A whistleblower complaint filed Monday has struck a nerve, nabbing headlines around the world, after a nurse alleged that immigrants in a U.S. Immigration and Customs Enforcement detention center are being subjected to a high rate of hysterectomies, procedures that remove a woman’s uterus or womb and leave her unable to get pregnant.

The charges center on Irwin County Detention Center (ICDC) in Georgia, which is operated by the private prison company LaSalle Corrections. Several legacy advocacy groups filed the complaint to the Department of Homeland Security’s Office of Inspector General on behalf of nurse Dawn Wooten, who worked at ICDC for three years. The complaint alleges that an off-site doctor performed the surgeries on women who complained of conditions such as heavy menstrual cycles or ovarian cysts. But Wooten alleged many of the women did not understand why they’d undergone the procedure.

ICE has responded that it takes “all allegations seriously” but that “anonymous, unproven allegations made without any fact-checkable specifics” should be treated with skepticism.

At a time when allegations of abuse at immigration detention centers are rampant, this complaint (which included a litany of other accusations, including that coronavirus safety precautions are routinely ignored), has led to demands for answers, including from Democratic lawmakers and immigrants rights activists.

As headlines emphasize these procedures, it’s important to understand how they fit into a long history of medical experimentation on and sterilization of low-income women of color in the United States.

The ‘father of gynecology’

The field of modern gynecology is often credited to J. Marion Sims, a surgeon who practiced medicine in Alabama between 1835 to 1849. Sims performed the first surgery for fistula, a devastating childbirth injury, and the first successful artificial insemination. Instruments he invented, including the vaginal speculum, are still in use today.

But Sims developed these techniques through gruesome experimentation on enslaved Black women he purchased in the 1840s, and he did not use anesthesia. In the book “Medical Apartheid,” author and medical ethicist Harriet A. Washington writes that he was assisted by male doctors who physically restrained women while he made incisions. As Washington describes: “Within a year they could bear neither the bone-chilling shrieks of the women nor the lack of progress any longer. The doctors left, leaving the women to take turns restraining one another.”

The eugenics programs that inspired Nazis

Medical experimentation blossomed quickly in the early 20th century with a complex network of programs that forcibly or, with coercion, led to the sterilization of hundreds of thousands of women. Alexandra Minna Stern, author of “Eugenic Nation,” writes in an article that policymakers, medical professionals and social reformers who were part of an emerging eugenics movement pushed sterilization as part of “a necessary public health intervention that would protect society from deleterious genes and the social and economic costs of managing degenerate stock.”

These programs went on to target poor women, Black women, immigrant women and disabled women — and in many cases men — so effectively that they drew the praise of Adolf Hitler, who went on to model his sterilization laws after those in the United States.

Sometimes these practices were part of state laws, including one passed in California that resulted in 20,000 residents being coercively sterilized between 1909 and 1979. Forced sterilizations were so frequently used to control Black populations in Southern states that they were referred to as “Mississippi appendectomies.”

They were also carried out by institutions founded for this express purpose, including the North Carolina Eugenics Board, which sterilized 7,600 women with mental disabilities between the 1940s and the 1970s. Residents at teaching hospitals in the North and South honed those skills by performing unnecessary hysterectomies on Black women.

In some cases, procedures were carried out across a population more systematically, including in Puerto Rico, where one-third of women of reproductive age were sterilized from the 1930s to the 1970s, the highest rate in the world. Many of them were sterilized involuntarily at clinics funded by the U.S. government and by Procter & Gamble heir and eugenicist Clarence Gamble. These clinics were used to perform nonconsensual experimental trials of the first birth control pill — which were also supported by pioneering birth control activist Margaret Sanger, who supported the pill as a eugenics tool.

Modern medical practices

Of course, many women choose to undergo sterilization themselves (often, though, this is done through tubal ligation rather than a hysterectomy). But as Judge Gerhard Gesell concluded in the 1973 landmark case Relf v. Weinberger, which required doctors to obtain informed consent before sterilizing someone in the United States, “the dividing line between family planning and eugenics is murky.” The case was filed on behalf of sisters Minnie and Mary Alice Relf, who were 12 and 14, respectively, when their illiterate mother unwittingly gave their doctor consent to sterilize them. After the sisters held a news conference, thousands of Black and native women came forward to report their own coercive sterilizations. Gesell estimated that in just a few years, 100,000 to 150,000 poor women had been sterilized under federal programs, and an indefinite number had been coerced to do so at the threat of losing their welfare benefits.

Despite the ruling and the mass media coverage it generated, the practice continued. Anxiety over the world’s growing population — and specifically the growing population of low-income Americans, many of whom were people of color — led the Nixon administration to significantly increase Medicaid funding to sterilize poor Americans, targeting people of color. About 90 percent of sterilization costs for poor people were covered by the government; from 1970 to 1975, sterilization increased by 350 percent, with about a million women undergoing sterilization annually.

Women have continued to experience this procedure even more recently than that, however. Doctors under contract at the California Department of Corrections and Rehabilitation sterilized 148 women between 2006 and 2010 without approval, according to the Center for Investigative Reporting, and possibly another 100 in the years before. In May 2017, a Tennessee judge issued a standing order giving incarcerated people 30 days jail credit in exchange for being sterilized (it was later rescinded). Today, many places in the United States require transgender people to undergo sterilization for their gender identity to be legally recognized.

Wooten’s allegations against ICDC have already drawn calls for action, many of which have highlighted the United States’ role in forced sterilizations.

“Reports of mass hysterectomies and medical neglect in ICE detention are horrifying but sadly not surprising. The United States has a long and sordid history of reproductive coercion and forced sterilization,” Jamille Fields Allsbrook, director of women’s health and rights at the liberal think tank Center for American Progress, said in a statement. She added, “These racist, eugenicist practices are often sanctioned by U.S. law.”

U.S. lawmakers have also responded, including House Speaker Nancy Pelos (D-Calif.), who demanded an investigation into the “appalling conditions described in the whistleblower complaint.” She, too, noted that “this profoundly disturbing situation recalls some of the darkest moments of our nation’s history.”

However, public surfacing of information about forced sterilizations in the past, including the Relf case and a number of reports, have rarely sparked change that rivals the scale of the revelations.

Editor’s note: A previous version of this article incorrectly noted that President Nixon put funding toward sterilizing people with AIDS. The first cases of AIDS were not identified until after his presidency. We regret the error.

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