A Bit More on Reproductive Choice

It occurs to me that, in my last post, I neglected to mention what has probably been the single most important reproductive-choice issue for disabled women throughout history: the right to reproduce.

Here is a brief passage from Edwin Black's 2003 history of the American eugenics movement, War Against the Weak, describing the far-reaching campaign to sterilize all people deemed "unfit"*:

In the two decades between Indiana's pioneering eugenical sterilization law and the Carrie Buck decision [link], state and local jurisdictions had steadily retreated from the irreversible path to human sterilization. Of the twenty-three states that had enacted legislation, Maine, Minnesota, Nevada, New Jersey, South Dakota and Utah had recorded no sterilizations at all. Idaho and Washington had performed only one procedure each, and Delaware just five. Even states with strong eugenics movements had only performed a small number: Kansas, for instance, had sterilized or castrated 335 men and women; Nebraska had sterilized 262 men and women; Oregon had sterilized 313; and Wisconsin had sterilized 144.

Although some 6,244 state-sanctioned operations were logged from 1907 to July of 1925, three-fourths of these were in just one state: California [link]. California, which boasted the country's most activist eugenic organizations and theorists, proudly performed 4,636 sterilizations and castrations in less than two decades. Under California's sweeping eugenics law, all feebleminded or other mental patients were sterilized before discharge, and any criminal found guilty of any crime three times could be asexualized upon the discretion of a consulting physician. But even California's record was considered by leading eugenicists to be "very limited when compared to the extent of the problem."

Many state officials were simply waiting for the outcome of the Carrie Buck case. Once [Justice Oliver Wendell] Holmes' ruling was handed down, it was cited everywhere as the law of the land. New laws were enacted, bringing the total number of states sanctioning sterilization to twenty-nine. Old laws were revised and replaced. Maine, which had not performed such operations before, was reponsible for 190 in the next thirteen years. Utah, which had also abstained, performed 252 in the next thirteen years. South Dakota, which had performed none, recorded 577 in the next thirteen years. Minnesota, which had previously declined to act on its legislation, registered 1,880 in the next thirteen years.

The totals from 1907 to 1940 now changed dramatically. North Carolina: 1,017. Michigan: 2,145. Virginia: 3,924. California's numbers soared to 14,568. Even New York State sterilized forty-one men and one woman. The grounds for sterilization fluctuated wildly. Most were adjudged feebleminded, insane or criminal; many were guilty of the crime of being poor. Many were deemed "moral degenerates." Seven hundred were classed as "other." Some were adjudged medically unacceptable. All told, by the end of 1940, no fewer than 35,878 men and women had been sterilized or castrated --- almost 30,000 of them after Buck v. Bell.

Because of differences in available procedures (the first vasectomy was performed in 1897, and they were being used for eugenic purposes by 1899, while tubal ligation did not become widely used until after 1930**), the sex ratio among people sterilized during this period changed with time. In the earlier years, from 1907 until about the mid-1930s, more men than women were sterilized, but in the 1930s and after, the trend reversed, with more women being sterilized even though tubal ligation is a more invasive, riskier procedure than vasectomy***.

In case you're under the impression that coerced sterilization of disabled people (particularly women) has been relegated to the history books, here is a brief, noncomprehensive list of forced-sterilization cases since 2000:

• Ashley X (2004)
• Katie Thorpe (2007) - a 15-year-old British girl with cerebral palsy, whose mother has asked that her growth be stunted and her uterus removed.
• Kristen Johnson (also called KEJ) (2008) - a 29-year-old Chicago woman who has said she wants to have children, but whose aunt filed a request for a tubal ligation, which the Illinois Appellate Court refused.
• Laura Ferris (2003) - 13-year-old girl from Tasmania with Childhood Disintegrative Disorder whose mother had sought a hysterectomy for her in order to prevent menstruation. The request was denied.
• "Carla" (2001) - 24-year-old woman with Down syndrome, cared for by her grandfather, who wants her to get a tubal ligation

Why do I bring all this up? I have two reasons, one political and one personal. (Or, since the personal is political, maybe one is just more explicitly political than the other). First, this new rule from the Department of Health and Human Services, which allows health-care workers to refuse any treatment that "violates their personal beliefs", could make it even harder for disabled women who want children to find an OB-GYN willing to help them. In a cultural climate where disabled women (and men) have, until fairly recently, been routinely sterilized for the perceived good of Society, and where, even now, disabled women and girls are sometimes sterilized without their consent because their parents or guardians believe it would be best for them, and disabled people are seen as selfish, irresponsible and reckless for choosing to have children, this rule adds another layer of uncertainty and hazard to the already-fraught process of Procreating While Disabled.

The other, more personal, reason I bring this up is that this is the context in which my own reproductive choices are being shaped, and into which they will reverberate. I do not wish to have children. I'm so confident in the strength and persistence of this wish (and the various reasons that feed into it) that I want, and am seriously considering, surgical sterilization. What I emphatically do *NOT* want, however, is to strengthen anybody's conviction that disabled women should not have children just because I don't want to. I'm choosing sterilization because it's what I want; I'm not being "unselfish" or "mature" or "responsible", except inasmuch as recognizing what one wants and taking steps to achieve it is mature and responsible. Hence, when I do go in, I think I will leave my autism (and depression) out of it entirely, and tell them why I don't want children in generic, personalized terms --- I don't much like other people, I like a lot of time to myself, I don't handle demands well, I like quiet --- or broad, impersonal terms --- I have ethical issues with adding more people to an already-overpopulated world, especially when I'd be adding them to the richest, most energy- and resource-hogging country on the planet, and when so many children who already exist need homes. I will shift the question from "Should I give this autistic woman a tubal?" to "Should I give Lindsay a tubal?"

*This term encompassed many different categories of people: racial and ethnic minorities (blacks, Native Americans, Mexicans, Chinese, and even non-Anglo-Saxon European immigrants), petty criminals, poor people, chronically unemployed people (researchers at the time observed that crime, poverty and unemployment tended to affect whole families, and inferred that therefore those things must be genetically transmissible!), alcoholics, epileptics, blind and deaf people, people with low IQ scores (who were, of course, overwhelmingly poor, nonwhite or immigrants), and people who had been committed to insane asylums. Often, the "unfit" also included blood relatives of any of the above.
**Procedures for female sterilization, like the salpingectomy and primitive, non-laparoscopic versions of the tubal ligation, had existed and been used infrequently since the 1880s.
***One possible reason more women were sterilized once tubal ligation came into common use might be the practice of clandestinely performing tubal ligations on women who had children by C-section.