“In order to prevent our being swamped with incompetence,” Supreme Court Justice Oliver Wendell Holmes wrote for the majority in 1927’s Buck v. Bell, the state could—and should—”prevent those who are manifestly unfit from continuing their kind.” Forced sterilization, the court held, was not only legal but laudable.
In 1924, 17-year-old Carrie Buck was institutionalized, having been deemed “feebleminded” on the grounds of “promiscuous” behavior. In reality, Buck was raped by her foster family’s nephew. Three years later, with the Court’s blessing, Virginia’s “State Colony of Epileptics and Feeble Minded” sterilized Buck against her will. The decision, passed at the height of the 20th-century eugenics movement, has never been overturned.
“There’s a very different standard being applied to disabled people’s autonomy.”
To this day, 31 states and Washington, DC, still have laws on the books that allow for the practice—and just two, Alaska and North Carolina, have laws that fully ban the nonconsensual sterilization of disabled people, according to a 2022 report from the National Women’s Law Center. There’s no official account of just how many disabled people have been sterilized under those laws.
Some of these laws aren’t even that old. In 2019, Iowa and Nevada passed new forced sterilization laws that applied to people under guardianship. Both bills passed unanimously, and the end result is consistent with laws on the books in other states. There was no discourse among politicians—let alone objections—about the ethics of sterilizing disabled people without their consent.
Sterilization and Social Justice Lab co-director and founder Alexandra Minna Stern said that early IQ tests, which sought to measure intelligence in part on the basis of class- and culture-based questions involving Beethoven’s sonatas, the early United States, and college athletics, were “used to categorize people who would then be targeted for sterilization,” generally those who were “marginalized or maligned in some way”: in California and the Southwest, often Mexican Americans; nationwide, Black, Indigenous and poorer white Americans, particularly women. The people behind the tests, Stern says, were “white, elite men who wanted to create a certain type of society in their own image.”
NWLC senior counsel for health equity and justice Ma’ayan Anafi, who is also disabled, told Mother Jones that “forced sterilization laws are a really powerful example of how violations of disabled people’s bodies and rights are baked into our legal system today.”
Plenty of Democratic-led states, including Massachusetts and Oregon, continue to allow disabled people to be sterilized against their will. “In many states, we’re seeing laws that generally affirm reproductive rights existing side-by-side with these forced sterilization laws,” Anafi continued. “There’s a very different standard that’s being applied to disabled people’s autonomy.”
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Stern says the political climate is ripe for “another wave of sterilization abuse” under Donald Trump, who is preoccupied with “good genes,” and his advisor Stephen Miller, who is preoccupied with white nationalism. “We have to be really vigilant,” Stern added.
Eugenics already figured into Trump’s first term, particularly in his and his advisors’ rhetoric criminalizing migrants of color. Trump has, moreover, reportedly expressed support for letting disabled people die. But eugenics is now taking center stage even more, with Trump emboldened by his “mandate” to punish immigrants without papers while welcoming, specifically, white South Africans. The addition of productivity-obsessed Elon Musk, who espouses harmful rhetoric about “abuse” by disabled Medicaid users and has an ugly record on disability, further reinforces Trump’s eugenicist turn.
Efforts to rectify the harms of forced sterilization have also fallen flat, both historically and in the present day. Following a 2013 Reveal investigation showing that incarcerated women in California were being sterilized without their consent, the state passed a bill to ban the practice behind bars. However, Victoria Valenzuela reported for Bolts, around four in five applications for compensation from people forcibly sterilized in California prisons were rejected.
Importantly, nonconsensual permanent contraception still has some backing from the American medical establishment, at least as an option. An October 2024 clinical report published by the American Academy of Pediatrics, for instance, calls nonconsensual permanent contraception a “violation of [the] interests” of people with intellectual and developmental disabilities—unless a court finds that they lack decision-making capacities. In that case, the authors argue, sterilization could still be chosen by guardians (though it is not the only option). But even the most experienced judges, as Holmes demonstrated in 1927, can fail appallingly in making that call.
“Courts routinely fail to understand disability…and they may act in a paternalistic manner.”
Disabled attorney Marissa Ditkowsky of Tzedek DC does not believe anyone should be sterilized without their consent, and says that “people who are legally deemed to lack capacity can still express their wishes or personal values”; she hopes appointed guardians will also support people under guardianship who do seek permanent contraception. Additionally, Ditkowsky says, “courts routinely fail to understand disability and the spectrum of capacity, and they may act in a paternalistic manner”—again on display in Buck v. Bell.
Monika Mitra, Brandeis University’s Lurie Institute for Disability Policy director, believes that opposing forced sterilization means reckoning with how disabled people are viewed as parents. After all, more than 40 states allow disability to be used as grounds for parental termination, and disabled parents are at a higher risk of being monitored by Child Protective Services.
“If you can call out eugenics, and if we can call out sterilization [and] institutionalization,” Mitra said, “we can think about how we as a society view whether disabled people should be pregnant and whether disabled people should be parents.”
This story was published with the assistance of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, supported by the Commonwealth Fund.
