Reproductive rights activists must acknowledge and confront the historical and continuing sterilizations of disabled people.

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In India, at least 15 women have died in government-run clinics due to complications from botched sterilization surgery. Many more are in the hospital. These tragedies are the latest consequence of India’s state-sponsored sterilization program, in which women are offered payments in exchange for consenting to an invasive—sometimes dangerous, even fatal—procedure.

For low-income women trying to meet expenses, these financial incentives can amount to a coercively high degree of pressure to undergo the surgery.

The practice has unmistakable roots in colonialism, as well: For years, activists have criticized Britain for funding reportedly dubious sterilization practices in India, including threatening women with the loss of their benefits, lying to them about the nature of the operation, and leaving patients in pain without any kind of aftercare.

Coercive or forcible sterilization is an epidemic worldwide. When it does receive attention, though, it’s usually in the wake of horrific events like those in India, or in investigations like the Center for Investigative Reporting’s exposé of mass unlawful prison sterilizations earlier this year. But as a continuing issue, the quiet, day-to-day use of sterilization as a weapon to infringe upon reproductive rights—including in the United States—rarely bubbles up into the public consciousness.

In the midst of the cone of silence surrounding sterilization, there’s an epicenter: Disabled people with significant impairments who are at the whims of doctors, guardians, and courts when it comes to their reproductive rights. That is slowly starting to change. Earlier this month, a group of Australian disability rights activists demanded an investigation from the United Nations into why at least 47 disabled Australians were forcibly sterilized by court order between 2004 and 2014. Reproductive rights activists worldwide should take a lesson here: In a landscape where everyone should have the ability to take personal control of her own fertility, they must acknowledge and confront the historical and continuing sterilizations of disabled people. In the process, advocates must take an intersectional approach to address concerns about other vulnerable groups also targeted for sterilization.

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The UN considers forcible sterilization to be a form of torture, pointing to a growing body of public opinion and legal cases. The UN’s report on the issue, released in February 2013, specifically noted that disabled people are often targeted for sterilization and articulated why forced sterilization is so damaging to reproductive and personal freedoms:

Forced sterilization is an act of violence, a form of social control, and a violation of the right to be free from torture and other cruel, inhuman, or degrading treatment or punishment. The mandate has asserted that ‘forced abortions or sterilizations carried out by State officials in accordance with coercive family planning laws or policies may amount to torture.’

A detailed report from the Washington College of Law concurred with these findings, noting, again, that disabled people are common targets for coerced sterilization. Some of the earliest eugenics programs in the United States, Germany, and other regions focused on sterilizing “defectives” so they couldn’t reproduce; such programs eventually expanded to include low-income people and people of color. Well into the mid-century, the Supreme Court and numerous appellate courts continued to affirm the validity of the coerced sterilization of disabled people at the behest of their guardians, who were often government-run residential facilities.

In numerous states, laws regarding sterilization for reasons of disability still remain on the books. These policies are not simply holdovers from a previous era, however. In 1993, a mentally ill patient was sterilized by court order, with a later court upholding the judgment on appeal. Five years later, a Michigan court approved a request for sterilization in the case of Lora Faye Wirsing, who had developmental disabilities, at the request of her guardian. And the horrific “Ashley Treatment” got a pass from a bioethics committee in 2007. In that treatment, surgeons removed a girl’s uterus and breast buds, while she was put on growth-stunting medications to keep her small, on the grounds that she would pose a “hardship” to her family as she matured. That procedure has been used on multiple children in the subsequent years.

All of these cases highlight the fact that disabled children and young adults continue to be sterilized as a matter of convenience. In turn, this reflects the social attitude that some disabled people should be sterilized “for their own good,” or with the goal of preventing difficulties with their care—in court, for example, lawyers have argued that developmentally disabled adults can’t care for their children, or that people with significant cognitive disabilities may not fully understand sexuality and reproduction.

These situations have prompted dismay from the medical community as well as disability rights activists. In 1999, the American Academy of Pediatrics provided official clinical guidance on the subject, cautioning against sterilizing patients without considering alternatives. Eight years later, the American College of Obstetricians and Gynecologists spoke out on the issue, saying, “The presence of a mental disability does not, in itself, justify either sterilization or its denial”; Human Rights Watch noted in 2011 that sterilization continues to be a global problem. And in 2012, the National Council on Disability specifically addressed its looming concern: “Equally alarming, a growing trend is emerging toward sterilizing people with intellectual or psychiatric disabilities.”

Yet, for the most part, cases like these remain largely out of the public eye. In the last few years, one of the only mainstream media outlets to interrogate the forced sterilizations of disabled people has been Al Jazeera, whose writer, Lori Jane Gliha, interviewed a nurse who oversaw potentially thousands of such procedures in Virginia. Another rare example of detailed reporting comes from the Winston-Salem Journal, which did an exhaustive multi-part piece on the subject beginning in 2002. As evidenced by those stories, there is a wealth of archival material, first-hand narratives, court transcripts, and other research to draw upon about this topic. Even so, politicians’ and the media’s paltry coverage of the nation’s history of eugenics leaves much of the public ignorant of these injustices. As Raquel Reichard noted at Mic, coerced sterilization is a moot subject even at many feminist websites.

When outlets or legislators do acknowledge the issue of forced sterilizations, they often focus on the abhorrent practice of sterilizing women of color and the subsequent discussions surrounding reparations in states like North Carolina. These women’s stories are undoubtedly important and should be publicized, but the disabled people who also suffered under these policies, and continue to suffer, must not be overlooked either. With such a wide body of evidence and material for discussion, the only logical conclusion is that the prevailing silence about the issue is a willful one.

Moreover, the refusal to discuss the disability aspect of coerced sterilization, when it comes up at all, leaves out an important point of intersectional organizing. At the Nation, Salamishah Tillet noted, “We are stuck in a hierarchy of traditional reproductive rights activism, which has historically placed abortion as its primary concern, and other issues, like forced sterilization, far below.” This speaks to the core issue behind the lack of engagement with forced sterilization: It, like the right to have and keep children, is an uncomfortable subject for many activists who do not want to feed into conservative anti-choice narratives.

Here, too, the Australian activists’ UN fight can act as an example for those in the reproductive rights movement. Those advocates aren’t just going to bat for their fellow disabled people. Their appeal also includes a discussion of “gender normalization surgeries”—which can affect fertility, too—forced upon intersex children at or around the time of birth. They argue that such surgeries are a violation of human rights, a position supported by many medical and psychiatric groups around the world, including the Intersex Society of North America. (In some cases, the surgeries may be medically indicated.) It’s a baby step for intersectionality, but those activists, unfortunately, fall somewhat into the same trap many in the United States do: Their case does not include a discussion of sterilization of prisoners and other marginalized groups.

This illustrates the importance of intersectional organizing, an issue activists in the United States have often struggled with. Forcible sterilization is certainly one aspect of reproductive rights, but the continued silence on the subject, especially where disabled people are concerned, effectively tolerates the abuse of scores of people in the United States.

It’s critical to engage with the history of forced sterilization in the country, to advocate for reparations on behalf of all victims, and demand protections for vulnerable groups now. Disabled people remain among the most vulnerable, thanks to the aforementioned laws still on the books permitting the sterilization of disabled wards at the request of their guardians, but women of color and low-income people still face pressures and sometimes outright coercion for sterilization. All of those stories must be folded into activism and organizing around the issue.

Taking the issue of forced sterilization to Congress, and possibly to the UN, would be a huge victory and show of solidarity for the American reproductive rights community. But that requires first engaging with the full history of sterilization—including coerced sterilization of disabled people, low-income Americans, and transgender people in addition to people of color—and how it continues to act in the modern-day United States.