Chapter two
In the summer of 1973, Minnie Lee Relf and her baby sister, Mary Alice, just fourteen and twelve, were taken from their home in Montgomery, Alabama, cut open, and sterilized against their will and without the consent of their parents by a physician working in a federally funded clinic. The Relf family sought justice, and their case brought shocking awareness to the brutality wrought on the bodies of Black women by medical providers financed by the federal government. The pain the Relf sisters endured also changed the course of history: The lawsuit Relf v. Weinberger revealed that 100,000 to 150,000 poor, mostly Black women had been sterilized under U.S. government programs over decades. It also stopped this practice and forced doctors to obtain informed consent before performing sterilization procedures.
What happened to the Relf girls is part of a through line of extreme abuse and disrespect of the Black body at the hands of medical providers in the name of science. It began during slavery and continued after emancipation and into the twentieth century, and remnants of it taint current medical education and practice. J. Marion Sims, MD, who until recently was celebrated as the father of modern gynecology, used Black women as guinea pigs in ways that would be unconscionable today. A slave owner, he practiced painful surgeries without anesthesia on enslaved women in Montgomery, Alabama, between 1845 and 1849. In his autobiography, The Story of My Life, Dr. Sims describes the pain the women suffered as he cut their genitals again and again in an attempt to perfect a surgical technique to repair vesicovaginal fistula, which can be a severe complication of childbirth. He described the agony endured by Lucy, one of the women, as “extreme.” He performed the operation more than two dozen times on Anarcha, another of the enslaved women. Dr. Sims operated on Lucy, Anarcha, and another woman named Betsey while they knelt, naked, on all fours in front of an audience of doctors, writhing in pain.
Almost a century later, beginning in the early 1930s, scientists recruited Black men to participate in what would become one of the most callous and now infamous episodes in American history, the Tuskegee Syphilis Study. Recruitment flyers read, “Colored People, Do You Have Bad Blood?” In bold print, the advertisements locked in the legitimacy of the “experiment” by offering free blood tests and treatment by the county health department and government doctors. Between 1932 and 1972, the U.S. Public Health Service enrolled 600 men in the study; 399 who had syphilis were part of the experimental group, and 201 were control subjects. Most of the subjects were impoverished sharecroppers who were unable to read. The goal was to examine the progression of untreated syphilis under the assumption that the infection manifested itself differently in Black people—“a notoriously syphilis-soaked race,” as physicians and scientists of the time believed. For the Tuskegee Study of Untreated Syphilis in the Negro Male, subjects were told they would receive treatment for their “bad blood,” though they never did. In 1943, when penicillin became widely available to treat syphilis, the participants in the study were not offered treatment. Instead, they were poked, prodded, and observed while the illness progressed. Once the men died, doctors autopsied their bodies to compile data on the ravages of the disease.
Late in the era of the syphilis experiment, doctors discovered that rather than bad blood, Henrietta Lacks, a poor Black tobacco farmer and mother of five, had magical cells, so hardy that they were labeled immortal. In 1951, Lacks visited Johns Hopkins Hospital in Baltimore complaining of vaginal bleeding. While she was undergoing treatment for cervical cancer, doctors noticed the resilience of the cells of her tumor and harvested them without her knowledge or consent. Though she died penniless from the cancer, Lacks’s cells—named HeLa after her—transformed medicine and were bought and sold to scientists, allowing them to perfect the polio vaccine, gene mapping, and in vitro fertilization. More than seventy years after her death, scientists buy HeLa cells and cells with modifications for anywhere from $400 to thousands of dollars per vial.
In more recent years, our country has faced the sins of the past and apologized to and sometimes compensated the victims of medical violence. In 1973, Congress held hearings on the Tuskegee Syphilis Study, and the following year the surviving participants and the heirs of those who died received a $10 million out-of-court settlement. As part of the agreement, the U.S. government promised to give lifetime medical benefits to living participants, and later wives, widows, and offspring. Lawmakers stepped up, creating new guidelines to protect human subjects in U.S. government–funded research projects. In 1997, when issuing a formal apology to the survivors of the Tuskegee study and the family members of those who died, President Bill Clinton called what the government did “wrong—deeply, profoundly, morally wrong.” Henrietta Lacks also received worldwide recognition. The author Rebecca Skloot brought her story to light in the 2010 book The Immortal Life of Henrietta Lacks. It became a New York Times number one best seller. HBO turned the book into a movie in 2017, starring Oprah Winfrey as Lacks’s daughter Deborah. In 2018, a statue celebrating Dr. Sims—situated in Central Park across from the New York Academy of Medicine—was removed after prolonged protest, including by women wearing blood-splattered gowns in memory of Anarcha, Betsey, Lucy, and other enslaved women he abused.
Despite their own history-making sacrifice, the Relf sisters never got their due. Mary Alice and Minnie Lee live in poverty and obscurity not far from where their fertility was taken from them. Unlike the survivors of the Tuskegee study and their relatives, the Relfs never received a presidential apology or a dime. Unlike Lacks, they didn’t get a movie starring Oprah. And unlike J. Marion Sims, the doctors and other health-care providers who were complicit in the sterilization of the Relf girls were not shamed or punished. The two sisters, now in their sixties, live together in a cramped Section 8 apartment behind a strip mall near the Mobile Highway in South Montgomery, scraping by on monthly Social Security checks. They are scarred by what they endured, in their hearts and their bodies. “I can show you what they did to me,” Minnie Lee says. She lifts up her T-shirt and reveals a jagged horizontal scar that rips down the center of her belly. “That’s where they cut me.” As she lowers her shirt—which has the word “courage” printed three times on the front—she drops her head.
Mary Alice, sitting in a chair next to her, watches, her half arm, a disability she was born with, resting lightly on her thigh as she leans in to listen intently to her sister. A speech impediment and intellectual disability make communication difficult for her. “It might have happened a long time ago, but it still brings back memories,” Minnie Lee says, looking at her sister. “We’re still thinking about it.”
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In 1972, Jessie Bly, a thirty-year-old Black social worker, was working in downtown Montgomery when she received a call from a local city councilman. Her employer, the City of St. Jude, had been founded by a progressive Catholic priest in the 1930s to serve as a “center for the religious, charitable, educational and industrial advancement of the Negro people.” Bly, born and raised in Montgomery, was the daughter of a housekeeper and a grave digger. Her parents understood early that their seventh child was bright and engaged and sent her to private school, and she was the only one of the eight siblings to finish college. Bly returned to Alabama from Europe in the late 1960s with her husband, Ray, an army man who had been transferred to a military base in her home state. Her work at the City of St. Jude included checking on the condition of the elderly and poor to make sure they had necessities and basic services.
That day in 1972, the councilman asked her to take a ride with him to a poor Black community in Montgomery called Flatwood to go see a family. When she asked, “What kind of family?” he replied, “Trust me, in the day that we’re living, I never thought that we would see anything like this in the United States of America.” In Flatwood, Bly was shocked by what she witnessed. “I was waiting to see a house,” she recalls, “but I never saw one.” The Relfs, a husband, wife, and three young girls, were living as squatters in a field, sheltered in a shanty built from cardboard boxes. “They had no running water, no electricity,” Bly says, closing her eyes and shaking her head as she remembers that first encounter. “I was really taken aback because I just couldn’t believe that anybody would be living in those conditions. But they were.”
But what Bly says crushed her heart most were the girls, the teenage Katie and her two little sisters, Minnie Lee and Mary Alice. Bly, now a mother, grandmother, great-grandmother, and ordained minister in Montgomery, couldn’t shake the image of the youngest girl, who was physically and intellectually disabled. “She was born with an automatic amputation, with the umbilical cord wrapped around her right arm,” says Bly. “She had no hand, and the arm was just a little stub.”
As she continued meeting with the Relfs, their story began to come together. Like many Black families at the tail end of the Great Migration in the 1950s and 1960s, Lonnie and Minnie Relf, both illiterate, were forced out of rural Macon County in Alabama—ironically, where the Tuskegee Syphilis Study took place. There, cotton was no longer king and mechanization had caused agricultural jobs in the fields to dry up. Like generations before them, some went north, but others crowded into southern cities like Montgomery, the state capital. In 1910, 90 percent of all African Americans lived in the South, three-fourths in rural areas. By 1970, more than half of all Black Americans lived in the North, the vast majority in urban areas. Of those remaining in the South, most now lived in cities. In Alabama specifically, census data shows that for the first time, in 1960, the state’s urban population exceeded the size of the rural population in a state that was one-third Black. This influx of rural Blacks, most unskilled and lacking education, increased poverty in Black communities in a number of southern cities like Montgomery.
Bly, desperate to help the Relfs, arranged with the director of the Montgomery Housing Authority for them to live in a three-bedroom apartment in Smiley Court, a public housing project on the southwest side of the city. Once the family moved into their new home, Bly took them to Salvation Army and Goodwill to buy used furniture and put out a call for donations of linens, cooking utensils, and other household items to the people in her church and network. She taught Minnie, who was used to preparing meals on a rudimentary oil burner in old burned pots, how to use a stove and the basics of keeping house. “They didn’t know how people really lived,” says Bly. “Life had passed them by.”
The girls had no idea about hygiene, so Bly showed them how to take care of themselves and got the two older daughters into school. She brought Mary Alice to a pediatrician who specialized in developmental disabilities for evaluation. He declared her mentally incompetent, not teachable but trainable, and recommended the McInnis School for Retarded Children. The diagnostic and guidance clinic he ran was sponsored by the public health service, and now Bly worries that visiting the government-funded facility put the Relf girls on the radar of the family planning clinic that would eventually set up the sterilizations. More likely, they were flagged by the government services they were receiving: food stamps, a $150 monthly welfare check, and a subsidized apartment in public housing. These benefits were lifesaving; even if he’d been able to find a job in Montgomery, Lonnie Relf had been disabled in an accident and was unable to work. The services were administered through the Office of Economic Opportunity (OEO), the federal agency established in 1964 as part of the U.S. government’s War on Poverty. Government administrators steered the Relf sisters to the Family Planning Clinic of the Montgomery Community Action Committee, which was also sponsored and controlled by OEO. The U.S. government created its family planning program in 1967 to “help” poor people prevent unwanted births.
The process began with Katie, who was about fifteen when nurses first injected her with Depo-Provera, a contraceptive. At that time, the shots were still in the investigational phase and not yet approved by the FDA for administration to adult women, let alone teenagers. Poor Black women in the South were the overwhelming recipients of the drug under the force of threats of the loss of welfare benefits. The staff at the Family Planning Clinic never obtained permission to perform the injections or adequately explained the shots to Katie or her mother. Some time later, Minnie Lee and Mary Alice also began receiving the shots. A member of the staff would later tell Bly that she was worried that “boys are hanging around the house and we don’t want no more of their kind.” The implication: they would engage in sexual activity and have children who would require more government benefits, though there was no evidence that any of the girls were sexually active, especially the two younger ones, who hadn’t yet reached the teen years. In reality, the Relfs were targeted because of their race and class and because they were judged to be intellectually inferior even though only Mary Alice would be diagnosed with an actual disability. The other two girls simply lacked formal education and were struggling to catch up to their peers. In March 1973, Katie, then seventeen, was again taken to the Family Planning Clinic, this time for insertion of an IUD, after the Food and Drug Administration terminated clinical trials of Depo-Provera because of its link to cancer in animals. Again, though Katie was under the age of consent, her parents say they were not consulted about the IUD.
A few months later, something more sinister happened. On June 13, two nurses came to the Relfs’ apartment and informed Minnie that her daughters would need to go to the hospital for what she understood to be more shots. Employed by the Family Planning Clinic, they drove the mother and her two younger daughters first to a doctor’s office and then to the Professional Center Hospital in downtown Montgomery. Health-care providers explained that Minnie needed to sign a paper to give consent for treatment. It is unclear what Minnie Relf understood, but she trusted her daughters in the hands of the staff at this clinic, sponsored by the same government that had given her family a home, food, money, and an education for her children. Still, it is very clear that she had no idea that signing the piece of paper would mean that her daughters would never be able to bear children. Since she could not read or write, Minnie signed the surgical consent form with an X and was then driven home, while the younger girls remained alone in the ward.
Before Minnie made it home, the same family planning nurse returned to the Relfs’ apartment to pick up Katie and bring her to the hospital. The teenager sensed something was wrong and refused to go, locking herself in her room. The following day, Jessie Bly stopped by and a frantic Katie filled her in on what had happened. “Where are your sisters?” Bly asked Katie. “I can show you, Miss Bly,” Katie told her, and they got in the car and drove to the Professional Center Hospital.
Even nearly half a century later, Bly has no trouble conjuring the image of the younger Relf girls in the hospital, huddled together, looking small and scared in cotton surgical gowns. The second they saw the social worker, they both began to cry. Clinging to Minnie Lee, a sobbing Mary Alice repeated over and over, “I just hurt so bad. I just hurt so bad, Miss Bly, help me. Help me, Miss Bly.”
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The violence perpetrated on the Relfs at the hands of health-care providers who should have been helping, not harming, them has its roots in slavery. For centuries, white physicians and scientists went to great lengths to prove that Black people were biologically and physiologically different from white people. They used their expertise and even empirical evidence to create deeply flawed theories, presented as fact, to justify forced labor and unspeakable cruelty and lend support to racist ideology and discriminatory public policies. According to this thinking, Black people were different in mind, body, and even soul, and different meant inferior. The lie that Black men, women, and even children could withstand enormous amounts of pain was the most dangerous, and it provided rationalization for the most vicious aspects of slavery—backbreaking unpaid labor, squalid living conditions, and brutal punishment—in service of keeping the wealth-generating institution alive and thriving. In the 1787 manual A Treatise on Tropical Diseases: And on the Climate of the West-Indies, a British doctor, Benjamin Moseley, a member of the Royal College of Physicians in London, claimed that Black people could bear surgical operations much more than white people, noting that “what would be the cause of insupportable pain to a white man, a Negro would almost disregard.” To drive home his point in a later edition, he added, “I have amputated the legs of many Negroes who have held the upper part of the limb themselves.”
It didn’t stop with just physical pain, because, as the false ideas went, Black people didn’t feel emotional pain as intensely as whites, justifying separating and selling off enslaved family members. And Black women were raped by their enslavers and other white men, and men and women were forced to reproduce to create a robust supply of free labor under the pseudoscientific notion that Black people were hypersexual, lascivious, and wanton, with genitalia that differed from those of whites, generally perceived as larger.
The genesis of some of this thinking might have been the words of Thomas Jefferson in his influential and widely circulated 1785 book Notes on the State of Virginia. Though he was not a doctor or scientist, Jefferson cataloged the physiological ways Black bodies differed from white bodies in this 244-page document. “They have less hair on the face and body,” he wrote. “They secrete less by the kidnies [sic], and more by the glands of the skin, which gives them a very strong and disagreeable odour. This greater degree of transpiration renders them more tolerant of heat, and less so of cold, than the whites.” He also advanced the myth that Black people had weak lungs, justifying hard labor as beneficial. Jefferson, who both owned and fathered enslaved people, extrapolated that Black people were different emotionally and intellectually. “They seem to require less sleep,” he wrote. “A black after hard labour through the day, will be induced by the slightest amusements to sit up till midnight, or later, though knowing he must be out with the first dawn of the morning.”
“They are more ardent after their female,” Jefferson wrote, “but love seems with them to be more an eager desire, than a tender delicate mixture of sentiment and sensation. Their griefs are transient.”
Doctors, many who profited from owning enslaved people, grabbed hold of Jefferson’s unproven pronouncements and wrapped them in the legitimacy of science. Some southern doctors claimed to be experts in “Negro Medicine,” presenting “facts” about Black people not derived from real evidence but pieced together by their own tainted observations. They believed, and went to great lengths to prove, that compared with whites, Blacks had not only higher pain tolerance and weaker lungs but also smaller skulls, better heat tolerance, resistance to some ailments, and susceptibility to others. In his widely read paper “Report on the Diseases and Physical Peculiarities of the Negro Race,” Dr. Samuel Cartwright, a New Orleans physician and academic, detailed a laundry list of physical differences between whites and Blacks—including that Blacks had darker blood; harder, whiter bones; smaller brains; and better hearing, smell, and sight than whites. He also suggested that a difference in the nervous systems of Blacks made them, as he put it, value sensuality over intellectuality. “Music is a mere sensual pleasure with the negro,” he wrote. “There is nothing in his music addressing the understanding; it has melody, but no harmony; his songs are mere sounds, without sense or meaning—pleasing the ear, without conveying a single idea to the mind; his ear is gratified by sound, as his stomach is by food.”
Cartwright took his theories a step further, insisting that slavery benefited Blacks. He believed that a deficiency in cerebral matter and excess of nervous matter distributed to the “organs of sensation and assimilation” created a debasement of the mind, which rendered Blacks childlike, unable to take care of themselves. As a result of these physiological failings, he wrote that slavery gave Black people “more tranquility and sensual enjoyment, [and] expands the mind and improves the morals, by arousing them from that natural indolence so fatal to mental and moral progress.”
Cartwright also picked up Jefferson’s claim that Blacks have lower lung capacity and saw forced labor as a way to “vitalize the blood” and correct the problem. Enslavement, he argued, offered physiological benefits. “It is the want of a sufficiency of red, vital blood, that chains their mind to ignorance and barbarism, when in freedom,” he wrote.
Most outrageously, Cartwright maintained that enslaved people were prone to a disease called drapetomania, which caused them to run away from their masters. Willfully ignoring the inhumane living and working conditions that drove desperate men and women to attempt escape, he insisted, without irony, that enslaved people contracted this ailment when their masters treated them as equals, and he prescribed working them harder or “whipping the devil out of them.”
Operating under these erroneous convictions, doctors also routinely bought, sold, and traded enslaved people as research subjects. They were made to suffer excruciating pain in the name of scientific advancement. After death, their bodies—often robbed from graves—were trafficked as cadavers or in pieces for medical students to dissect as part of their training. Under the fallacies of racial physiological differences that southern doctors and scientists were working so hard to advance, John Brown, enslaved on a plantation in Baldwin County, Georgia, during the 1820s and 1830s, was subject to a variety of excruciatingly painful medical experiments and procedures that left him sick and weak, his body disfigured by a network of scars. Brown—or Fed, as his owners called him—had been lent to Dr. Thomas Hamilton, a neighboring physician, who needed a subject to test a cure for sunstroke. After working a full day in the fields, Brown was forced to strip and sit in a pit on a stool resting on a plank just above a hundred-degree fire. Damp blankets were fastened over the hole to make sure heat didn’t escape; only his head remained aboveground. As the pit became unbearably hot, Hamilton fed Brown a number of remedies, supposedly to help his body withstand the heat. After about half an hour, Brown would faint and would be lifted out and revived, as the doctor took note of the degree of heat the enslaved man could withstand. Eventually, based on these experiments, Hamilton marketed a remedy for sunstroke. This supposed cure—a pill made from flour combined with a cayenne pepper tea concoction—made him a fortune.
Following the heat experiments, Hamilton became consumed with proving Black-white physiological differences and used Brown to determine how deep Black skin went, believing it was thicker than white skin. Brown, who eventually managed to escape to England, became one of the small number of enslaved people to record his experiences, in an 1855 autobiography, Slave Life in Georgia: A Narrative of the Life, Sufferings, and Escape of John Brown, a Fugitive Slave, Now in England. In Brown’s own words, Hamilton “appl[ied] blisters to my hands, legs and feet, which bear the scars to this day. He continued until he drew up the dark skin from between the upper and the under one. He used to blister me at intervals of about two weeks.” Brown was with Hamilton for a total of nine months until “the Doctor’s experiments had so reduced me that I was useless in the field.”
Hamilton seems monstrous and his experiments are clearly less scientific than sadistic, but he was actually a courtly southern gentleman, a widely respected physician, and a trustee of the Medical Academy of Georgia. And, like many other doctors of the era in the South, he was also a wealthy plantation owner. Though Cartwright’s ideas are preposterous and his 1851 paper reads like satire, he was considered a leader and authority in Negro medicine. Cartwright was a professor of “diseases of the Negro” at the University of Louisiana, which is now Tulane, and served as chair of the committee of Louisiana’s medical association that specialized in illness and physiology of the Negro. He presented his theories on Black inferiority, including the drapetomania hypothesis, at the annual meeting of the medical association of Louisiana and his paper was published in the May 1851 issue of The New Orleans Medical and Surgical Journal. And somehow his theories have managed to stick, and his footprint remains on modern-day medicine.
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Bly was shaken by what had happened to Minnie Lee and Mary Alice. She recalls being unable to sleep, feeling haunted by the image of the young girls crying and calling her name as they stood in the hospital ward. She also worried that this was somehow her fault. Though she had no clue about the contraceptive shots or the sterilizations, she felt responsible for introducing the girls into the system in the first place. “I knew I wouldn’t be able to rest knowing that this kind of an injustice had been perpetrated upon these young ladies and nobody was speaking for them,” she says. “It happened because of where I am, so I felt like God wanted me to be the mouthpiece for them. I was going to do what I had to do.”
After asking around, she was referred to two young civil rights lawyers, Morris Dees and Joe Levin, who were making their names as social justice champions. The two attorneys had recently founded the Southern Poverty Law Center, with the civil rights leader Julian Bond as its first president, when Jessie Bly walked into their office—then a small, old house on Washington Avenue in Montgomery that they had refurbished as a law office. She shared the story of the Relfs with Levin and Dees, who were outraged but also intrigued. In July 1973, they filed Relf v. Weinberger in federal district court in Montgomery alleging that “the U.S. Department of Health, Education and Welfare (HEW), now the Department of Health and Human Services (HHS), was funding the administration of experimental drugs (Depo-Provera) and sterilization procedures under the guidance of HEW and Office of Economic Opportunity (OEO) to poor black persons who were dependent upon governmental benefits programs.” Caspar Weinberger, the director of HEW from 1973 to 1975, who would later become Ronald Reagan’s defense secretary, was named in the suit. The case was later amended to include two former White House aides of Richard Nixon’s, John W. Dean III and John D. Ehrlichman.
Just before the official filing, Levin picked up the phone and called Julian Bond to brief him on the Relf case. Immediately, Bond saw it as a lightning rod, “a horrendous attack on privacy, innocence and the right of motherhood,” he would tell The New York Times. He encouraged Levin and Dees to contact the news media. Articles in the Times and Time magazine and a piece on NBC News shone a white-hot spotlight on the plight of the Relfs and the issue of forced sterilization. “The suit all of a sudden attracted a great deal of attention,” remembers Levin. “And it’s not that we hadn’t had attention but this was actually at a scale that we hadn’t seen before.”
After she was interviewed by reporters from The Washington Post and Jet magazine, the media attention became too intense for Bly. “I couldn’t go home; I couldn’t go to work,” she says. “Newspaper, magazine people were following me around to get information, and I had to take my kids and we had to go stay at my mom’s for a while.”
As publicity about the case increased, Orelia Dixon, the director of the Family Planning Clinic, defended the actions of her facility. In a July 2, 1973, New York Times story, Dixon insisted that her nurses were clear when they explained to Minnie Relf that the injections for her daughters were no longer authorized, and suggested sterilization as an alternative. Dixon also explained that she and her staff pushed sterilization as an alternative because the girls were not disciplined enough to take daily birth control pills. “There’s no doubt in my mind that they all knew what that meant,” Dixon told the Times, adding, “We explain everything, and we do not use words that people can’t understand.” The issue of racism came up when the Relfs’ lawyers told the court that the girls had been targeted for sterilization because they were Black. Though Dixon was white, as was the physician who performed the operation, clinic employees noted that the nurses who took the girls from their home were Black.
A Times article a few days later included this exchange between Morris Dees and young Minnie Lee:
Q. Are you ever going to get married?
A. Yes.
Q. Are you going to have any children?
A. Yes.
Q. How many?
A. One.
Q. A boy or a girl?
A. A little girl.
The news stories caught the eye of Senator Edward Kennedy, chairman of the Senate Subcommittee on Health of the Committee on Labor and Public Welfare, and he asked Levin and the Relfs to appear before the Senate and tell their story. Bly didn’t participate in the hearing, though she knew about it. Her husband had received orders to serve in Germany, and she was preparing to move her family to Frankfurt, where they would live for several years. Levin, along with Lonnie, Minnie, Katie, Minnie Lee, and Mary Alice, flew to Washington—the Relfs’ first and only time on an airplane—to testify. Levin and the Relf parents had agreed that it would be too difficult for the girls to speak in an open hearing, so on the morning of July 10, 1973, Katie, Minnie Lee, and Mary Alice met with Kennedy behind closed doors. Levin recalls that the senator showed them pictures of his children, spoke to them gently, and listened closely, moved by what he heard. During the open hearing, Kennedy could barely hide his outrage as he grilled Henry Simmons, MD, HEW’s deputy assistant secretary for health and scientific affairs, and other administrators about why the federal government was involved in coercive, nonconsensual sterilizations of Black and poor women. When it was their turn, Lonnie and Minnie stepped tentatively up to the mic to face the senator. Speaking in the gentle tone he had used earlier when meeting with the younger Relfs, Kennedy thanked the parents for appearing and asked them to describe in their own words what had happened to their daughters. They told their story haltingly, Minnie explaining how she had signed an X on the form given to her by the public health service workers. Lonnie insisted, “I didn’t want it done, and I’m still upset.”
“What was your feeling when you heard that they had operated on your children?” Kennedy asked Mrs. Relf.
“I felt very bad about it,” she said. “I got mad.”
“Would you have permitted it if you had known about it?” Kennedy asked.
“No,” she said. “I would not have let them do that. They said they were going to give the shots.”
Kennedy again thanked the Relf family for their testimony, complimenting their three daughters and acknowledging their courage. “We have seen too many mothers and fathers that have been saddened by these kinds of occurrences,” Kennedy said. “We are going to do our very best to make sure that it does not happen again.”
Levin now says that the Senate testimony and Kennedy’s support for the case and issue had an enormous effect. Though the case would take years to resolve, as it made its way through the courts—and the media—a number of things happened. First, the suit helped uncover a pattern of sterilization abuse, financed by the U.S. government and practiced for decades. At the Family Planning Clinic that executed the sterilizations of the Relf children, eleven other teenage girls had been sterilized, ten of them Black. But the practice turned out to be even more widespread. In July 1973, the same month Levin and Dees first filed the Relfs’ case, a Black woman from North Carolina, Nial Ruth Cox, also filed a suit against a doctor who had surgically sterilized her after telling her that the results would “wear off.” At the time of the sterilization in 1965, Cox was eighteen, unmarried, and the mother of a baby girl. Cox lived with her mother, who was a recipient of government benefits. A governmental caseworker threatened to strike the family from the welfare rolls unless the mother agreed to have her daughter’s tubes tied temporarily. Five years later, Cox would learn that the sterilization was permanent. Though Cox—who was represented by several lawyers, including the future Supreme Court justice Ruth Bader Ginsburg—lost in court, her suit revealed that her sterilization was part of a eugenics program that had begun decades before. In North Carolina, doctors performed some 7,600 sterilizations between 1933 and 1974, justified as a way to keep welfare rolls low, reduce poverty, and improve the gene pool by preventing the “mental deficient” from reproducing. The vast majority of those sterilized in that state were Black. Like North Carolina, thirty-one other states had eugenics programs. Government-sanctioned sterilization has extended beyond Black women and includes women of other races. In California, more than 17,000 women of Mexican descent were sterilized between 1920 and 1945 under a U.S. eugenics law used to prevent reproduction of those deemed “unfit.” In 1976, a study by the U.S. General Accounting Office found that between 1973 and 1976, four of the twelve Indian Health Service regions sterilized 3,406 Native American women without their permission, including three dozen who were under twenty-one. The same year, HEW reported that over 37 percent of Puerto Rican women of childbearing age, most in their twenties, had been sterilized between the 1930s and the 1970s. The U.S. government had been involved in population control beginning in 1898, when it assumed governance of Puerto Rico, worried that overpopulation would increase poverty and other social and economic conditions.
Eventually, because of the Relfs’ case and others, the hearings and the media unearthed an estimated 100,000 to 150,000 poor, mostly Black women sterilized each year in the United States under federally funded programs. Many others were coerced into sterilization when health-care providers threatened to cut off their benefits unless they agreed to give up their fertility. The Relfs’ suit ended these practices, and HEW was forced to withdraw regulations under which the government funded forced sterilizations. The federal government also created a requirement that health-care providers obtain informed consent—more than the X Minnie Relf signed—before performing sterilization procedures.
Before the case came to a close in 1977, Levin and Dees wanted to help out the Relf family, who were still living on the margins in the same public housing apartment, subsisting on monthly checks from the government. Neither attorney had much experience in personal injury law, so they recruited Melvin Belli to file a damages suit to compensate the Relfs. Belli, nicknamed King of Torts—and Melvin Bellicose by insurance companies—was an unlikely choice to handle the Relf case. Loud, outrageous, and flamboyant, Belli was best known for his celebrity clients: Errol Flynn, Mae West, Lana Turner, Lenny Bruce, Zsa Zsa Gabor, Muhammad Ali, and the Rolling Stones. In 1964, Belli first reached celebrity status himself by defending Jack Ruby after Ruby shot Lee Harvey Oswald, John F. Kennedy’s assassin. Belli’s firm filed a $5 million damages suit on behalf of the Relfs in February 1974 and, after it was dismissed, upped the ante with another suit for $15 million in July of that same year. This suit would have obviously offered a tectonic reversal of fortunes for the Relf family.
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Accounts of medical violence dating back to slavery and outlandish, supposedly scientific theories by physicians like Cartwright are greeted with shock and presented as a throwback to the past or as an aberration, the work of a few bad actors. Still, the concept of biological and psychological differences based on race and some of the deeply questionable medical theories and practices from slave times have clung stubbornly to the present, normalized in today’s medical theory and practice. Even today the centuries-old fallacies of Black immunity to pain and weakened lung function still show up. At the same time, scientists and doctors ignore or downplay the social and environmental conditions that mar Black lives and communities, and overlook the dark history of racial prejudice based on the assumption of inherent Black inferiority that has poisoned the U.S. health-care system. Even Cartwright’s fabrications somehow remain embedded in current medical practice. To validate his theory about lung deficiency in African Americans, he became one of the first American doctors to measure pulmonary function with an instrument called a spirometer. Using a device he designed himself, Cartwright estimated that “the deficiency of the Negro may be safely estimated to be 20 percent.” Today, most commercially available spirometers, used by medical providers around the world to diagnose and monitor respiratory illness, have a “race correction” built into the software, which controls for the false notion that Black people have less lung capacity than whites. In her book Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics, the Brown University professor Lundy Braun notes that race correction is standard practice, treated as fact in textbooks and still taught in many medical schools.
For a variety of illnesses, surgeries, and other medical procedures, in the emergency room and during childbirth, numerous studies have found that Black people receive less evaluation for pain and less relief from it compared with people of other races. Recent data shows that present-day doctors neglect to sufficiently treat the pain of Black adults and children for a variety of medical issues. A 2013 review of studies examining racial disparities in pain management published in the American Medical Association’s Virtual Mentor found that Black and Hispanic people—from children receiving tonsillectomies to elders in hospice care—received inadequate pain management compared with their white counterparts. The research noted that in some cases the more severe the pain, the wider the disparity in treatment. As recently as 2016, a survey of 222 white medical students and residents published in The Proceedings of the National Academy of Sciences showed that half of them endorsed at least one myth about physiological differences between Black people and white people, including that Black people’s nerve endings are less sensitive than whites’. When asked to imagine how much pain white or Black people experienced in situations like getting their hands slammed in a car door, the medical students and residents insisted that Black people felt less pain, which made the providers less likely to recommend appropriate treatment. About 40 percent of first- and second-year medical students and 25 percent of residents believed the lie that Thomas Hamilton tortured John Brown to prove: that Black skin is thicker than white skin.
This disconnect between what is known and what many scientists, doctors, and other medical providers—and those training to fill their positions in the future—still believe allows them to ignore their own complicity in health-care inequality. Their insistence on belief in racial difference as science lets them dismiss internalized racism and both conscious and unconscious bias as forces that drive them to go against their oath to do no harm.
The Relf case happened almost fifty years ago, in another century, and many insist that it was a dark moment in history that could never happen now. But coerced contraception, including sterilization, at the hands of physicians and other health-care providers has continued in various forms. In 2013, the Center for Investigative Reporting found that physicians under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without required state approvals. At least 148 women received tubal ligations in violation of prison rules during those five years. State documents and interviews pointed to some 100 more dating back to the late 1990s. From 1997 to 2010, the state paid doctors $147,460 to perform the procedure, according to a database of contracted medical services for state prisoners. In 2017, Judge Sam Benningfield of White County, Tennessee, was reprimanded for promising thirty-day sentence reductions to incarcerated men and women who agreed to receive vasectomies or birth control implants. Benningfield claimed he was trying to encourage personal responsibility and prevent incarcerated people from being burdened with children when they were released. Civil rights attorneys called the program both “an unconstitutional, coercive intrusion on the rights of vulnerable people and a modern-day eugenics scheme.” It hasn’t ended: In the fall of 2020, a nurse at a for-profit Immigration and Customs Enforcement detention center in Georgia reported that unnecessary gynecological procedures—including hysterectomies—had been performed on immigrant women. The women said that they had undergone the surgeries without fully understanding or consenting to them.
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Even after the Relf case created changes in laws, regulations, and guidelines regarding forced or coerced sterilization, the damages suit ushered through the courts by Melvin Belli dragged on, mired in mountains of paperwork and technicalities—motions, reversals, reconsiderations, and transfers. The Relfs’ damages suit finally ended, dismissed on a technicality in January 1977 with the family, still penniless, receiving no money. “I felt sorry for them, the kids and family,” Joe Levin says now. “The issue was brought to light but had no beneficial consequences for the kids and the Relf family. It felt very bad.”
Two states that were part of the government’s long-running eugenics plot stepped up and compensated their victims. In 2013, North Carolina, where Nial Ruth Cox’s suit shined a harsh light on that state’s eugenics program, agreed to give victims of forced or coerced sterilization financial compensation, setting aside up to $50,000 per individual. Virginia followed in 2015 and gave each surviving victim $25,000. Though California apologized to the victims of its eugenics program in 2003, none of the other states have acknowledged the pattern of sterilization of poor and mostly Black women, and the federal government has remained silent regarding its role in providing funding.
The Relfs have been left out in the cold. Minnie Lee never finished high school, dropping out in the eleventh grade. Keeping up with classwork was difficult for her, given the absence of formal learning in her early childhood and the limitations of her parents. “I was a slow reader in school,” she says now. “I can read, but I’m just slow. I was just slow.”
She also recalls her classmates making fun of her. “People was just picking at me at school, always saying, ‘You can’t have no children. You can’t do this and you can’t…’ ” she says, her voice trailing off. “It hurt me. I felt so sad.”
Mary Alice did end up in McInnis, the special needs school that Jessie Bly had sought out for her. But she didn’t graduate either. Both women remember that Mary Alice spent several years in foster care, living with a woman named Ms. Dot. Their mother died in 1980, just as they reached womanhood, and their father passed away in 2009. Katie, their older sister, lives nearby in another home in the same complex, and they also have other family, including several other siblings. But it’s mostly the two of them, walking to the store together for groceries, attending church, sitting side by side watching TV—bound together by love, blood, hurt, and trauma. “Some days I feel sad, but other times just tired,” says Minnie Lee, who explains that she and her sister struggle with hypertension and asthma. Mary Alice also suffers from seizures. “Not long ago, I was crying and felt like doing something to myself, like I wanted to go with my mom and dad,” Minnie Lee adds, looking over at her sister, who doesn’t seem to understand.
They survived the injustice but cannot grasp the importance of their sacrifice or the way it changed history. Minnie Lee recalls the lawsuit; Dees, Levin, and of course Miss Jessie; the trip to D.C. and Senator Kennedy. But when I describe the impact of their case, Minnie Lee looks confused, her face slack. Mary Alice holds on to my arm and smiles. Minnie Lee may not understand what the world gained because of the Relf case, but she is crystal clear about what she and Mary Alice lost. Each woman sleeps with a brown baby doll, Mary Alice’s nestled in a tangle of sheets, Minnie Lee’s laid across her pillow. These are the shadows of the children that were stolen from them. “I know I can’t have kids, and it gets to me sometimes,” explains Minnie Lee. “Every time I see somebody like my cousin or my niece Debbie with their child, I think about it. Seeing these little pretty babies, I wish that was me.”