was denied compensation for her involuntary sterilization because the sterilization did not occur under the authority of the Eugenics Board, so the Court was unable to allow compensation for the claimant. [ 71 ]


In the early 1900s a law was passed allowing the sterilization of inmates and “so-called defectives, though it rarely happened with only thirty-nine known cases. Around ten years later, the law was deemed “invalid” because the basic human rights of each individual were not being accounted for. In a ten-year span, around 580 people were reported being sterilized.  [ 72 ]


Under Ohio statutory law, "no resident shall be subjected to sterilization without the resident's informed consent" except as provided in the statute. [ 73 ]


In 2004 the  Supreme Court of Ohio  vacated part of a decision from a lower court that required for the defendant to make “all reasonable efforts to avoid conceiving another child” during his five-year probationary period. [ 74 ]


Under the Oregon Revised Statutes section 436.305, a court has the authority to order a sterilization on a patient who is unable to give informed consent if a hearing proves with clear and convincing evidence that the "sterilization is in the best interest of the individual. [ 75 ]  Under the statute, "Best interest” means that: (a) The individual is physically capable of procreating; (b) The individual is likely to engage in sexual activity at the present or in the near future under circumstances likely to result in pregnancy; (c) All less drastic alternative contraceptive methods, including supervision, education and training, have proved unworkable or inapplicable, or are medically contraindicated; (d) The proposed method of sterilization conforms with standard medical practice, is the least intrusive method available and appropriate, and can be carried out without unreasonable risk to the life and health of the individual; and (e) The nature and extent of the individual's disability, as determined by empirical evidence and not solely on the basis of standardized tests, renders the individual permanently incapable of caring for and raising a child, even with reasonable assistance." [ 76 ]


In 1972, the  Oregon Court of Appeals  upheld the sterilization of a seventeen-year-old mentally ill girl with a history of sexual and physical abuse by her family. The Court based its decision on the recommendation of the State Board of Social Protection and the testimony of a psychiatrist who stated that the patient would never be able to provide parental guidance and judgment, saying, "she would never be able to provide the parental guidance and judgment which a child requires even though she might be able to master the skills necessary to take physical care of herself and a child." [ 77 ]
The psychiatrist "based this conclusion on the girl's lack of emotional control, her consistent low scores in areas of judgment on psychological tests, and the likelihood that she would abuse a child." [ 77 ]


In 1993, the  Superior Court of Pennsylvania  held that a mentally incompetent patient may be sterilized without her informed consent if there is clear and convincing evidence the sterilization is in her best interest. [ 78 ]


It was not until the late 1900s that it became legal for “patients and doctors” to be sterilized by choice. Information regarding Rhode Island is difficult to find because proper records were never kept and most documentation was lost. Due to Rhode Island being a predominantly Catholic state, birth control such as sterilization was never made mandatory for any reason. [ 79 ]


No sterilization laws were ever passed in Tennessee, though bills have been created. In the mid 1960s a bill was created to pass sterilization for mentally ill patients. Tennessee was a part of a series of surveys regarding mental stability in the southern states. An institution was then created for the “feeble-minded” as a result. Tennessee eventually supported said institution. [ 80 ]


In 2012, Katie Barnhill wrote that minimal laws exists in Texas for courts and guardians to know what to do if a non-medically necessary sterilization is in the best interest of the mentally incompetent person. [ 81 ]  It was stated in the mid 1800s that those with “undesirable traits” such as those who come from low income or who are mentally ill should be sterilized.  [ 82 ]


Vermont does not have any kind of documentation regarding their sterilization laws open to the public. “Our understanding” of any laws that were created in regards to sterilization in this state is that all types of sterilization was completely voluntary.  [ 83 ]


An act, passed by the  General Assembly of Virginia  in 1988 and amended in 2013, provides the procedural requirements necessary for a physician to lawfully sterilize a patient capable of giving informed consent and incapable of giving informed consent. [ 84 ]


A physician may perform a sterilization procedure on a patient if the patient is capable of giving informed consent, the patient consents to the procedure in writing, and the physician explains the consequences of the procedure and alternative methods of contraception. [ 84 ]


A court may authorize a physician to perform a sterilization on a mentally incompetent adult or child after the procedural requirements are met and the court finds with clear and convincing evidence the patient is or is likely to engage sexual activity, no other contraceptive is reasonably available, the patient's mental disability renders the patient permanently unable to care for a child, and the procedure conforms with medical standards. [ 84 ]


In 1980, the mother of a mentally incompetent minor petitioned the court for an order authorizing the sterilization of the minor. [ 85 ]  The  Washington Supreme Court  held that the  Washington Superior courts  have authority under the Washington constitution to grant the sterilization; however, the mother failed to show with clear and convincing evidence the sterilization was in the best interest of the minor. [ 85 ]


In 1991, the  Washington Court of Appeals  heard a petition for sterilization brought by the parents of an incompetent child named K.M. [ 86 ]  The Court held that the sterilization of a mentally incompetent patient can be constitutional; however, the incompetent must be represented by independent counsel and the attorney must take an adversarial role in defense of the incompetent’s reproductive rights. [ 86 ]  Two physicians testified in support of K.M.’s psychological need for sterilization, however; the Court held that K.M.'s attorney did not take an adversarial role because the physicians and witnesses should have been cross examined, and every argument in defense of K.M. should have made. [ 86 ]  The Appeals Court “remanded for a new hearing, with counsel appointed to represent K.M.” [ 86 ]


The  Ashley Treatment  occurred in Washington state.


West Virginia allows sterilizations on competent non-minors who give informed consent to the procedure. [ 87 ]


Under section 54.25 of the Wisconsin Statutes, a court may determine that a person who was found incompetent has incapacity to consent to a sterilization procedure. The guardian may not provide substituted consent for the incompetent person, unless the court determines the "individual is competent to exercise the right under some but not all circumstances." [ 88 ]


In 2001, the  Wisconsin Supreme Court , in  State v. Oakley , upheld a lower court's decision to impose a probation requirement that prohibited a man from having more children "unless he shows that he can support that child and his current children." The Court held that the condition was reasonably related to Oakley's rehabilitation and not overly broad because Oakley already had nine children and intentionally refused to pay child support, and Oakley was eligible for prison so the condition was less restrictive than prison. Additionally, the Court held that the restriction satisfies  strict scrutiny  since the restriction was narrowly tailored because Oakley could have not intentionally refused to pay child support, and the restriction met the State's compelling interest of having parents support their children. [ 89 ]


Sterilization of Latinas  has been practiced in the  United States  on women of different Latin American identities, including those from Puerto Rico [ 1 ]  and Mexico. [ 2 ]  There is a significant history of such sterilization practices being conducted involuntarily, [ 3 ]  in a coerced or forced manner, [ 4 ]  as well as in more subtle forms such as that of constrained choice. [ 5 ]  Forced sterilization was permissible by multiple states throughout various periods in the 20th century. Issues of state sterilization have persisted as recently as September 2020. [ 6 ]  Some sources credit the practice to theories of racial  eugenics . [ 3 ]


The movement of eugenics developed into the Neo-Eugenics movement. [ citation needed ]  This Neo-Eugenics movement supports and studies the encouragement of people with more desirable traits to reproduce in order to positively influence the population's gene pool and the discouragement of people with undesirable traits to reproduce. This led to the practice of preventing people with undesirable traits to reproduce. Undesirable traits correlated with reproductive fitness which included race and ethnicity. [ 7 ]  In the late nineteenth and early twentieth century, the immigration rates in the United States spiked along with the reproduction rates in immigrant families. This provoked a deeper fear from eugenicists that native born Americans and Americans with strong reproductive fitness would be outnumbered by immigrants who possess a low reproductive fitness. [ 7 ]  This fear became ingrained into many Americans across the nation and became fuel for the sterilization of Latinas movements in the twentieth century.


Some of the factors that  may catapulted the movement behind the sterilization abuse in Latina women in the state of California, began with one of the earliest organizations in eugenic sterilizations in the U.S., the Human Betterment Foundation (HBF), the Sterilization Act of 1909, and the Immigration Act of 1924. The California Act of 1909 was one of the major legal and political influences that established authority for doctors and psychiatrists of state hospitals and mental institutions to perform sterilizations on the people unfit to function in society because of their intelligence levels, presumed future deviant behavior and sexual activity. With that established, organizations such as the Human Betterment Foundation came to be the organization that held these ideologies and promote eugenic sterilizations and the Immigration Act of 1924 further developed the idea that labor-migrants were needed, but women and children were not as there was a fear of Latino and Immigrant invasion.


The  Human Betterment Foundation  operated in California from 1929 to 1942. In those years, the foundation specialized in researching eugenic sterilizations effects, providing literary contributions of their findings to the public. The foundation distributed literature, such as this in order to promote the efficacy of sterilizations among socially- Sterilizations during this time were promoted and imposed in state institutions.


In the pamphlet, the organization describes that the problem is families living on government assistance or "public charity" use more of the public charity than those families sustaining themselves more by 50 percent. [ 8 ]  The pamphlet stated that families whose children ended up in state homes were increasingly doubling, at a fast rate. The foundation too states that additional children to the state is a burden, but also that taxation rates were increasing because of more children being in need along with the notion that with more children from unfit parents would increase crime and delinquency rates. [ 9 ]


And another example of anti-Latino sentiment was with state authorities when dealing with minorities.  Immigrants that were feeble minded and at borderline intelligence were of the undesirable type. California's state authorities wrote in a survey conducted by the California State Board of Charities and Corrections that Latinos of low intelligence or mental sanity were of the undesirable types. [ 10 ]  State institutions that were allowed to perform sterilizations on patients that seemed like the perfect candidate, was very common. Current research shows that Latinas were targets for sterilization at higher rates than white women. The disproportion among sterilization rates in the Latino community could not be quantified in its current time, but data from sterilization forms suggest that 88 percent of Californians with a Spanish last name were of Mexican origin and descent. [ 3 ] [ 8 ]  The surnames of people in forms recommending institutionalized patients between 1920 and 1945 shows that Latino were more likely to be sterilized than non-Latino men and Latina women experienced sterilization at higher rates than non-Latina women. This data shows that there was an unfair application of the California law that allowed institutions to take health measures for other people on their behalf. [ 3 ]


This law passed in California in 1909, authorized medical staff like doctors and medical superintendents to perform sterilization procedures on both men and women deemed as feeble-minded, whose mental diseases, IQ, and intelligence could be passed down to future generations. A survey in mental deviations in prisons, public schools, and orphanages in California institutions reported worriness of feeble-mindedness and relation of intelligence to previous delinquency record. [ 10 ]  In their survey, they found that California had drawn a large proportion of immigrants of undesirable types and would therefore recommend them to sterilization processes. Later research shows that there the number of sterilizations were disproportionate to racial and ethnic minorities, such as people of low class and female gender. [ 11 ]   Research also suggests that Latinas were targets for sterilizations at higher rates than white women because data from sterilization forms collected, the number of people with Spanish surnames suggests that 88 percent of these patients were of Mexican origin and descent. [ 3 ]


Anti-miscegenation laws, along with the  Immigration Act of 1924 , contributed to the anti-immigrant sentiment that existed during the development of United States history. At this point in time, the United States was concerned with foreigners coming into the country in higher numbers and therefore enforced its first border patrol and regulated the number of foreign immigrants from south and eastern Europe, as well as permitting people from the southern people specialized in agriculture and work from the southern border. [ 12 ]  In the forgotten narrative of Latin American History, U.S., Mexican immigrants and citizens were labeled and seen as a problem in society because they were seen as hyper-fertile and supported theories that Mexicans were of a lower racial level. By the first half of the 20th century, almost 60,000 people had been sterilized under the different U.S. Eugenics Programs implemented. [ 13 ]


The history of sterilizations in the United States and  Puerto Rico  can be defined as an intersectional form of oppression that connects race, class, and sex to the social, political, and economic status of Puerto Ricans. The oppressive nature of these procedures lie within the fact that they were politically backed and used within the court of law against Puerto Ricans. Other women on the island experienced an increase in surveillance and control of their body within social realms. This illustrates how sterilizations were conducted on a continuum and had vast as well as long lasting consequences. In 1947, 7% of mothers aged 20–49 received tubal ligation which almost doubled in 1954 as sterilizations increased on the island to 16%. By 1965, over 34% of Puerto Rican women within this age bracket received sterilizations, which is five times the rate two decades prior. [ 14 ]  Sterilization was the most heavily promoted method of contraception in Puerto Rico and was legitimized by concerns of population, which can be associated with the same concerns of race and class that date back to the island's annexation. [ 14 ] [ 15 ]


After the US gained  ownership of Puerto Rico , it was viewed as a province in urgent need of a way to prevent greater poverty and population rates. This heavily influenced the US decision to begin sterilizing Puerto Rican women and implementing experimental birth control methods. Puerto Rican women in particular have served as test subjects for various contraceptive studies in the United States, [ 16 ]  of which included involuntary sterilization. Many Puerto Rican women were sterilized from the 1930s to the 1970s in order to decrease poverty and population growth in Puerto Rico. [ 17 ]


Concerns about the population density in Puerto Rico can be traced back to 1898 when Puerto Rico became a US colony. [ 14 ]  These concerns from scholars, scientist, and government officials inform the thought process behind the association between poverty, health, and economy with population throughout the 20th century.


When Americans began to occupy the island of Puerto Rico, they asserted more than their ideals and beliefs. American colonizers asserted absolute dominance over Puerto Rico due to the idea of  Manifest Destiny , which greatly shifted the dynamics of the island. The U.S. capitalized on the fact that Puerto Rico utilized a large fraction of its resources to gain independence from Spain, which left the island's economy depleted. During this time, many Puerto Ricans lost land while their natural resources became exploited.  In the mid-1920s, Puerto Rico's dependency on the production of sugar, devastated the island when the sugar market collapsed. [ 18 ]  Additionally, the nation-wide economic depression in 1927 exacerbated the effects of this collapse as well as the overall stability of the island. [ 18 ]  In 1928, Puerto Rico suffered the consequences of a hurricane in San Felipe. [ 18 ]   The Okeechobee Hurricane  resulted in over 300 deaths and property damages ranging from $50-$80 million, while the agricultural market also suffered. [ 18 ]  In the 1930s, Puerto Rican citizens began to experience the adverse health effects of  tuberculosis ,  malaria , diarrhea-enteritis,  hookworm , and dietary-deficiencies that were responsible for over 40 percent of deaths. [ 18 ] [ 19 ]  This later on gave medical professionals grounds to support sterilization on the island. [ 19 ]


Furthermore, these factors resulted in immense and widespread poverty. Many Puerto Ricans faced perpetual hunger and growing unemployment rates. In 1930, the median family income was reported to be approx. $250 a year and "economically productive families" were attributing around 94% of their income toward acquiring food. [ 18 ]  Additionally, 27% of the labor force was unemployed. [ 18 ]


The current state of Puerto Rico confirmed the ideals Americans projected in the midst of the island's annexation about the longevity and potential of Puerto Rico. [ 18 ]  Puerto Ricans were once again viewed as ignorant and devious as they participated in "reckless breeding" in the midst of this economic downward spiral. [ 18 ]  This caused many Americans and a fraction of Puerto Ricans to believe that overpopulation essentially was the cause of the wide variety of problems on the island.


Messages about Puerto Rico's increase in population began to spread rapidly by citizens, government officials, scientist, and industrial leaders/capitalist. In 1899, the population of Puerto Rico was less than a million and in 1917 was half of the population size that it would be four decades later. [ 18 ]  In the 1930s, Puerto Rico had a population growth rate of approximately 1.5%, while fertility rates were lower than developed and industrialized nations. [ 19 ]  According to Puerto Rico's planning report decades later, the island's population has grown from 687 people per square mile in 1960 to 793 in 1970. This growth continued as the population was 815 people per square mile in 1972, 863 people per square mile in 1973, and 871 people per square mile in 1974. Concurrently, the death rate decreased to 6.5 per 1,000 persons as the birth rate the year before was 23.3. As the population grew by 2 percent each year, Puerto Rico was predicted to have a total population of 4,339,000 by the year 2000, or 1,300 people per square mile. [ 20 ]  The current and predicted rates of population growth provoked a high level of concern, which made birth control the primary solution for health concerns, poverty, and this idea of overpopulation.


Operation Bootstrap  was enacted in 1948 and was the result of Puerto Rico's desire to attract outside capital by inviting U.S. private funds. [ 14 ]  Therefore, a tax arrangement was made by the U.S. to improve the industrial production on the island in an effort to increase profits and funnel money to the mainland. [ 19 ]  This economic development program enticed industries within the U.S. that were in search of "cheap labor, tax exemptions, and free trade between Puerto Rico and the mainland". [ 14 ]


This rapid foreign investment provided promise for disadvantaged Puerto Rican women who were struggling to navigate through domestic working conditions and limited job opportunities. [ 19 ]  Operation Bootstrap was marketed and believed to be an advantageous new service sector for women in search of white collar jobs. [ 19 ]  However, Puerto Rican women and the vast majority of the island experienced the exact opposite. Operation Bootstrap resulted in "high unemployment, increased migration, exacerbated poverty", and most importantly, economic colonization. [ 14 ]


United Nations Special Rapporteur on Violence against Women defines forced sterilizations as "a method of medical control of an individual's fertility without consent". Another source adds that sterilization abuse is "any procedure completed without the patient knowing they are being sterilized" as well as "when the patient is coerced or deceived in order to obtain the consent to the procedure". [ 21 ]  Many Puerto Rican women were manipulated through incorrect information, language barriers, incentivization, testing, and withholding information as they knowingly or unknowingly consented to sterilization. [ 21 ]  Although, in some cases sterilization was completely voluntary and consented. In fact, the Puerto Rican government conducted a study that stated that 83 percent of 3000 families supported sterilizations that were free. In 1968, 75 percent of the women that had sterilizations were upper and middle-class women that could afford the $100-$125 procedure. [ 22 ]  Although, the term "family" does not specifically state the perspective of the woman. Lastly, it is important to recognize that sterilization was a choice that was made in the setting of a few or no alternatives. [ 14 ]  As mentioned earlier, sterilization was the most promoted and harmful form of contraception in Puerto Rico. [ 15 ]


Due to a lack of educational materials distributed in Puerto Rico, many women had misconceptions about  tubal ligations . For example, one common misconception about sterilization is that the procedure is not permanent. A 1968 study reported that over one-third of Puerto Rican women were not aware that tubal ligation was permanent or irreversible. [ 23 ]  Some doctors did not even request consent while other doctors threatened to not deliver the baby right before delivery unless the mother consented to sterilization after birth. [ 24 ]  If mothers were receiving government assistance, many women were threatened to have their welfare terminated. [ 15 ]


Additionally, the U.S. government and institutions worked collaboratively to incentivize sterilizations. Many doctors and hospital administrators began to encourage sterilizations due to the fact that the Joint Committee for Hospital Accreditation refused to accredit hospitals in Puerto Rico "unless a ten percent limit of sterilization (in proportion to all hospital deliveries) was agreed upon". [ 19 ]  In the 1930s, Puerto Rican women began to occupy jobs within factories. The women working in these factories felt an immense amount of pressure to undergo a sterilization to prove to employers that their pregnancy would not deter them from completing their job. [ 14 ]  This same year, approximately three sugar plantations housed birth control clinics and discriminated against women that were not sterilized as they refused employment to women who would not get the procedure. [ 14 ]  Puerto Rican women on sugar plantations were discriminated against while others were incentivized to alter their reproductive capacity to become the ideal responsible and dependable female worker.


Coercive strategies experienced in the delivery room and at work, were also entrenched in the process of clinical trials for birth control pills in 1955. [ 25 ]  These trials took place in poor areas in Puerto Rico like  San Juan . Outside of San Juan, the Common Wealth Health Department controlled more than 19 free clinics. These clinics were reported to be operating at full capacity as approximately 1,000 sterilizations were completed a month. [ 22 ]  Within these clinics, low socioeconomic women were unknowingly being used as test subjects. [ 25 ]  Class inequality was apparent during these trials due to educated middle-class women fearing the side effects and refusing to try the new medication while poor-less educated women unknowingly became test subjects out of desperation to avoid pregnancy and ultimately sterilization. [ 25 ]  On many occurrences, these pills such as Enovid, contained an unusually high quantity of hormones compared to 21st century birth control pills. [ 25 ]  Doctors disregarded women that reported nausea, blood clotting, and depression. [ 25 ]  Three women allegedly died during the underground testing of this pill, but their deaths were never put to trial or investigated. In the mainland, testing for this pill, Enovid, continued and was approved in 1957 regardless of dangerous and adverse side effects. [ 25 ]  Additionally, poor Puerto Rican women in Ryder Memorial Hospital were tested on for six different variations of birth control along with the  IUD  in the 1960s. [ 19 ]  These same women were also subject to extremely long and extensive interviews so that the Population Council's International Population Program could document their marital and fertility histories. [ 19 ]  This same secrecy and oppression was experienced by Puerto Rican women as they were unknowingly being tested for the Depo Privera shot and contraceptive foam. [ 14 ]  Once the implications of sterilizations became more widely known, many women opted to take other forms of contraception during the dangerous phases of development to avoid the permanent procedure. [ 25 ]


In 1937, Law 116 legalized sterilization in Puerto Rico. [ 24 ]  This law implemented Eugenics Boards within 32 states that oversaw compulsory sterilizations. [ 24 ]  More specifically, the Puerto Rican Eugenics Boards reviewed and confirmed petitions from the government and private entities to inflict sterilizations amongst the perceived "insane", "feeble minded", "diseased", and "dependent". [ 21 ]  The purpose of the Puerto Rican Eugenics Board was to regulate the reproductive capacities of "socially inferior" and perceived undesirable Puerto Ricans. [ 21 ]  This led the Puerto Rican Eugenics Board to approve 97 sterilizations before it was dissolved. [ 24 ]  Additionally, a large purpose of Law 116 was to further the science of eugenics and incite economic growth. [ 21 ] [ 24 ]


Law 116 was the result of an increase of curiosity and political support for the science of eugenics. [ 24 ]  It was legitimized by the belief that Puerto Rico was a failing economy that consisted of "unfit" people that should be addressed by decreasing the population density through the means of forced sterilizations. [ 24 ]  Therefore, population control programs became institutionalized as well as federally subsidized. [ 24 ]  Funds from both the U.S. government and private investors enabled the last eugenics sterilization law passed under United States territorial jurisdiction. [ 20 ]  It also legalized state-mandated and forced sterilizations, which further exploited Puerto Ricans. [ 24 ]


Immigration of Mexican citizens into the United States caused much controversy in how well they had adjusted to the American life and culture. Because of this, starting in the early 20th century, they were deemed as a significant problem to the community as they were believed to be mentally weak due to their prolonged adjustment to the American culture.  The increase of city populations also led to the belief that mental health degraded, as more mental breakdowns seemed prevalent. This discrimination against Mexican and Mexican-Americans led to eugenics laws in which women were targeted and utilized in sterilization procedures. [ 26 ]


Starting in the year 1909, women of Mexican descent were used as targets for the eugenics movement to reinforce population control and purity. Women of all ages were victims of the many sterilization acts performed in hospitals, correction facilities, and asylums, but younger women were especially targeted. Pacific Colony (later known as  Lanterman Developmental Center ), a home designated for the mentally defective in LA, California, took in many young women and classified them as mentally defective and sexually delinquent starting in 1944. [ 27 ]  According to laws in California justifying sterilization acts, staff at this clinic deemed it was in the best interests of society to go forth with the procedure on some of the women who were sent here. [ citation needed ]


In Los Angeles, between 1969 and 1973, Mexican and Chicana (Mexican-American) women were also disproportionately targeted by involuntary sterilizations. A number of these women would go on to join a class action lawsuit,  Madrigal v. Quilligan ,  discussed below.


These Mexican and Mexican-American women were given the stereotype as "hyper-fertile" and were believed to lack the knowledge of birth control methods due to the high numbers of teen pregnancies occurring within their community. At the Hospital of LA County+USC, coercive sterilization was justified as it was an attempt to control the birthrate of these women. In 1998 the US government performed a census and multiyear analysis of Latino births and found the women of Mexican origin displayed the highest rate of childbirth compared to other Latina women. From these statistics, the "Save our State" campaign arose and worked to enforce more eugenic sterilization of these women. [ 28 ]


In 1973 an investigation by progressive anti-sterilization advocacy groups discovered the stories of Mary Alice's and Minnie Lee Relf's sterilization. This story was released by the Southern Poverty Law Center and led to the discovery of 16 thousand women and 8,000 men being sterilized using federal funds in 1972. In addition to this finding, they found more than three hundred of these patients were under the legal age of 21. Following this discovery and exposure, in 1977 Mexican-American began coming forth to file lawsuits in relation to coercive sterilization they faced while in labor. [ 1 ]


In 1979 a bill to repeal the eugenics laws passed that legalized sterilization was proposed to the legislature in California. Many women were coerced into have the tubal ligation procedure done right after postpartum which was paid for using federal money that was dispersed into the War On Poverty first initiated by Lyndon B. Johnson. [ 29 ]


Many of these sterilizations were done involuntarily and without consent. Oftentimes, these women signed off on paperwork without being able to read the English language. This sterilization was seen as a result of barriers experienced by Spanish speaking women. [ 7 ]  Other times, they were told it was necessary in order to maintain their welfare benefits. It became common to sterilize women after giving birth whether by tubal ligation or hysterectomy. Even when the women did consent, it was often under false pretenses that the procedure could be reversed if they decided to have children again in the future.


The film  No Más Bebes  tells the stories of several Chicana women sterilized at the Los Angeles County-USC Medical Center in the 1970s. They were part of a larger group of women who underwent sterilization without a proper form of consent. Many women only learned of their sterilization months and perhaps years later. Antonia Hernandez, the plaintiff's attorney in the  Madrigal v. Quilligan  (1978) lawsuit, is largely responsible for relaying such information, as she spent significant amounts of time patrolling Mexican American barrios searching for Chicana women listed on hospital documents. [ 30 ]  Hernandez and Charles Nabarette learned of the coerced tubal ligations from Dr. Bernard Rosenfeld, a resident at the teaching hospital. In the documentary, he compares the medical center's practices to the sterilization of Jews in Nazi Germany at the beginning of  World War II . Consequently, he was terminated for acting as a whistleblower, and nearly at risk of losing his medical license. The ten women who filed the lawsuit were U.S. citizens with varying proficiencies in the English language. The film reveals many justifications for the tubal ligations performed, including rushed, last-minute decision-making, misunderstanding of medical jargon, language barriers, and written signatures of consent. Dr. Edward James Quilligan, the main defendant on trial, claims that the hospital was simply “practicing good medicine” in one of his interviews for the documentary. [ 31 ]  He was dismissed from the case early on for playing a managerial role and maintaining no real presence during the performance of tubal ligations. Ultimately, the ten mothers fighting for financial compensation, accountability for medical physicians, and a shift in government policies lost the case. Federal judge Jesse Curtis Jr. ruled in favor of the hospital, concluding that the doctors were not aware of the harm sterilization would have on Mexican-American women. In essence, the judge used the anthropological analysis conducted by Carlos Velez-Ibanez to blame the Chicano subculture for the negative effects of sterilization. However, the case proved significant beyond an unsuccessful lawsuit; in the aftermath of  Madrigal v. Quilligan  (1978), consent forms were required in both English and Spanish, as well as a description of medical procedure in colloquial terms, and a waiting period of seventy-two hours before sterilization procedures. Translators were also readily available in California's hospitals in following years.


At a time where both the  Chicano Movement  and the  Abortion rights movement  were well underway, many Mexican-American women were pushed to the margins of both historical developments. The Chicana women interviewed in  No Más Bebés  (2015) briefly touched on experiences of neglect from white feminist developments; while Antonia Hernandez and ten immigrant mothers were fighting for the right to bear children, many white, women activists were advocating for the legal right to immediate sterilization. In other words, white women wanted to establish on-demand sterilizations while Chicana women were advocating against the harmful policy. [ 31 ]  The absence of a waiting period for (postpartum) sterilizations put non-white women like Maria Hurtado, Consuelo Hermosillo, and Maria Figueroa in direct danger of forceful sterilization. [ 32 ]  In essence, the racialization of Latina's bodies had profound effects on their inclusion in the Women's Rights Movement of the 1960s and 1970s. This plays a significant role in how the Abortion Rights Movement is remembered in particular; though it is often characterized by inclusive activism, the lived experiences of Mexican-American women prove otherwise.


Several women from the  No Más Bebés  documentary also expressed the disregard of Mexican-American men within the Chicano Movement. Though none of the women involved in the  Madrigal v. Quilligan  case directly participated in the Chicano Movement kickstarted by Cesar Chavez's United Farm Workers Movement, their lives were uprooted by postpartum sterilizations. In fact, as revealed by the documentary, many men within the Mexican-American community considered women who received sterilizations as “mujeres de la calle”; wanton street walkers who wanted to sleep with multiple men at the same time. [ 31 ]  Such a reaction from their male counterparts had harmful effects on immigrant mothers. Maria Figueroa was barred from testifying in the lawsuit by her husband, and even attempted suicide in the aftermath of losing the ability to bear children.


Gendered issues of bodily autonomy and sexual power relations were also a concern amongst Mexican-American women advancing the Chicano Student Movement. A lack of reproductive health counseling on college campuses contributed to the increasing dropout rates amongst Chicana students. Unplanned pregnancies and little to no access to birth control barred Chicana students from completing their undergraduate studies, though they tended to excel academically. [ 33 ]  There was also a general sense of skepticism amongst Mexican-American families about sending their children to American universities, as children were culturally expected to economically support their loved ones. Young Mexican-American women would also be expected to help raise their siblings—not have kids of their own just yet. Such a phenomenon across college campuses reflected a common double standard; Chicanos could enjoy their sexual freedom while assuming leadership positions in student activist groups while Chicana students were limited to supplemental roles in the movement and obligated to bear the brunt of an unplanned pregnancy.


Involuntary sterilization programs were in some instances supported and funded by the states. In  California , the rationale for forced sterilization was primarily for eugenics purposes, although this later shifted to a fear of overpopulation and welfare dependency. [ 34 ]


California passed the third law in the United States that allowed state institutions to sterilize "unfit" and "feeble-minded" individuals. As eugenics gained credibility as a field in science, sterilization rates increased, especially after the 1927  Buck v. Bell  U.S. Supreme Court decision, which upheld the constitutionality of sterilization laws in Virginia. See below. According to available data, California performed one third of all reported sterilization procedures in the United States between 1910 and 1960.


Although the Californian state was the third state to legalize sterilization as mentioned previously, it has made the greatest impact by performing over half of the sterilization procedures throughout the eugenics era from 1907 to 1979. Their laws granted prison authorities and asylum medical superintendents the right to sterilize a patient if it would be proven to better their conditions. It surpassed the other 32 states who had passed eugenics laws due to its large Latino incarceration rates and advocacy found within the eugenics movements. [ 29 ]  Between 1920 and 1945, over 17,000 individuals were recommended for sterilization in California. During this time, Latinas were at a 59% greater risk of being sterilized than non-Latinas. [ 3 ]  Eugenic philosophy claimed scientific legitimacy to uphold racial stereotypes of latino/as, deeming them as unfit and even "hyper-fertile, inadequate mothers, criminally inclined, and more prone to feeblemindedness." At a time of segregation and growing anti-Mexican immigration sentiment, eugenic programs have been linked to efforts to reduce immigration."Novak_2018" The unjust laws in California from 1909 to 1979 allowed for nonconsensual sterilization of over 20,000 individuals. [ 35 ]


The forced sterilizations in California began in 1909 when a eugenics law was passed. It allowed doctors to sterilize people who were thought to be "unfit" to have children at state hospitals. Before this law was nullified in 1979, more than 20,000 people, including teenagers were victims of this sterilization. Doctors recommended people who they thought should be sterilized for certain reasons; this included not only people with a medical condition but also perfectly healthy ones as well. Minors as young as thirteen years old were sterilized. This law was meant to keep the "undesirable population" from growing. Women of Latina Origin were 59% more likely to be sterilized than women who were not of latino descent.


An example of California's eugenic and neo-eugenic practices is a case from 1966.  Nancy Hernandez  was a 21-year-old mother of two in Santa Barbara, California. Nancy pleaded guilty, in 1966, for being with her boyfriend, Joseph Sanchez, while he used illegal narcotics. [ 36 ]  The judge that presided over the trial, Judge Kearney, requested that if she wanted to get probation then she must submit to sterilization. The judge's reason behind his decision was that if she acts immorally then she should not be allowed to have more children. Hernandez inevitably did not submit to forced sterilization and instead was sentenced to three months in jail. Following the trial Nancy's lawyer submitted a writ of  habeas corpus  and requested that Hernandez be released from the Court's Order. Hernandez's lawyer stated that Judge Kearney was using Hernandez to make the public consider what is moral or immoral and his decision was based on  neo-eugenic  principles and assumed that because Hernandez was a minority and in the presence of marijuana that she naturally would descend to non-moral conduct and should not have children. Kearney's main goal all along was to reduce the state's welfare expenditures through forced sterilization. Many citizens across America, when this case went National, felt that her drug related misdemeanor had nothing to do with her parenting skills and style. It seemed that many people in America agreed that there should be a punishment for her crimes, but that forced sterilization was never a fit punishment. [ 37 ]


Some other instances in California's sterilization practices in the 1960s and 1970s was shown in the movie,  No   mas   bebes,  multiple women and families discuss the impact of sterilization abuse on their mental health, their relationship, and their family planning. [ 38 ]  Many women reported that at the L.A. County hospital, throughout the 1960s and 1970s, that they were forced to submit to sterilization. Many of these women did not know that they had been sterilized until they found out through 26-year-old Chicana Lawyer and a whistle blowing doctor. These mothers mounted a civil rights lawsuit during the same time of  Roe v. Wade  and other  reproductive rights  justice movements.  These stories made many  Chicanas  and other women across the nation question their  government  and reproductive rights.


In Los Angeles, hundreds of Mexican women were sterilized after giving birth at Los Angeles County Hospital. In the documentary  No Mas Bebes , some of the women who were sterilized at this hospital shared their experiences. All of the women shown did not want to be sterilized. "In California, at least into the 1950s, compulsory sterilization was consistently described as a public health strategy that could breed out undesirable defects from the populace and fortify the state as a whole". [ 29 ]  Women who were unhappy with this situation marched and protested to speak up for their reproductive rights. [ citation needed ]


In 1973, Acosta was living in Los Angeles. She was a poor Mexican woman. She gave birth to a child with brain damage so he did not survive. The doctor sterilized her stating that her husband had given permission for a tubal ligation. The husband denied giving such consent. [ 39 ]  In an interview done by Claudia Dreifus Guadalupe stated "My nerves and my head are in great pain. Ever since the operation, I am very inattentive. Not forgetful, inattentive. People sometimes have to tell me things twice. I am not there". [ 40 ]  Guadalupe later gave more details about her experience at the hospital, her physician worked in an aggressive manner to induce her labor. She said that he pushed down her abdomen with great force and even hit her in the stomach due to her swinging arms. [ 41 ]  Acosta died in 2003. She had a baby in Mexico but it was taken away from her because he was born out of wedlock. The baby that she delivered at Los Angeles Hospital was her fourth baby. Her husband left her and her two kids due to her tubal ligation.


Jovita Rivera was one of the ten plaintiffs in the federal class action suit of  Madrigal v. Quilligan . On October 12, 1973, Rivera went to the USC-LA hospital to give birth to her second child. She was under medication and in labor pains when medical staff misinformed her about the risk and chances of getting pregnant right after birth. She consented and a tubal ligation was done. Rivera, 27 at the time, states that during her stay at the hospital, while in advanced labor and under pain medication due to complications, her doctor told her she would be a burden to the government. Women like Rivera were offered the choice of sterilization under poor circumstances, under medication, and with no language assistance for translation. Some of the other plaintiffs for this case faced hostility from staff when told they could receive more pain medication if they signed papers consenting to sterilization.


Rivera stated: "... the doctor told me that I had too many children, that I was poor, and a burden to the government and I should sign a paper not to have more children [...] The doctors told me that my tubes could be untied at a later time and I could still have children." [ 42 ]  While Rivera was under distress, she believed the process was reversible and consented. When Rivera and the other plaintiffs testified in court to prove that they had been coerced into getting a procedure, the judge did not rule in their favor.


Low-income minority women were more dependent on sterilization than other groups. [ 43 ]  In a study conducted in El Paso, Texas, groups of women were asked why they would choose sterilization; many of the top reasons included: not wanting any more children, their current age and health, plans of working or attending school or inability to afford another child. [ 43 ]


Indiana passed the first sterilization law in the United States, the 1907 Indiana Eugenics Law. It was proposed as a part of the  Progressive-era  wave in which public health advocacy began coming to light. [ 29 ]


As recent as September 2020, whistleblower complaints were filed concerning "the rate at which hysterectomies are performed on immigrant women under ICE ( U.S. Immigration and Customs Enforcement ) custody at ICDC". The whistleblower complaint also includes reports from many detained women who described "not understanding why they had received a hysterectomy" and even details "miscommunications" that led to patients receiving hysterectomies they may not have needed. [ 6 ]