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Editors' Picks Opinion

Do No Harm: Reflecting on a legacy of pain for black women and girls in the United States

It’s not difficult to imagine: Under fluorescent lights, the five men sitting down in sleek, comfortable office chairs in a building in Raleigh and reviewing the facts of the case. The “feebleminded” black girl was irredeemable, they thought. A life of promiscuity would naturally be her fate unless they, the Eugenics Board of North Carolina, intervened.

Molested, kidnapped, and pregnant from a rape several months earlier, Elaine Riddick received no sympathy. It was 1968 in a segregated North Carolina town. She was 14 years old, living with her grandmother Maggie Woodward. 

Woodward, who had never received a formal education, was given two choices when the social worker sent by the Board showed up at their door to take away her granddaughter: She could lose her welfare benefits, or she could mark X on an ambiguous consent form. As with so many other cases, the will of the Eugenics Board prevailed. 

State doctors strapped Riddick to a table, delivered her baby, and proceeded with the tubal ligation immediately after. They anesthetized her. Sliced her open. Located her fallopian tubes. Burned them and stitched her up afterward. While the stitches eventually healed, Riddick’s anguish did not.

She found out only when, five years later, she tried to start a family of her own. Test after test after test, the reason for her infertility was still a bold question mark. Her doctors performed laparoscopic surgery to search for the answer. Again, they sliced her open. Under the harsh white light of the surgical lamp, they saw butchery. With a steely resolve, she said in an interview with The Politic, “The doctors at the county hospital [in 1968], because of my race, didn’t care how they did the surgery. They so severely damaged me that I eventually had to have a total hysterectomy.”

Degraded and humiliated, Riddick, with help from the American Civil Liberties Union, took her case to court in Chapel Hill in 1981. After a mere 30 minutes of deliberation, the nearly all-white jury sided with the state. In their eyes, no one violated Elaine Riddick. The Supreme Court refused to even hear the case. Indeed, in 1927, the Court had officially legitimated forced sterilization in Buck vs. Bell. The case still stands. 

“I felt like I was being punished all over again, first by the rapist and then by the state of North Carolina…. They had taken away my womanhood,” Riddick recalled in an interview with The Politic. “What could little boys and girls as young as eight do to cause their government to want to castrate them, except for being born poor while black?”

***

Violating the reproductive autonomy of black women was not a 20th-century invention. As Alexandra Stern, director of the Sterilization and Social Justice Lab at the University of Michigan, explained in an interview with The Politic, “Slavery and the white supremacist treatment of black women’s bodies set a framework for reproductive injustice that continued past 1865 and into the Jim Crow era.”

Dating back to slavery, portrayals of women differed along racial lines. White women were paragons of modesty and purity, while black women and girls were Jezebels—alluring African-American figures valued purely for their sexuality. Even in American material culture from emancipation to the 1950s, quotidian items like ashtrays, postcards, and drinking glasses depicted black women with little clothing or sexual restraint. Today, research suggests that black women are still more often oversexualized than white women in mainstream media. 

These characterizations have had other horrific consequences throughout history. In courtrooms across the South, where white men stood accused of raping black women, judges and juries delivered the same verdict again and again: not guilty. From emancipation through most of the 20th century, not one white Southern man was convicted of raping or attempting to rape a black woman. 

The oversexualization of black women is also seen through the thousands of state-sanctioned eugenic sterilization practices that occurred during the 20th century. Specifically, in North Carolina, notions of the black population as a parasitic influence on the body politic informed the state’s intense focus on regulating the reproduction of girls as young as 12.

The door to the past is wide open. As the Center for Investigative Reporting documented in 2010, two women’s prisons in California signed 150 pregnant women up for permanent sterilization after childbirth without following state approval procedures. 

In an interview with NPR in 2013, former inmate Kimberly Jeffrey said she resisted the pressure to be sterilized even within the operating room as she was being sedated. But her rights as an autonomous human being didn’t matter. What mattered to the state of California was her status as a member of a supposedly undesirable group. Carceral spaces today predominantly contain those historically targeted for sterilization: the poor and people of color. 

There may not be hope for an end to these horrific practices. In response to the recent incidents in California, Riddick replied, “I am not surprised.” 

                                                        ***

It’s not difficult to imagine: Under the blinding fluorescent hospital lights, Minnie Relf sighing calmly, remembering what the doctors had told her. Her daughters would get “some shots,” that was all. Her eyes scanned the pages and then she marked X. Minnie Lee and Mary Alice Relf, her two daughters, were poor, black, and lived in public housing. The state didn’t think twice about sterilizing them.

Alabamian doctors and legislators were convinced that the girls—just 12 and 14—were too likely to impose a burden on state resources by having babies. That day in 1973, it didn’t matter to the federally funded Montgomery Family Planning Clinic that the girls were themselves children, or that their parents didn’t give informed consent for the procedure. 

The Relf family sued the clinic and the federal government for $1 million worth of damages. In July of that shame year, Massachusetts Senator Edward Kennedy invited Lonnie to testify to the subcommittee to help pass a bill he authored to improve protective systems for human research subjects. In his oral testimony, the girls’ father Lonnie stated, “I didn’t want it done, and I’m still upset.” 

In light of the national outcry caused by the Relf sisters’ case and the Tuskegee Syphilis Study, Senator Kennedy’s bill suggested the creation of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, catalyzing debate about coercion and informed consent. President Nixon signed it into law on July 12, 1974. 

The Relf sisters were only two of thousands of misinformed, medically exploited black patients in an unending legacy. Throughout the United States, 65,000 people were sterilized during the 20th century. From 1933 to the 1970s, during the program’s heyday, the Eugenics Commission of North Carolina alone carried out 7,686 sterilizations, justifying them as measures to stop “mentally deficient persons” from reproducing. After 1960, 99 percent of those sterilized were women. The promiscuous, lazy, unfit, and sexually uncontrollable had to be contained. By the late 1960s, 60 percent of sterilization victims were young African-American women, even though they comprised only a quarter of the North Carolinian population. 

Criminals, the disabled, and people with mental illness were also in the crosshairs of the state’s mission to limit the reproduction of the unfit. In North Carolina, the language of mental uselessness was a discursive tactic to refract racism through the obfuscating terminology of eugenics. To eliminate future recipients of welfare, the recipients of which included a growing number of black women, was to eliminate growing financial burdens on the state.      

***

“This is not sterilization,” Tony Riddick, Elaine’s son, explained to the North Carolina Governor’s Eugenics Compensation Task Force in 2011. “This is genocide.” His mother agreed: “This is a depopulation process. They don’t want black people here. They don’t see us as human.” 

In 2012, North Carolina became the first state to compensate the victims of mass sterilization programs and offered $50,000 and funding for their mental health services to each living survivor. Virginia is the only other state that has compensated victims—they offered half of that amount. Seven out of the 33 states that engaged in mass sterilization programs issued public apologies. 

To survivors, apologies and compensation are meaningless. Riddick received $43,000, and she sees it as a slap in the face. 

Questions about whether eugenic sterilization programs like North Carolina’s rise to the level of genocide still linger. In studying the political economy of North Carolina’s program, William A. Darity Jr., Samuel DuBois Cook Professor of Public Policy in the Sanford School at Duke University, found that there was an explicit intent to eliminate the black population in North Carolina. Even when accounting for the sterilizations of people deemed “feebleminded”—which the state used to mean biologically unfit due to mental health characteristics—Darity noted that eugenic sterilizations increased with the black unemployed population. He calls the program a “campaign of black genocide.” 

Stern refrained from labeling these programs as such. “When does something meet the threshold of genocide?” she queried. “That is a debate that we should have.” Article 2, Section D of the UN’s Convention on the Prevention and Punishment of the Crime of Genocide stipulates that genocide must include two elements: the intent to destroy and a form of physical destruction.This standard of dolus specialis—requiring a proven intent to physically destroy a national, ethnic, religious, or racial group, which is associated with the existence of a state or organizational policy—makes genocide during peacetime a rare, but real, possibility. The physical element can include “imposing measures intended to prevent births within that [racial, national, ethnic, or religious] group.” 

Stern cited cases like the sterilization of hundreds of thousands of Native American women on reservations by the Indian Health Service as a guide for future discussion on the issue. In a country founded on a bedrock of settler colonialism and anti-blackness, violence isn’t limited to acts of deadly aggression. 

As Nial Ramirez, a woman sterilized in Washington County in 1965, put it in an interview with the Winston-Salem Journal: “If you were poor, black, and had nothing, they wanted to get rid of you. They wanted to get rid of your kids.”

In 2002, John Railey and a team of reporters at the Winston Salem Journal were the first to gain access to records that exposed the inner workings of North Carolina’s sterilization program in 2002. It was not the North Carolina he had grown up in, which he knew as one of the only states in the South with relatively peaceful racial integration efforts. Like many other North Carolinians, he was dismayed by what his state had done. “We think this stuff happens in other countries, but it happens here,” he lamented in an interview with The Politic. “Nazi Germany modeled its sterilization program on North Carolina’s. Morality has nothing to do with legality.”

***

I thought they were complimenting me. The words they used were innocuous. They seemed sincere. “You look so grown for your age.” 

I was a child then. I didn’t know what made me look older to them. Nothing happened to me. But other black girls who look “grown” aren’t as lucky. The teenage girl violently thrown across a classroom by a South Carolina school resource officer in 2016 wasn’t as lucky. Neither was the 11-year-old girl tasered by police for allegedly shoplifting groceries in Cincinnati in 2018.  If those girls were white, the altercations might have gone differently. Guilty until proven innocent, we are robbed of the leeway given to our white peers. In viewing us as “grown” and stripping us of our childhood, society holds us to the standard of adults, placing undue responsibility on us for our actions. 

As the Georgetown Law Center on Poverty and Inequality reported in 2017, “compared to white girls of the same age (i.e. age range of five to 14), adults perceive that black girls need less protection, know more about adult topics, and know more about sex.” Yet they are seen as too childlike and promiscuous to exercise reproductive autonomy over their bodies.

Mistreatment at the hands of police and school resource officers differs greatly from the experiences of Minnie Relf and so many others, but the same underlying principles unite them. For black women and girls, the past is ever-present: We see and feel the painful legacies of slavery all around us.

As a black woman and Yale student, I am electrified by course options like “African Literature in the World” and “Introduction to Ethnicity, Race, and Migration.” Yet the specter of a different Yale than the one we know looms over us.

The same classrooms and lecture halls that house enriching discussions about empowering minority communities today were once spaces in which eugenics was lauded. The Yale Alumni Magazine notes that in 1921, famed Yale economics professor Irving Fisher spoke animatedly of the “race suicide among the well-to-do classes that meant that their places will speedily by taken by the unintelligent, uneducated, and inefficient.”

Not far from the New Haven Green, the American Eugenics Society’s office once stood, supported by numerous Yale faculty. Yale president James R. Angell, celebrated football coach Walter Camp ’80, primatologist Robert Yerkes, and Yale School of Medicine dean Milton Winternitz all strongly defended the cause. 

Stern said, “All the Ivies were heavy into eugenics in the first part of the 20th century…. Institutions can be at the cutting edge where these kinds of knowledge are legitimated. You can see from the historical record that eugenics would not have thrived the way it did in the United States without universities.” In turn, we must critically engage with the kinds of knowledge that educational institutions perpetuate. These horrific injustices continued because people didn’t ask questions. People trusted authorities to distinguish between right and wrong. Horrors like this can go on. And if we don’t step up, they will.

Fisher and his peers may not have known Minnie Lee Relf or Elaine Riddick, but the women felt the impacts of the views he so proudly espoused. 

                                                               ***

In the historic African-American fight for racial equality, black men are often cast as the protagonists of the struggle, while the distinct oppression of black women is a marginalized narrative. Look no further than Elaine Riddick for evidence.

Riddick’s tragedy motivated her to start building a sanctuary shelter for youth at risk, abandoned babies, chemically dependent children, and victims of human trafficking. Now the president of the Rebecca Project for Justice, she advocates for young women and girls in the United States and Africa who have suffered from physical, sexual, and medical violence. But her own pain will not subside. 

“I still get teary-eyed. I still cry…. You just don’t get over stuff like that,” Riddick said, her voice trembling.

Historically, black bodies bore the weight of advancement in medicine. Dr. Marion Sims, the father of American gynecology, performed painful, experimental procedures on enslaved women without anesthesia because he believed that African Americans did not feel pain. To this day, false beliefs of biological difference between black and white people color the way medical students and residents assess and treat black patients. 

Ultimately, our lives are at stake. Faced with racial disparities that leave us three to four times more likely to die during or after childbirth than our white peers, black women contend with a healthcare system that never favored us. Even outside the eugenics programs, doctors took it upon themselves to sterilize women on welfare with more than two to three children. Programs of mass sterilization throughout the nation are evidence of deeply entrenched medical racism. With their right hands raised, doctors swore to do no harm. Yet harm has been done. Racism’s intersecting hands reach deep into our lives. And they hurt.