Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950 – 1980

In 2004, at the age of twenty-three, I entered my gynecologist's office to request permanent sterilization. My doctor repeatedly refused my request, and would not honor my alternate request for an IUD. I tried changing doctors, but still encountered severe resistance to my wish to be permanently sterilized. Now that the IUD I did eventually obtain will be ready to come out at age thirty, my doctor has still indicated that she will not perform the procedure.

After reading Rebecca Kluchin's Fit to Be Tied, I am left wondering if my doctors' refusals to honor my wishes are, consciously or not, vestigial traces of America's bleak history involving positive and negative eugenics—separate categories for "fit" and "unfit" women. From the turn of the twentieth century to the late 1970s, social, legal, and medical authoritarianism and paternalism combined with white anxiety over losing social dominance in America to result in extraordinarily skewed, disparate policies of reproductive "rights" for white middle class women and poor women of color.

In the post-WWII era, concerns were raised about the population "explosion" and the resulting fear that poor, uneducated immigrants and people of color were "outbreeding" the white middle and upper classes. Griswold v. Connecticut, the landmark Supreme Court decision legalizing contraception for married couples, would not be decided until 1965, and few if any women had access to contraception at all. The solution put into effect by medical and legal authorities was to adopt a policy of eugenics: the undesirable minorities, often unwed, sunken into poverty, and with little to no recourse, were aggressively encouraged and often forced into unwanted sterilizations. Women were deceived, lied to, and even legally sentenced to sterilization under the white- and male-dominated cultural paradigm. The worst of these forced sterilization cases were known colloquially in the South as "Mississippi appendectomies," in which women deemed "unfit" to reproduce by physicians entered hospitals for routine surgeries (such as appendix removal) only to later find that their ovaries and uterus had been taken out as well.

Meanwhile, advances in sterilization procedures made the operation quite attractive to middle class white women who wanted to take control of their reproductive destiny. These women appealed to physicians and hospitals in order to obtain tubal ligations, only to find themselves rebuffed. Educated white women of privilege were denied sterilization because it was believed that they should give birth to as many children as possible, despite their own feelings on the matter. Many hospitals developed what was known as the "120 rule" of age/parity: if a reproductively "fit" woman's age multiplied by the number of children she had added up to 120, a sterilization was provided.

Sterilization for men is also touched upon in Fit to Be Tied. Infuriatingly, but perhaps not surprisingly, vasectomies have historically been provided on demand for men with little to no trepidation on the part of medical professionals.

On another personal note, I discussed this book with a friend of mine, who said it sounded interesting but "suspect." He did not know that eugenics was practiced openly in America for many decades, and believed that Kluchin's book was essentially feminist conspiracy theory. This sort of troubling ignorance of history only deepens the importance and necessitates the knowledge of medico-legal authoritarianism over women in America's past. Kluchin's work is straightforward, factual, academic, and exhaustively researched, but not intimidatingly so. It is a highly absorbing read and an incisive, grim but eminently necessary look into pre-Roe v. Wade America.

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