The Washington PostDemocracy Dies in Darkness

What the next 50 years of reproductive rights activism can learn from the last 50

Success moving forward requires building a more inclusive movement than what existed during the Roe era

Rep. Lizzie Fletcher (D-Tex.), center, then-House Speaker Nancy Pelosi (D-Calif.) and other House Democrats applaud as Rep. Marilyn Strickland (D-Wash.) speaks at an event at the Capitol in July. (Andrew Harnik)
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In June 1973, the Southern Poverty Law Center began publicizing a case it was pursuing in defense of two Black children from Alabama, Minnie Lee and Mary Alice Relf. The Relf sisters, 14 and 12 years old, had been sterilized on the recommendation of a nurse employed by the federal government. The girls’ mother, who reportedly could not read or write, signed consent forms for the sterilization of her two young daughters with an “X” and said later that she thought she was authorizing a form of reversible birth control, not a permanent removal of her daughters’ reproductive capacity.

Relf v. Weinberger burst onto the scene just six months after Supreme Court Justice Harry A. Blackmun published his opinion for the majority in Roe v. Wade on Jan. 22, 1973, 50 years ago this week. This was a time of celebration for most feminists, and justly so: Their movement, working ardently at the grass roots and uniting across many lines of difference, had persuaded the nation’s highest court to recognize people’s need to make autonomous choices about whether to end their pregnancies. Roe forbade states to regulate abortion access in the first trimester of a pregnancy and allowed only limited regulation in the second trimester.

At the same time, to many advocates for poor people and communities of color, the Relf case demonstrated that Roe did not ensure reproductive rights for all Americans. Even if Roe had established abortion access as an absolute right (it didn’t), it would have only guaranteed people the ability to end a pregnancy. It would not have guaranteed their ability to become pregnant or to raise a child. For as long as authorities persuaded or coerced individuals and families to pursue permanent sterilization, including of minors, those individuals and families did not have full reproductive rights.

Roe v. Wade is no longer in force as a constitutional precedent, but it still percolates through our politics. Even as many of us mourn the loss of Roe, we know that reestablishing the right to access abortion on a national level will require rethinking in the movement. Perhaps the best way to mark Roe’s 50th is to consider the opinion’s limits as well as its strengths. This means looking carefully at a question that grew out of scandals like that surrounding the Relf girls in the 1970s: What does it take to ensure all people the right to choose childbearing, free from forced or coerced sterilization as well as from economic pressures that make it impossible to choose to be a parent, while also guaranteeing access to contraception and abortion?

The Relf case alone did not make sterilization abuse a touchstone of reproductive politics. Members of the Black freedom movement, Puerto Rican independentists and activists in cities on the U.S. mainland, socialists of all backgrounds, Native Americans who organized on reservations, Chicanas in Los Angeles and a small number of whistleblowing medical professionals brought the issue to the fore.

These activists were responding to what had become a rampant recourse to sterilization under federal and medical policy by the late 1960s and early 1970s. Many policymakers and individual professionals believed in “population control,” the idea that among the best ways to prevent familial and community poverty was to make sure that fewer children were born to poor families and communities — even if this was not what the people involved wanted for themselves. Rooted in eugenics, population control policies targeted women of color in particular as those who should have fewer children.

Civil rights leaders in the South revealed the scandal of what were called “Mississippi appendectomies,” involuntary sterilizations of Black women who went into the hospital for one procedure and left with a loss of their reproductive ability. Indigenous women blew the whistle on the widespread sterilization of women living on reservations — and they organized as Women of All Red Nations to combat sterilization abuse at Indian Health Service clinics. Similarly, with the help of a doctor-whistleblower, women of Mexican origin found alarmingly high rates of sterilization at L.A. County Hospital (served by the University of Southern California Medical School) and went to court in 1978 to hold the doctors involved accountable.

Puerto Rican independentists played a particularly important role in encouraging members of the mainstream reproductive rights movement to confront sterilization abuse. In the mid-20th century, sterilization was the preferred method of contraception on the island by both the commonwealth government and the U.S. government. By 1965, Puerto Rico had the highest rate of sterilization in the world, at 35 percent of adult women, two-thirds of whom were in their 20s.

The Young Lords Party, a Puerto Rican near-equivalent of the Black Panther Party for Self-Defense, called attention to high rates of sterilization at public hospitals in New York City. In 1970, the Young Lords took over a portion of Lincoln Hospital in the South Bronx — known as one of the worst hospitals in one of the most heavily Puerto Rican neighborhoods in the country. They demanded community control of medical services and an end to sterilization abuse, as well as other kinds of abuse they believed people of color suffered because of indifferent medical care and under-resourced public hospitals. Soon after, physician Helen Rodríguez-Trías of San Juan was appointed director of pediatrics at the hospital.

After Roe and Relf, Rodríguez-Trías brought the issue of sterilization abuse to the mainstream women’s movement. She discussed what happened to the Relf sisters at a panel on sterilization abuse at a feminist meeting on health care and remembered getting “a lot of flack from White women who had private doctors.” These feminists worried that any policies that sought to control sterilization abuse might create a slippery slope to controls on other reproductive options, like abortion or fully voluntary sterilization procedures. The debate revealed that feminists disagreed about the very thing that seemed to unite them in the years before Roe: reproductive rights.

In 1974-1975, Rodríguez-Trías and a small group of others, including Puerto Rican Socialist Party member Maritza Arrastía, founded the Committee to End Sterilization Abuse (CESA), the first dedicated anti-sterilization activist group in U.S. history.

CESA did not get much help from advocates in the best-known reproductive rights groups, such as Planned Parenthood and NARAL. But they had support from communities and activists of color and health-care dissidents who understood the significance of this new branch of the movement. In 1977, Rodríguez-Trías and other left-of-center feminists founded the Committee for Abortion Rights and Against Sterilization Abuse (CARASA), the only reproductive rights group that stood for both demands at once: continued access to safe, legal and affordable abortion care as well as freedom from the threat of coercive or forced sterilizations.

From their starting point protesting sterilization abuse, Rodríguez-Trías and her comrades came to demand what they called “reproductive freedom,” the freedom to choose to have children, as well as the freedom to refrain from childbearing when that is one’s choice. They concluded that such freedom could be secured only if all people had access to high-quality, free or affordable medical care; safe neighborhoods, with adequate housing and no police violence; and a range of other social supports and financial resources to meet related needs like high-quality, affordable child care. They anticipated the erosion of reproductive freedom, even before the end of Roe, as states have chipped away at abortion access and criminalized those seeking to exercise reproductive choices, and those without economic security and resources have borne the brunt of such restrictions.

As we pause this week to remember Roe, let us remember its limits as well as its strengths. The nearly forgotten movement against sterilization abuse, and the insights it developed about the nature of reproductive rights, are a great place to start as we rethink, rebuild and prepare for the next 50 years.