Mississippi Appendectomies: Reliving Our Pro-Eugenics Past

Recent accusations brought forth by immigrant detainees bring back to light the shadows of America’s pro-eugenic history.

Mississippi Appendectomies: Reliving Our Pro-Eugenics Past
In 1961, civil rights leader Fannie Lou Hamer received a hysterectomy by a white doctor without her consent while undergoing surgery to remove a uterine tumor. Forced sterilization of Black women was so widespread it was dubbed a “Mississippi appendectomy.” (Wikimedia Commons)

As Amy Coney Barrett’s Supreme Court nomination has stirred up conversations of what her confirmation could mean for reproductive rights, many women are raising their voices fearful of not being able to have control over their own reproductive health.

The collective heartache of our nation sustained a surprising and overwhelming insult this year. As we fight for our reproductive freedom, we must also advocate for those whose voices are frequently dismissed. 

Last month, a whistleblower complaint that described women being coerced into having unnecessary surgeries, including hysterectomies, without their knowledge and consent at the Irwin County Detention Center in Georgia. This week, 19 more women have spoken out that they were subject to medical abuse while they were detained there.

As a physician, it is fundamental to ensure that any patient we care for consents for treatment especially if surgery is involved. These allegations are shocking but unfortunately, not surprising given the amount of human rights violations that have been occurring in the last few years.

The idea that an improved human race could be built by encouraging healthy and intelligent people to reproduce more frequently is the core of the idea of eugenics. While we commonly associate that term with the atrocities in Nazi Germany leading up to WWII, the birth of eugenics started in America. And there is no better time to discuss the history of coerced sterilization in the United States. 


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For over 70 years, sterilization was used not only to control the population phenotype of America but to also control who was deemed fit enough to care for future generations. The science and implementation of these ideas are credited to a man named Charles Davenport.

Davenport applied basic principles of genetics known at the time and applied it to humans in an effort to prove his theory that undesirable traits such as criminality, poverty, promiscuity and feeble-mindedness were genetically inherited. If he could limit the reproduction of these “undesirable” traits by sterilizing those who exhibited them, he theorized, it would be a benefit for the economic and social strains that the country was experiencing in the early 1900s.

After securing financial support from several well known financial moguls of the decade including the Rockefeller and Carnegie families, Davenport successfully launched a campaign based on public health concerns to limit the reproduction of those with traits deemed undesirable. The first sterilization law was accepted in 1907 in Indiana. A total of 31 states had laws for forced sterilization, up until 1978.

While today we know the science behind eugenics is flawed, Americans in Davenport’s era considered it a positive idea as it provided citizens with the false belief that they were acting in the best interest of the country.

Even the Supreme Court gave weight to coerced sterilization with its 1927 ruling in Buck v. Bell, where the sterilization of a 17-year-old with mental issues was upheld after she became pregnant as a result of rape. This ruling was the fuel that led to over 60,000 involuntary sterilizations in the United States from the early 1900s-1970s.

Horrifyingly, it seems that the atrocities committed in Germany against the Jewish people may have had some inspiration in American laws and policies. The Supreme Court ruling of Buck v. Bell was even used by defense lawyers during the Nuremberg trials to show the hypocrisy of trying to criminalize sterilization in Germany that was no different than that which was occurring in the United States. (A young Adolf Hitler had written to colleagues of Davenport’s praising the U.S. for its sterilization laws.) 

While support for eugenics based involuntary sterilization significantly decreased in the U.S. after the war, it did not disappear, but morphed with careful planning, huge financial supporters, and growing racial tensions in the country. A campaign launched in North Carolina and Iowa highlighted the need to limit the reproduction of those who were unfit to do so. 

The formation of Medicaid in the 1960s allowed further widespread use of involuntary sterilization in more non-discrete ways. Because the government was now involved, many institutions saw an opportunity to benefit financially from doing these procedures.

In the south, the high number of hysterectomies and sterilizations were referred to as “Mississippi appendectomies.” Compared to the 1930s and ’40s, where most sterilization occurred on institutionalized women, over 70 percent of sterilizations in the 60s and 70s were on non-institutionalized women. Informed consent and full disclosure were not at the forefront of many of these conversations.

Medicaid reform has helped quell the number of involuntary sterilizations, while informed consent and patient autonomy have come to the forefront of standard medical care in the United States. However, there are still many examples across the nation of women stating they never really understood why certain procedures or medications were given to them.

In 2013, a report found that 148 female prisoners in California were sterilized between 2006-2010 without proper consent.

In 2015, a Nashville District attorney was fired after it was revealed he had sterilization requirements as part of his plea deals.

In fact, the 1927 Buck vs Bell case has never officially been overturned. 

While we have come a long way from our past, we are still not clearly out of the grip of racist ideals and problematic medical practices. The recent accusations brought forth by detainees are bringing back to light the shadows of our pro-eugenic history.

It’s time we fully reckon with our shameful legacy to help prevent more tragedy.  

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Jessica Pearce is a board certified OBGYN.