Killing the Black Body: Race, Reproduction, and the Meaning of Liberty

For white women, particularly middle-class white women, “birth control has been an emblem of reproductive liberty” (58). However, racism has long affected women’s access to contraception. For much of the 20th century, the government sponsored family-planning programs that targeted Black women. Some programs coerced Black girls and women into sterilization. In this chapter, Roberts focuses on the use of birth control for social engineering. The relationship between birth control and racism divided the Black community: Some considered birth control essential to elevating the community; others argued that abortion and contraceptives encouraged racial “genocide.”

In the late 19th century, numerous states passed laws banning the distribution of information about contraception. The Comstock Law, a federal law passed in 1873, classified all information about contraception as obscene. Those who distributed such information by mail would be subject to criminal charges.

The Supreme Court wasn’t involved in arguments about birth control until 1965. In Griswold v. Connecticut, the court ruled that Connecticut’s ban on contraceptives violated the right to privacy. The decision was “the culmination of a movement for access to birth control that began in the early twentieth century” (59). When Margaret Sanger began her activism for reproductive rights, the eugenics movement was in its early stages.

White Americans feared that immigrants, particularly those from Eastern and Southern Europe, were reproducing faster than those of Anglo-Saxon descent. Meanwhile, fear of African Americans’ social advancement after the First World War prompted “a race riot in Chicago in the summer of 1919” (62). Lynching, usually of Black men, was prevalent throughout the South. In 1903, President Theodore Roosevelt condemned what he called “willful sterility” among American-born women.

The philanthropists Andrew Carnegie, Mary Williamson Harriman, and John Harvey Kellogg financed the American eugenics movement. Activist Angela Davis has posited that the movement helped justify the West’s imperialist activities throughout the world, as well as the continued exploitation of African American agrarian laborers in the South. Swedish writer Sven Lindqvist traced the Nazi Holocaust to European imperialism: Imperialists attempted to use racist ideas about the people who inhabited other nations to justify their conquests of those countries.

Initially, American eugenic policies mainly targeted white populations, particularly undesirable immigrants, and people with personal flaws, such as people with alcoholism. The practice of sterilization, which had been common in the Pacific West, especially in California, shifted to the South. Physician Thurman B. Rice wrote in his book, Racial Hygiene (1929), that the Black birthrate would outpace that of white births. In addition, concern arose about the intermingling of Black and white people, centering on interracial children and the elimination of the white race. Walter Ashby Plecker, the Virginia registrar of vital statistics, and eugenicist Harry Laughlin amended the Virginia anti-miscegenation law in 1924 to prevent interracial marriages between white people and “anyone with a trace of Negro ancestry” (72). Plecker sought the support of other eugenicists in gaining access to “better census records to verify the racial history of families” (72). In a 1936 issue of Eugenical News, a member of the Ku Klux Klan, Earnest Sevier Cox, advocated repatriating all African Americans of childbearing age back to Africa.

When outlining her proposal for a “Negro Project,” Sanger quoted an essay by writer and early civil rights leader W.E.B. DuBois, written for the June 1932 issue of Birth Control Review. Du Bois, who held that the contraceptive movement needed to address the needs of African Americans, was on the Birth Control Federation of America’s (BFCA) national advisory council on Negro issues. Other board members included educator Mary McLeod Bethune, executive director of the NAACP Walter White, the sociologist E. Franklin Frazier, and Abyssinian Baptist Church minister Adam Clayton Powell, Jr. Sanger received a grant from Dr. Clarence J. Gamble, a member of the board of directors and “heir to the Proctor and Gamble fortune” to disperse birth control information to Southern Black sharecroppers (77).

Black people, however, were often suspicious of white-run birth control programs. In 1939, the Division of Negro Service launched two key projects in the South. The first project, in Nashville, “operated clinics at a Black settlement house called Bethlehem Center and at Fisk University, staffed by Black doctors and nurses” (78). Public health nurses, all of them Black women, visited domestic workers who couldn’t visit the clinic during the day. The second project ran programs in a few rural counties in South Carolina, where Black nurses received training to offer contraceptive advice and instruction. The BCFA, however, firmly controlled each project’s policies. To assuage Black people’s suspicions that the programs were extermination plots, the BCFA made it appear as though Black people were operating the programs.

Black people throughout the US availed themselves of the few birth control clinics that opened in their communities. Black activists played a crucial role in establishing those clinics. After emancipation, newly freed Black women continued to use folk methods for contraception and abortions. The Women’s Era, a newsletter for Black women, advocated reproductive choice when it printed, in 1894, that “not all women are intended for mothers” (82). Black newspapers published in the 1920s and 1930s mentioned the prevalence of both contraception and abortion, usually in their advertisements.

Between 1880 and 1940, Black birth rates dropped. Some demographers attribute this to “higher rates of venereal disease, tuberculosis, infections, and rickets” in the 1930s (82). This hypothesis didn’t account for the use of contraceptives. Moreover, middle-class Black people, who were least likely to contract diseases that caused infertility, had the fewest children.

During the years between the world wars, numerous activists published articles on the need for birth control in Black communities. Birth Control Review published a special issue in September 1919 called “The New Emancipation: The Negroes’ Need for Birth Control, as Seen by Themselves.” The issue included a one-act play by Mary Burrill and an interview with the editor of The Messenger, Chandler Owen. A 1932 issue of the same journal likewise addressed the need for birth control and featured articles from Opportunity magazine editor Elmer A. Carter, Du Bois, Fisk University professor Charles S. Johnson, and Dr. W.G. Alexander, general secretary of the National Medical Association. These leaders promoted birth control to avoid high maternal and infant death rates—and as a way for Black people to improve their standard of living.

Du Bois was one of the first leaders within the Black community to promote birth control. He fought for women’s rights and particularly worked to defend Black women, “whom he admired for their triumph over adversity” (83). In his view, birth control would support economic independence for Black people and women’s independence from traditional roles. He promoted these ideas in his 1920 book Darkwater: Voices from Within the Veil. Du Bois disagreed with the notion that a high birthrate could solve Black people’s subordination. Oberlin College professor Newell Sims agreed and wrote, in his 1932 article “Hostages to the White Man,” that the strategy of outbreeding white people might backfire and result in even more repressive measures to circumscribe Black people’s lives. However, Du Bois wasn’t immune to elitist thinking. He and some other civil rights leaders “sometimes advocated birth control for poorer segments of their own race in terms painfully similar to eugenic rhetoric” (84). Conversely, Marcus Garvey, leader of the Universal Negro Improvement Association (UNIA), condemned birth control at his organization’s 1934 annual convention, claiming that it interfered with nature and God’s purpose.

Black leaders who supported birth control never presented it as a means of weeding out those with hereditary defects. Du Bois and others opposed sterilization. In a column for a 1936 issue of the Pittsburgh Courier, he wrote that sterilization programs usually target Black people. Meanwhile, Black women’s clubs in cities throughout the country “worked to educate their less fortunate sisters about birth control” as part of their racial uplift efforts (85).

In 1924, James Hubert, executive secretary of New York’s chapter of the Urban League, asked Sanger about opening a birth control clinic in a Black community in the city. Sanger’s organization had operated a clinic for white women for more than a year. Over the next few years, Sanger met with members of the Urban League to talk about setting up a clinic in Harlem, and a clinic opened in the neighborhood in February 1930. It offered the same services as the main branch dedicated to white women, including gynecological examinations and contraceptive services. Two thousand patients visited in the first year and several thousand in each succeeding year. However, until 1933, about half the patients were white women referred to the clinic from downtown.

Despite support for the Harlem clinic, some members of the community suspected that it practiced a form of racial genocide. Its name, the Clinical Research Bureau, fanned those suspicions. After the clinic moved into the Urban League building and hired Black staff members, including a Black physician, more Black women visited. Sanger resisted giving the Harlem Advisory Council control over the clinic. Moreover, she never invited Black council members to participate in national planning efforts or allowed them to manage clinics that catered to Black patients. In 1935, due to difficulties with funding during the Depression, Sanger “relinquish[ed] the clinic’s management to the New York City Committee of Mother’s Health Centers, affiliated with the American Birth Control League” which cut the clinic’s services and “treated the advisory council with even greater paternalism than Sanger had” (87). The League shut the clinic down a year later.

By the 1940s, eugenics had fallen out of fashion. Critics regarded it as bad science that attempted to legitimize racism. However, between 1929 and 1941, more than 2,000 eugenic sterilizations occurred each year in the US. More than 70,000 people “were involuntarily sterilized under these statutes” (88). Even after the Second World War, Black women, particularly those in the South, underwent involuntary sterilization procedures. All 23 patients sterilized at South Carolina’s State Hospital in 1955 were Black women. In addition, Black men underwent involuntary castration and vasectomies at a much higher rate than white men. This was particularly prevalent at the State Hospital for Negroes in Goldsboro, North Carolina, where around 200 such surgeries occurred.

The sterilizations performed on Black women weren’t part of any official eugenic efforts but were conducted by doctors whom the government paid to provide health care to Black women. In the 1970s, sterilization became the most common form of birth control meted out to Black women. Black Southerners held that Black women were frequently sterilized without their consent. Teaching hospitals often “performed unnecessary hysterectomies on Black women as practice for their medical residents” (89). By the middle of the decade, hysterectomies cost $800 compared to $250 for tubal ligation. Surgeons, who received reimbursements from Medicaid, found more financial incentive in performing hysterectomies—despite the risk that the procedure might kill the patient.

Unnecessary hysterectomies also occurred in Northern hospitals. In 1972, a group of medical students issued a complaint that Boston City Hospital “was performing excessive and medically unnecessary hysterectomies on Black patients” (89). The director of obstetrics and gynecology at a municipal hospital in New York City reported that Black and Puerto Rican women often underwent hysterectomies for training purposes. Another tactic in such hospitals was to offer tubal ligations to Black women while they were still in labor. Some doctors confessed that they considered sterilization the best method to obstruct the growth of poor populations. Social workers sometimes colluded in sterilization plans, threatening women that if they didn’t get sterilized, they’d lose their welfare benefits.

In the 1960s, state legislatures issued numerous proposals ordering the sterilization of single mothers, most of whom were Black. Louisiana and Mississippi successfully passed laws that made it “a crime to give birth to two or more illegitimate children” (92). For a few decades, the Puerto Rican government and the International Planned Parenthood Federation used federal funds to sterilize Puerto Rican women. The project, managed by Dr. Clarence Gamble, who had spearheaded the Negro Project in the South, resulted in the sterilization of over one-third of all Puerto Rican women of childbearing age by 1968—“the highest percentage in the world at that time” (93). A similar effort on Indigenous reservations in the 1970s left a quarter of Indigenous women sterile. One doctor reported sterilization of every female member of Oklahoma’s Kaw tribe.

While coercing Black, Puerto Rican, and Indigenous women into sterilization, health authorities usually deterred white middle-class women who sought sterilization. They typically needed “the endorsement of two doctors and a psychiatrist” (93), although a woman with three children would be ineligible for sterilization until age 40. If they had no children at all, they were denied the procedure. These disparate experiences led to disagreement between Black and white women regarding sterilization. When women activists formed the Committee to End Sterilization Abuse in the late 1970s and introduced guidelines to the New York City Council “to prevent coercive sterilization” (94), other birth control advocates balked, claiming that the guidelines would only make birth control more difficult to obtain.

In 1978, the Department of Health, Education, and Welfare restricted “sterilizations performed under programs receiving federal funds” and demanded both “informed consent and thirty-day waiting period requirements” (94). The department also banned hysterectomies “for sterilization purposes” and prohibited the use of federal funds “to sterilize minors and mentally incompetent and institutionalized persons” (94-95). Physicians and other health care workers, however, continued to pressure women of color to agree to sterilization. By 1990, around 24% of Black women, compared to 17% of white women, had undergone sterilization. Additionally, 9.7% of college-educated Black women had the procedure “compared to 5.6% of college-educated white women” (95). The rate increased with less educated Black women. For several decades, sterilization was the only birth control method that Medicaid funded.

In the 1960s and 1970s, Black nationalists usurped Marcus Garvey’s theory that birth control was a surreptitious method of genocide. The Nation of Islam vociferously opposed birth control. The Black Power conference organized in Newark, New Jersey by poet and activist Amiri Baraka “passed a resolution denouncing birth control” (96). The National Association for the Advancement of Colored People (NAACP), the Urban League, and People United to Save Humanity (Operation PUSH) also voiced concern about the government’s interest in family planning.

Many Black women, however, countered the notion that birth control was a means of genocide. In addition, they sought independence from white-dominated reproductive organizations such as Planned Parenthood and rejected the urging of some Black men to have more children, declaring their right to decide when it was in their interest to have children. The Black Panther Party had divided views on the issue. While some male members opposed birth control, the organization “offered contraceptives as part of its free health care program” (98). A study published in 1970 discovered that 80% of Black women living in Chicago supported birth control and 75% used contraception. Part of this support was likely because Black women had disproportionately been the victims of unsafe abortions before national legalization of the procedure in 1973. Half of all “maternity-related deaths among Black women in New York City in the 1960s were attributed to illegal abortions” (98-99).