Defining Reproductive Freedom for Women 'Living Under a Microscope': Relf v. Weinbergerand the Involuntary Sterilization of Poor Women of Color
Summary
During the 1970s, many women on welfare, especially African Americans, were involuntarily sterilized. Because they were dependent on government assistance, poor women were vulnerable to coercion. They sometimes "consented" to sterilization in response to threats that lack of cooperation would lead to loss of benefits. Linking distribution of birth control devices with the medical profession obscured the women's reproductive rights claims made during the original movement to legalize birth control and led to paternalistic control over family planning. Especially in the cases of poor women, it was medical professionals who had power over women's reproductive systems, not the women themselves. After the Relf sisters brought a class action lawsuit, new regulations were issued to ensure that sterilizations were truly voluntary. Reproductive freedom was redefined to include freedom from coerced sterilizations as well as access to birth control and abortions.
In 1964, Congress created Community Action Programs (CAPs), which helped low-income families and individuals become self-sufficient. The Montgomery, Alabama CAP (CAC) discovered the Relfs, an African American family living in poverty, directed them to a housing project, and persuaded them to use certain social services, including family planning. CAC officials took the Relf girls-Katie, 16, Mary Alice, 14, and Minnie, 12-to a doctor who gave them injections of Depo-Provera before it was approved by the FDA. When the administration of Depo-Provera was banned pending FDA approval, nurses first took Katie to have an IUD inserted and later sterilized the minor Relf daughters, Minnie and Mary Alice. Their mother, told only that the girls would receive "some shots," signed a consent form.
A social worker later informed the Relfs about what had happened and took them to the Southern Poverty Law Center, which filed a complaint. The litigation brought the prevalence of sterilization abuse to light and prompted Senator Kennedy to hold hearings on the subject. The Office of Economic Opportunity, the parent agency responsible for the community action grant program, drew up guidelines for sterilization requiring counseling, informed consent and reporting, but their distribution was delayed. After the hearings, HEW drafted and implemented stronger guidelines, but the U.S. District Court for the District of Columbia found that these guidelines were insufficient to ensure that sterilizations would be voluntary. For the first time, a federal court acknowledged and condemned the practice of involuntary sterilization. The U.S. Court of Appeals for the D.C. Circuit later dismissed the claim as moot when the Department of Health and Welfare issued new regulations on the use of sterilization in federally funded programs.
Before the Relf case, many reproductive rights advocates viewed informed consent requirements as impediments to reproductive freedom because they involved government interference with a woman's control over her fertility. Some feared that such regulations would interfere with women's reproductive autonomy. Proponents of informed consent requirements argued that they were necessary to protect poor women from coercion and to give reproductive autonomy real meaning. As a result of the Relf case the concept of reproductive freedom evolved to include freedom to reproduce as well as freedom from unwanted pregnancies.
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