Rebecca M. Kluchin. Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980. Critical Issues in Health and Medicine Series. New Brunswick: Rutgers University Press, 2009. 288 pp. $45.95 (cloth), ISBN 978-0-8135-4527-1.

Reviewed by Wendy Gagen
Published on H-Disability (October, 2012)
Commissioned by Iain C. Hutchison (University of Glasgow)

This is an in-depth exploration of experience and policy surrounding sterilization and reproduction. By engaging with ideology and practice around reproduction via contemporary neo-eugenic thought in the United States in the second half of the twentieth century, Rebecca M. Kluchin juxtaposes the experience of women seen as either “fit” or “unfit” to reproduce. In many senses, this book, sadly, highlights little contemporary thought that will surprise those who have studied eugenic ideology. Kluchin’s detailed research and analysis shows us that, in the shift away from traditional eugenic ideas of biological determinism, a move toward culturally and socially constructed ideas of the “unfit” was embraced.

She finds that such traditional concepts were not necessarily abandoned by all, but rather that they could provide the foundations that other ideas rested on. The usual suspects are in evidence and Kluchin recounts the contemporary arguments created to supposedly expose the black, Mexican, Puerto Rican, and native American woman especially represented as “unfit” to breed. Such women were often depicted as the “Welfare Queen” or “Pregnant Pilgrim.” These women were denounced as being socially and culturally unfit to have children due to their inability to be good mothers, as being a drain on the state, and as deliberately choosing to have children so they did not have to support themselves. This was often backed up by suggesting that such women were also often less intelligent and that sterilization would be both a benefit to the state and the individual. Kluchin is particularly good at weighing up evidence, and, instead of just running down an avenue that only condemned, she acknowledges that sterilization was a lifeline for some of the women in these ethnic groups.

Where the line to involuntary sterilization was crossed, she shows us the complexity of argument that surgeons put forward as well as showcases the women who suffered loss of personal control. Again the geographic hotspots of such behavior do not cause surprise (New York, California, North Carolina, Mississippi, and Alabama) as they closely replicated the patterns of people experiencing severe poverty and following immigration routes. What is particularly interesting about Kluchin’s work is the way in which she explores the debates that surrounded the women who fought back--and the responses of medics, support workers, and the courts. The arguments put forward by such professionals indicate the deep-seated view of their own intellectual superiority and, conversely, their belief in the physical and mental insignificance of the women. The book details how women were coerced into sterilization in times of extremis and were lied to about its long-lasting impact; it discusses what they may have been asked to sign, and reveals that consent forms were often filled in after the fact. For me, the most damning testimonies on those who endorsed such behavior were from women who underwent sterilization while under the knife for another reason, e.g., Mississippi Appendectomies, and surgeons who used it as an excuse to practice their skill (opting for the more challenging hysterectomy rather than tubal ligation). These acts showed such professional disregard for patients as people that it does beggar belief.

In contrast to the seemingly endless desire to halt the possibility of further pregnancy from the “undesirables,” Kluchin also uncovers the experience of those deemed “fit” to breed. She shows the way in which many white middle-class men were quick to get a vasectomy as a way to support their partners and “do their bit” (9 percent of white men versus 1 percent of black men). Moreover, this analysis highlights different beliefs surrounding reproduction and behavior that were connected to socioeconomic grouping and geographical space. In contrast to “unfit” women, women who were desirable breeders often found it difficult to arrange sterilization as a form of permanent contraception. This resulted in court cases to overturn hospital policy. In experiences of both “fit” and “unfit” women, the frankly deplorable nature of hospital ethics and policies stand out, as does the often patronizing and rabidly paternalistic nature of healthcare and the law.

I have to admit an interest here because, as a British white, middle-class woman who never wanted children, the medical experience of such women did ring true to me (I guess I would have been seen in the “fit” camp). It would have been interesting to consider how the actions of these women were seen culturally through their experiences. That is true for both the “unfit” and “fit” women since much of the neo-eugenic ideology had, and has, currency via everyday experiences. Kluchin begins to assess this through the “Welfare Queen” and “Pregnant Pilgrim,” but it is the day-to-day erosive quality of such notions that give neo-eugenics its clout. Thus, I can attest to the dinner parties where people (male and female) have literally castigated both me and my husband for our lack of interest in childbearing. Another approach has been the humorously (I find them funny, not the speaker) supportive comments that tell me I would make a good mother. This suggests it is fear of parental performance that had stayed our hands. It is precisely these moments that are internalized and used to validate the behavior of medics and their support staff in regard to either “fit” or “unfit” parents.

It would also have been useful to intersect the debates around sterilization with the changing face of parenting. Here, ideas around “good” parenting certainly inform debates around those “fit” to breed. Kluchin does this to some extent, but I think the particular changes that have occurred in this arena might also tell us something more about changes in neo-eugenic thought. My final entry on my wish list would have been some time spent comparing the U.S. experience with other countries. This would have given the reader an idea of where the United States stands in the neo-eugenic debate and a way to assess its sterilization policies in a wider context. Indeed, my British students were always astounded by the twentieth-century American eugenics program (not forgetting the United Kingdom and the rest of Europe) as they only connected such ideas with Germany in the Second World War. It is precisely by showing the frightening ubiquity of such an ideology, whether in various countries or at the dinner table, that one can erode it.

While the above may be beyond the scope of just one book, Kluchin’s work is remarkable for its attention to detail and its ability to let the readers make up their own minds through a careful handling of both sides of the debate. It is a must for all those wishing to know more about the continuing history of eugenic thought and the ways in which reproduction remains both a state and personal issue.

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Citation: Wendy Gagen. Review of Kluchin, Rebecca M., Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980. H-Disability, H-Net Reviews. October, 2012.
URL: http://www.h-net.org/reviews/showrev.php?id=31036

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