“Three Generations of Imbeciles”: Past and Present Coercive Sterilization in the U.S.

Calista Kayatta

Edited by Samantha Tonini, Braxton Bullock, Judge Baskin, and Sahith Mocharla

In 1973, Mary Alice and Minnie Lee Relf, at ages twelve and thirteen, fell victim to the rampant practice of forced sterilization of poor Southern Black women. When their mother signed a document believing she was giving authorization for the children to receive birth control shots, the girls were instead surgically sterilized without their consent. Such a horrific abuse sparked the Southern Poverty Law Center to file a lawsuit on their behalf. In Relf v. Weinberger (1974), it was revealed that 100,000 to 150,000 Black, Latina, and Indigenous women were sterilized under government programs in the U.S. over multiple decades [1]. The District Court of the District of Columbia ruled that federal funds could not be used for involuntary sterilization, and the lawsuit's exposure led to requirements for doctors to provide “informed consent.” However, despite the District of Columbia’s ruling, forced and coerced sterilization by state governments would continue into the 21st century.

Relfs demonstrates that, despite what many may think, forced and coerced sterilization of ‘undesirable’ individuals is hardly a relic of the past. In fact, although forced sterilization has been rendered effectively illegal, the foundational Supreme Court case Buck v. Bell (1927) has never been overturned, and coerced sterilization as a requirement in plea deals persists to this day. Moreover, legacies of eugenics and forced sterilization laws still permeate within our criminal justice system, being the original backing for legislation such as “Three Strikes” laws. These practices fly in the face of the constitutional guarantees of the Eighth and 14th Amendments and pose concerning legal precedent(s) for future infringement of reproductive autonomy. With language surrounding restraints on reproductive freedom resurfacing, Americans should be acutely aware of the history and present implications of compulsory sterilization in the United States.

The history of forced sterilization in the U.S. has its roots in the early 1900s eugenics movement. Although now widely understood as inaccurate and prejudiced, at the time, the eugenics movement was highly respected and backed by ‘reliable’ scientific studies and journals. These “scientific” backings led to the first compulsory sterilization law passed by the State of Indiana in 1907. This law legalized the forcible sterilization of “confirmed criminals, idiots, imbeciles, and rapists” in state institutions [2]. By the 1930s, over 30 states had similar laws on the books. These laws targeted individuals labeled as “feeble-minded,” “epileptic,” “insane,” or “habitual criminals”—(perhaps intentionally) vague terms that were often used to target anyone deemed socially undesirable. At the peak of forced sterilization in the U.S. under the Asexualization Acts, a series of legislation passed as a part of California’s broader eugenics program aimed at controlling the reproduction of “undesirable” individuals, the state sterilized around 20,000 people, disproportionately people of African American and Hispanic heritage and descent [3]. Over the course of the 20th century, more than 60,000 people were forcibly sterilized under eugenics laws [4]. 

The foundational Supreme Court case, Buck v. Bell, provided the legal precedent necessary for this widespread practice. In 1927, Carrie Buck, a poor seventeen-year-old orphan, became pregnant after being raped by her foster parent’s nephew. The Dobbes, Buck’s foster parents, petitioned to have her institutionalized. After being diagnosed with “feeble-mindedness” and “sexual promiscuity,” she was placed in the State Colony for Epileptics and Feebleminded. After giving birth, Buck became the test case for a new Virginia law that allowed for the compulsory sterilization of people “afflicted with hereditary forms of insanity that are recurrent, idiocy, imbecility, feeble-mindedness, or epilepsy” [5]. The Supreme Court case that followed debated the question: did the Virginia statute, which authorized sterilization, deny Buck the right to due process of the law and the equal protection of the laws as protected by the 14th Amendment? In an eight-to-one vote, the Court found that Virginia’s law did not violate the Constitution. In the Court’s majority opinion, Justice Oliver Wendell Holmes Jr. affirmed the value of eugenic-based sterilization laws in order to prevent the nation from "being swamped with incompetence,” uttering the infamous quote “Three generations of imbeciles are enough" [6]. Although later limited by the Supreme Court’s ruling in Skinner v. Oklahoma (1942), Buck v. Bell has yet to be officially overturned, leaving it a zombie precedent that could, in theory, still be cited. 

In 1935, Oklahoma passed the Criminal Sterilization Act, which allowed the state to sterilize a person who had been convicted three or more times of crimes “amounting to felonies involving moral turpitude.” Petitioner Skinner brought forth a suit after his third conviction. He was determined to be a habitual offender and ordered to be sterilized. In the subsequent landmark Supreme Court case, Skinner v. Oklahoma, he argued that the law violated the 14th Amendment. In a unanimous decision, the Court held that the Act violated the Equal Protection Clause of the 14th Amendment. The Court reasoned that because certain crimes, such as embezzlement, were excluded from the Act’s jurisdiction without explanation or reason, the statute was unjustly targeting “blue-collar” crimes, i.e., crimes committed by lower middle-class individuals, typically manual laborers, such as stealing a car or drug possession compared to “white-collar” crimes committed by higher class individuals such as embezzlement or money laundering. Moreover, the Court reasoned that because of the social and biological implications of reproduction and the irreversibility of sterilization operations, compulsory sterilization laws should be subject to strict scrutiny. Notably, in his concurrence, Chief Justice Harlan F. Stone stated that he disagreed with the majority opinion’s reliance on the Equal Protection Clause and instead cited the Due Process Clause to prevent Skinner from being sterilized [7]. Although this case is often thought of as the end of forced sterilization in legislation, as Justice Stone pointed out, its reasoning rested on the unequal distribution of the mandatory procedures rather than the violation of the Fifth Amendment’s Due Process Clause. Compulsory sterilization laws were not deemed wholly unconstitutional, just the ones that were not equally applicable to all crimes. Thus, Skinner v. Oklahoma, though furthering protections against forced sterilization, did not overturn Buck v. Bell. 

After WWII, with the horrors of eugenics-based legislation made clear by Nazi death camps, many states repealed their sterilization laws. However, forced sterilization still pervaded throughout the 20th century. From the 1930s to the 1970s, nearly one-third of the women in Puerto Rico, a U.S. territory, were coerced into sterilization under the claim that Puerto Rico’s economy would benefit from a reduced population [8]. Black women were likewise targeted and subjected to reproductive abuse. In the 1960s, nonconsensual sterilizations were performed so frequently on working-class Black women in the South that it was colloquially referred to as a “Mississippi appendectomy” [9].

Furthermore, many Indigenous women were subjected to this same practice. Historian Jane Lawrence wrote that the Indian Health Service was accused of forcibly sterilizing ~25% of Indigenous women in the 1960s and 70s [10]. Many of these patients would come in for ‘Operation X’ (such as a removal of an ovarian cyst) and, without their knowledge, receive a sterilizing surgery as well. Alternatively, doctors would offer to do ‘Operation X’ for free if the patient also consented to the sterilization, leaving poorer populations even more vulnerable to the fiscal manipulation. Some women were asked to sign a permission form minutes after giving birth. This manipulation of consent exposes many of the loopholes that allow coerced sterilization to happen to this day. The year that Roe v. Wade (1973) supposedly ensured reproductive rights for all women, the autonomy of thousands was being disregarded. 

In 2020, the history of eugenics and forced sterilization resurfaced in a public outcry when the Irwin County branch of the United States Immigration and Customs Enforcement (ICE) was accused of giving hysterectomies, in which the uterus is removed, to women in their custody without their expressed consent. These surgeries were either performed completely without consent or under the premise that the surgery was required for other clinical reasons. One woman claimed she was told she was having surgery to remove an ovarian cyst, and a tablet was handed to her to sign with no explanation [11]. Other detained women stated they were told they would “die” if they did not receive the surgery. Both represent cases of misinformation regarding a clinical procedure (presumably) to induce consent [12]. After a congressional investigation, proof was found of many unnecessary, invasive surgeries performed on women, the Irwin County Center was shut down, and no court ruling or conclusive answer was found regarding the alleged mass hysterectomies [13] [14]. These cases sparked mass outcry of comparisons to Nazi Germany and shouts of “This is not my America” [15]. Yet, as with many issues of justice, this is and has been ‘our’ America. From the targeting of minorities and vulnerable persons to the infringement of reproductive rights under false pretenses and shoddy science, this is the precedent and practice that the American justice system has set. 

Unfortunately, the 2020 ICE hysterectomies are not an outlier in an otherwise reformed system. To this day, coerced sterilization still threatens our Fifth, Eighth, and 14th Amendment rights. The regulation of forced sterilization remains up to state legislatures, and most have outlawed explicit unconsented sterilization; however, coerced procedures, particularly in exchange for sentence reductions, occur often within the criminal justice system today. As recently as May 2017, Tennessee Judge Sam Benningfield signed an order that offered misdemeanor offenders 30-day sentence reductions if they underwent either a vasectomy or a birth control implant [16]. In 2009, in West Virginia, a 21-year-old unmarried mother of three agreed to have her tubes tied in 2009 as part of her probation after she pleaded guilty to possession with intent to distribute marijuana [17]. In 2015, a Tennessee woman was sterilized as a condition of her plea deal after being charged with child neglect [18]. Between 2005 and 2013, 144 women were coerced into sterilization in California [19]. Although technically signing a consent form for these invasive surgeries, when faced with an incentive such as a shorter sentence, the question arises of whether or not it is really consent or a form of coercion. This practice is not only invasive and predatory but also violates the spirit behind the Court's decision in Skinner v. Oklahoma. When forced or coerced sterilization is applied inequitably and inconsistently, it calls into question the protections enshrined in the 14th Amendment. 

The ICE hysterectomies and modern-day plea deal negotiations involving sterilization expose two nuances of legal consent. In the ICE hysterectomies, although signing a waiver allowing the procedure, the women did not give informed consent. Informed consent occurs when there is agreement to an interaction or action rendered with knowledge of relevant facts, such as the risks involved or any available alternatives; it is almost always required in medical procedures [20]. When told they were getting an ovarian cyst removed or that they would die otherwise, the women in the detention center were not made aware of the accurate facts of the situation and the surgery they were agreeing to. When looking at the legality of inserting sterilization as a condition in plea deals, it becomes similarly ethically dicey. The limitations for what a prosecutor can and cannot put in a plea deal are vague, but generally, “the adjudicative element inherent in accepting a plea of guilty must be attended by safeguards to insure the defendant what is reasonably due in the circumstances” [21]. What is “reasonably due” in any particular case is clearly subjective; however, broadly, for a stipulation to be “reasonable,” it should 1) be rationally connected to the crime and its correction and 2) not be “cruel and unusual.” Mandating sterilization for unrelated crimes violates both of these prongs and thus seems to be a far cry from what is “reasonably due.” Moreover, using minimized sentences as an incentive for agreeing to sterilization has been deemed unconstitutional by numerous district attorneys who have banned their use in many states, as it points to coercion [22]. Many proponents of sterilizing the incarcerated point to a lack of personal responsibility in individuals as justification. In reality, however, many of these people simply lack resources and support, like Carrie Buck. 

But there is another, more common and controversial side of forced sterilization. The chemical and surgical castration of sex offenders remains a highly debated legal quandary, grappling with public protection, autonomy, and cruel and unusual punishment. On September 18, 1996, California became the first state to authorize the use of either chemical or physical castration for certain sex offenders who were being released from prison into the community [23]. Currently, eight states legalize the sterilization of convicted sex offenders, including California, Florida, Iowa, Louisiana, Montana, Texas, Wisconsin, and Alabama [24]. Two main legal arguments have been advanced against this legislation, contending that it violates the First and Eighth Amendments. From the Supreme Court case Stanley v. Georgia (1969), legal scholars have argued that castration reduces or eliminates deviant sexual thoughts and fantasies, infringing on the sex offender’s First Amendment right to entertain sexual fantasies. Although perhaps an unforeseen argument, the Supreme Court has held that one’s First Amendment right to free speech also encompasses their right to their own thoughts not to be interfered with by the government [25]. Likewise, many scholars have also contended that this legislation violates the Eighth Amendment. Three questions that the Supreme Court asks when assessing whether a punishment violates the Eighth Amendment include: Is the punishment inherently cruel or excessive? Is the punishment or condition proportional to the crime? Can the state achieve its goal through less intrusive means? [26]. Although the U. S. Supreme Court has yet to hear a case that addresses whether castration represents cruel and unusual punishment, the South Carolina State Supreme Court has ruled on this question. In the case of State v. Brown (1985), three defendants pled guilty to first-degree criminal sexual conduct in connection with a brutal sexual assault. Their sentences were suspended, conditioned on the defendants’ completion of surgical castration. In reviewing the case on appeal, the South Carolina Supreme Court held that surgical castration was cruel and unusual punishment, as prohibited by the South Carolina Constitution [27]. Even when the punishment “fits the crime,” the constitutional principles of equal protection, cruel and unusual punishment, and due process transcend any state-sanctioned sterilization. 

Beyond current cases of coerced sterilization, remnants of government-sanctioned efforts to inhibit the reproduction of the incarcerated still pervade our legal system. Although they are widely understood to have emerged from the “tough-on-crime” movement in the 1980s and 1990s, “habitual criminal” and “three-strikes” laws originated in the 1900s eugenics movement. During this period, several states passed laws requiring judges to impose life sentences for third convictions for certain offenses. With the backing of eugenic premises, like Cesare Lombroso’s claim that criminality was inherited, states passed these “habitual offender” laws throughout the 20th century [26]. These laws intentionally imposed sentences long enough to bar reproduction functionally. They were advocated for in explicitly eugenic terms and were considered in tandem with, or as less controversial alternatives to, sterilization laws. Laws like these still permeate our criminal justice system.

The history of forced and coerced sterilization in the United States shows a continuity of state abuse of reproductive autonomy. Beginning as openly eugenic policies, legitimized by landmark decisions like Buck v. Bell, legalized unconsented sterilization has not wholly disappeared as many would assume it has, and has instead adapted to modern legal frameworks. Although cases like Skinner v. Oklahoma introduced important limitations, they stopped just short of fully repudiating the idea that the state has the power to forcibly sterilize individuals. The failure to decisively overturn the precedent of Buck v. Bell has allowed for coercive sterilization practices to persist in more subtle forms, like plea deals. From the euphemistic “Mississippi appendectomies” of the mid-20th century to ICE hysterectomies, there is a clear pattern of marginalized groups—specifically women of color, the impoverished, and incarcerated individuals—being disproportionately targeted. These practices expose the fragility of legal protections like informed consent within systems marked by power imbalances and misinformation. In these contexts, the distinction between choice and compulsion is blurred. Ultimately, this history directly challenges the notion that reproductive rights in the U.S. are secure or universally protected. Until decisions like Buck v. Bell are formally overturned and stronger safeguards against coercion are universally enforced, the possibility of future violations remains. 

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[1] Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974). 

[2] Ind. General Law § 215 (1907). 

[3] Charles A. Loeb et al., Forced Sterilization in California: A Haunting Past and Persistent Inequity, The Journal of Urology (May 1, 2024), https://www.auajournals.org/doi/10.1097/01.JU.0001008828.35887.de.02. 

[4] Alexandra Minna Stern, That Time the United States Sterilized 60,000 of Its Citizens, HuffPost (Jan. 7, 2016), https://www.huffpost.com/entry/sterilization-united-states_n_568f35f2e4b0c8beacf68713. 

[5] Buck v. Bell, Britannica, https://www.britannica.com/topic/Buck-v-Bell (last visited April 5, 2026).

[6] Buck v. Bell, 274 U.S. 200 (1927).

[7] Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942). 

[8] Isabella Long, From Forced Sterilization to Fertility Technology: Addressing Medical Mistrust in Puerto Rico, Health and Human Rights (April 21, 2025), https://www.hhrjournal.org/2025/04/21/from-forced-sterilization-to-fertility-technology-addressing-medical-mistrust-in-puerto-rico/. 

[9] Jack Lasky, Mississippi Appendectomy, EBSCO (2023), https://www.ebsco.com/research-starters/women-s-studies-and-feminism/mississippi-appendectomy. 

[10] Jane Lawrence, The Indian Health Service and the Sterilization of Native American Women, 24 American Indian Quarterly, 400. 

[11] Medical Mistreatment of Women in ICE Detention: Hearing Before the Permanent Subcomm. On Homeland Sec. & Govt. Affs., 117th Cong. (November 15, 2022). 

[12] Liana Woskie & Mindy Jane Roseman, Contemporary Human Rights Violations in Female Sterilization Care: Legal and Ethical Considerations when Coerced Patients Do Consent, NIH (May 13, 2025), https://pmc.ncbi.nlm.nih.gov/articles/PMC12615512/#Sec5. 

[13] Dale Chappell, Whistleblower Claims Female Detainees at Privately Run Georgia ICE Facility Had Forced Hysterectomies, Prison Legal News (December 1, 2020), https://www.prisonlegalnews.org/news/2020/dec/1/whistleblower-claims-female-detainees-privately-run-georgia-ice-facility-had-forced-hysterectomies/. 

[14] Camilo Montoya-Galvez, Investigation Finds Women Detained by ICE Underwent "Unnecessary Gynecological Procedures" at Georgia Facility, CBS News (November 15, 2022), https://www.cbsnews.com/news/women-detained-ice-unnecessary-gynecological-procedures-georgia-facility-investigation/. 

[15] Forced Hysterectomies Underscore Horrors of Immigrant Detention, Immigrant Legal Defense (October 13, 2025), https://www.ild.org/immigrant-legal-defense-blog/forced-hysterectomies-underscore-horrors-of-immigrant-detention. 

[16] Zoë Beery, America’s Long, Shameful History of Sterilizing Prisoners, The Outline (July 25, 2017), https://theoutline.com/post/1963/americas-long-shameful-history-of-sterilizing-prisoners?zd=3&zi=ag52aemp. 

[17] Andrew Clevenger, Judge Arranges Sterilization as Part of Charleston Woman’s Probation, Digital Point (June 3, 2009), https://forums.digitalpoint.com/threads/judge-arranges-sterilization-as-part-of-charleston-womans-probation.1365709/.

[18] Sheila Burke, Attorneys: Sterilizations were Part of Plea Deal Talks, Associated Press (March 28, 2015), https://apnews.com/general-news-824ffb7d2ed84849b5d87c41cdf8c0f7. 

[19] Mary Ellen Cagnassola, California Coerced 144 Women to be Sterilized Between 2005 and 2013: Audit, Newsweek (July 7, 2021), https://www.newsweek.com/california-coerced-144-women-sterilized-between-2005-2013-audit-1607683.

[20] Informed Consent, Legal Information Institute, https://www.law.cornell.edu/wex/informed_consent (last visited April 8, 2026).

[21] Plea Bargaining, Legal Information Institute, https://www.law.cornell.edu/constitution-conan/amendment-5/plea-bargaining (last visited April 8, 2026). 

[22] See [18].

[23] Cal. Penal Code § 645 (West 2003).

[24] Charles L. Scott & Trent Holmberg, Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety, 31 The Journal of the American Academy of Psychiatry and the Law (2003). 

[25] Stanley v. Georgia, 394 U.S. 557 (1969). 

[26] Walker KM: Judicial control of reproductive freedom: the use of Norplant as a condition of probation. Iowa Law Rev 78:804–6, 1993

[27] State v. Brown, 284 S.C. 407, 326 S.E.2d 410 (S.C. 1985). 

[28] Daniel Loehr, The Eugenic Origins of Three Strikes Laws: How “Habitual Offender” Sentencing Laws Were Used as a Means of Sterilization, The Sentencing Project (March 5, 2025), https://www.sentencingproject.org/reports/the-eugenic-origins-of-three-strikes-laws-how-habitual-offender-sentencing-laws-were-used-as-a-means-of-sterilization/.