Demographic Patterns of Eugenic Sterilization in Three U.S. States: Mixed Methods Investigation of Reproductive Control of the Unfit

From the passage of the country's first sterilization law in Indiana in 1907 until the 1960s approximately 60,000 people were sterilized based on eugenic criteria that sought to regulate the reproduction of the "unfit" and mentally deficient. California performed about 20,000, or one-third, of all documented sterilizations nationwide. Few empirical historical analyses of this practice are available. In 2007, while conducting historical research at the Department of Mental Health (now Department of State Hospitals) in Sacramento, Dr. Stern located 19 microfilm reels from this era that contain 15,000 sterilization recommendations along with supplemental letters and forms from nine state hospitals (in total, over 30,000 individual documents). Over the past two years Dr. Stern and her team have created a de-identified HIPAA-compliant data set of these recommendations, which date from 1921 to 1952. We now propose to conduct quantitative analyses with the eugenic sterilization dataset, which contains 212 coded variables, to describe trends in sterilization over time and to describe patterns of sterilization according to gender, age, ethnicity, nationality, diagnosis, institutional home, and many other variables. We propose to link the eugenic sterilization dataset to individual-level census microdata and tract-level census reports, which will allow us to calculate population-based estimates of sterilization rates and test hypotheses about the associations of gender, age, ethnicity, nationality, and diagnosis with the risk of sterilization. or example, we hypothesize that teenagers and Spanish-surnamed patients were disproportionately sterilized in California institutions. In addition, we will analyze qualitative patterns in the data with respect to familial resistance to sterilization, patient refusal, and experiences of institutionalization and sterilization. This study is relevant to contemporary ethical, legal, and social issues in human genomics, as it will provide an empirically-based, richer understanding of how medical paternalism and a particular variant of genetic determinism operated during the eugenics era in the United States, and how eugenic stereotypes about ethnicity, gender, sexual behavior, and intellectual disability influenced the state's intervention into the reproductive lives of institutionalized persons. Furthermore, our findings can inform contemporary conversations about the extent to which societal values of "fitness" and "unfitness," abnormality and normality, can insinuate themselves into the norms of disease prevention and human improvement that guide some genetic technologies and tests. PUBLIC HEALTH RELEVANCE: We will conduct quantitative and qualitative analysis of 15,000 eugenic sterilization recommendations processed by the state of California from 1921 to 1952. Working with a de-identified HIPAA-compliant dataset we created during the pilot phase of this project, we will describe patterns of sterilization according to over 200 coded variables such as gender, age, ethnicity, nationality, parental status, and diagnosis. We will expand this analysis by linking the eugenic sterilization dataset to individual-level census microdata in order to statistically compare risk of sterilization across demographic groups, and by conducting qualitative analysis to better understand familial resistance to sterilization, patient refusals, te fraught process of consent, as well as individual experiences of institutionalization and sterilization.