Sterilizing the Sick, Poor to Cut Welfare Costs: North Carolina's History of Eugenics

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Shaping the U.S. Gene Pool Through Sterilization

From today's vantage point, government-mandated sterilization feels more like science fiction than history, but during the 1930s and 1940s, the concept of eugenics was widely discussed and supported among many medical professionals and politicians. The concept was simple: don't let those with "bad genes" have kids, and over time the American gene pool will become healthier, stronger, better.

In a landmark 1927 Supreme Court case that legitimized compulsory sterilization of the "unfit", Justice Oliver Wendell Holmes, Jr wrote: "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."

Long-time proponent of eugenics, Dr. Clarence Gamble, of Proctor & Gamble fame, wrote in a 1947 article, "Tomorrow's population should be produced by today's best human material." He bemoans that only one in 41 people with severe mental illness have been sterilized to date, writing, "this means that for every one man or woman who has been sterilized, there are 40 others who can continue to pour defective genes in to the state's blood stream to pollute and degrade future generations."  

Though eugenics advocates at the time may have believed they were actually working towards a stronger gene pool, scientists' limited understanding of genes at that time meant that eugenics as public policy merely opened the doors to rampant discrimination against virtually anyone with an "undesirable" trait: alcoholics, those who were depressed, "promiscuous" women pregnant out of wedlock, and ultimately, poor men and women on welfare, who were often shuffled through the system under the vague and clinically meaningless diagnosis of "feeblemindedness."

This flexibility meant that some states kept their programs alive long after eugenics fell out of favor following World War II (a result of the glaring similarities noted between the Nazi sterilization programs and those in the U.S.). Especially in the south, sterilization programs merely shifted their focus on which populations were to be "controlled".

"Starting in the 1950s, I think a lot of sterilization was about racism," says Kluchin. "After WWII, welfare expands, the rate of illegitimacy expands and this anxiety grows among middle-class white people that a culture of poverty is being propagated in these rural, poor, black areas."

North Carolina sterilization program was at its peak during the civil unrest and exploding welfare costs of the 1960s, says Johanna Schoen, an associate professor of history at University of Iowa and expert in the North Carolina sterilization program.

It was the only state where social workers had the right to suggest "clients" for sterilization and the eugenics board seldom turned down those recommended -- they had a 95 percent acceptance rate. What's more, the program created a climate where doctors felt entitled to take sterilization into their own hands, doling them out when they saw fit, she says.

Instead of sterilizations taking place in mental institutions, in a few southern states they became more common in rural hospitals where poor unmarried women would be sterilized without their knowledge after coming in to give birth. In North Carolina, 85 percent of sterilization were performed on women as young as 9-years-old.

"Mississippi appendectomies, they were called," Kluchin says, "because they would tell women that they needed to get their appendix out, but then sterilize them." For women, the procedure involved an incision to the abdomen and the tying off of the fallopian tubes. If done correctly, this doesn't affect hormones or libido, making it possible for women to live their entire lives unaware that they had been sterilized.

Sterilization was seen as a way to cut welfare costs, "by sterilizing the daughters on welfare," says Schoen.

Though it's unlikely that the U.S. would ever return to this approach, the attitudes driving the sterilization of those on welfare isn't so foreign to us today, says Schoen: "Many people today think that women on welfare shouldn't have children outside of marriage." It's only a short jump to "shouldn't be allowed to have children," she says.

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