Wombs in Captivity: Mass Hysterectomies, America’s Changing Face and the Politics of Motherhood for Incarcerated Women of Color
Originally posted: December 10, 2020
The women of Irwin County Detention Center (ICDC) are migrant women. Their movement is a direct challenge to border imperialism[1] and the geographic boundaries constructed by racial capitalism. Today, detained within the walls of this Georgia ICE detention facility, their travel beyond the confines of ICDC’s rigid carceral borders is mostly, if not wholly, limited to the nearby town of Douglas, Georgia[2]. Here resides the office of the primary gynecologist treating women housed in the facility — the women often refer to him as the “uterus collector[3]”. In September 2020, licensed practical nurse Dawn Wooten, a Black woman employed at the center, filed a formal complaint through the NGO Project South, alleging widespread medical neglect and abuse by ICDC staff[4]. Her claims were consistent with shamefully common allegations of abhorrent treatment and conditions found within ICE detention facilities. That is, until Wooten raised concerns about the performance of mass hysterectomies on women detained at the center, by a physician named Dr. Mahendra Amin.
In lieu of the racialized historical uses of gynecological care in the United States, the performance of mass-hysterectomies at Irwin County cannot be divorced from the genocidal and white supremacist ideologies undergirding their enactment[5]. As such, the widespread practice of sterilization procedures on predominantly Latina migrant women at the facility is inextricably linked to the pre- and postbellum desire to control the populations of Black, Indigenous, and other communities of color. These eugenic predilections were operationalized through the medical abuse of Black and brown women’s reproductive bodies. Consequently, the historical legacies of eugenics within the medical establishment are simultaneously a contemporary happening, rendering incarcerated women of color uniquely vulnerable to sterilization procedures. These surgeries function to quell white racial anxieties about the changing face of America through the destruction of women of colors’ potential for biological motherhood, and in turn, access to citizenship.
Rates of Hysterectomy Procedure: Across Racial Lines
Hysterectomy procedures are the most frequent non-pregnancy related surgery performed on women in the United States, and approximately 96% of these surgeries are for benign conditions[6]. Despite this, there are stark racial disparities within the frequency in which women of color receive these surgeries. According to a 2005 study of over 15,000 women between the ages of 40 and 55, ethnic and racial minority women had the highest odds of past hysterectomy for a benign condition: 30.2 percent of African American participants, and 15.5% of surveyed Hispanic women[7]. Despite higher rates of hysterectomy procedure for Black and Latina women, these rates could not be explained by common risk factors such as lesser access to education, nor a higher prevalence of obesity[8]. Looking beyond medical explanations for this disparity, by shifting our attention toward the racialized legacies of gynecological care, the causal reasons for the marked higher rates of hysterectomy procedure amongst women of color become illuminated.
The Racialized History of American Gynecology
If the women detained at Irwin County have not yet become patients of Dr. Amin themselves, they have heard many stories about his care. Recounting her conversations with five women who had received hysterectomies from Dr. Amin, a detained immigrant woman told Project South: “When I met all these women who had had surgeries, I thought this was like an experimental concentration camp. It was like they’re experimenting with our bodies[9].” Skeptics may dismiss her claims as conspiracy, but the historical record of medical experimentation on the bodies of enslaved Black women affirm this felt experience as truth.
According to Harriet A. Washington, “medical theories of criminality are important because medicine has long claimed special provenance over criminality[10].” It is under these pretenses that J. Marion Sims, widely heralded as the “father of gynecology,” was able to perfect his “cure” for obstetric fistula. While his discoveries were in service of white women, this medical progress was dually contingent, and at the expense of enslaved women and their labor, whom he used as both nurses and patients[11]. Racist and carceral sensibilities held by Sims, and the medical establishment at large, marked enslaved women as reasonable test subjects based upon their status as property As a result, the discipline of gynecology became well-suited for “racecraft,” and racist assumptions about Black female bodies were transformed into medically codified “truths” about the reproductive rights of Black women[12].
Given this history, it becomes increasingly clear why several women detained at ICDC have made claims of Dr. Amin’s consistent overstatement of the size and risks associated with cysts and masses attached to their reproductive organs[13]. Women have also reported his routine listing of patient symptoms, including chronic pelvic pain and heavy bleeding with clots, which function to justify his frequent recommendation and practice of surgical intervention. However, in some cases, women receiving care from Dr. Amin claim they never experienced nor reported these symptoms at all[14]. As the discipline of gynecology has continued to legitimize itself without recognizing the influence of race essential beliefs over the course of its development, claims to ownership of knowledge has been transferred away from patients, and placed into the hands of physicians. Doctors are believed to know women’s reproductive bodies better than themselves. Subsequently, it is no wonder how eugenic practices of sterilization on incarcerated women of color have been sustained by the medical establishment across time.
Eugenics and the Forced Sterilization of Women of Color
The work of eugenicists preyed upon early 20th century fears of white “race suicide” and “the girl problem.” These white supremacist sensibilities were operationalized through the restriction of the reproductive capacity of women deemed “feebleminded,” particularly poor women and women of color[15]. In the time since, numerous examples of coercive and compulsory sterilization have emerged. Throughout the 1900s, in Puerto Rico, New York City, and California, Puerto Rican women were specifically targeted by government sterilization policy. A 1965 survey found that 35 percent of all Puerto Rican mothers between the ages of 20 and 49, living in the United States had been sterilized[16]. Black women have also survived a long historical trend of sterilization abuse. In North Carolina, 65 percent of sterilization procedures were performed on Black women, despite being only 25 percent of the state’s female population[17]. Additionally, throughout the 1970s Native American women were forcibly provided family planning services through the Indian Health Service (IHS), which served to sterilize as much as 25 percent of indigenous women between the ages of 15 and 44[18].
Compulsory Sterilization in Carceral Environments
Women detained at Irwin County have made numerous complaints including long wait times when seeking care, dirty conditions within the medical unit, refusal by staff to communicate with patients in their native language, and confusing or inaccurate information regarding their diagnosis and the procedures being performed[19]. These conditions contribute to a general lack of informed consent, and Roth argues that in carceral environments, the line between “coercion” and “choice” when confronting the power of the state on the matter of reproductive rights, becomes intensely blurred[20]. As such, women facing incarceration remain highly vulnerable to suggestions and procedures limiting their right to their own sexuality, bodily autonomy and integrity, and ability to make future or immediate reproductive decisions for themselves[21].
In many cases, presently incarcerated women are the most ideal targets for forced sterilization due to two factors: 1) racial disparities within prison populations, whereby Black and Latina women have been incarcerated at higher rates than their white counterparts[22], and 2) the social location of prisoners, beyond the scope of public purview. As of current, federal regulations prohibit the use of federal funds for the sterilization of people who have been institutionalized, setting a strong policy precedent against government involvement in the sterilization of incarcerated persons[23]. Despite this, one would be remiss to assume that these reproductive procedures have halted.
In 2013, Reveal reported that between 2006 and 2010, a minimum of 148 pregnant women incarcerated at two California prisons received tubal ligations shortly following childbirth[24]. The majority of these women were Black and Latina, whom prison staff targeted based upon their likelihood of recidivating and thus, reincarceration[25]. Although this may appear as merely an isolated incident, California’s lengthy and sinister history of compulsory sterilization states otherwise. From 1909 to 1979, roughly 20,000 people in state institutions deemed “unfit to produce” were forcibly sterilized[26]. The individuals targeted were disproportionately Latino, women, and people with disabilities; the programs average victim aged 17, and as young as 12 years old[27]. Accordingly, California coercively sterilized the largest number of people of any state during the eugenics era[28].
Eugenic Control of Latinx Women’s Bodies
During the 1970s, Chicano lawyers filed two landmark lawsuits against a Los Angeles County hospital alleging the coercion of Latina women into sterilization operations: Andrade v. Los Angeles County and Madrigal v. Quilligan. Evidence put forth during litigation suggested that physicians at the L.A. County hospital sought to lower to birth rate of women of Mexican heritage through their practices[29]. Collectively, these suits served as a direct challenge to speculation during the 1950s and ’60s that eugenic beliefs had undergone a decline.
Despite the perception that eugenic influence was waning, advocates of population control continued their practices arguing that the reproductive lives of Latina women must be controlled for the greater good of the entire nation. The connection between white racial anxieties surrounding demographic change and eugenic medical practices is often cemented in the realm of the historical. Or rather, it is represented as a past and not present harm. However, an examination of current “Hispanic” birth rates, and overall demographic trends in the U.S. population necessitates an understanding of the relationship between race, population, and the medical establishment as a contemporary occurrence.
Fear of White Decline: America’s Progression Towards “Minority-Majority” Status
The United States is projected to become a “minority-majority” country by 2045. Simply put, the nation’s population is becoming increasingly racially and ethnically diverse. This shift is the result of two long-term trends: 1) significant birth rates amongst minority women, and thus continued gains in the combined racial minority population, and 2) an aging white population set to experience decline[30]. In fact, this year, for youth under 18, minorities have already begun to outnumber whites[31]. The rhetoric used to discuss this change is significant, and “demographic narratives” emphasizing the threat of white decline have stirred racial anxieties, especially amongst white supremacists[32]. By stressing the threat of a shrinking white segment of society, as opposed to increasing American diversity, demographic change becomes a “zero-sum game that white Americans [are] losing…and could provoke a political backlash[33].”
“Hispanic” Birth Rates: Women’s Wombs and the Changing Face of America
The wombs of Black and Latina women have functioned to quite literally, change the historically-white face of America. As such, the success of racialized population control, and the potential reversal of white decline, is contingent on the regulation minority birth rates, and in turn, women of color’s reproductive capacity. Latina women are now responsible for nearly a quarter (24 percent) of the overall share of births in the United States. Consequently, their reproductive bodies have become central cites for eugenic attacks inspired by racial panic regarding the United States’ ascension towards “minority-majority” demographic status.
In 2018, among immigrant women, half of all births were to women of Hispanic origin, down from 58 percent in 2000. Moreover, 17 percent of all births in the United States during 2018 were to women of Hispanic origin; up from 10 percent in 2000[34]. The “Hispanic” population is set to grow 86 percent from 2018 through 2060; immigration contributing to one third of this growth, the rest the result of naturally occurring reproduction[35]. This rapid expansion of the Latinx population, coupled with a marked decline in birth rates for white women, whose share of births fell from 71 to 64 percent from 2000 to 2018[36], has reawakened white racial panic about population. In turn, undocumented Latina women housed in ICE detention facilities are particularly vulnerable to reactionary medical practices, inspired by eugenic sensibilities. It is within these facilities, beyond the visible reaches of public concern, that racialized sterilization abuse is hidden and enacted.
Motherhood as Citizenship: Sterilization as an Imperial Project
In “Menacing (Re)Production,” LeFlouria writes, “…biological oppression was used to impede black women’s ability to express their rights to citizenship through reproduction and motherhood[37].” Sterilization functions to alienate some mothers, and not others, from the privileges and protections citizen-status. Furthermore, it designates these women’s rightful place as somewhere beyond, and not within, the imperialist borders of the nation state. Ominously consistent with the historical record, at ICDC, through the care of Dr. Mahendra Amin, white racial anxieties concerning demographic change were weaponized by the medical establishment. This abusive power was executed through the reproductive control and sterilization of incarcerated Latina women. What the performance of mass hysterectomies at Irwin County Detention Center makes glaringly apparent, is that eugenic traditions are not merely historical legacies, but also contemporary happenings and practices –and they continue to harm incarcerated women of color the most.
References
[1] Harsha Walia, Undoing Border Imperialism (AK Press, 2013).
[2] Dickerson, Wessler and Jordan, “Immigrants Say They Were Pressured Into Unneeded Surgeries,” The New York Times, September 29, 2020.
[3] Project South to Joseph V. Cuffari, Cameron Quinn, Thomas P. Giles and David Paulk, September 14, 2020, 19.
[4] Ibid., 7–27.
[5] Natasha Lennard, “The Long Disgraceful History of American Attacks on Brown and Black Women’s Reproductive Systems,” September 17, 2020.
[6] Powell, Meyer, Weiss et. al. “Ethnic differences in past hysterectomy for benign conditions,” Women’s Health Issues 15, no. 4 (2005), 179.
[7] Ibid., 183.
[8] Ibid., 180.
[9] Project South, September 14, 2020, 19.
[10] Harriet A. Washington, Medical Apartheid (Anchor, 2008), 247.
[11] Marie J. Schwartz, “Gynecological Surgery,” in Birthing a Slave (Harvard University Press, 2010.
[12] Schwartz, “Gynecological Surgery.”
[13] Dickerson et al., “Immigrants Say They Were Pressured.”
[14] Ibid.
[15] Virginia R. Espino, “Belly of the Beast: California’s dark history of forced sterilizations,” (Arizona State University, 2007).
[16] Committee for Puerto Rican Decolonization, “35% of Puerto Rican Women Sterilized,” Chicago Women’s Liberation Union.
[17] Kathryn Krase, “The History of Forced Sterilization in the United States,” Our Bodies Our Selves, October 1, 2014.
[18] Jane Lawrence, “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly 4, no. 3 (2000).
[19] Project South, September 14, 2020.
[20] Rachel Roth, ““No New Babies?” Journal of Gender, Social Policy, & Law 12, no. 3 (2004).
[21] Ibid.
[22] Marc Mauer, “The Changing Racial Dynamics of Women’s Incarceration,” The Sentencing Project, February 27, 2013.
[23] Roth and Ainsworth, “If They Hand You a Paper You Sign It!” Hastings Women’s Law Journal 26, no. 1 (2015).
[24] Corey G. Johnson, “Female inmates sterilized in California prisons without approval,” Reveal, July 7. 2013.
[25] Ibid.
[26] Shilpa Jindia, “Belly of the Beast: California’s dark history of forced sterilizations,” The Guardian, June 30, 2020.
[27] Ibid.
[28] Roth and Ainsworth, “If They Hand You a Paper.”
[29] Espino, “Belly of the Beast.”
[30] William H. Frey, “The US will become ‘minority white’ in 2045, Census projects,” Brookings, March 14, 2018.
[31] Ibid.
[32] Aisla Chang, “How the “Majority-Minority” Projection Took on a Life of Its Own,” All Things Considered, March 30, 2020.
[33] Sabrina Tavernise, “Why the Announcement of a Looming White Minority Makes Demographers Nervous,” The New York Times, November 22, 2018.
[34] Gretchen Livingston, “Hispanic women no longer account for the majority of immigrant births in the U.S.,” Pew Research Center, August 8, 2019.
[35] Frey, “The US will become minority white.”
[36] Livingston, “Hispanic women.”
[37] Talitha L. LeFlouria, “Menacing (Re)Production,” in Caging Borders and Carceral States (University of North Carolina Press, 2019), 174.
