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Who Chooses?American Reproductive History since 1830$

Simone M. Caron

Print publication date: 2008

Print ISBN-13: 9780813031996

Published to Florida Scholarship Online: September 2011

DOI: 10.5744/florida/9780813031996.001.0001

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Who Pays for What? Abortion and Sterilization, 1960–1975

Who Pays for What? Abortion and Sterilization, 1960–1975

(p.187) 7 Who Pays for What? Abortion and Sterilization, 1960–1975
Who Chooses?

Simone M. Caron

University Press of Florida

Abstract and Keywords

This chapter discusses changes in reproductive policy from 1960 to 1975. In order to lower illegitimacy, break the cycle of poverty, and reduce welfare expenditures, the government subsidized services, including contraceptives, abortion for a short time, and sterilization. Government action in this area had little to do with women's right to control their bodies but rather with concerns over mounting welfare expenditures and perceived uncontrolled fertility among the indigent, especially ethnic and racial minorities. To resolve these “problems” the federal government increased financial support for family planning by 1,300 percent between 1967 and 1973. This involvement coincided with the welfare explosion of the late 1960s and the escalating costs to society of programs for the indigent. Through subsidized contraception white elites in powerful positions attempted to shape the racial and socioeconomic quality of the population along lines suitable to them. While many women faced coercive tactics, others were able to take advantage of new subsidized services to govern their life choices.

Keywords:   abortion, reproductive policy, sterilization, family planning programs, welfare costs, conceptives

In the early 1960s illegal abortions continued unabated, with underground services proliferating as the decade progressed. A number of influential organizations pushed for change, including Nixon's Commission on Population Growth. A number of factors triggered growing acceptance of abortion and sterilization: environmental concerns, scarcity of world resources, greater openness about sex and contraception, and the availability of relatively safe and simple procedures. Women increasingly called for reproductive rights, a demand that held little sway over state and federal legislators. Fiscal conservatives, population controllers, and demographers' pressure to reduce government expenditures, especially AFDC, did influence state and federal decisions not only to legalize but also to fund abortion and sterilization procedures. State reform provided statistics demonstrating the impact of legalization, namely, declines in illegitimate birthrates, teenage births, maternal mortality, and the fertility rate of indigent women. Although population controllers hailed these statistics as proof that abortion could help solve the population “problem,” Nixon opposed abortion. Concern for the Catholic vote led him to reject abortion but not sterilization, despite official church rejection of both procedures. Of the two, Catholic opposition was much stronger to abortion than sterilization. The latter provided Nixon an opportunity to keep elite white population controllers' support without losing the Catholic vote—a win-win situation for him. As with earlier reform, the rhetoric used to justify liberalization was not as important to individual women as the reproductive freedom many gained. While middle- and upper-class women enjoyed more choice, many lower-class and indigent women faced coercive tactics by white officials who believed they should choose who ought to be allowed to procreate. As it had during the genocide accusations with the pill, PPRI remained unscathed by the coercion controversy. The clinic adapted its programs to suit client demands, offering abortion services and opening the first vasectomy clinic in New England.

(p.188) The Push for Abortion Reform

During the early 1960s illegal abortions rose percent, reaching an estimated 1.5 million annually. A study of urban North Carolina found 14.9 illegal abortions per conceptions for whites and 32.9 per 100 conceptions for blacks. It also found a high rate of illegal abortions for women of both races who had five or more pregnancies.1 Growing numbers of abortions among single women concurred with rising illegitimacy rates. Both trends demonstrated increased premarital sexual activity. While arguing that contraception could prevent these pregnancies, some social critics contended that abortion laws should be reformed to terminate unwanted pregnancies that did occur. Demographer Charles Westoff claimed that between 800,000 to 1 million unwanted births took place annually, most among the indigent and low-income women who burgeoned welfare costs. He asserted that 20 to percent 25 of all pregnant women each year sought abortions. In almost all cases, the wealthy secured legal operations (approximately 10,000 per year) because they either had a trusted doctor or traveled abroad.2

While indigent and low-income women might encounter a sympathetic doctor willing to help them, they often experienced unsanitary conditions and painful, botched procedures. A twenty-four-year-old married woman with three children paid Mrs. Dorothy E. Furtado of Providence $150 for an abortion performed in Furtado's apartment. The woman developed an infection and had to be hospitalized. Such stories did not prevent other women from seeking illegal abortions. In fact, women protected abortionists. When thirty-year-old Anthony Altieri was arrested for performing an abortion on a twenty-two-year-old Providence woman, the latter refused to cooperate with police and testified in court that she did not see the abortionist. With legislative immunity still in place, she stood to lose nothing from refusing to identify the man. Her testimony forced the state to dismiss the charges against Altieri.3

Several events in the s brought the legal status of abortion to a head. First, in 1962 Dr. Helen Brooke Taussig of the FDA investigated thalidomide, a European narcotic marketed as a sleeping tablet, tranquilizer, and miracle aid to combat morning sickness, and found it caused fetal malformations, especially in early pregnancy.4 Sherri Finkbine, a television personality and mother of four in Arizona, had taken thalidomide after her husband brought it from England to ease her morning sickness. Her doctor recommended she terminate the pregnancy, but state officials refused; she traveled to Sweden.5 Sarah Weddington, the lawyer who argued Roe, contended that Finkbine “had a great impact” because she was a middle-class woman who “had other children she loved very much, and she was very articulate about simply not (p.189) wanting this particular pregnancy.” The American public agreed: 52 percent supported her, 32 percent disapproved, and 16 percent had no opinion.6

Second, after four years' work at the behest of physicians concerned with ambiguous abortion laws, the American Law Institute (ALI) affirmed abortion when the woman's physical or mental health was endangered; the fetus was physically or mentally defective; or the pregnancy was the result of rape, incest, or other felonious intercourse.7 The mental health inclusion was important: as medical advances eliminated conditions dangerous to pregnant women, physical health justifications decreased. Psychiatrists increasingly recognized the impact on a woman's mental health if she was forced to carry an unwanted pregnancy to term.8

Third, German measles swept the nation from 1962 to 1965, posing a 50 percent chance of fetal deformity to infected women. Many sought abortions. Sympathetic doctors in California ignored the law and performed them. Patricia Maginnis argued that these doctors came under scrutiny because the state was “heavily dominated by Catholic politicians.” The inquiry suspended further abortions, but indictments raised a public outcry, and many physicians came to the defense of the accused.9

Fourth, the 1967 European introduction of vacuum (or suction) aspiration made abortion more acceptable to many physicians. Earlier, the primary method was dilation and curettage (D&C), a bloody procedure many doctors found troublesome.10 Vacuum aspiration done in the first trimester was a relatively easy and painless procedure that reduced aversion to abortion among some doctors, just as vasectomy had earlier replaced castration as a more acceptable medical practice.

As abortion demands increased, abortion referral services emerged to help women secure safe, albeit illegal, abortions. The New York Clergy Consultation Service on Abortion (NYCCSA) was established in under the leadership of the Reverend Howard R. Moody, pastor of the Judson Memorial Baptist Church in Greenwich Village. The church administrator at Judson, Arlene Carmen, became NYCCSA director, motivated by her belief that abortion laws were designed to keep women “in their place. It had nothing to do with our safety or protection at all.” As Carmen concluded, the church a liation of NYCCSA lent a “certain appeal … for the public, which I'm sure the authorities shared.” Even the Catholic Church made no efforts to “do anything” about the NYCCSA, perhaps because it was not calling for the legalization of abortion. It simply assisted women who “were going to have abortions anyway.” The NYCCSA operated from May 1967 to July 1970.11 Sadja Goldsmith organized a clergy counseling service at the San Francisco Planned Parenthood in 1967, believing that the clergy a liation gave the service an “umbrella of respectability.” Goldsmith encountered resistance (p.190) from conservative Planned Parenthood board members who argued that involvement with abortion would damage fund-raising for contraception. When she refused to abandon the project, some board members resigned, and some foundations withdrew financial support, but the service continued to operate. In Los Angeles Hugh Anwyl organized a similar group, and in Chicago underground services were available through “Jane,” who arranged approximately eleven thousand abortions. The National Clergy Consultation Service, founded in November 1968, operated affiliates in twenty states, involved thousands of ministers, rabbis, and laypersons, and counseled over 300,000 women by 1970. Most National Clergy Consultation Service clients were middle class.12

Low-income and indigent women often faced back-alley abortions. Warren M. Hern, physician and staff member of OEO's family-planning program, wrote that these women suffered and sometimes died because they could not afford safe abortions, “obtained with relative ease by the more affluent. … A disproportionate number of the women who die are Puerto Rican, black, Mexican American, or members of some disadvantaged group.” Magazines such as the Christian Century, Pageant, the Saturday Evening Post, Parents Magazine, Atlantic Monthly, Redbook, and the New York Times Magazine ran articles decrying the bungled criminal abortions to which low-income and indigent women had to resort because safe, antiseptic operations were available only to the affluent.13

While referral services and some journalists were concerned with women's health and safety, population controllers and fiscal conservatives pushed for reform to manipulate demographics and to save money. The hazards of back-alley abortions scared many low-income and indigent women into carrying a pregnancy to term, often resulting in additional AFDC expenditures. Women in poverty accounted for 60 percent of white and 80 percent of nonwhite illegitimate births. Demographers asserted that within eight years legal abortions might reduce illegitimacy by 50 percent and eliminate the cost of maintaining defective o spring.14

Public opinion also supported reform.15 Studies in 1965 and 1970 asked six identical questions regarding abortion and found a substantial change (see table 7.1)16. The percent favoring abortion for couples who could not afford a child more than doubled in every group. The increase was even greater for those in favor of abortion for unmarried mothers and seemed to correspond with mounting illegitimacy rates and AFDC costs. In 1965, for example, AFDC expenditures totaled $1.5 billion; in 1969 they reached $3.3 billion, and 31 percent of all children on AFDC were illegitimate. Critics argued that legalized abortion would give these mostly young mothers an alternative and save taxpayer dollars.17


Table 7.1 Percent of Wives Who Approve Different Reasons for Abortion, 1965–1970

Year and reason for abortion



Black olic

White Cat


Mother's health endangered



















Pregnancy result of rape



















Probable deformity of child



















Mother unmarried



















Couple cannot afford child



















Couple do not want child



















Source: Elise F. Jones and Charles F. Westoff, “Attitudes toward Abortion in the United States in 1970 and the Trend since 1965,” in Demographic and Social Aspects of Population Growth, ed. Charles F. Westoff and Robert Parke, Jr. (Washington, D.C.: Government Printing Office, 1972), 572.

By the late 1960s cost-cutting arguments, combined with concern for women's health and safety, led various organizations to support reform. The United Presbyterian Church, Unitarian-Universalist Association, ALI, American Civil Liberties Union, American Medical Women's Association, New York Academy of Medicine, local affiliates of PPFA, National Council of Women of the United States, and YWCA called for liberalization. A survey of 2,285 gynecologists in New York found that 87 percent favored a new law.18 The Citizens' Advisory Council on the Status of Women, established under Kennedy, argued in its 1968 report that the government should be removed from a private decision and called for outright repeal rather than reform because proposals that “permit abortions under certain circumstances while penalizing all others deny the right of a woman to control her own reproductive life in light of her own circumstances, intelligence, and conscience.” Yet the report spent more time discussing overpopulation and the environment than women's right to choose.19

(p.192) Feminists attempted to shift the discussion to women's rights. Redstockings, founded in 1969, defined abortion as integral to women's autonomy and called for the decision to be in the hands of women, not doctors, lawyers, or courts.20 The National Organization for Women (NOW) called for “the right of women to control their own reproductive lives” and removal “from the penal code laws limiting access to contraceptive information and devices … and governing abortion.”21 NOW's attempt to redirect the abortion movement from health, economic, and population concerns to individual freedom was not successful. Lucinda Cisler, national cochair of NOW's task force on abortion, acknowledged that this line of reasoning was the least popular. She criticized “those who caution us to play down the women's-rights argument” because the feminist perspective was a “really disturbing idea.” She resented that the growing popularity of abortion reform stemmed not from a women's rights standpoint but from “improved health, lower birth and death rates, freer medical practice, the separation of church and state, happier families, sexual privacy, [and] lower welfare expenditures.”22 Feminists gained support when the American College of Obstetricians and Gynecologists (ACOG) stated that abortion should not be used “as a means of population control.” In 1969 the Group for the Advancement of 280 Psychiatry, an organization of psychiatrists with abortion rights activist Lawrence Lader as one of its major representatives, recommended repeal because “a woman should have the right to abort or not, just as she has the right to marry or not.”23

Such feminist arguments held little sway with legislators. Fiscal contentions on decreasing welfare expenditures were much more persuasive to these overwhelmingly white men than any notion of women's reproductive rights. Burgeoning state budgets, not feminist demands, were key to abortion reform.

Reform of State Laws

Some states began to alter laws and looked to legislation in other countries. In 1920 the Soviet Union authorized abortion on request during the first trimester. Japan legalized it for socioeconomic reasons in 1948. Between 1965 and 1958 Czechoslovakia, Hungary, Yugoslavia, Poland, and Bulgaria legalized abortion on request. Population controllers and fiscal conservatives pointed to the 30 to 50 percent decline in the illegitimacy rates in these nations.24 Abortion reform in the United States, they argued, could bring similar results and thereby reduce welfare expenditures.

One of the first states to reform its law was California. E orts had begun (p.193) in the early 1960s but failed, according to Maginnis, because of “Catholic Church influence on legislation.” In 1962 Maginnis formed the Society for Humane Abortion, a tax-exempt educational body, and the Association for the Repeal of Abortion Laws as a parallel for lobbying and other political activities.25 The association tried to defeat a reform measure, the Bielenson Bill, but it passed in 1967. It allowed women to petition a committee of three to five physicians for an abortion, but applicants did not have the right to meet with this committee, which could grant abortions for rape or incest or grave impairment to women's physical or mental health. To meet the mental health criterion a woman needed two psychiatrists' letters, a time-consuming and expensive mandate. Moreover, insurance companies often deemed such women suicidal and canceled their policies. Women in teaching or other sensitive occupations found their jobs on the line because these letters entered their permanent medical records as signs of mental instability.26

Feminists resented such paternalism. Many male legislators believed women should have no say in “when they should be bred and not bred.” The procedure to fulfill the rape or incest condition struck many women as an “absolute, shocking insult.” Many legislators claimed that “girls” would use the mental health stipulation to “get even with their husbands.” There was a “huge distrust of women” and contempt for them among these legislators. They “always” referred to women as “girls,” and “fetuses were, just as now, incorrectly called babies.” Some legislators described women desiring abortions as “sluts' irresponsible ' self-serving' and selfish.” In the end, male legislators designed the law “to keep women under control” (a statement heard repeatedly at the hearings) and to make a woman “crawl on her belly with an immense lump of cash in her hand.”27

Illinois activists attempted to avoid the problems associated with the California law by calling for repeal rather than reform. Lonny Myers established the Illinois Citizens for the Medical Control of Abortion (ICMCA) in 1966 as the first state group to call for repeal on grounds that abortion was a private matter between a woman and her doctor. This reasoning attracted conservatives as well as liberals because it placed abortion within the context of individual freedom and responsibility. Myers chose the name to attract physicians, but this tactic failed. She then sought the support of professional men, “the most prestigious people.” Although she also attempted to enlist women, “there just weren't that many prestigious women who were willing to come out for abortion in Chicago.” Hugh Hefner endorsed ICMCA, and Playboy did all its printing. The endorsement of a man and magazine that treated women as sex objects did not fill the credibility gap left by physicians. Between 1967 and 1968 the ICMCA unsuccessfully lobbied the legislature (p.194) for repeal. While the Committee on Public Welfare supported the measure to reduce expenditures, Governor Otto Kerner vetoed it, fearing strong Catholic opposition.28

In other states some reforms were so complex that few women could meet the criteria. North Carolina allowed licensed doctors to perform abortions in hospitals for life and/or health endangerment; deformed fetus; incest; and rape, if reported within seven days. The law also stipulated a four-month residency requirement except in case of emergency and written consent from three doctors not engaged in private practice together.29 The latter aspect posed an insurmountable financial burden for most women. The restrictive nature of this and other measures led ICMCA to sponsor the First National Conference on Abortion Laws in Chicago in 1968, which led to the formation of the National Abortion Rights Action League (NARAL) in 1969 to pursue legislative repeal and judicial change. By 1970 Alaska, Arkansas, Delaware, Georgia, Hawaii, Kansas, Maryland, New Mexico, New York, Oregon, South Carolina, Virginia, and Washington had altered their statutes. Most laws adhered to ALI restrictions, but legal abortions still increased from 5,000 in 1963 to more than 200,000 in.30

The most significant change occurred in New York, where Constance Cook, a Republican representative, led the repeal e ort in 1970. She rejected requirements that women go before a doctors' committee and hospital committee and consult with psychiatrists. Cook was “bothered” that “the speeches were so outrageous, and so male-oriented,” with men making “the whole decision as to what women's lives shall be.” She gained the support of liberals concerned with women's reproductive rights and conservatives who believed repeal would reduce welfare rolls, especially AFDC. To ensure enough votes, Cook compromised, stipulating that abortions be performed by a doctor within the first twenty-four weeks. New York health law already required that doctors carry out the procedure; she backed down “reluctantly” on the time limit but did not believe she “sacrificed the basic principle.” Cook refused amendments mandating veto power for the husband and parental consent for minors. Groups working for the bill's passage included the New York branch of NOW, NYCCSA, NARAL (a group Cook considered “radical”), and the Association for the Study of Abortion, a group formed by doctors tired of “playing God” when determining if a woman qualified for a therapeutic abortion. New York's AMA did not endorse repeal because many of its members were Catholic; and, according to Cook, doctors feared that abortions would “hurt the profession economically” by reducing pediatric care. Planned Parenthood affiliates in Syracuse, New York City, and elsewhere endorsed the Cook Bill, but PPFA took no stand because it feared loss of its tax-exempt status if politically involved. This concern did not dissuade (p.195) the Catholic Church. The bill carried by a single vote, surprising everyone but Cook. First, she had downplayed feminism so as not to alienate male politicians. Second, as Cook recalled, there was “a whole group' who thought this would be a good way to cut welfare.” Third, as Alan Guttmacher remarked, the law passed due “to mounting concern about U.S. population growth and pollution.”31

The new law was the most liberal policy passed by 1970. New York left the decision to the patient and her doctor. It required no residency, no parental permission for teenagers, no consultations with other doctors, and no justification of the procedure. In the first six months 69,000 abortions were performed in New York City alone: 45 percent of clients were city residents, 4 percent were from other parts of the state, and 49 percent were out-of-state residents. Within the first year, according to department of health statistics 181, 182 legal abortions occurred in New York City—a figure that surpassed the expectations of reform proponents.32

The impact was clear. Birthrates declined, and illegitimate births dropped for the first time since 1954. Teenagers accounted for 13.8 percent of live births but 16 percent of abortions; of these, 33 percent were girls seventeen years old or younger. “All” shelters in New York City that cared for unmarried pregnant girls reported a “sharp decline” in applicants.33 This abatement suggests that legal abortions did not merely replace underground operations; rather, teenagers terminated pregnancies that would otherwise have resulted in births. As Representative Shirley Chisholm (D-NY) noted, New York policy before 1970, intentionally or not, served “to maximize illegitimacy”; the new law would help alleviate the problem of illegitimate children, who were usually “the most unwanted of the unwanted.”34 It also reduced the fertility rate of indigent women. Women difficult to reach with contraceptives were likely to resort to legal abortion. Between 1 July 1970 and 31 March 1971 ward patients accounted for 46 percent of live births but 55 percent of abortions. In addition to hospital services, Carmen and Moody established the nonprofit Center for Reproductive and Sexual Health in New York City in 1970 to offer low-cost abortion services. The center charged only $25 for an abortion and set aside 25 percent of abortions for indigent women. Fifteen months of legalized abortion brought a 7.5 percent decline in out-of-wedlock births and cut the maternal death rate in New York City by more than half to two deaths for every ten thousand live births, the lowest rate in city history.35

Black women comprised a sizable percentage of women seeking abortions. Nonwhites were more likely than whites to abort when the operation was legal. Nonwhite residents of New York City, for example, accounted for 32 percent of live births between 1 July 1970 and 31 March 1971 but 42 percent of abortions (see table 7.2 ). In a follow-up study black women accounted (p.196)

Table 7.2 Characteristics of Women Having Abortions, New York City, 1970–1971 Characteristics


Legal abortions per 1,000 live births





First births


Age nineteen or less




Source: Jean Pakter and Frieda Nelson, “Abortion in New York City: The First Nine Months,” Family Planning Perspectives 3 ( July 1971): 1–15.

for 47.6 percent of abortions versus 39 percent for white women, although more than twice as many white women lived in New York City.36

This high incidence of abortion among black women renewed genocide arguments of militant black males. Carmen confirmed that some white elites donated money “for all the wrong reasons,” but this goal did not reflect clinic staff attitudes, and black women realized the difference.37 Many black women argued that illegal, not legal, abortions were tantamount to genocide. Frances Beal asserted that “rigid laws concerning abortions” were a means of “outright murder,” because 80 percent of abortion deaths in New York City during the 1960s were among black and Puerto Rican women. Editor Renee Ferguson of the Washington Post contended that the New York law would have a “positive effect on halting the heretofore growing rate of New York hospital emergency cases of black and other minority-group women” who self-induced abortions.38 Shirley Chisholm worked actively for the repeal of remaining laws for the same reasons. She argued that 49 percent of pregnant black and 65 percent of pregnant Puerto Rican deaths resulted from criminal abortions. She concluded that “to label family planning and legal abortion programs ‘genocide’ is male rhetoric, for male ears. It falls flat to female listeners and to thoughtful male ones.”39 Genocide arguments did not stem the flow of women seeking abortions.

In fact, abortion on demand gained wide support. The Women's National Abortion Coalition supported abortion as a civil right;2,500 demonstrators, mostly women, marched in Washington, D.C., to demand repeal of restrictive laws.40 In June 1970 the AMA House of Delegates voted 103 to 73 to allow doctors to perform abortions for social and economic as well as medical reasons as long as the doctor was licensed, the abortion was performed in an accredited hospital, and two other doctors were consulted. In response, Dr. Gino Papola of Pennsylvania, president of the, 6,000-member National Federation of Catholic Physicians Guild, resigned from the AMA and urged th 35,000 Catholic doctors to do the same.41 Despite Catholic opposition, most doctors favored a liberalized policy. The ACOG called for abortion to (p.197) be left to the woman and her doctor. In addition, close to two hundred doctors and medical professors wrote a friend of the court brief to the Supreme Court in August 1971 claiming that abortion restrictions were unconstitutionally interfering with their right to practice medicine; these constraints led to “anti-social” results, such as unwanted children and dangerous illegal abortions.42

Public opinion also favored reform. In a 1965 poll 91 percent opposed liberalized policies, but a 1971 survey conducted by Nixon's Commission on Population Growth and the American Future found that 50 percent believed the decision should be left to the woman and her doctor, 41 percent claimed abortion should be permissible in certain circumstance, 6 percent stated it was unacceptable under any conditions, and 3 percent had no opinion. A further breakdown found that 33 percent of blacks but 51 percent of whites approved of liberalized policies; 45 percent of women but 53 percent of men approved; 45 percent of those over age thirty but 58 percent of those under age thirty approved; and 39 percent of Catholics, 48 percent of Protestants, and 91 percent of Jews approved of reform. A second question asked if abortion was acceptable for parents who had all the children they desired or could afford: 49 percent approved, 42 percent disapproved, and 9 percent had no opinion. Another survey by the American Council on Education found that 83 percent of first-year college students favored legalized abortion.43

In early 1972 three influential groups added their support. First, the ABA's 307-member House of Delegates approved a statute permitting abortions “on demand” during the first twenty weeks. Beyond twenty weeks, the ABA approved if the mother's mental or physical health was threatened, if the fetus was gravely deformed, or if the pregnancy resulted from rape or incest. Only thirty members dissented in this traditionally conservative body. The liberal tone of their statute was startling: of laws in effect at that time, only New York's was more permissive. Perhaps their stand derived less from a liberal belief in women's rights than from a conservative, elite concern with population composition, government expenditures, and government intervention in private and/or medical matters. Second, the UN's population division reported that abortion “may be the single most widely used method of birth control in the world” and that death rates among women undergoing legal abortions were “very low.” Third, Nixon's Commission on Population Growth and the American Future, with John D. Rockefeller III as chair, made public conclusions reached after a two-year investigation of population policy: the majority of the commission believed abortion should be left to the woman and her doctor. The commission called for laws “creating a clear and positive framework for the practice of abortion on request,” recommended government funding for it among the indigent, and urged health insurance companies (p.198) to cover its costs. The commission also asserted that contraceptives and sex education should be available to minors and that state laws impeding full access to these services should be reformed.44

Abortion and the Federal Government

Despite Nixon's strong support of contraceptives for population control and welfare savings, he refused to endorse abortion. Mindful of Catholic voters, he argued that “nothing should be done on the Federal level”; he preferred abortion laws “be considered by each State, and … acted upon by each State depending upon the opinion in that State.”45 Nevertheless, the early 1970s saw numerous bills introduced to Congress. Senator Robert Packwood (R-OR) sponsored S 3501, a bill to liberalize abortions in the District of Columbia, in February 1970 to serve as “an example to the rest of the country as to what the States should pass.” Because overpopulation was the “most important problem” facing the nation, he supported a policy to “control, restrain, and plan the population in this country.” He also introduced S 3502 to provide tax incentives for family limitation: a tax deduction of $1000, for the first child, $750 for the second, $500 for the third, and none for subsequent children. Neither proposal received much attention.46

The following year, on 31 July 1970, an administrative memorandum allowed physicians at military hospitals to perform abortions at government expense. This policy may have been connected to chemical warfare in the Vietnam War. In 1961 the military launched Operation Hades (later renamed Operation Ranch Hand), poisoning and defoliating Southeast Asia for at least ten years. By 1970 the United States had destroyed more than 5 million acres in South Vietnam by spraying nearly 23 million gallons of defoliants. The United States assured South Vietnam that this spraying was harmless to animals and humans, yet not until 1966 did the National Institutes of Health study the impact on pregnant animals. Results showed that a pregnant Vietnamese woman who drank water from a sprayed area had a 90 percent rate of fetal malformation.47 In June 1968 South Vietnamese newspapers reported a “remarkable rise” in deformed babies as a result of American defoliation. In December an American C-123 with engine trouble jettisoned a thousand gallons of defoliant on Tanhiep, twenty miles north of Saigon; the village later reported malformed infants.48 By February 1969 officials knew that Agent Orange (2,4,5 -T) caused fetal deformity: it was 100,000 times more potent than thalidomide as a cause of birth defects. Yet no government agency safe-guarded American servicemen or Vietnamese civilians. That summer, law students affiliated with consumer advocate Ralph Nader investigating the FDA discovered a report that found that “all dosages, routes, and strains” (p.199) of Agent Orange resulted in a threefold increase in abnormal fetuses and an almost percent fetal mortality rate. The study was unable to achieve a “no-effect” level—every dosage level produced deformed fetuses.49

On 29 October 1969 Dr. Lee Du Bridge, Nixon's science advisor, announced that the government would restrict the use of 2,4,5 -T in domestic food crops and military operations. White House officials would give no further information because the government did not want “wild speculation” similar to that over the birth control pill, which had “caused millions of women to get hysterical with worry.” The following day, however, the Pentagon announced that military use of 2,4,5 -T in Vietnam would continue and refused to acknowledge that it caused fetal deformities. Continued use opened the United States to charges of “callous disregard for innocent human life” and war crimes involving genetic damage to American GIs and Vietnamese civilians. By late 1969 both WHO and the UN General Assembly condemned American use of chemicals in Vietnam. Not until 15 April 1970 did the deputy secretary of defense ban Agent Orange use in Vietnam. By that point the military had sprayed forty million pounds of it there. The off- spring of Americans involved in Operation Ranch Hand as well as GIs on the ground displayed birth defects and genetic damage.50

Knowledge of fetal abnormalities presumably influenced the decision to allow and subsidize abortions at military hospitals. In San Antonio, Texas, the Wilford Hall Air Force Medical Center performed 135 abortions on service wives within a four-month period.51 This trend stirred abortion opponents in Congress. In October Representative John G. Schmitz (R-CA), former national director of the John Birch Society, unsuccessfully introduced a bill to reverse the July policy.52 Some doctors on bases refused to perform the operation. The Pentagon stipulated that in such situations the servicemen's wives could go to a civilian hospital with government funds as long as abortion was legal in that state.53 This stance outraged Schmitz, who told Congress that the “Federal Government should not be in the forefront of the baby elimination movement.” He introduced HR 4257 to require military hospitals to abide by state laws in which they were located, but again Congress took no action.54

The controversy spilled into the 1972 presidential race. In March 1971 Senator Edmund Muskie, the leading Democratic candidate and a Catholic, contended that abortion within the first six weeks of pregnancy was acceptable but “beyond that point” posed a moral dilemma because he believed the fetus had “quickened.” Despite his support for family planning, he opposed abortion as a remedy to reduce welfare.55 Paul N. McCloskey, Jr. (R-CA), a Republican challenger, asserted that the “rights of a woman to determine whether she bears a child” deserved a “heavier weight in the scales of justice in than the rights of the fetus to life.”56 His stand conflicted with the (p.200) majority of his fellow Republicans, especially Nixon. In April Nixon broke his silence, maintained since his 1968 campaign. He reiterated that the issue was for the states, not the federal government. “Partly for that reason,” he stated, “I have directed that the policy on abortions at American military bases in the United States be made to correspond with the laws of the States where those bases are located.”57 With most bases in states where abortion was illegal, Nixon's directive substantially lowered abortion access for military women. Bella Abzug (D-NY) criticized Nixon for invoking states' rights when the armed forces had no choice in their military assignments.58

Nixon took this opportunity to present his views. He stated that “from personal and religious beliefs I consider abortion an unacceptable form of population control.” Moreover, he claimed that “unrestricted abortion policies, or abortion on demand, I cannot square with my personal belief in the sanctity of human life—including the life of the yet unborn. … A good and generous people will not opt, in my view, for this kind of alternative to its social dilemmas. Rather, it will open its hearts and homes to the unwanted children of its own, as it has done for the unwanted millions of other lands.”59 Critics pointed out that Nixon's abortion view conflicted with the doctrine of his family's church, the American Friends Service Committee, which stated that “no woman should be forced to bear an unwanted child” and that “abortion, performed under proper conditions, is preferable to the birth of an unwanted child.”60 His Southeast Asia policies also clashed with Quaker pacifism and the “sanctity of human life.” Nixon took no action to aid the ten to fifteen thousand children fathered by American servicemen in South Vietnam: the government had “no authority” over or “responsibility” to children fathered by GIs. Servicemen attempting to bring their o spring into the United States encountered numerous obstacles, not the “open hearts and homes” to which Nixon referred.61

Editorials proliferated in reaction to Nixon's speech. Dr. E. James Lieberman of the National Institute of Mental Health questioned Nixon's “selective reverence for life”: “By tightening the military hospital abortion policy while softening the Mylai court-martial verdict, the President appears more concerned with the survival of the unwanted fetus than with the murder of those unlucky families who had to face Lieutenant Calley's guns.”62 A letter to the New York Times argued that if Nixon would “generalize his deep personalconviction ‘on the sanctity of human life’ beyond the abortion issue to one of universal life and limb,” then he would order a withdrawal from Vietnam and bring the “senseless carnage” to an end.63 A New York Times editorial concurred: “Issues affecting the ‘sanctity of human life’ are far more involved in the Vietnam war than they are in the removal of legal obstacles to abortion.”64 NARAL claimed that Nixon “seemed more concerned with the survival (p.201) of the unwanted fetus than with the heartbreaking waste of American and Vietnamese lives in Southeast Asia.”65

Nixon also drew criticism for interjecting his personal opinion into the public arena. Some accused him of playing politics by endorsing the “Catholic position” when the Supreme Court and state legislators were deciding whether the state had jurisdiction over a pregnant woman's body and her physician's professional judgment.66 The New York Times argued that any federal or state actions to make Nixon's personal views “the basis for public policy would be both cruel and regressive.” The editors also critiqued Nixon's claims regarding unwanted children: “Astonishing, indeed, is the President's assertion that America ‘will open its hearts and homes’ to these unwanted children. He, more than most, has reason to be aware that the nationwide conservative revolt against the cost of welfare is centered on the tens of thousands of children born out of wedlock in welfare homes.” They concluded that “to deny mothers in these homes the same freedom of choice as wealthier women … is an act of inhumanity and social irresponsibility.”67

This perceived threat to reform ignited increased activism. Senator Packwood introduced a bill in May 1971 that authorized abortions in the first twenty weeks if performed by licensed physicians and after that time if continuing the pregnancy endangered the woman's health.68 In July 1971 Abzug introduced a bill to provide consistent quality medical care, including abortion, to all military women regardless of the state in which they resided.69 The following May Abzug introduced the Abortion Rights Act of 1972. It would “finally and completely affirm the right of every American woman to choose whether or not she will be the mother of a child.” Abzug argued that restrictive policies discriminated against the indigent, who “most often” experienced the “problem of unwanted children.” These women had “been compelled to bear their unwanted children and to subject them to the deprived environment of poverty.”70 The Women's National Abortion Action Coalition, NOW, and Zero Population Growth promoted this act. Once again, however, the bill received little attention. Dr. George S. Walter, an advocate of Abzug's bill, claimed that resistance to legalized abortion was a holdover of male desire to dominate women: “The pregnant woman symbolized proof of male potency, and if the male loosens his rule over women and grants them the right to dispose of that proof when they want to, the men then feel terribly threatened lest the woman can, at will, rob them of their potency and masculinity.”71

Three days after Abzug introduced her bill, Nixon reiterated his aversion to liberalized policies. Expressing gratitude to his commission for their population study, he repudiated their primary recommendations: “I want to reaffirm and reemphasize that I do not support unrestricted abortion policies” and “unrestricted distribution of family planning services and devices to minors.”72 (p.202) Rumors circulated that Nixon's concern over the population problem was supplanted by his fanatical drive to win reelection—a goal he believed he could achieve by appealing to southern conservatives and Catholics. White House Chief of Sta H. R. Haldeman recalled Nixon arguing in fall that “the place for us is not with the Jews and the Negroes, but with the white ethnics and that we have to go after the Catholic thing.”73 Nixon walked a fine line between paying lip service to the population movement backed by business elites, which promoted both contraception and abortion, and opposing abortion and teen access to contraceptive information to woo the Catholic Church.

By 1972 abortion was a political football. The National Women's Political Caucus unsuccessfully tried to place abortion on the Republican platform. Democratic presidential hopeful George McGovern personally opposed abortion, while the caucus wanted an abortion rights plank in the platform. Gloria Steinem offered a modified resolution that prohibited government “interference in the sexual and reproductive freedom of the American citizen.” Shirley MacLaine, actress and liaison between McGovern and women's groups, omitted it because she believed it undermined McGovern's chances. Steinem reviled Gary Hart, McGovern's campaign manager: “You promised us you wouldn't take the low road, you bastards.”74 With abortion rejected by both political parties, some feminists feared a repeal of rights already won in some states.

The Supreme Court Legalizes Abortion

On 22 January 1973 the Supreme Court handed down its decision in Roe v. Wade, U.S. (1973). Attorney Sarah Weddington had met Jane Roe, an unmarried pregnant high school dropout, through her law school friend Linda Coffey. Roe, who lived in Texas, had challenged her state's law prohibiting abortions. In 1970 the case came before a federal court in Dallas, which declared the abortion statute unconstitutional because it denied women their Ninth Amendment right to decide when and if to procreate. The court failed to interdict the district attorney from indicting physicians, assuming the state would comply with the court's decision. District Attorney Henry Wade, however, announced he would pursue such prosecutions, giving Weddington and Coffey the basis for an appeal to the Supreme Court.75

With approximately twenty-five abortion cases pending, the Court chose the Texas and Georgia (Doe v. Bolton, 410 U.S. 179[1973]) cases, planning to dispose of them in one hearing. Weddington argued her case twice, first on 31 December 1971, but the retirements of John Harlan and Hugo Black left the Court “hesitant on such a key kind of case to decide it with only seven (p.203) judges.” She reargued in 1972 after Nixon had appointed Lewis Powell and William Rehnquist, men he believed would reject a liberalized federal abortion policy. Weddington contended that the real justification for the delay was Nixon's reelection concerns: “Burger, being a Nixon appointee, thought that it would be very embarrassing to the President for the Nixon court to come out with a decision in favor of the right to choose during the time he was campaigning.” Justice Harry Blackmun's notes confirm a similar suspicion. The Court announced its decision on the first Monday after Nixon was inaugurated to his second term.76 In Roe, Blackmun, also a Nixon appointee, wrote the critical opinion establishing women's right to choose but not mandating access to abortion. Doe asserted that the state cannot interfere with the exercise of a woman's right by prohibiting or limiting access to abortion. Following Roe and Doe, state laws allowed women to procure abortions without third-party interference.

Women's sovereignty over abortion was not absolute. Blackmun placed the power in the first trimester in the “medical judgment of the pregnant woman's attending physician.” The Court limited abortion in the second and third trimesters, allowing for state interest in promoting women's health and for “appropriate medical judgment.” In sum, abortion was, “primarily, a medical decision.”77 sovereignty was key. Many physicians transformed this sovereignty into profit. Carmen argued that, following Roe, “cutthroat competition” emerged among doctors “out to make a buck.” They quickly established clinics such as Park Medical Center in New York City, where some doctors made $500,000, a year performing abortions “part-time.” Goldsmith claimed that even conservative doctors changed their stance and began to perform abortions because “they realized that abortion was going to become a very lucrative new part of their practice.”78 While women benefited from safe abortions offered by physicians, the Court restricted services to the discretion and availability of doctors.

Roe represented the culmination of e orts by many state legislators andpolitical leaders to curb large families among single mothers on welfare. As historian Rosalind Petchesky concluded, the state “carefully avoided concessions to feminist ideology about reproductive freedom. To accommodate popular pressure without legitimating feminism, … state and population planners subsumed abortion politics under the rubric of population control.” The push for abortion reform, while a feminist plank, was truly “spearheaded by a coalition of private and family planning organizations, foundations, and corporate interests organized around the population issue.”79 Federal and state governments financed abortions for indigent women through Medicaid and other public health bills, allowing easy access to services for women deemed responsible for increasing welfare expenditures. Regardless of the (p.204) motivation of population controllers and the limits of the decision, individual women at the local level benefited from safe abortions. Female mortality from abortion decreased with its legalization.80

Abortion in Rhode Island

Rhode Island failed to liberalize abortion in the s, despite attempts beginning in. PPRI supported abortion reform but heeded PPFA's recommendation that any endorsement come from sta members as individuals, not as representatives of PPRI.81 The Rhode Island Medical Society argued, to no avail, that abortion was not a legislative problem but a medical one.82 Catholic leaders blocked reform and pushed, unsuccessfully, for legislation to eliminate the century-old exemption to save the woman's life.83

With only therapeutic abortions available, PPRI counseled and referred women elsewhere. The medical director spent percent of her time in abortion counseling. In 1971 610 women requested abortions. The sta put clients in touch with Clergymen's Advisory Committees in Rhode Island and Massachusetts or referred them to legal New York clinics. PPRI board members traveled to clinics to ensure their safety and were often disappointed by the disparity among them: “Unfortunately there is a good amount of financial exploitation of abortion patients and incredibly high profits being made in some facilities.” Technically, PPRI violated state law by participating in referrals.84 Walking this fine line was dangerous, especially in light of a “worsening climate in Rhode Island” as the Catholic Church did all it could to hold back state reform.85 The church lost the battle with Roe in 1973.

Following Roe, the PPRI executive committee felt a “sense of urgency” to establish “a free standing abortion clinic as soon as is feasible.” Anne Wise argued that “PPRI owes its existence to the fact that people risked community censure to offer a service in which they believed and for which there was a desperate need. Feeling against birth control in 1931 was stronger and more widespread than is feeling against abortion in 1973. We have the highest law of the land and the majority of American citizens behind us.” Even with Supreme Court sanction, PPRI realized that the church's power in the state would make widespread acceptance “highly unlikely.” By the summer of 1973 PPRI was conscious of increasing opposition to the Supreme Court's decision and “a growing movement in Congress toward a constitutional amendment to prevent abortions.”86 PPRI continued to help women procure abortions out of state, but this assistance became difficult. Following Roe, New York curtailed its abortions for no-fee, low-income women because of the decreased demand as other states offered the procedure. By April 1973 some New York clinics reported a decrease in daily abortions from to: “For (p.205) this reason most clinics can no longer afford to do $25.00 or free abortions.” As a result, “Rhode Island's low income women have no access to legal abortion and therefore are the victims of unequal protection of the law.”87

The summer of 1973 saw plans begin for a clinic. After Lying-In opened a facility in August, Pelham, a New York group, informed PPRI that if it did not open a clinic, Pelham would. The staff believed Pelham was interested only in profits. A freestanding clinic at PPRI would offer lower cost and a more sympathetic atmosphere, and, most important, “it would be far less traumatic for patients that already established a relationship with Planned Parenthood if they were able to remain here after counseling.” In September all but one board member voted to incorporate abortion.88 Yet health department regulations posed a barrier: an anesthesiologist must be present, the operating room must be equipped for abdominal surgery, blood must be stored, and death certificates must be filed. Wise objected to the latter as “an invasion of privacy.” These restrictions would “make operating an out-patient clinic impossible.” In order to comply, PPRI needed a new building.89

During the interim, PPRI noticed a shift in the national discourse regarding abortion. “Population seems to have lost popularity as a topic; abortion is the subject of most concern.” Few people continued to tout abortion as a means of population control and welfare savings in the face of antiabortion rhetoric that equated abortion with murder. The explosion from antichoice groups drowned out prochoice advocates. PPFA “warned” PPRI that “antiabortion forces in the country are organizing for a spring offensive … and have started a growing movement to appeal [Roe].” PPRI believed the vehemence of the opposition “gave us the opportunity to realize that we cannot remain complacent.”90

By 1974 a new building had been secured and plans were under way for the clinic. The staff estimated that each year 22 percent of clients (about two thousand women) would seek abortions from PPRI, a number that fell within the PPFA national directive that abortions “not exceed 25% of the total patient load.” No explanation was given for this national policy, but perhaps national was concerned that the public would perceive abortion as a regular method of birth control, a belief that could damage financial contributions to the organization. The staff planned to charge $150 and expected that 15 percent would be unable to pay. Even with this “bad debt,” they projected the abortion clinic would be “economically advantageous,” with an annual profit of $103,212 to defray other health care costs.91 No one mentioned the irony of PPRI's earlier criticism of Pelham's interest in profits associated with abortion.

In the spring of 1975 the abortion clinic opened. Within two weeks “Right to Life” groups picketed the entrance, and Catholic pressure made finding (p.206) doctors to staff the clinic difficult. Women and Infants Hospital informed PPRI that no new residents wanted to work at PPRI, and two doctors slated to perform abortions “decided not to do so.” National polls demonstrating doctors' approval of abortion did not necessarily translate into their willingness to perform abortions. The shortage of physicians meant the clinic was only able to perform 25 percent of expected abortions. Moreover, increased lab fees, a “jump in professional fees,” and other unanticipated costs brought estimated profits down to $28,000,.92 By summer the situation looked “grim indeed.” Francine S. Stein, administrator of the PPFA abortion loan and technical assistance program, visited PPRI and “had the unhappy feeling that in a variety of ways, perhaps unconscious or unexamined, the program was not fully accepted by the Affiliate. The staff verbalized dread, fear, even nervous flippancy about abortion.” Stein found that some volunteers believed “too much e ort was being expended on abortion.” She recommended that staff who could not “whole heartedly … support the program” be “given a choice of new job assignments … or of resignation.” Similar problems occurred with college interns. A University of Rhode Island professor wrote the clinic concerning an “older, mature student (Protestant)” seeking a fall internship but only if she could avoid the abortion program. This student “very much wants to work in a family planning agency—contraception, sex education, et al.—but … has not yet come to terms with her feelings about abortion.”93 Supporting abortion in the abstract was easier than providing abortions to women.

PPRI managed to expand its services while not sacrificing the humane aspect central to its identity. Stein found that the staff spent too “much time with each patient” and that “pre-abortion clinic procedures appeared terribly cumbersome … because everything is done individually.” She recommended pamphlets to replace one-on-one counseling when possible and organizing groups of four or five women with a counselor for a “brief 20/30 minute group discussion about what will happen.” PPRI resented this criticism of “too much TLC” and refused to follow her suggestion that the staff be “Brief, Concise, Write Little, less TLC.” Their decision paid o. As one patient told the Providence Journal, “This place is right. Women are treated as humans here. They are given support. They are never intimidated.”94

National Trends in Sterilization

In the face of a well-funded, well-organized, and highly visible antichoice movement, few population controllers continued to tout abortion as a solution to the social and economic “problems of population.” Instead, emphasis shifted to more acceptable and permanent means of government-funded fertility (p.207) control, in particular, sterilization. Many people considered this operation less “offensive” than abortion because it prevented rather than terminated pregnancy. A marked increase in contraceptive sterilization occurred in the late 1960s. By the early 1970s sterilization as a means of voluntary family planning had become popular. Unfortunately, coerced sterilization had increased as well.

A number of reasons explain the popularity of sterilization. First, the ACOG relaxed its guidelines for eligibility in 1970. Earlier, ACOG prerequisites required consultation with two doctors and a psychiatrist. Second, advances in medical technology made the procedure relatively easy and risk-free. Third, for growing numbers of two-income families and female-headed households, sterilization guaranteed against work interruptions due to pregnancy and childrearing. Fourth, Catholics increasingly turned to sterilization because it constituted one “sin” rather than the constant turmoil over contraceptives and church doctrine. Fifth, population controllers touted this option as a more reliable answer to the population explosion and mounting welfare expenditures than contraception and abortion. Individual philanthropists and public officials provided funds to encourage indigent women to undergo sterilization, hoping to end permanently high fertility among them.

Early sterilization bills targeting the indigent occurred in the South. In the early 1960s Virginia twice attempted to reduce welfare costs with compulsory sterilization for women with illegitimate children. Although both attempts failed, the legislature passed a voluntary sterilization law in, 1962 the first in the nation to accept economic hardship as a pretext for the operation.95 A Mississippi bill in 1964 authorized jail terms for unwed mothers with two or more children unless they agreed to sterilization. The dual intent of this proposal was to reduce welfare and run unwed mothers out of the state, which would also save the state money. The uproar from civil rights leaders over this “genocide” legislation led to its defeat.96

In California police arrested twenty-one-year-old Nancy Hernandez on a superficial drug charge. Santa Barbara municipal court judge Frank P. Kearney sentenced her either to six months in jail or immediate probation if she agreed to sterilization. With no attorney present, she chose the latter. Later, her public defender labeled this action “unreasonable, capricious, illegal, and unconstitutional.” Hernandez revoked her coerced consent and was freed within three hours.97 Hernandez had two children, one from her estranged husband and one from her current partner, Joseph Sanchez. Kearney told a press conference that she was an “unfit mother' in danger of continuing to lead an immoral, dissolute life endangering the health, safety and lives of her children.” To charges of racism he answered: “I'm not trying to be a Nazi. It seemed to me that she should not have more children because of her propensity (p.208) to live an immoral life.” Conservative critic William F. Buckley contended that “the original ruling of the judge ought to remain as a permanent exhibit in our judicial chamber of horrors.”98 Sterilization was irrelevant to the crime committed.

Not all sterilization abuse received as much attention as the Hernandez case. Dr. Julius Paul of the Walter Reed Army Institute of Research in Washington, D.C., told a meeting of the Population Association of America in the spring of 1966 of his reservations regarding sterilization of unwed mothers on welfare or sometimes of both parents of illegitimate children. He warned that current emphasis on compulsory sterilization as a means to protect the public from its “unfit” members, a term now used to denote social and economic undesirables rather than mental and physical “defectives,” echoed the 1930s eugenic movements. Between 1960 and 1965 seven states—Delaware, Georgia, Illinois, Maryland, Mississippi, North Carolina, and Virginia—considered legislation to sterilize parents of illegitimate o - spring. Although none passed, Dr. Paul warned that they indicated that the country had “come full circle” to the punitive attitudes of the early twentieth century, when many states sterilized criminals and other “undesirables.”99 Most of these laws remained in effect: twenty-six states authorized sterilization for the “mentally ill or mentally defective,” fifteen did so for epileptics, and twelve for certain criminals.100 The 1960s campaign differed in that it had racial and economic rather than physical and mental overtones. Part of this change can be explained by the rising level of concern for the mentally and physically handicapped, a movement fueled by family members. They established the National Association for Retarded Children; with chapters in each state by the 1960s, it was an influential pressure group.101 Protection for this group previously defined as “unfit” did not extend to the socially and economically “unfit” of the 1960s and 1970s. Dr. Paul even warned against voluntary sterilization, because “consent” might be a price paid for something in return, such as release from jail or continued welfare benefits.102

Yet voluntary programs did emerge. Fauquier Hospital in Warrenton, Virginia, established a free sterilization clinic for indigent women primarily to reduce the county's tax burden. By September 1962 sixty-three women had been sterilized, 66 percent of them black. This program drew national attention; many considered it the best solution to poverty and its costs to society.103 The opposition stemmed from concern over coercion. The New York Times believed this policy raised profound questions: “The almost feudal disparities between landlord and tenant, millionaire and poor man” in Fauquier could not be solved with “free medical care for the indigent or sterilization.” America criticized the program as “an adroitly aimed slap in the face of the poor.”Its “‘voluntary’ aspect” was a “mere anodyne. … It is no secret that people, (p.209) perhaps the poor most easily of all, can be cunningly trapped between their own legitimate personal pride and the external forces of social pressure.” Once an official suggested sterilization because of a woman's economic status, her freedom to choose became tainted. Not surprisingly, some women had “‘voluntarily’ knuckled under in the face of such pressure.”104 Church officials again employed a social critique rather than moral condemnation. Archbishop Patrick A. O'Boyle of Washington, D.C., objected to paternalism and racism: those taking part in the program—mainly blacks—were “treated as irresponsible children” who did not possess “enough intelligence to lead a normal existence.” In addition, he charged that the “crudely selfish” purpose was “to reduce the tax rate in Fauquier County.” Baptist evangelist Billy Graham and Commonweal concurred.105 Some black women also criticized this program. Frances Beal contended that county officials pressured “poor and helpless black mothers and young girls” into undergoing sterilization “in exchange for a continuation of welfare benefits.” Although the world denounced Nazi sterilizations, “no one seems to get upset by the repetition of these same racist practices today in the United States of America—land of the free and home of the brave.”106

Clinic officials, however, hailed sterilization to relieve indigent conditions and to reduce welfare. Other regions followed Fauquier's example. A 1963 North Carolina law permitted a patient to choose sterilization if two physicians agreed it met a family need. In Berea, Kentucky, part of depressed Appalachia, Dr. Louise Gilman Hutchins, long active in providing contraceptives to combat poverty, received $25,000 from Jesse Hartman, a Manhattan investor, to offer sterilization to prevent the chronically unemployed from bearing children they could not afford. With Hartman's money Hutchins sterilized 140 women and 50 men. Once Hartman's funds ran out, the Mountain Maternal Health League maintained this service because Hutchins argued that sterilization reduced welfare payments. Because the state paid a fifty-dollar delivery fee plus hospital expenses for each birth to indigent women, officials claimed this program saved the state thousands of dollars in six months.107

The success in reducing welfare led to increased support for sterilization. A national poll in 1966 found that 64 percent approved of sterilization for “women who have more children than they can provide for properly,” 24 percent disapproved, and 12 percent had no opinion. Some groups pressured the federal government to fund this service. The Association for Voluntary Sterilization literature stressed government-subsidized sterilization as one answer to the waste of “billions more of our tax dollars … on relief” and to the “critical need to control the population explosion.”108 The association joined the American Civil Liberties Union (ACLU) in protesting the ban on using OEO funds to sterilize low-income men and women. Although OEO underwrote (p.210) wrote contraceptives in 1966, sterilization funding seemed too risky. At the same time, however, federal money poured into the Population Council for projects bureaucrats believed were too controversial for federal involvement, including sterilization.109

By 1970 social acceptance of sterilization had grown considerably among physicians, mainstream periodicals, and federal officials.110 Federal bureaucrats advocated incorporating federally funded sterilization into clinics. Eighty percent of OEO clinics wanted it as an option. Nixon's Commission on Population Growth recommended that “all administrative restrictions on access to voluntary contraceptive sterilization be eliminated so that the decision be made solely by physician and patient.” Although Nixon had rejected this commission's recommendation regarding a similar medical context for abortion, he supported its stand on sterilization. Federal funds became available in 1971.111

As sterilization became an accepted method of family planning among white middle-class couples, some doctors sterilized women “whose fertility patterns offended their values” or indigent and low-income women, especially ethnic and racial minorities.112 Many physicians misled women about the dangers or permanence of tubal ligations. Health care officials sometimes coerced women during labor or abortion or convinced them that their welfare services would be rescinded unless they consented. Some women did not even know they had been sterilized.

These acts of coercion were joined by attempts to pass another wave of legislation to reduce welfare. The Senate considered a bill to sterilize any woman on welfare with two illegitimate children. In Oregon legislators discussed sterilizing wards of the state. A Maryland proposal called for the sterilization of mothers of illegitimate children on relief rolls. Georgia welfare director William Benson suggested sterilization to contain welfare expenditures. Louisiana followed the Georgia example. In 1970 William Shockley, cowinner of the Nobel Prize for Physics in 1956, stated that racial quality was declining in part because the average black IQ was lower than that of whites; he endorsed a “Sterilization Bonus Plan” to pay “intellectually inferior” peoples of both races to undergo sterilization.113 His plan echoed Hitler's.

Classism and racism prevailed in these discussions. Bruce Hilton, director of the National Center for Bio-Ethics, contended that racism as well as paternalism led to coercion in sterilization. He stated that “otherwise decent, God-fearing, church going people still feel that God has given them the black man as a responsibility. And that kind of paternalism says that if this woman isn't smart enough to stop having children, then it is my responsibility to help her.” This type of “help” was just an unspeakable wish to control blacks. Susan LaMont of the Women's National Abortion Action Coalition (p.211) believed the sterilization campaign resulted from hatred of the poor, both black and white.114 Doctors' attitudes substantiated these arguments. A survey of teaching hospitals in the late 1960s found 53.6 percent made sterilization a condition for obtaining an abortion among indigent women, deeming welfare women incapable of using contraception effectively. In two surveys in the early 1970s 6 percent of doctors said they discussed sterilization with private patients, while 14 percent recommended it as the best choice to indigent women. Moreover, 94 percent of obstetrician-gynecologists approved of compulsory sterilization of welfare mothers with three illegitimate children.115

The impact of such attitudes can be seen in sterilization trends. The National Abortion Action Committee found that fourteen states had considered legislation “designed to coerce women receiving welfare to submit to sterilization.” In South Carolina Representative Lucius N. Porth proposed in 1971 to force female welfare recipients with two children to choose sterilization or forfeiture of welfare payments because such families were not only a threat to society but an expense the public should not have to bear.116 Women dependent on public funds were sterilized more than others, and minority women on welfare were sterilized more than whites in the same situation. Sixty percent of black postpartum women in Sunflower County, Mississippi, had been sterilized by 1965 without their knowledge or consent. In North Carolina the proportion of blacks sterilized by the state increased from 23 percent during the Depression to 64 percent by 1966, mainly due to new ADC regulations that included blacks in welfare programs. Once they came under the scrutiny of social workers, their chances of involuntary sterilization increased. Sterilization rates inflated for both races with the number of children born to welfare mothers. While this increment could reflect women achieving their desired family size, more likely they faced pressure from welfare officials to limit their families. Welfare officials targeted women, despite the fact that tubal ligation is more complicated and recuperation more difficult than vasectomy. Popular culture promoted female sterilization under the guise of sexual liberation, but coerced sterilization of welfare mothers had little to do with liberation.117

Involuntary sterilization came to a head in the summer of 1973. In June newspapers revealed that federal funds had been used to sterilize black children on welfare. The Montgomery Family Planning Clinic, an OEOfunded facility, had given the Relf sisters Depo Provera, an experimental contraceptive. When the FDA banned its use for birth control, the Relf family caseworker insisted that the girls lacked the “mental talents” to take contraceptive pills. Because “boys were hanging around” the girls, she recommended sterilization. The clinic presented Mrs. Relf with a consent form. Believing (p.212) the girls were receiving a replacement contraceptive, their illiterate mother placed an X on the signature line. Although one sister refused to undergo the procedure, the clinic sterilized twelve-year-old Minnie Relf. A Senate investigation found that the Relf family had not asked for family-planning assistance. Instead, welfare officials had sought out the girls. Newspapers revealed that eleven other girls might have been involuntarily sterilized at the same clinic.118

While population controllers looked favorably on these actions, the black press was outraged. The Chicago Daily Defender called the Relf case “a blatant infringement on human rights” as well as “a clear and revolting instance of Southern race prejudice intruding itself into the private lives of illiterate blacks bereft of either power or influence.” The Black Panther, the party newspaper, argued that it demonstrated the true intention of the Montgomery family-planning clinic—the premeditated murder of a race. Muhammad Speaks considered the incident “a deliberate act of genocidal sterilization” and declared that the “demonic advocates of ‘population controls’ had escalated their war against the nonwhite people” with two new lethal weapons, abortion and sterilization. The New York Daily Challenger believed the situation demonstrated “the low esteem in which Black life is held and the genocidal nature of programs supposedly designed to help Blacks.” The Pittsburgh Courier, the paper that had earlier supported black women's access to OEOfunded contraceptives, asserted that the Relf incident was “another case of a white director of a white-run institution deciding what is ‘best’ for blacks in the long run.” Columnist Vernon E. Jordon wrote in the Afro-American that the Relf case was “an act that makes the blood run cold in its callous disregard for the most fundamental rights of the individual.”119

One month after the Relf story broke, Nial Ruth Cox, an unwed black mother, charged that she had been coerced to undergo sterilization in New Bern, North Carolina, at age eighteen. State law allowed the parent of a “mental defective” under the age of twenty-one to sign consent forms for this procedure. State officials deemed Cox a “mental defective” because she had given birth to a daughter at age seventeen, just as Carrie Buck's mother had been labeled in the early twentieth century. Similar to the 1930s, some bureaucrats used the ruse of teenage sexuality, especially that resulting in illegitimate births, to be sufficient evidence of mental instability to warrant sterilization. Cox's mother, a widow with nine children, signed the consent forms after the caseworker informed her that if she refused, her family might stop receiving welfare checks. No one explained that the procedure was permanent. As Nial Cox told a reporter, “Nobody explained anything. They treated us as though we were animals.”120

(p.213) That same summer Mrs. Carol Brown, a welfare mother pregnant with her fifth child, visited three doctors in her hometown of Aiken, South Carolina, to find one who would deliver her baby. All three refused unless she consented to sterilization. In the same town another doctor, Clovis H. Pierce, refused to deliver the third child of welfare mothers unless they first agreed to sterilization. In a six-month period in 1973 Pierce performed twenty-eight sterilizations: eighteen were welfare mothers, of whom seventeen were black. Yet his nurse claimed, “This is not a civil rights thing, or a racial thing, it is just welfare.”121

Events in Aiken became controversial. Black newspapers criticized the violation of black women. The Black Panther believed the Aiken incidents were part of a “racist, genocidal extermination directed at poor Black girls and women.” The Afro-American contended that Pierce's ultimatum sounded similar to “some sinister un-American horror story unraveling.” Yet many whites in Aiken supported coerced sterilization of welfare mothers. The executive director of the Chamber of Commerce, Bryan McCanless, argued that both black and white “trash ' should be sterilized.” Others circulated petitions that justified compulsion when welfare mothers did not voluntarily use subsidized contraceptive devices. Other petitions rationalized coercion because taxpayers maintained the right to dictate the medical treatment of welfare recipients. Doctors in Aiken claimed they did what was “best for society.”122 As elite white men, they believed they should control the reproductive choices of indigent women.

Other groups reacted strongly to coercion. Black congresswomen Shirley Chisholm, Barbara Jordon, Yvonne Burke, and Cardiss Collins wrote letters of outrage to DHEW secretary Caspar Weinberger warning him that sterilization abuse “raised doubts in the minds of minority citizens concerning the voluntary nature of federally funded family planning programs.” NAACP and Urban League officials also made heated speeches. Fourteen national groups condemned further use of public funds until Congress drafted “comprehensive statutory prohibitions” for this procedure.123 Some feminists condemned coerced sterilization. Gloria Steinem told Ebony that sterilization “affects all of us but ' especially minority women. The government thinks it not only has the right to tap our phones but to interfere in all areas of our personal lives, including governing our very bodies.” Some women organized groups against abuse, such as the West Coast Committee Against Forced Sterilization and New York's Committee to End Sterilization Abuse.124 The feminist critique, however, was muted and slow in coming, perhaps because population control groups that supported sterilization among the indigent had been strong allies of the prochoice movement. Moreover, the issue of coerced (p.214) sterilization did not a ect the feminist movement, which was dominated by white middle-class women. In fact, they were the very group population controllers encouraged to procreate.

Most of the immediate reaction came from legal and government sources. The ACLU brought additional abuse cases to public attention. Eleven Chicanas filed suit against the Los Angeles County Medical Center, charging they were either coerced or deceived into signing consent forms during labor or under the influence of medication. One mother had anesthesia withheld until she agreed to sign. Others had not signed any form at all. Few of these eleven spoke more than minimal English, and all were indigent; four were unaware the procedure had been performed until they asked for contraceptives; one woman only found out four years later during a routine medical exam. The Chicana case was particularly traumatic not only because doctors decided who should not reproduce but because traditional Mexican American society often judged women on their ability to bear children. Judge Jesse W. Curtis was unsympathetic: he decided against them in Madrigal v. Quilligan No. 75–2057, Ninth Circuit U.S. District Court, 1978, because he believed the situation was “essentially the result of a breakdown in communication between the patients and the doctors.”125 The white male establishment united against abused women of color.

Following this case, the Health Research Group investigated surgical sterilization in 1973 and concluded that consent forms were a “farce” because hospital staffs pressured women to consent while in labor. This study also found that coercion of indigent white and black women was widespread, especially in the South. Research by Barbara Caress at the Health Policy Advisory Center concurred. “Sterilization abuse is not the exception but the rule,” she wrote. “It is systematic and widespread. … Such abuse is the most widespread example of medicine as an instrument of social control.”126 The lack of strict federal regulations facilitated the injustices many indigent women faced.

Native American and Puerto Rican women were especially victimized. The Indian Health Service (IHS), part of the federal government, sterilized so many women that, according to one observer, it could have eliminated all pure-blood tribes within fifteen years. Every full-blooded Oklahoman Kaw woman had been sterilized. Between 1973 and 1976 the IHS sterilized 3,406 Native women. By the end of the decade nearly 25 percent of women of childbearing age had undergone tubal ligations. Officials did not inform them about the irreversibility of the operation. Investigations concluded that the cause of abuse was the cultural insensitivity of doctors: they pushed a middle- class family norm of two children and believed single, indigent women should not procreate. Similar to the Chicanas, many Native American women (p.215) were ashamed that they could no longer have children. This loss undermined their sense of tribal identity.127 In Puerto Rico more than one in three women in their childbearing years were sterilized, yet legal abortions were essentially unavailable.128

Although funding for abortions had decreased substantially since Roe and private insurance companies generally refused to cover contraceptives, both public and private funds for sterilization remained intact. A survey of thirty-seven private insurance companies found that one paid for the pill and two paid for IUDs, but thirty-four covered female sterilization, while twenty-seven covered vasectomies. Sterilization was much more cost-effective and efficient than contraception.129 Moreover, it provided a permanent solution to population concerns.

Outcry over abuses led to government investigations. A 1973 survey of federally funded programs revealed that two-thirds of clients were white and one-third black, yet blacks constituted 43 percent of those sterilized. A DHEW report concluded that from the summer of 1972 to the summer of 1973, 25,000 adults were sterilized in federally funded clinics. Of these, 153 females were under eighteen. Another report found that of 1,620 sterilizations in North Carolina between 1960 and 1968, 63 percent were performed on blacks, 55.9 percent of whom were teens. In Alabama more than 50 percent of involuntary sterilizations authorized by the state health department in 1973 were performed on black women.130 White middle-class health officials used their power to shape the population along lines they deemed acceptable.

A small part of the blame for these abuses rested with the federal bureaucracy. Officials drafted guidelines in 1972 for federally funded sterilizations. Although OEO had 25,000 copies ready for distribution, the White House “suppressed” them: 1972 was an election year, and Nixon did not want his administration openly linked with sterilization for fear of losing Catholic votes. The guidelines sat on the shelf, while the federal government financed sterilization without safeguards until 1974. By that point the most blatant abuses had occurred.131 Whether guidelines would have prevented abuse is debatable: officials could have ignored them the way doctors ignored the Nuremberg Code in medical experiments. These abuses violated women's constitutional rights. They were not allowed to choose a method of family planning; others chose for them. Because officials did not apply the same coercion to self-supporting women, Relf, Cox, and others in the same situation were denied equal protection under the law.

What action did these women take? Cox sued North Carolina for $1 million. The Relf family retained prominent attorney Melvin Belli to sue clinic officials and federal health officials for $5 million. The civil suit against (p.216) then-DHEW secretary Casper Weinberger alleged that the “intrusion into the plaintiffs' bodies and personal lives” was an infringement of their basic constitutional rights. When investigators discovered the White House connection, Belli amended the suit to include former White House aides John W. Dean III and John D. Ehrlichman.132 The National Welfare Rights Organization also brought suit against Weinberger for failing to establish clear-cut guidelines within DHEW for federally funded sterilizations.133

In March 1974 Judge Gerhard Gesell of the United States District Court for the District of Columbia handed down Relf et al. v. Weinberger et al. He stated:

Over the last few years, an estimated 100,000 to 150,000 low-income persons have been sterilized annually under federally funded programs. … Although Congress has been insistent that all family planning programs function on a purely voluntary basis, there is uncontroverted evidence in the record that … an indefinite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that various federally supported welfare benefits would be withdrawn unless they submitted to irreversible sterilization.

Gesell observed that the “dividing line between family planning and eugenics is murky” and ruled that the lack of guidelines to protect patients was “both illegal and arbitrary because they authorize involuntary sterilizations, without statutory or constitutional justification.” Federally funded sterilizations were permissible only with the “voluntary, knowing and uncoerced consent of individuals competent to give such consent.” What had occurred in Alabama, according to Belli, was “the kind of thing Hitler did.” Not only racism but paternalism played a role, according to Howard Phillips, ex-director of OEO: “This is a classic example of the mentality that ‘the social worker knows what's best.’”134 Although Phillips excluded doctors from his condemnation, they too believed they were in a position to make such life-altering decisions.

On 6 February 1974 DHEW issued guidelines for federally funded sterilizations. They imposed a moratorium on sterilizing patients under the age of twenty-one, prohibited obtaining consent during labor, mandated a waiting period, and ordered women be informed that no benefits would be lost if they refused sterilization. DHEW also required a review committee of five to approve the operation and insisted upon a court ruling that sterilization was “in the best interest of the patient.” Moreover, DHEW decertified Dr. Pierce of Aiken and barred him from providing obstetric services for Medicaid money. His private practice, however, continued to flourish.135 These guidelines drew criticism. Some groups wanted all federal funding of sterilization eliminated. (p.217) Others believed the guidelines did not protect individuals against coercion because the government provided no enforcement mechanism. As Richard Babcock, Jr., of the Center for Law and Social Policy in Washington, D.C., stated, “The H.E.W. regulations are … wholly inadequate. … As the incidents which were exposed last summer illustrate, welfare recipients in this country can be threatened, lied to, or misinformed until they consent to be sterilized. The H.E.W. regulations … in fact do nothing to prevent such coercive tactics.” The guaranteed voluntary nature of all family-planning services before Relf did not prevent the abuses reported in the summer of 1973. Without adequate police power, the new stipulation for a signed consent would do little to stop further abuse. “Obviously, agreeing to something with a gun at your head is not really agreeing at all,” argued Babcock. Similarly, accepting an offer “you cannot refuse” would be equally involuntary. These objections, however, brought no change in DHEW guidelines.136

Studies confirmed the persistence of abuse. One investigation discovered that 76 percent of hospitals did not comply with DHEW guidelines, while another claimed 94 percent were noncompliant. One-third did not even know guidelines existed. A follow-up study in 1979 discovered that 70 percent of hospitals involved with Medicaid sterilizations continued to breach the 1974 regulations.137 Part of this noncompliance was a result of doctors' attitudes. Dr. Hutchins agreed that sterilization should be voluntary but believed DHEW guidelines were too rigid as a result of government overreaction to the uproar surrounding Relf. Doctors should be given latitude in deciding who should be sterilized.138 Doctors in the Northeast agreed. Boston City Hospital as well as hospitals in New York City performed unnecessary hysterectomies on black women, ostensibly to train interns in the procedure.139 The fact that white doctors targeted black women implies that physicians believed that they, not women, had the right to decide who procreates.

Despite the sterilization controversy, Congress amended section 19 of the Social Security Act in 1975 to allow federal funds to pay 90 percent of its cost for indigent patients. Concurrently, federal funds covered only 50 percent of abortions. These revisions enticed health care officials to promote sterilization.140 Not only did these financial inducements decrease return patients at clinics, but federal coverage could be viewed as a blanket endorsement of sterilization. The Committee for Abortion Rights and Against Sterilization Abuse, founded in 1976, argued that population controllers purposefully funded sterilization but not abortion to force indigent women, many of whom were also women of color, to end their fertility permanently.141

In September 1977 ational Conference on Sterilization Abuse brought delegates from fifty organizations to Washington, D.C., including feminists, health reformers, family planners, minority women, Native Americans, and (p.218) church social action groups. They conferred with DHEW representatives and demanded stricter regulations. In response DHEW issued a new policy in 1978 that required a translator where needed, prohibited gaining consent during any other medical procedure (abortion or birth), limited sterilization to those twenty-one or older, and extended the waiting period from three to thirty days. Many feminists saw the latter as paternalistic: women did not need thirty days to make up their minds.142 While a woman seeking sterilization might not need this time, indigent women facing pressure from officials could use it to investigate their rights. With new guidelines in place, most abuse watchdog organizations disbanded.

The unethical use of sterilization as a form of population control led many indigent groups, particularly ethnic and racial minorities, to mistrust family-planning services. A survey of 1,890 blacks in one northern and one southern city found that 47 percent rejected sterilization as a means of birth control. Yet Dr. Emily Hartshorne Mudd of Pennsylvania found that a surprising number of black women chose sterilization following the completion of their last wanted pregnancy. Because of the genocide issue, Mudd required that a married woman obtain the consent of her husband. Although men were leery of sterilization for themselves, they agreed to it for their wives, especially if their economic situation was desperate. Most blacks preferred less permanent birth control. Ninety percent of those polled agreed that contraception should be taught in junior and senior high schools, and 87 percent approved publicly financed contraceptive clinics.143

Sterilization in Rhode Island

While sterilization abuse was common in many areas, PPRI remained unscathed: no accusations of genocide or coercion occurred. The staff differed from welfare officials in recommending sterilization for men, not for women. As a private nonprofit organization, it had no budgetary connections to the concern over welfare costs. With no laws regulating sterilization in Rhode Island, the decision was left to doctors. Most physicians refused to sterilize single men or first-time fathers upset by the disruption of a new baby, and most required a consent form signed by both husband and wife. The late 1960s saw a growing grassroots demand from men for easier access to vasectomies.144

PPRI responded with the first vasectomy clinic in New England on 30 September 1970. From the start it had a “long waiting list.” Married men met with the medical director; the clinic encouraged but did not mandate wives' attendance. To ease male embarrassment the clinic hired a male aide. PPRI continued to serve as a training center, allowing male student nurses health, but economics may have played a role as well. PPRI could not perform tubal ligations but could perform vasectomies. (p.219) to attend each vasectomy clinic. By November PPRI had received over 175 applications, and 122 men were waiting for appointments. PPRI experienced problems staffing the clinic because of “an acute shortage of urologists.” While demands for tubal ligations also increased, PPRI emphasized the relative ease of vasectomy.145 The emphasis on male versus female procedures was due to concern for women's

For the remainder of the decade the number of vasectomies mounted. In early 1971 “the demand for vasectomies far surpass[ed] our ability to perform them.” More than 150 men were on a waiting list, leading the Lying-In to open a vasectomy clinic in August 1971; it was immediately booked, with “a long waiting list.” PPRI hired five urologists to cut the wait time.146 The clinic allowed low-income men the same reproductive control as middle- and upper-class men who could afford private physicians.

Dr. Rudy K. Meiselman, a Providence urologist, cited two factors for the grassroots demand. First, both men and women “routinely discussed” all available methods of contraception. Second, the widespread use of the pill “promoted the notion of spontaneity in sexual relationships.” Whenever negative publicity surfaced concerning side effects from the pill, Meiselman and PPRI experienced an increased demand for vasectomies. Dr. Nathan Chaset, chief of urology at Lying-In, concurred but added that “Women's Liberation [brought] pressure for a reassigning of responsibilities.” Chaset argued that researchers should develop male methods: “There ought to be some way of getting to the male. The average woman is ready to quit (having children) at 30, and to put her through all that (the pill, etc) for another 20 years doesn't make sense.”147

Yet Wise found targeting men was not always successful because of remaining “hangups.” Wives would come to PPRI and “get all the information for their husbands,” but then men failed to follow through on the procedure. Dr. Charles Potter of PPRI found male reluctance rooted in “fears” of “reduction in his (sexual) drive.” Dr. Meiselman concurred, contending that it perhaps explained the residual social stigma attached to the procedure. He had some patients who “preferred to pay out of their pocket (rather than put in for Blue Shield) because they don't want people around their office to know. There's still a cloud over it.”148

Those men who did undergo vasectomies were satisfied. One man's account was revealing: “In less time than it took my wife to have a cup of coffee with a friend … I was sterile. … It would be nice to say that the Zero Population Growth movement had gotten to me, that I had undergone a vasectomy from a sense of social and ecological responsibility. But the truth is, the choice was purely selfish. We had just had our fourth child.” Ten weeks (p.220) after the operation “arguments and discussions over the Pill, the Loop, the Foam, and other contraceptive methods would seem as remote from my new lifestyle as the horse and buggy.”149


How successful were family-planning programs during the 1960s and 1970s? The 1970 census suggests that during the late 1960s the birthrate in families with less than $5,000 annual income declined sharply. The number of births fell almost twice as far in indigent as it did in wealthy families: births to indigent women dropped thirty-two per thousand, while the rest of the population dropped seventeen per thousand. The largest decrease occurred among black women—a decline of forty-nine per thousand. Newsweek claimed that the “chief cause” for this reduction was “the increase in government sponsored birth control clinics.” Another study found that subsidized family-planning services lowered the pregnancy rate among teenagers and that access to abortion substantially reduced the incidence of illegitimate childbirth.150

In order to lower illegitimacy, break the cycle of poverty, and reduce welfare expenditures, the government subsidized services, including contraceptives, abortion for a short time, and sterilization. Government action in this area had little to do with women's right to control their bodies but rather with concerns over mounting welfare expenditures and perceived uncontrolled fertility among the indigent, especially ethnic and racial minorities. To resolve these “problems” the federal government increased financial support for family planning by, percent between and. This involvement coincided with the welfare explosion of the late s and the escalating costs to society of programs for the indigent. Through subsidized contraception white elites in powerful positions attempted to shape the racial and socioeconomic quality of the population along lines suitable to them. While many women faced coercive tactics, others were able to take advantage of new subsidized services to govern their life choices. At PPRI these choices included a full range of contraceptives, abortion, and vasectomy.


(1.) Abernathy, Greenberg, and Horvitz, “Estimates of Induced Abortion,” 19.

(2.) “More Abortions: The Reasons Why,” Time, 17 September 1965, 82; “Abortions on the Increase,” America, 25 September 1965, 311; Hern, “Family Planning,” 17–19.

(3.) Providence Journal, 24 August 1962, 15, 9 October 1962, 35.

(4.) Helen B. Taussig, M.D., interview with Charles A. Janeway, M.D., August 1975, v, 41–46, Family Planning Oral History Project.

(5.) Finkbine, “Sherri Finkbine's Story,” in Rubin, The Abortion Controversy, 69–70.

(6.) Sarah Weddington, interview with Jeannette Cheek, March 1976, 54, Family Planning Oral History Project; Gallup, Gallup Poll Public Opinion, 19 September 1962, 1784.

(7.) U.S. Congress, Congressional Record 13 (3 May 1971): 157; Schoen, Choice&Coercion, 179.

(8.) Schoen, Choice&Coercion, 176–77.

(9.) Maginnis interview, 105–6.

(10.) Schoen, Choice&Coercion, 185.

(11.) Arlene Carmen, interview with Ellen Chesler, January 1976, 2–6, 9–10, 35–36, Family Planning Oral History Project.

(12.) Goldsmith interview, 22–23; Weddington interview, 43; Carmen interview, iii, 21.

(13.) Hern, “Family Planning,” 17–18; Christian Century, 11 January 1961, 37; America, 21 May 1966, 738–42; Newsweek, 14 November 1966, 92; Parents Magazine 45 (October (p.311) 1970): 58–61; Redbook 125 (October 1965): 70–71, 147–50; New Republic, 25 October 1969, 12.

(14.) Cutright, “Illegitimacy,” 382; Teitelbaum, “Some Genetic Implications,” 495.

(15.) Gallup, Gallup Poll Public Opinion, 19 September 1962, 1784, and 21 January 1966, 1985.

(16.) Jones and Westoff, “Attitudes toward Abortion,” 570–71.

(17.) Greene, “Federal Birth Control,” 35–36; U.S. National Center for Health Statistics, Vital Statistics; Cutright, “Illegitimacy,” 408–9.

(18.) U.S. Congress, Congressional Record 117 (3 May 1971): 13161.

(19.) Task Force Report on Family Law and Policy, “Personal Rights Relating to Pregnancy,” in Rubin, The Abortion Controversy, 57–63.

(20.) Nelson, Women of Color, 5–6.

(21.) NOW, “Bill of Rights,” in Morgan, Sisterhood Is Powerful, 512–14; Wandersee, On the Move, 18–19.

(22.) Hole and Levine, Rebirth of Feminism, 298; Cisler, “Unfinished Business,” 246, 276–78.

(23.) ACOG, College Statement and Minority Report on Therapeutic Abortion, May 1969, Abortion Reports file, box 39; “280 Psychiatrists Urge End of Abortion Laws,” Boston Globe, 5 November 1969, Maternal Health 1966–69 file, box 39, both in RIMS, RIHS Library.

(24.) David, “Unwanted Pregnancies,” 455–56; J. de Moerloose, “Abortion Legislation throughout the World,” WHO Features, no. 3 (March 1971); Francome, Abortion Freedom; Sachdev, International Handbook on Abortion.

(25.) The Society for Humane Abortion, originally named the Citizen's Committee for Humane Abortion Laws, changed permanently to the Society for Humane Abortion in 1964 and existed until 1975. Maginnis interview, 79–97; Lana Clarke Phelan, interview with Jeannette Baily Cheek, November 1975, iv-v, 34, Family Planning Oral History Project.

(26.) Maginnis interview, 99–102, 149; Goldsmith interview, 14.

(27.) Phelan interview, 17–18; Maginnis interview, 100–101, 150–52.

(28.) Myers interview, 36–48.

(29.) Jain and Sinding, North Carolina Abortion Law 1967, 15–16, 48–51.

(30.) Myers interview, 36–39; Maginnis interview, 152–54. Estimates for legal abortions in 1970 range from 197,000 to 236,000. See David, “Unwanted Pregnancies,” 456; Tietze, “The Potential Impact,” in 581.

(31.) Constance Cook, interview with Ellen Chesler, January 1976, 27–28, 34–38, 42–45, 48–49, 52, 54, 56–64, 72–73, 79, Family Planning Oral History Project; Guttmacher quoted in President's Report, Annual Reports 1970, 6–7, file 1970, box 2, PPRI Records.

(32.) David, “Unwanted Pregnancies,” 456; New York Times, 7 February 1971, 70, 6 April 1971, 78, 21 August 1971, 26, 15 October 1971, 38.

(33.) Pakter and Nelson, “Abortion,” 1–15. See also Djerassi, “Fertility Control,” 9–14, 41–45.

(34.) Chisholm, Unbought, 120.

(p.312) (35.) Pakter and Nelson, “Abortion,” 1–15; New York Times, 13 October 1971, 15; Carmen interview, 59–60, 73, 80, 82–83. Church reaction was swift: twenty Catholic bishops in New York warned in a pastoral letter that “the church disowns by immediate excommunication any Catholic who deliberately procures an abortion or helps someone else to do so” (New York Times, 7 April 1971, 43).

(36.) Pakter and Nelson, “Abortion,” 1–15; Pakter et al., “Two Years Experience,” 524–35.

(37.) Carmen interview, 45.

(38.) Frances M. Beal, “Double Jeopardy: To Be Black and Female,” in Morgan, Sisterhood Is Powerful, 349–50; Ross, “African-American Women,” 161; Renee Ferguson, “Women's Liberation Has a Different Meaning for Blacks,” in Lerner, Black Women, 587–92.

(39.) Chisholm, Unbought, 114–16, 122; Carmen interview, 45. See also Carolyn Jones, “Abortion and Black Women,” Black America 5 (September 1970): 49; Marsha Coleman, “Are Abortions for Black Women Racist?” Militant, 21 January 1972, 19; Treadwell, “Is Abortion Black Genocide?” 4–5.

(40.) New York Times, 20 July 1971, 30, 21 November 1971, 95.

(41.) “A.M.A. Eases Abortion Rules,” New York Times, 26 June 1970, 1.

(42.) The case was United States v. Vuitch, 402 U.S. Reports 62 (1971). See New York Times, 4 May 1971, 38, 15 August 1971, 56.

(43.) New York Times, 20 December 1970, 42, 28 October 1971, 1.

(44.) “ABA Convention Approves Abortion ‘On Demand,’” in News Dictionary 1972 (New York: Facts on File, Inc., 1973), 1; “Worldwide Use Widespread,” in News Dictionary 1972, 2; “Liberalized Laws Urged, Rejected,” in News Dictionary 1971 (New York: Facts on File, Inc., 1972), 2. This report was read into the record during the introduction of the Abortion Rights Act of 1972. See U.S. Congress, Congressional Record 118 (2 May 1972): 15331.

(45.) Nixon-Agnew Campaign Committee, Nixon on the Issues, 124.

(46.) “Speech by Senator Bob Packwood,” in Rubin, The Abortion Controversy, 72–74.

(47.) U.S. Congress, Congressional Record 116 (15 June 1970): S 20079–80; U.S. Congress, Congressional Record 116 (25 August 1970): S 30000; U.S. Congress, Congressional Record 116 (12 March 1970): H 5619.

(48.) U.S. Congress, Congressional Record 116 (12 March 1970): H 7415–16; U.S. Congress, Congressional Record 116 (12 June 1970): S 19600.

(49.) U.S. Congress, Congressional Record 116 (3 March 1970): S 5616–17.

(50.) U.S. Congress, Congressional Record 116 (3 March 1970): S 5617–18, 116 (15 June 1970): 20079, 116 (25 August 1970): 30001–2, 116 (23 March 1970): H 9450, 116 (12 March 1970): H 7415.

(51.) U.S. Congress, Congressional Record 117 (3 March 1971) 4950; New York Times, 21 January 1971, 37. To put the statistic in context, WHMC had 1,953 births between 1 October 1969 and 30 September 1970. See Selected Statistical Summary for Administrator at Wilford Hall Medical Center, 1990, in History files at Wilford Hall Medical Center, provided to me by WHMC historian George Kelling, 11 August 1999.

(52.) U.S. Congress, Congressional Record 116 (9 October 1970): 35994. In February (p.313) 1971 Schmitz introduced HR 4257, concerning abortion in the military, but no action was taken. See U.S. Congress, Congressional Record 117 (10 February 1971), 2394.

(53.) New York Times, 17 January 1971, 43.

(54.) U.S. Congress, Congressional Record 117 (1 March 1971), 4496; New York Times, 21 January 1971, 37.

(55.) New York Times, 7 April 1971, 43.

(56.) New York Times, 4 October 1971, 27.

(57.) Nixon, “Statement about Policy,” 500.

(58.) U.S. Congress, Congressional Record 117 (20 April 1971): H 11016.

(60.) American Friends Service Committee, Who Shall Live?

(61.) U.S. Congress, Congressional Record 117 (5 October 1971): 35140, 117 (7 December 1971): 45244.

(62.) In March 1968 Lt. William Calley led American soldiers into the village of My Lai, where his men murdered more than two hundred civilians, most of them young children, women, and elderly. Three years later a military court convicted him of murder and sentenced him to life in prison. Nixon reduced the sentence to twenty years and then granted him parole in 1974 after serving only three. See Herring, America's Longest War, 212, 236.

(63.) New York Times, 13 April 1971, 38.

(64.) New York Times, 5 April 1971, 32.

(65.) New York Times, 22 April 1971, 30.

(66.) New York Times, 13 April 1971, 38, 7 April 1971, 54, 16 April 1971, 73.

(67.) New York Times, 5 April 1971, 32.

(68.) U.S. Congress, Congressional Record 117 (3 May 1971): 13155–61.

(69.) U.S. Congress, Congressional Record 117 (31 July 1971): 28608.

(70.) U.S. Congress, Congressional Record 118 (2 May 1972): 15327–28.

(71.) Walter quoted in U.S. Congress, Congressional Record 118 (2 May 1972): 15331.

(72.) Nixon, “Statement about the Report,” 576.

(73.) Haldeman, Haldeman Diaries, 370.

(74.) Quoted in Wandersee, On the Move, 29.

(75.) Weddington interview, 7–11; Weddington, Question of Choice, 44–70.

(76.) Weddington, Question of Choice, 102–6; Weddington interview, 12–15, 24–28, 60; Greenhouse, Becoming Justice Blackmun, 127.

(77.) Roe v. Wade, 166; Greenhouse, Becoming Justice Blackmun, 98–99.

(78.) Carmen interview, 71–72; Goldsmith interview, 16.

(79.) Shapiro, Population, 23; Petchesky, Abortion, 117.

(80.) Kolbert and Miller, “Legal Strategies,” 99; “Healthier Mothers,” 1809.

(81.) Executive Committee Minutes, 17 December 1968, file 1968, box 2; Executive Committee Minutes, 11 June 1969, 11 September 1969, and 26 November 1969, Board Minutes, 8 May 1969,Executive Director's Report, “Abortion and the Law,” 8 May 1969, file 1969, box 2, all in PPRI Records.

(82.) Maternal Health Committee Report, Appendix A, 24 January 1968, Abortion Reports file, box 39, RIMS, RIHS Library; H 1659, H 1660, H 1661 all introduced 12 March 1968, Failed Bills of 1968, State Archives; Providence Journal, 18 March 1968, 23; (p.314) H 1400, H 1401, H 1402 all introduced 14 February 1969 and H 1776, 28 March 1969, Failed Bills of 1969, State Archives.

(83.) H 1653, 30 March 1966, Failed Bills of 1966, State Archives; Providence Journal, 31 March 1966, 1, 2 April 1966, 17, 12 January 1967, 7; H 1069, 11 January 1967, H 1716, 21 March 1967, H 1806, 31 March 1967, Failed Bills of 1967, State Archives.

(84.) Executive Committee Minutes, 16 February 1970, 20 July 1970, and 16 November 1970, Board of Directors Meeting, 20 April 1970, 19 October 1970, file 1970, box 2; Board of Directors Meeting, 18 January 1971, 18 October 1971, file 1971, box 2; Board Minutes, 26 June 1972, Staff Meeting, 29 November 1972, file 1972, box 2, all in PPRI Records.

(85.) Executive Committee Minutes, 16 February 1970, 20 July 1970, and 16 November 1970, Board of Directors Meeting, 20 April 1970, 19 October 1970, file 1970, box 2; Board of Directors Meeting, 18 January 1971, 18 October 1971, file 1971, box 2; Board Minutes, 26 June 1972, Staff Meeting, 29 November 1972, file 1972, box 2, all in PPRI Records.

(86.) Executive Committee, 1 February 1973, 16 July 1973, Wise to Executive Committee, 28 February 1973, Wise to Board Members, 20 June 1973, file 1973, box 2, PPRI Records.

(87.) Wise to Board Members, 20 June 1973, Staff Meeting, 25 April 1973, file 1973, box 2, PPRI Records.

(88.) Board Meeting Minutes, 25 June 1973, 24 September 1973, file 1973, box 2; Staff Meeting, 4 October 1973, file 1972 [sic], box 2, all in PPRI Records.

(89.) Staff Meeting, 4 October 1973, file 1972 [sic], box 2, PPRI Records.

(90.) Annual Reports 1973, 12, file 1973, box 2, PPRI Records.

(91.) Staff Meeting, 4 October 1973, Cost/Profit Projections of Full Operation in Abortion Services, December 1973, file 1973, box 2, PPRI Records.

(92.) Annual Report 1975, Executive Committee, 14 April 1975, 12 May 1975, Board of Directors Meeting, 27 June 1975, 21 July 1975, file 1975, box 2, PPRI Records.

(93.) Stein to Viola C. Crolius, Executive Director of PPRI, 12 September 1975, Mimi Frank to Viola C. Crolius, 17 December 1975, file 1975, box 2, PPRI Records.

(94.) Director of Social Service's Report, Annual Reports 1973, 13, file 1973, box 2; Some Thoughts on the Planning Process of PPRI, 1 May 1974, file 1974, box 2; Stein to Crolius, 11 September 1975, file 1975, box 2; Handwritten Sheet and “Planned Parenthood Delivers,” Providence Journal, February 1976, file 1976, box 2, all in PPRI Records.

(95.) “Sterilization: New Argument,” U.S. News and World Report, 24 September 1962, 55.

(96.) James Ridgeway, “Birth Control by Surgery,” New Republic, 11 November 1964, 11.

(97.) “Cruel and Unjust?” Newsweek, 13 June 1966, 46; “Jail or Sterilization?” Time, 3 June 1966, 46.

(98.) “Cruel and Unjust?” 46; “Jail or Sterilization?” 46; William F. Buckley, “Sterilize That Woman!” National Review, 12 July 1966, 666.

(99.) “Sterilization Sentiment Focuses on the Poor,” Science News, 14 May 1966, 371; Slater, “Sterilization,” 152.

(p.315) (100) Slater, “Sterilization,” 154.

(101.) Reilly, Surgical Solution, 117.

(102.) “Sterilization Sentiment,” 371; Slater, “Sterilization,” 152.

(103.) “Sterilization: New Argument,” 55.

(104.) New York Times, 12 September 1962, 13 September 1962; “Sterilize Them!” America, 22 September 1962, 764.

(105.) “Sterilization: New Argument,” 55; “A Sterile Issue?” Newsweek, 24 September 1962, 88; “Sterilize Them!” 764; “Sterilization in Virginia,” Commonweal, 28 September 1962, 3.

(106.) Beal, “Double Jeopardy,” in Morgan, Sisterhood Is Powerful, 347–49.

(107.) Hutchins interview, 16; U.S. Congress, Senate, Committee on Government Operations, Hearings (1965), 1768; Ridgeway, “Birth Control by Surgery,” 9–10; “Voluntary Sterilization,” Time, 15 January 1965, 43–44. Hartman gave $25,000 for a similar program in several poor Florida counties.

(108.) The Association for Voluntary Sterilization encouraged sterilization throughout the twentieth century, changing its name several times before it settled in 2001 on EngenderHealth to increase funding opportunities. See 〈www.engenderhealth.org/pubs/ehnews/sp01/sp01_2.html 〉, accessed 18 September 2006.

(109.) Gallup, Gallup Poll Public Opinion, 2000; Association for Voluntary Sterilization quoted in Shapiro, Population, 57–58, 73; “Voluntary Sterilization Approved by Majority,” Science News, 8 October 1966, 277.

(110.) Gallup, Gallup Poll Public Opinion, 2262; Presser, “Demographic and Social Aspects,” 529–33; “One Man's Answer to Over Population,” Life, 6 March 1970, 42–47; Lawrence Lader, “Laws to Limit Family Size,” Parents Magazine 45 (October 1970): 58–61; and Walter Goodman, “Abortion and Sterilization: The Search for Answers,” Redbook 125 (October 1965): 148.

(111.) U.S. Congress, Senate, Committee on the Federal Role in Health, Hearings; Commission on Population Growth and the American Future, Population and the American Future, 171.

(112.) Emilio and Freedman, Intimate Matters, 255.

(113.) Pittsburgh Courier, 9 November 1968, 1, 24 May 1968, FF 857, box 32, Rice Papers.

(114.) Slater, “Sterilization,” 152; Caress, “Sterilization,” 4.

(115.) Measham, Hatcher, and Arnold, “Physicians and Contraception,” 499.

(116.) National Abortion Action Committee, press release, 12 July 1973, National Abortion Action Committee Files; New York Times, 23 April 1971.

(117.) Measham, Hatcher, and Arnold, “Physicians and Contraception,” 499; Shapiro, Population, 6–7, 97–98, 116; Petchesky, Abortion, 178–82; Roberts, Killing the Black Body, 90–91; Schoen, Choice&Coercion, 108.

(118.) U.S. Congress, Senate, Committee on the Federal Role in Health, Hearings, 1562–62; Richard R. Babcock, Jr., “Sterilization: Coercing Consent,” Nation, 12 January 1974, 51; Judith Coburn, “Sterilization Regulations: Debate Not Quelled by HEW Document,” Science, 8 March 1974, 935–39; Slater, “Sterilization,” 150.

(119.) Chicago Daily Defender, 25 July 1973; Black Panther, 7 July 1973; Muhammad Speaks, 13 July 1973; New York Daily Challenger, 17 July 1973; Pittsburgh Courier, 21 (p.316) July 1973; Afro-American, 28 July 1973. The Jordan column was also printed in the Pittsburgh Courier, 28 July 1973.

(120.) Babcock, “Sterilization,” 51; Coburn, “Sterilization Regulations,” 150; Caress, “Sterilization,” 1–13.

(121.) Pittsburgh Courier, 21 July 1973, 3; Babcock, “Sterilization,” 51; Coburn, “Sterilization Regulations,” 150; Caress, “Sterilization,” 1–13.

(122.) Black Panther, 11 August 1973; Afro-American, 28 July 1973; Pittsburgh Courier, 28 July 1973.

(123.) U.S. Congress, Senate, Committee on the Federal Role in Health, Hearings, 1562–63; Muhammad Speaks, 31 May 1969, 26 December 1969; Pittsburgh Courier, 21 July 1973, 16.

(124.) Slater, “Sterilization,” 152.

(125.) Dreifus, Sterilizing the Poor, 105–7; Judith Herman, “Forced Sterilization,” Sister Courage (January 1976): 8; Shapiro, Population, 90–91; Velez-Ibanez, “Se Me Acabó,” 71–91.

(126.) Rosenfeld, Wolfe, and McGarrah, Health Research; Dreifus, Sterilizing the Poor, 105–7; Herman, “Forced Sterilization,” 8.

(127.) Torpy, “Native American Women,” 8.

(128.) Shapiro, Population, 6–7, 54, 91–92.

(129.) Shapiro, Population, 111, 117–21.

(130.) Coburn, “Sterilization Regulations,” 936; Caress, “Sterilization,” 4; Vaughan and Sparer, “Ethnic Group,” 224–29.

(131.) “Sterilization Guidelines: 22 Months on the Shelf,” Medical World News, 9 November 1973; “White House Named,” Pittsburgh Courier, 21 July 1973, 1.

(132.) “White House Named.”

(133.) Pittsburgh Courier, 21 July 1973, 1; Relf et al. v. Weinberger et al., 372 F. Supp. 1196 (D.D.C. 1974); National Welfare Rights Organization v. Weinberger, Civil Action no. 74–243, 1973. These two cases were consolidated into the Relf case.

(134.) Relf et al.; Babcock, “Sterilization,” 51; Coburn, “Sterilization Regulations,” 935–39; Slater, “Sterilization,” 150; “A Well-Meaning Act,” Newsweek, 16 July 1973, 26.

(135.) Coburn, “Sterilization Regulations,” 935–39; Babcock, “Sterilization,” 52–53.

(137.) Gordon, Woman's Body, 433–34; Shapiro, Population, 92–93, 107.

(138.) Hutchins interview, 34–35.

(139.) Roberts, Killing the Black Body, 91.

(140.) Shapiro, Population, 124.

(141.) Nelson, Women of Color, 5–6.

(142.) Shapiro, Population, 142, 148; Gordon, Woman's Body, 435.

(143.) Williams, “Blacks Reject Sterilization,” 26; Mudd interview, 254.

(144.) Annual Report of Medical Director for 1963, 17 April 1964, file 1964, box 2; Medical Director's Report to the Board of Directors, 31 January 1968, file 1968, box 2; Annual Reports 1970, 2, file 1970, box 2, all in PPRI Records.

(145.) Annual Reports 1970, Board of Directors Meeting, 19 October 1970, Executive Committee Minutes, 16 November 1970, file 1970, box 2, PPRI Records.

(146.) Board of Directors Meeting, 18 January 1971, Executive Director's Report, 18 (p.317) October 1971, file 1971, box 2; Board Minutes, 13 March 1972, and 16 October 1972, file 1972, box 2; Annual Report 1974, file 1974, box 2; Annual Report 1975, file 1975, box 2, all in PPRI Records.

(147.) Providence Journal, 20 September 1970, W1.

(150.) Restrictions in abortion funding and through parental consent led to increasing illegitimate pregnancies among indigent teens. See Providence Journal, 13 June 1989, 3. This report found teen pregnancy highly correlated with poverty: birthrates were ten times higher among poor than among high-income teens. Moreover, more poor teens carried their pregnancies to term than wealthy teens (31 percent of indigent versus 71 percent of wealthy teens aborted).