Reduced health insurance payments for hospital births had a bigger impact on sterilization rates than correcting an injustice |
For decades, female sterilization has been one of the most common forms of birth control in the U.S.: 11.5% of U.S. women, ages 15-49, use female sterilization as their primary contraceptive method – nearly identical to the pill.
But the history of sterilization is also deeply entangled with coercion in the form of racial targeting, invalid consent and state control.
As a health economist and a political scientist, we wanted to better understand what factors influence women’s choices around contraception and sterilization. Our recent study found that a policy change in the 1990s which reduced the length of hospital stays for women giving birth appears to have inadvertently had a more meaningful effect on female sterilization rates in the U.S. than a landmark civil rights intervention in the 1970s.
This leads us to believe that seemingly innocuous, practical policy changes may exert greater influence on women’s reproductive choices than even public outrage over an injustice.
Looking at inflection points
In our study, we revisited Relf v. Weinberger, a 1974 civil rights case that involved the sterilization of two Black girls – the Relf sisters – without valid consent. The girls’ mother was told they were receiving a birth control shot that would temporarily prevent pregnancy. Instead, doctors subjected them to an unwanted tubal ligation surgery, in which the fallopian tubes are sealed off to permanently prevent pregnancy.
The Relf sisters were not alone: In the the early 1970s, the sisters’ case helped bring to light broader patterns in federally funded sterilization that included invalid consent and pressure tied to public benefits. Though the U.S. District Court did not find that each of these sterilizations had been coerced per se, it did find strong........