GG16CH15-Reilly ARI 29 July 2015 13:44

ANNUAL
REVIEWS Further Eugenics and Involuntary
Click here for quick links to
Annual Reviews content online,
including:
Sterilization: 1907–2015
• Other articles in this volume
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

• Top cited articles Philip R. Reilly

• Top downloaded articles
• Our comprehensive search Concord, Massachusetts 01742; email: preilly46@comcast.net
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

Annu. Rev. Genomics Hum. Genet. 2015. Keywords

16:351–68
heredity, immigration restriction, population control
The Annual Review of Genomics and Human Genetics
is online at genom.annualreviews.org
Abstract
This article’s doi:
10.1146/annurev-genom-090314-024930 In England during the late nineteenth century, intellectuals, especially
Francis Galton, called for a variety of eugenic policies aimed at ensuring
Copyright  c 2015 by Annual Reviews.
All rights reserved the health of the human species. In the United States, members of the Pro-
gressive movement embraced eugenic ideas, especially immigration restric-
tion and sterilization. Indiana enacted the first eugenic sterilization law in
1907, and the US Supreme Court upheld such laws in 1927. State programs
targeted institutionalized, mentally disabled women. Beginning in the late
1930s, proponents rationalized involuntary sterilization as protecting vulner-
able women from unwanted pregnancy. By World War II, programs in the
United States had sterilized approximately 60,000 persons. After the horrific
revelations concerning Nazi eugenics (German Hereditary Health Courts
approved at least 400,000 sterilization operations in less than a decade), eu-
genic sterilization programs in the United States declined rapidly. Simplistic
eugenic thinking has faded, but coerced sterilization remains widespread,
especially in China and India. In many parts of the world, involuntary ster-
ilization is still intermittently used against minority groups.

351
 GG16CH15-Reilly ARI 29 July 2015 13:44

ORIGINS
During the second and third decades of the twentieth century, the policies and practices premised
on eugenics—the thesis that a progressive society may and should act to protect its gene pool, even
to the extent of eliminating the reproductive rights of certain individuals—reached full flower.
The nature of the early discourse on eugenics, now more than a century ago, was vastly different
than it might be today, so a brief consideration of the origin of the idea is in order.
Francis Galton, a Victorian polymath, coined the term eugenics, derived from the Greek for
“good birth,” in 1883 (29). His central concern, which he had been investigating for more than a
decade (28), was that the more talented British families were contributing proportionately fewer
children to the next generation than were families whom he ranked far lower on various social
measures, such as education, artistic talent, and wealth, and if left unchecked, this trend would
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

cause humanity’s demise.

The ideas of three men exerted considerable influence on Galton. The most immediate was his
cousin, Charles Darwin, who published On the Origin of Species in 1859 (12). However, Darwin was
cautious in applying his ideas about natural selection to humankind, and did not directly address
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

that topic until he published The Descent of Man in 1871 (13). Thomas Malthus, the Oxford-
educated English preacher who in 1798 published (originally under a pseudonym) An Essay on
the Principle of Population, the first caution that the earth could not support unlimited population
growth, provided the key intellectual rationale for Galton’s views (59). In addition, Galton was
influenced by the polemics of Herbert Spencer, an immensely important mid-nineteenth-century
social thinker who abhorred social welfare programs and coined the phrase “survival of the fittest”
in 1864 (79). Darwin borrowed the famous phrase from Spencer, first using it in 1869 in his fifth
edition of On the Origin of Species. Spencer was much more influential in the United States than in
England. The historian Richard Hofstadter wrote, “In the three decades after the Civil War it was
impossible to be active in any field of intellectual work without mastering Spencer” (41, p. 33).
Less than a decade after Darwin published On the Origin of Species, Galton initiated multigen-
erational studies of the lives of eminent English families, work that, as it expanded to include other
groups, led him to conclude that a social crisis loomed. Many upper-class persons in England were,
no doubt, drawn to Galton’s thesis (which he supported with extensive, albeit flawed, evidence)
that England’s preeminence was at risk because the lower classes were swamping society with large
families. By approximately 1890, Galton had embraced “positive eugenics,” the idea that society
should adopt programs to encourage the more gifted and able to have larger families (24). Using
a word that would echo through the generations, Galton wanted the “fit” to have more children.
This idea reached full flower in the American Midwest in the 1920s and 1930s, when county
fairs regularly included “Fitter Family Contests” along with the traditional contests to judge
which farmers had bred the best farm animals. This tradition grew out of a public health
movement initiated prior to World War I that sought to ensure that every baby received health
screening. One of the earliest of these contests occurred at the 1911 Iowa State Fair. After the
war, the American Eugenics Society—especially one of its leaders, Mary Parsons—energetically
supported such contests, which at their peak were held in approximately 40 states (10).
Beginning in 1935, the Nazi regime embraced an extreme version of positive eugenics known
as Lebensborn, a program in which physicians and social workers called race examiners essentially
matched young men and women who best satisfied Aryan ideals of health and beauty and sent them
to special camps to conceive and care for large families in an idealized environment. The policy,
which was embraced in part as a national response to the huge death toll of young German men
during World War I, was designed both to increase and improve the quality of future German
birth cohorts. Even before Hitler came to power, ideals of Teutonic purity were used to determine

352 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

eligibility for membership in the SS. After 1934, it fell to Heinrich Himmler, a member of Hitler’s
inner circle, to oversee the Lebensborn Society, which was launched on December 12, 1935 (40).
Although progressive thinkers in the United States considered proposals to drive positive
eugenics, for several decades the notion was largely overshadowed by policies that came to be
called negative eugenics—discouraging or preventing certain persons from tainting the “race.” In
the United States, the fullest and the most successful implementation of negative eugenics was
the enactment of various laws to sharply limit the immigration of certain people into the United
States. Restrictive immigration policy began with the Chinese Exclusion Act of 1877 and reached
its zenith with the Immigration Restriction Act of 1924, which set national immigration quotas
by country of origin (73). This law, heavily influenced by champions of negative eugenics, greatly
favored immigration from northern and eastern Europe and sharply curtailed entry by citizens
from southern and eastern Europe. It was the legislative cornerstone of US immigration policy
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

for more than 40 years and was not substantially amended until 1968 (73).
More than a dozen books, hundreds of articles, and doubtless thousands of college term papers
have probed almost every copse of the eugenics landscape in the United States and Europe, espe-
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

cially England and Germany. The vast majority of that scholarship has focused on an era that began
in the last quarter of the nineteenth century and ended in 1945, that is, from the naive optimism
that characterized Galton’s work to the hideous atrocities of the Third Reich. As with any field, the
quality of the scholarship has varied widely, from the fine work of historians such as Kenneth Lud-
merer (58), Mark Haller (37), Daniel Kevles (47), and Paul Lombardo (56, 57) to the diatribes of
conspiracy theorists (3, 75) (for a brief survey of key books from the past 50 years, see sidebar,
A Historiography of Eugenic Sterilization in the United States). One of the attractions of social
history is that as time passes, the persistence of certain ideas can be reexamined, often from new
perspectives shaped by access to new information. Scholarly analysis of eugenic thinking has grown
substantially over the last two decades.
In this article, I focus predominantly on one important aspect of the eugenics movement—state-
enabled involuntary sterilization of certain types of people carried out with the (quixotic) goal of
protecting the “race.” In using the term involuntary, I refer to the sterilization of humans who have
not freely consented to the operation or whose consent is highly suspect owing to either mental
incapacity or coercion. By the term movement, I suggest a sustained effort by activist citizens to
influence their political leaders to implement government programs. There is no easy definition
of a social movement, but surely the fact that, during the first third of the twentieth century, state
legislatures annually introduced scores of bills favoring sterilization of certain persons for eugenic
reasons, newspapers and magazines published hundreds of articles favoring eugenic programs, and
eugenics became a standard topic in high school biology texts gives some basis for using the term
(73).
In the United States, the beliefs that supported eugenic thinking began to change during
the mid-1930s and continued to evolve after World War II. The original focus on negative
eugenics—to prevent persons from transmitting defective genes—faded away. Two new trends
emerged. First, physicians and other professionals began to argue that sterilization of women
who were intellectually incapacitated would free them from institutions and allow them to live
independently without fear of pregnancy—in effect, that the operation was to their advantage.
Second, there was a substantial growth in the movement to provide all women with legal access
to contraception. The most forceful proponent was Margaret Sanger, who opened the nation’s
first birth control clinic in New York in 1916 and who in 1932 imported a diaphragm from Japan
in violation of a federal law so that she could challenge the law’s constitutionality (9). Sanger and
her protégées continued this battle for more than three decades, during which they created the
organization today known as Planned Parenthood. It may seem difficult to believe, but as recently

www.annualreviews.org • Eugenics and Involuntary Sterilization 353

 GG16CH15-Reilly ARI 29 July 2015 13:44

A HISTORIOGRAPHY OF EUGENIC STERILIZATION IN THE UNITED STATES

During the two decades after World War II, few scholars focused on the history of eugenics or on its major policy
objectives: immigration restriction and sterilization of the unfit. Mark Haller’s book Eugenics: Hereditarian Attitudes
in American Thought (37), published in 1963, is a seminal work that put scholars on notice that the history of eugenics
in the United States merited attention. In 1972, Kenneth Ludmerer published Genetics and American Society (58),
which explored the history of scientific eugenics. In 1981, Stephen Jay Gould, an evolutionary biologist, a supremely
talented writer, and a leading public intellectual, published The Mismeasure of Man (32), in which he skewered as
pseudoscience early experiments intended to prove the superiority of the white race.
Daniel Kevles, a historian of science at the California Institute of Technology, wrote the first widely acclaimed
book in the field, In the Name of Eugenics: Genetics and the Uses of Human Heredity (47), published in 1985. He
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

looked closely at the origins of eugenic thinking among intellectuals in nineteenth-century England but devoted
little attention to the history of involuntary sterilization. In 1991, I published The Surgical Solution: A History of
Involuntary Sterilization in the United States (73), an analysis of legally enabled, widespread, involuntary sterilization of
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

institutionalized persons. In 1995, Diane Paul, an independent scholar writing from a feminist and leftist perspective,
contributed Controlling Human Heredity: 1865 to the Present (67). Also in 1995, Edward Larson published Sex, Race,
and Science: Eugenics in the Deep South (53), which garnered a well-deserved Pulitzer Prize.
Since about 2000, the number of scholarly works devoted to eugenics and sterilization in the United States has
mushroomed. The ever-growing corpus now includes works that report in great detail on small but interesting local
topographies of the larger historical landscape, such as eugenics in Vermont (27). A few works seem determined
to discover vast conspiracy theories that never existed, but fine contributions continue to emerge. Paul Lombardo,
currently a professor of law at Georgia State University and a leader in the scholarship on eugenics conducted
during the last two decades, recently edited A Century of Eugenics in America (57), which contains three chapters on
the history of sterilization.

as the mid-1960s, a few states had laws that adult married women could not undergo sterilization
unless they had already borne two children and obtained the written permission of their husbands
(50). On the other hand, efforts to curb childbearing through coerced sterilization of individuals
thought likely to be poor parents continued in the United States long after World War II.
Space permits a brief overview of eugenic sterilization in Europe, especially Germany, where
hundreds of thousands of persons were sterilized during a relatively brief period (1934–1944). After
addressing events in Germany, I devote the balance of this review to the practice of involuntary
sterilization around the world during the seven decades that have elapsed since the fall of the Third
Reich. Although less eugenically driven, involuntary sterilization has been widely used in national
programs to curb population growth. In some cases, the obvious focus on the poor and minority
groups recalls Galton’s original concerns, and overtones of racism are obvious. I conclude with a
few thoughts on the possible course of eugenic thinking in future decades.

EUGENIC STERILIZATION IN THE UNITED STATES

AND EUROPE: 1900–1945
The concerns that reified as the legislative authorization for state-enabled involuntary sterilization
programs to curtail reproduction by the “unfit” can be readily traced to late nineteenth-century
American thought, especially to the “progressives” in the northern states who, with the deep trauma
of the Civil War fading into the past and a rapidly growing economy, energetically embraced the
thesis that society could and should improve the lot of all its citizens (73). One of the earliest links

354 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

of this thinking to eugenics was a once famous book about a large extended family in upstate New
York who disproportionately populated the state’s prisons. In 1877, Richard Dugdale, a prison
inspector who was charged with monitoring the treatment of incarcerated persons, published The
Jukes, a study of that family, which focused on the extraordinary financial burden that its members
placed upon the state (19). The Jukes was the first of dozens of such book-length studies published
over the next four decades, each of which reiterated the initial theme. Many of those that followed
were enabled or inspired by the Eugenics Record Office (ERO) at Cold Spring Harbor, Long
Island, which from 1910 to approximately 1939 was the major intellectual center for eugenic
policy, especially in regard to sterilization (10, 51, 87).
The genetic and biological research programs at Cold Spring Harbor were directed by a first-
rate biologist named Charles Davenport (87). Although he should not be counted among the
more passionate advocates of eugenics, Davenport, who was deeply influenced by the rediscovery
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

of Mendel’s laws of inheritance, strongly suspected that many forms of intellectual disability were
driven by the inheritance of “defective” genes. His 1911 book Heredity in Relation to Eugenics
(14), arguably the first textbook of clinical genetics, provided intellectual legitimacy to efforts to
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

protect the human gene pool. Davenport recruited Harry Hamilton Laughlin, a Missouri teacher
who was already a zealous advocate for negative eugenic policies, to direct the ERO. For more
than 20 years, Laughlin was a major influence on government-enabled involuntary sterilization
programs in the United States (47, 73).
Although the ERO rapidly became an intellectual center for those who promoted eugenic
sterilization, efforts to enable such programs by legislation date back to at least 1897. Between
1895 and 1901, the legislatures in both Michigan and Pennsylvania debated sterilization bills.
During the 1890s, several states enacted laws to limit the right of certain persons (such as the
mentally disabled, the mentally ill, and men who had lived in homes for the indigent) to marry,
essentially by refusing to issue marriage licenses to them (6). Of course, this was a largely symbolic
act that had little practical effect.
In 1907, Indiana became the first government body in the world to enact an involuntary
sterilization law (73). The details have been nicely recounted elsewhere, but in essence the bill
codified an existing program that Dr. Harvey Sharp, the surgeon at the Jeffersonville prison,
had initiated in 1905, partly with the conviction that a vasectomy would prevent the passage of
defective “germ plasm” (the term gene had not yet been coined) and curb the sexual urges of
the prisoners (73). A small body of medical literature from that era suggested that vasectomy
quelled masturbation, a practice that was then thought to have harmful long-term psychological
consequences.
The history of the Indiana law is typical of several other early state laws. Its focus on a spe-
cific class of persons raised concerns about the constitutional promise of due process and equal
protection. Though enacted, it remained controversial, and in 1921 the Indiana Supreme Court
overturned it (86). However, after the US Supreme Court upheld a more carefully crafted Virginia
law in 1927 (7), Indiana officials enacted a new one, which established a modestly sized sterilization
program that remained active until shortly after World War II. The Indiana legislature did not
repeal the law until 1974.
Between 1907 and 1939, approximately 30 states enacted laws that permitted authorities
who oversaw the operation of state homes for the mentally disabled and state hospitals for the
mentally ill to sterilize individuals who they thought were unfit to be parents. After an initial
period (1907–1918) in which some poorly drafted, quasi-compulsory laws did not survive judicial
challenge in state appellate courts, Laughlin (who consulted with constitutional scholars) drafted a
model sterilization law, which purported to attend to the due process rights of the persons it would
target (37, 73). In addition to providing the template for many of the ensuing state laws, Laughlin’s

www.annualreviews.org • Eugenics and Involuntary Sterilization 355

 GG16CH15-Reilly ARI 29 July 2015 13:44

bill helped to shape the content of the “racial hygiene” law enacted by the Nazi party in 1934.
Later that year, the University of Heidelberg awarded him an honorary degree for his work (73).
From 1907 to 1927, sterilization of institutionalized persons, most of whom local officials
believed were intellectually disabled or mentally ill owing to a dominantly or recessively acting
condition, varied widely among the states. Prior to 1924, the midwestern states had the most
active programs, which were focused mostly on men, perhaps in part because a vasectomy was
easier and safer to perform than was a hysterectomy or the not yet perfected tubal ligation.
California operated a large program that was most active at institutions for the mentally ill. For
many years, it annually performed approximately 20% of the nation’s eugenic operations. Detailed
information on the history of eugenic sterilization in California is available in part because a self-
made millionaire named Ezra Gosney became a zealous advocate. In 1929 he created the Human
Betterment Foundation, an advocacy group that propagated eugenic ideals (73). Gosney hired
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

Paul Popenoe, a sociologist, to study the sterilization programs. Within the year, the two men
published a book written to generate more public support for state sterilization programs (31).
Although there are ample records concerning many state programs, in this short article I am
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

able to offer only a couple of examples. One of the most informative is available thanks to the
memoir of Mildred Thompson, who, reflecting on the more than three decades (1924–1957)
she spent as supervisor of the Department for the Feebleminded and Epileptic in Minnesota,
gave us an eyewitness account of the sterilization program in that state. In 1913, the legislature
considered and rejected a bill proposing involuntary sterilization of institutionalized persons to
prevent the birth of children with mental disorders. Twelve years later, as the state was developing
plans to “deinstitutionalize” some longtime residents of the state schools, it enacted a carefully
drafted permissive sterilization bill that attended to due process rights. The rationale was clear.
Proponents no longer viewed sterilization as a weapon to protect the gene pool; instead, they
argued that it would allow mentally disabled women (and men) to live in the community without
fear of becoming burdened with the responsibilities of parenthood. In the first three years of its
operation, the state program performed sterilizations on 157 women and 8 men (83).
The watershed event in the history of eugenic sterilization began in Virginia in 1924, when
state officials decided deliberately to test the constitutionality of a recently enacted law. In essence,
institutional leaders convinced an attorney to represent the interests of a young woman named
Carrie Buck, whom they had determined to be mentally disabled and unfit for parenthood and
thus eligible for sterilization, in order to challenge the legality of the law. The case, Buck v. Bell,
was eventually argued before the US Supreme Court. Writing for a substantial majority, Oliver
Wendell Homes Jr. unflinchingly upheld the power of the state to operate a sterilization program,
concluding his opinion with the now famous phrase “three generations of imbeciles is enough”
(7).
The decision had an immediate impact; over the next few years, approximately a dozen ad-
ditional states enacted laws to permit the sterilization of institutionalized persons. By 1930, laws
were on the books in nearly 30 states and legislatures had funded programs in many, and the
number of sterilizations per year grew rapidly throughout the decade. It was at about this time
that the state programs that had clearly focused on sterilizing men began to tilt rapidly toward
sterilizing mentally disabled women. Available data indicate that, by the late 1930s, officials in
most states were selecting two to three women for sterilization for every man who was subjected
to a vasectomy (45, 73).
Until after World War II, eugenic sterilization programs in the United States were conducted
almost exclusively inside the walls of state institutions that housed “mentally defective” or “insane”
individuals, often in large, rural, farm-like settings in which the inmates had much latitude in daily
movement. For example, they might attend classes or work in agricultural settings, engaging in

356 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

activities that were thought to be salubrious. By 1890, leaders of these institutions, which had grown
rapidly in number beginning in the 1870s, were corresponding frequently and meeting annually
to discuss how to improve their “schools.” Almost all the institutions churned out extensive annual
reports, often written to justify annual requests to the legislatures to approve state budgets. These
documents typically included statistics concerning the sterilization programs. Access to these
reports permits historians to report confidently that in the United States in the decades before
World War II, at least 60,000 institutionalized persons were sterilized. These reports sometimes
note that sterilizations were performed on women because of concern that they were sexually
active and likely to become pregnant, rather than for overtly eugenic reasons. This concern became
increasingly important as the decades passed (73).
Although they were among the earliest of settings for such programs, sterilization never became
widespread in prisons. This was in part because of decisions by federal appellate courts in Iowa (15)
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

and Nevada (61) that sterilization of inmates violated the Eighth Amendment protection against
cruel and unusual punishment. In addition, the prison population was composed almost entirely
of men with no freedom of movement. California operated the only substantial prison-based
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

sterilization program (at San Quentin), mostly after World War II (73).
Given this nation’s troubled racial history, it is tempting to suppose that in some states, offi-
cials might have used involuntary sterilization laws to target institutionalized African Americans.
This did not happen during the 1930s (although there is some evidence of racial discrimination
in state sterilization programs, especially in North Carolina, in the decade after World War II)
(90). In a few states, notably South Carolina, state officials operated sterilization programs for
mentally deficient persons under the separate but equal doctrine. In South Carolina, such institu-
tions were racially segregated, but available data suggest that officials performed sterilizations at
approximately the same pace in both races (73).
Perhaps under the influence of activity in the United States, the province of Alberta in Canada
adopted a eugenic sterilization law in 1928 that was very similar to laws in the United States. Over
the next six decades, officials in Canada sterilized more than 2,800 persons. In 1995, a woman sued
the government for sterilizing her without her consent in 1959. The case became a class-action
lawsuit and resulted in a settlement in which 850 persons who had been sterilized without their
informed consent were awarded C$142 million in damages (34).
Beginning in the late 1930s in the United States, eugenic sterilization programs began to
decline. One important reason was that advances in genetics and medicine made it clear that the
initial, simplistic eugenic argument that much mental illness and intellectual disability arose from
single-gene disorders was wrong. But few scientists emerged as vocal critics. The vast majority of
professional biologists never supported negative eugenics, but few ever attacked it as being based
on scientifically flawed ideas. A more obvious reason for the decline was that during World War II,
the surgeons working in most state-based sterilization programs were pulled into military service.
Another blow to eugenic sterilization came in 1942, when the US Supreme Court overturned an
Oklahoma statute that enabled the involuntary sterilization of some, but not all, kinds of “habitual
criminals,” ruling that it violated the Equal Protection Clause (78). However, the high court wrote
a narrow opinion, declining an opportunity to overturn or limit its holding in Buck v. Bell (7).
In the spring of 1945 came the astounding news of the Nazi death camps, and in 1946 the
Nuremburg trials revealed to the world the horrors of a eugenics movement run amok. The history
of eugenic sterilization in Germany begins in 1934, when the new Nazi government enacted a
“racial hygiene” law, one substantially based on the model law that Laughlin had drafted. Within
the year, more than 200 new Hereditary Health Courts reviewed more than 84,000 applications
for sterilization and approved more than 64,000, eclipsing the total performed in the United States
over three decades (65, 71). In 1934, the German Supreme Court ruled that the new sterilization

www.annualreviews.org • Eugenics and Involuntary Sterilization 357

 GG16CH15-Reilly ARI 29 July 2015 13:44

law applied to non-Germans who lived in Germany. Records indicate that the law was applied
equally to both genders (52). Those who have studied the history of the Nazi program have
estimated that under the powers granted to the Hereditary Health Courts, between 1934 and
1944 (when the population was 73 million) German doctors sterilized at least 400,000 persons,
including the mentally ill, the mentally disabled, the deaf, persons with tuberculosis, homosexuals,
gypsies, and, of course, Jews (65, 71). One advocacy group has argued that the true figure may be
tenfold higher (77). The exact number of persons who were sterilized during that era in Germany
without their consent will never be known.
Support for eugenic sterilization in Germany did not arise suddenly when the Nazi regime came
to power. Beginning around 1890, the immensely influential philosopher Friedrich Nietzsche
advocated measures such as segregation to protect the Aryan bloodline. In 1895, the historian
Otto Seeck published History of the Downfall of the Ancient World, a widely read work in which he
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

argued that Greek culture had collapsed because of dysgenic influences. Perhaps the single most
influential race theorist was Wilhelm Schallmayer, whose 1900 book Inheritance and Selection in
the Life of Nations won a prize from the Krupp Foundation (55). Although he embraced eugenic
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

ideals, Schallmayer stopped short of advocating for the sterilization of the unfit. By the early 1930s,
German culture was enmeshed in the doctrine of Aryan racial superiority.
German physicians and scientists, including some early clinical geneticists, provided crucial
intellectual justification for the doctrine of racial superiority and for eugenic sterilization pro-
grams. In 1895, the physician Alfred Ploetz published Foundations of Eugenics. He founded the first
German eugenics society, the Society for Racial Hygiene, in 1905. In 1921, this society adopted a
comprehensive eugenics program and lobbied for implementation. In 1923, Bavaria became the
first German state to create a university chair in eugenics. In 1921, three prominent biologists,
Erwin Bauer, Eugen Fisher, and Fritz Lenz, published a book on “race hygiene” that advocated
sterilization of the unfit. In 1925, the publisher sent a copy of the second edition of the book to
Adolf Hitler while he was serving a prison term. These were the months when he wrote Mein
Kampf, in which he advocated the sterilization of defective persons. The book sold nearly 10,000
copies during the first year it was in print, and by 1934 German citizens had purchased millions
of copies (69).
The notion of Aryan superiority was not much different from the belief in white supremacy,
which was widely articulated and embraced in the American South as far back as the eighteenth
century and provided an important intellectual rationale for slavery. In the decades before the
Civil War, Southern thinkers had adopted a finely tuned doctrine of racial superiority, including
biblical references that were aligned with scientific findings (66). In the first third of the twentieth
century, belief in the superiority of the white race was common at the top of the nation’s upper
socioeconomic ladder throughout the United States (33).
What of other countries? In England, interest in eugenics as a tonic for the British people
reached its zenith before World War I. Galton was at the forefront of what was, comparatively
speaking, an enlightened approach to human betterment, one premised on education and rational
choice. In 1905, he endowed a Eugenics Records Office that was housed for decades in a building
owned by the University of London, and he lectured frequently on the topic to the lay public
(24). But despite being the birthplace of modern eugenic thought, England never legislatively
implemented a eugenic sterilization program (39). Advocates for these programs did occasionally
put bills before the House of Commons. In 1931, the House commissioned the Brock Report
(named for its chairman), which came out against involuntary sterilization to further eugenic
goals, but cautiously accepted limited use of voluntary sterilization for family planning (5). Not
unexpectedly, staunchly Catholic nations such as France and Italy never developed state-based
sterilization programs. In the decades before World War II, however, programs premised on

358 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

the same ideas that flourished for several decades in the United States took hold in many other
countries, including Sweden (4, 81), Norway (4, 36), Denmark (4, 46), and Finland (4).

INVOLUNTARY STERILIZATION IN THE UNITED STATES: 1945–2015

After World War II, most state-based eugenic sterilization programs in the United States quietly
ended. In 1950, institutions reported sterilizing 1,526 persons, far short of the 2,500 operations
reported in 1939. In addition to revulsion evoked by Nazi practices, the thesis that intellectual
disability and mental illness were largely products of single-gene disorders became untenable.
Also, during the late 1940s and 1950s leaders within the Catholic Church frequently spoke out
against local programs. In some states, programs declined rapidly. In 1945, officials at San Quentin
State Prison in California sterilized 145 men; in 1946, they performed only 7 such operations;
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

and in 1950, the chief surgeon wrote that the “Department of Corrections is entirely adverse to
sterilization” (73, p. 135).
In 1949, officials in California institutions for the mentally ill reported sterilizing 381 persons,
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

but just three years later the total dropped to 39. During the late 1940s and early 1950s, officials
in South Dakota, Missouri, and Virginia were among those who reported that they found little
scientific justification for sterilizing women to curb the inheritance of faulty genes (73). Before
the war, officials in Minnesota had sterilized more than 200 persons each year at Faribault State
Hospital. During 1951 and 1952, they reported only 17 operations (15 women and 2 men). After
1954, no sterilizations were officially reported, but officials continued to authorize a few (largely
on intellectually disabled woman who had given birth to children or who were thought highly
likely to become pregnant) (83).
The overall decline in state-enabled sterilizations would have been even more dramatic but for
new activity in a few southern and midwestern states. These programs arose in no small part from
the energetic activities of a single organization. During the 1940s, a New Jersey–based not-for-
profit organization called Birthright, led by Dr. Clarence Gamble, the wealthy scion of a founder
of Procter & Gamble, began to campaign in favor of offering sterilization to young, poor, ru-
ral women. His effort flowered first in Orange County, North Carolina, and then more broadly.
Birthright reported that in 1948, welfare workers in North Carolina provided sterilization services
to more than 150 young, mostly black women who were neither mentally deficient nor institution-
alized (30). This program continued well into the 1970s, annually providing sterilization service
to dozens of young, poor women, even though North Carolina ceased operating its institutionally
based programs in the 1950s. The state repealed its original sterilization law in 1974, and in 2002
the governor issued a public apology for the state’s earlier participation in eugenic sterilization
programs (85). In so doing, he followed in the footsteps of governors in Virginia (68) and Oregon
(48). Nevertheless, in 1976 a federal district court upheld a law that permitted the sterilization of
certain noninstitutionalized persons (73).
During the late 1940s and 1950s, Birthright supported the creation of state-based Human
Betterment Leagues. The Iowa chapter was particularly active, reporting that from 1947 to 1951 it
had annually fostered an average of 145 sterilizations, mostly among poor, rural women (73). These
programs were not intended to prevent the birth of children with genetically caused intellectual
disability, but they did seek to convince young women who Birthright staff thought were unlikely
to provide for children to forgo further pregnancies.
Another group that underwent deceptive, clandestine, and possibly coerced sterilization in the
United States after World War II was young Native American women (72). By deceptive, I mean
a situation either in which a woman was told that sterilization was needed to preserve her health
or (probably more commonly) in which she consented to one surgical procedure without knowing

www.annualreviews.org • Eugenics and Involuntary Sterilization 359

 GG16CH15-Reilly ARI 29 July 2015 13:44

that a second would also be performed. In one not uncommon scenario, surgeons performed
tubal ligations incidental to appendectomies. During the 1930s in some state institutions in which
sterilizations were permitted, the annual number of appendectomies was much greater than one
might reasonably anticipate in a population of that size (73).
Most of the sterilizations of Native American women were performed in the 1960s and 1970s
by physicians employed by the federal Indian Health Service bureau. In an era in which there
were approximately 150,000 Native American women of childbearing age in the United States,
estimates of the number of possibly involuntary female sterilizations range from 3,406 by the US
General Accounting Office to a much higher figure offered by a few Native American scholars
(54). There is little evidence to support a larger number and none to support occasional assertions
of a clinical conspiracy. To the contrary, during the period 1960–1990, the population of Native
Americans in the United States grew at an annual rate of 4.3% (far greater than the rates for other,
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

larger groups).
During the late 1960s and early 1970s, there were occasional reports that surgeons working in
federally funded medical facilities occasionally performed involuntary (unconsented) sterilizations
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

of young, poor black women. The most famous of these, which was widely reported in the press,
arose in Alabama in 1973 and asserted that a surgeon had sterilized a mildly intellectually disabled
12-year-old black girl named Minnie Relf. In July of that year, the National Welfare Rights
Organization joined with her to file a class-action lawsuit to ban the use of federal funds for
sterilization procedures. Although the federal government moved quickly to issue guidelines to
sharply restrict use of funds for this purpose, the case continued. In 1974, a federal district court
ruled that the federal government had no authority to provide sterilization services to any person
who under state law would be incompetent to consent to the procedure (74).
There is also substantial evidence that during the early 1970s, several obstetricians in California
who worked in federally funded family planning programs sterilized immigrant Mexican women
without obtaining their consent. Such operations were typically performed incidental to Caesarean
sections. In preparation for filing a class-action lawsuit against these physicians and programs,
activists secured statements from 140 Mexican women saying they had been sterilized without
their consent. The plaintiffs lost the case, but their action drove California to adopt guidelines
(including a Spanish-language consent form and a three-day waiting period) to reduce the risk of
such events (80). Some lawsuits were settled by the payment of a negotiated damage claim. These
incidents likely reflected the prejudices of particular surgeons rather than the policies of a welfare
clinic (49).
During the 1980s and 1990s, a new debate emerged. With increasing frequency, state courts
were asked to rule on petitions in which young, intellectually disabled women (acting through their
guardians) asserted a right to be sterilized as a means of birth control. By this time, sterilization
to control family size was widely practiced, so why should intellectually disabled women not also
have this right? These cases (in two of which I acted as an expert witness) were often resolved in a
family court, where a judge heard evidence concerning what constituted the “best interests of the
woman” who lacked the capacity to decide. Court-appointed guardians usually argued in favor of
sterilization, but sometimes they did not.
In reflecting on the history of involuntary sterilization in the United States after World War
II, it is well to remember that this era also included a widespread and sustained drive by women
to expand and secure their reproductive rights. It may seem bizarre that as recently as the 1960s,
in a few states married women with several children could not legally obtain elective sterilization
without the written consent of their husbands, the sale of contraceptive devices was illegal, and
access to abortion services was extremely limited. In a string of decisions from 1965 to 1973, the
US Supreme Court struck down laws that restricted such access (35), culminating, of course, with

360 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

Roe v. Wade, which ruled that a constitutional right to privacy included the right (balanced against
the state’s interest in protecting human life) to terminate pregnancies (76).
Today, no US state operates a eugenic or social sterilization program targeting either institu-
tionalized or noninstitutionalized persons. Each year there are a few petitions in state courts to
approve the sterilization of young women of limited mental capacity who have already given birth
to children or who family members feel are likely to become pregnant. These cases proceed as
arguments about what constitutes the best interests of the young woman.
Although eugenic thinking no longer drives efforts to limit childbearing, there have always
been those who argue that various state-based services, especially Medicaid, should place a ceiling
on the support available to women with a large number of children (89). Family caps, as they are
called, place limits on family welfare payments after families have reached a certain number of
children. Social debate over this policy reached its zenith in the United States in 1970, when the
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

Supreme Court was asked to rule on the constitutionality of a Maryland law that shut off benefits
after a woman had given birth to six children. The court held that the law was a reasonable effort to
limit costs (for it did not prevent further childbearing, but merely refused to pay support beyond
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

a certain level) and did not violate the Equal Protection Clause (11).
As of 2015, at least 24 states have family caps built into their welfare programs. Given that
such programs are well entrenched, it should be no surprise that even more radical steps to limit
the costs of Medicaid programs are widely embraced by ultraconservative groups. As recently as
September 6, 2014, Russell Pearce, vice chairman of the Arizona Republican Party, resigned after
he provoked a furor by stating on a radio talk show that if he were in charge of the state’s Medicaid
program, “the first thing [he would] do is get Norplant, birth-control implants or tubal ligations”
(60, p. A20).

STERILIZATION TO CURB POPULATION GROWTH

In the late 1970s, nearly two centuries after Malthus wrote his prescient essay, the leaders of the
Chinese Communist Party, confronting runaway population growth and growing ever more con-
cerned about their ability to feed the population, instituted a one-child policy that was rigorously
implemented across most sectors of Chinese society. In the ensuing three decades, this policy,
surely one of the most far-reaching societal experiments in human history, dramatically reduced
the fertility rate in the world’s largest country. According to one Chinese writer, since 1971 there
have been 222 million sterilizations and 336 million abortions performed in China. The vast ma-
jority of the sterilizations have been performed on women. Wealthy couples can circumvent the
law by paying a “social compensation fee” that varies between 3 and 10 times the median annual
income of a Chinese family (42).
Although the policy was made in Beijing, population control in China was implemented and
enforced in thousands of local jurisdictions, where the workers who were charged with the task used
economic incentives and disincentives in pursuit of national goals. In some regions, all women of
reproductive age who already had a child were forced to undergo placement of intrauterine devices.
Women who gave birth to a second child after the one-child initiative was in place were urged to
undergo tubal ligation. If they refused, the local officials imposed harsh economic penalties and
denied school entry certificates for their children. Such aggressive measures were most rigorously
enforced in cities, such as Huizhou in Guangdong Province, where in some years officials fell
significantly short of the targeted reduction in annual births. In 2013, Amnesty International
reported that officials in Puning City (which has a population of more than 2 million) planned to
sterilize some 9,559 persons over a three-week period, and that they had achieved half of that quota
in the first four days (1).

www.annualreviews.org • Eugenics and Involuntary Sterilization 361

 GG16CH15-Reilly ARI 29 July 2015 13:44

In 2002, China adopted a new Population and Family Planning Law that was intended to curb
population growth without resorting to coercion, a goal yet to be fully realized. Many analysts
believe that forced sterilizations are still frequently implemented by local officials who are pushed
by higher-level officials to meet target fertility rates, even if it means violating the law. I could find
no evidence that zealous local officials who violate official policy are or ever have been prosecuted
for their misdeeds.
Given the widespread cultural desire to have a son, the one-child policy has had a hugely
disparate impact on the birth and well being of girls. During the last two decades of the twentieth
century, the illegal use of ultrasound for sex selection, followed by widespread female feticide and
infanticide, led to what is probably the greatest sex-ratio imbalance ever experienced in human
society. In China today, among persons under age 30 there are approximately 118 males for every
100 females, which means that there are many millions more men than women. This will almost
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

certainly foster much social unrest (23). In recent years, the one-child policy has come under much
criticism, but as of 2014, the official party line has not altered, despite a national fertility rate that
is well below replacement level.
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

In contrast to the fantasies of racial or ethnic purity that motivated Nazi eugenic policies
in the 1930s, the leaders of the Communist Party in China today foster interethnic marriages.
Given that China has at least 55 recognized minorities, some of which have been in sharp and
sustained regional conflicts with the nation’s Han majority, the central government has advocated
intermarriage as a long-term approach to smoothing ethnic relations. In 2014, officials in Qiemo,
a county in Xinjiang in western China, were offering 10,000 renminbi annually for five years and
20,000 renminbi annually over the same period in health and education benefits to couples formed
by the marriage of a Turkic-speaking Uighur and a member of the Han (88). Although China’s
president, Xi Jinping, has asserted that such marriages further the dream of a universal Chinese
motherland that embraces all groups, many Uighurs view the policy as a crass attempt to destroy
their culture and assimilate them into a Han-dominated culture. The policy forces the question,
why should the pursuit of social harmony be premised on the dilution of certain ethnic minorities?
The population of India—which, with more than 1.2 billion people, is the world’s second-
largest nation—increased by approximately 18 million in 2013. Total fertility rates vary widely
among the 28 states in India, and these rates are highly correlated with the health of the regional
economy (38). In the poorest and most rural regions, women on average give birth to five children,
whereas in rich states such as Kerala, the fertility rate is approximately the same as that in the
United States.
Just five years after it became a sovereign nation (1947), India created its first commission on
population. Beginning in the mid-1950s, the national government introduced multiple programs
to reduce the birth rate, with modest success. In 1975, Prime Minister Indira Gandhi, having
concluded that population growth constituted a great threat to India’s future, introduced what
many believe to be the most aggressive effort to reduce family size ever undertaken. Among other
measures, the government declared that men who had fathered two children should undergo ster-
ilization. By some estimates, during the period known as “the Emergency” (1975–1977), 10 million
persons in India underwent sterilization, often under coercive circumstances (38). Although the
government soon relented from its most extreme policies, for decades India has pursued a policy to
curb population growth by providing financial incentives for poor couples of reproductive age to
undergo sterilization (18). Today, in this male-dominated society, more than 90% of all steriliza-
tions are performed on women. Most operations are performed in small rural clinics. The women
who “agree” to be sterilized are typically among the poorest in society, for whom an incentive
of approximately $10 offers significant help for feeding their existing children. The government-
employed physicians who perform the surgery, sometimes in “sterilization camps” that are set up

362 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

for a few weeks in a particular town and then move on to another, are expected to meet certain
quotas. If they exceed a quota, they receive a bonus for sterilizations that they perform above the
regional target figure (20).
In 2011 in Bihar, the state with the lowest per-capita income and the lowest literacy rate,
the government planned to operate 13,000 camps and set a target goal of sterilizing 650,000
women and 12,000 men. In 2012, approximately 4.6 million women were sterilized in India; most
operations were performed under conditions that fall far short of the deliberative, voluntary, and
consensual nature of such a decision in the United States and Europe (38).
Despite an aggressive, incentivized, coercive population control policy, India continuously falls
short of its fertility target goals. There are few data to support the claim that female sterilization is
the major contributor to the fertility reductions that have been achieved. In the rich southern state
of Kerala, where the female literacy rate is approximately 92%, the fertility rate is approximately
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

1.7, significantly lower than that in the United States. The population of Kerala rate grew by
less than 5% over the last decade, and government-supported coercive sterilization programs are
nonexistent. In Bihar, where the female literacy rate is only 53%, the population grew by more
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

than 25% during the last decade. Nowhere else in the world is there a tighter correlation between
economic status and fertility than in India, and the sterilization of poor, often illiterate women is
a core element of the government’s population control program.
It should be no surprise that sustained efforts to sterilize unusually large numbers of poor
women have occurred close to home. The history of sterilization of young women in Puerto Rico
over several decades calls into question whether even cursory attention was paid to obtaining their
informed consent (70).
Even though the Russian government has pursued an aggressive pronatalist policy for many
decades, Russia currently has one of the world’s lowest fertility rates. On average, women bear 1.7
children, well below replacement level. Currently, the major government incentive is to award
the equivalent of $13,000 to women who bear a second child. Thus far, the various pronatal-
ist incentives have had minimal success (26). Yet in at least one region of the former USSR,
Uzbekistan, the government has aggressively used female sterilization for more than a decade
to sharply reduce its fertility rate. In 2007, the United Nations Committee Against Torture re-
ported that the government in Uzbekistan was coercing women with two or more children to
undergo sterilization. Its investigation found that Uzbek leaders had been using sterilizations as
a tool to curb population growth since the mid-1990s (62). In 2005, the minister of public health
acknowledged that state-employed physicians were ordered to achieve targeted reductions in na-
tional fertility. In May 2012, Uzbek president Islam Karimov publicly stated to Russian president
Vladimir Putin that Uzbekistan sought a fertility rate of 1.2–1.3, far below replacement level (62).
It is disheartening to contemplate the breadth and depth of the ethnic hatred that is still so
painfully apparent around the planet. Although the current favorite weapons in the worst of such
conflicts—such as suicide bombings—are designed to kill outright, in regions where one group
has near total control over a small, unwanted minority, involuntary sterilization continues to be
used intermittently as a subtle form of state-sponsored terrorism. Coerced sterilization—almost
always of women—advances “ethnic cleansing” in a less visible way than do murders. Involuntary
sterilization of despised ethnic groups is not common, but the fact that any modern government
condones or advances such programs is cause for deep discontent. As there is no international
effort to corroborate the allegations that emerge from time to time and no registry reliably counts
instances of abuse, one is forced to draw inferences from secondary sources. Unfortunately, there
are many. Several examples follow.
Starting in 1973, the government of Czechoslovakia initiated a program that offered small
social benefits to poor Romani (gypsy) women in exchange for their agreement to undergo tubal

www.annualreviews.org • Eugenics and Involuntary Sterilization 363

 GG16CH15-Reilly ARI 29 July 2015 13:44

ligation. In 1977–1978, dissident Czechs denounced the practice as genocide, but it continued after
the Velvet Revolution of 1989. In 2005, an independent counsel appointed by the government
of the Czech Republic identified “dozens” of coercive sterilizations that were performed between
1979 and 2001 and called for the investigation and prosecution of several health care officials
(17).
During Alberto Fujimori’s presidency in Peru (1990–2000), his regime operated a program
of forced sterilizations against indigenous peoples (Quechuas and Aymaras) in that nation (2). In
1995, this program was officially recognized as part of the national public health program, one
that was funded in part by financial aid from the United States and the United Nations Population
Fund. In September of that year, despite vigorous opposition from the Catholic Church, Fujimori
offered to the legislature a “General Law of Population” that explicitly legalized sterilization for
family planning purposes, which was enacted. Members of activist groups in Peru have estimated
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

that hundreds of thousands of poor women have been sterilized without their informed consent.
In Brazil, there have been numerous reports of the involuntary sterilization of indigenous
women. Most notorious is the work of a physician and politician named Ronald Lavigne, who has
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

been accused of sterilizing 80 young women of the Pataxuh-he tribe in Bahia without their consent.
Brazilian activists have charged that this practice is widespread and constitutes state-sponsored
genocide intended to remove indigenous peoples from vast tracts of valuable land (43). Even Israeli
authorities have been accused of giving birth control to minorities without their consent (16).
Historically, few persons have suffered more social opprobrium than those with leprosy. For
more than a century across the globe, the public health response to leprosy was to incarcerate
affected individuals for the remainder of their lives. In parts of Europe, Japan, and the United
States, governments enacted laws to create so-called leper colonies. In the United States, the
government funded such institutions in Louisiana and Hawaii for decades. Japan enacted Leprosy
Prevention Laws in 1907, 1931, and 1953 that included provisions for indefinite containment. In
Japan, many physicians thought there could be a genetic predisposition to contracting leprosy, and
involuntary sterilization of patients, especially women, was initiated around 1915 (63). Japan also
may be the only nation to have enacted a Eugenic Protection Law after World War II. This law,
under which approximately 16,500 persons were sterilized, most without their informed consent,
was largely applied to women living in residential institutions. The text of the law is reminiscent
of the early American state laws, but it also specifically called out several monogenic disorders,
including hemophilia and albinism (84). It was repealed in 1996.
In South Africa, many women with AIDS have alleged that they were sterilized without their
consent. Most of the relevant reports refer to years in which a fetus being carried by an HIV-
positive mother was at high risk for becoming infected with the virus during parturition (22).
The examples above do not constitute a complete accounting of the practice of coercive ster-
ilization. They serve instead as a reminder that the practice has not yet been extirpated.

THE FUTURE OF EUGENICS

In 2015, state-enabled programs to deprive people of fertility for eugenic reasons no longer
operate. The eugenic thesis that most forms of mental illness, mental disability, criminality, and
social deviance are driven by single-gene disorders is scientifically untenable. The idea that there
are certain universal human rights (including the right to reproductive freedom), which has been
widely embraced (including by the United States and the European Union), is ascendant. It was
first formally embraced by the United Nations in 1968 (25). I cannot imagine a scenario in which
a state moves to deprive large groups of women or men of their reproductive freedom for eugenic
reasons.

364 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

Yet I also think that in technologically advanced nations in the near future (within ten years),
there could be a dramatic reduction in the incidence of children born with chromosomal and
genetic disorders. One can anticipate a scenario in which couples in wealthy nations use DNA-
based carrier testing to assess reproductive risk and whole-exome sequencing to determine fetal
status (64). In the United States, it is already the standard of care to offer screening for fetal
aneuploidy to all pregnant women. Positive test results will lead to the termination of a significant
majority of such pregnancies. In a world in which women and couples prefer small families, in
which an increasing number of women will delay pregnancy while building a career (already a clear
trend in the United States) (82), and in which affordable, highly accurate tests can search for a large
number of severe, essentially untreatable single-gene disorders, this change is inevitable. In some
parts of the world, we have already seen a marked reduction in the birth of children with specific
recessive disorders, including beta-thalassemia (8) and disorders that are relatively common to
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

the Ashkenazim (44), and that trend is broadening (21). If researchers establish that some of the
relatively common copy-number variants are strongly associated with risk for significant behavioral
and/or cognitive disorders, it is likely that they will be added to the list of targets screened during
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

prenatal diagnosis. Perhaps Laughlin’s dream of reducing the numbers of persons born with
genetic conditions that predispose to behavioral disorders and social deviance will be realized
without any need for state intervention.
I do fear that coerced or involuntary sterilization to limit family size could have a more dystopian
future. One need only reflect on the dramatic success China achieved in sharply reducing its fertility
rate over just two decades to imagine what programs governments in some third-world countries
might eventually undertake to restrain population growth in the coming decades. A world in which
the human family has soared past 10 billion and in which much of the annual world population
growth is concentrated in a few countries might well accept deeply interventionist policies to curb
that growth. Sadly, I also think that small coercive sterilization programs targeting indigenous
peoples will recur. In these instances, I think it likely that the central governments will be quietly
complicit as local officials move against relatively powerless people, using money and persuasion
as weapons against fertility. It will be exceedingly difficult to expose all such programs. Perhaps
the best hope is that the physicians who perform these operations demand that they operate only
after obtaining the voluntary informed consent of the patient.

DISCLOSURE STATEMENT
The author is not aware of any affiliations, memberships, funding, or financial holdings that might
be perceived as affecting the objectivity of this review.

LITERATURE CITED
1. Amnesty Int. 2013. Amnesty International Report 2013: The State of the World’s Human Rights. London:
Amnesty Int.
2. BBC. 2002. Mass sterilisation scandal shocks Peru. BBC News World Ed., July 24. http://news.bbc.co.uk/
2/hi/americas/2148793.stm
3. Black E. 2012. War Against the Weak: Eugenics and America’s Campaign to Create a Master Race. Washington,
DC: Dialog
4. Broberg G, Roll-Hansen N, eds. 2005. Eugenics and the Welfare State: Sterilization Policy in Denmark,
Sweden, Norway, and Finland. Lansing: Mich. State Univ. Press
5. Brock R. 1934. Report of the Departmental Committee on Sterilization. London: His Majesty’s Station. Off.
6. Bruinius H. 2007. Better for All the World: The Secret History of Forced Sterilization and America’s Quest for
Racial Purity. New York: Vintage

www.annualreviews.org • Eugenics and Involuntary Sterilization 365

 GG16CH15-Reilly ARI 29 July 2015 13:44

7. Buck v. Bell, 274 U.S. 200 (1927)

8. Cao A. 1994. 1993 William Allan Award address. Am. J. Hum. Genet. 54:397–402
9. Chesler E. 1992. Woman of Valor: Margaret Sanger and the Birth Control Movement in America. New York:
Simon & Schuster
10. Cold Spring Harb. Lab. 2014. Fitter family contests. Topic, Image Archive on the American Eugenics
Movements. http://www.eugenicsarchive.org
11. Dandridge v. Williams, 397 U.S. 471 (1970)
12. Darwin C. 1859. On the Origin of Species by Means of Natural Selection. London: John Murray
13. Darwin C. 1871. The Descent of Man. London: John Murray
14. Davenport CB. 1911. Heredity in Relation to Eugenics. New York: Henry Holt
15. Davis v. Berry, 216 F. 413 (1914)
16. Dawber A. 2013. Israel gave birth control to Ethiopian Jews without their consent. Independent, Jan. 27.
http://www.independent.co.uk/news/world/middle-east/israel-gave-birth-control-to-ethiopian-
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

jews-without-their-consent-8468800.html
17. Denysenko M. 2007. Sterilised Roma accuse Czechs. BBC News, Mar. 12. http://news.bbc.co.uk/
2/hi/europe/6409699.stm
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

18. Dowbigggin I. 2008. The Sterilization Movement and Global Fertility in the Twentieth Century. New York:
Oxford Univ. Press
19. Dugdale RL. 1877. The Jukes: A Study in Crime, Pauperism, Disease and Heredity. New York: G.P. Putnam’s
Sons
20. Dugger CW. 2001. Relying on hard and soft sells India pushes sterilization. New York Times, June 22,
p. A14
21. Dupuis A, Hamilton D, Cole DE, Corey M. 2005. Cystic fibrosis birth rates in Canada: a decreasing trend
since the onset of genetic testing. J. Pediatr. 147:312–15
22. Essack Z, Strode A. 2012. I feel like half a woman all the time: the impacts of coerced and forced steril-
izations on HIV positive women in South Africa. Agenda 26:24–34
23. Feng W, Cao Y, Baochang G. 2013. Population, policies, and politics: How will history judge China’s
one-child policy? Popul. Dev. Rev. 31(Suppl.):115–29
24. Forrest DW. 1974. Francis Galton: The Life and Work of a Victorian Genius. New York: Taplinger
25. Freedman LP, Stephen LI. 1993. Human rights and reproductive choices. Stud. Fam. Plan. 24:18–30
26. Freyka T, Zakharov S. 2013. The apparent failure of Russia’s pro-natalist family policies. Popul. Dev. Rev.
39:635–47
27. Gallagher NL. 2015. Vermont eugenics: a documentary history. http://www.uvm.edu/∼eugenics
28. Galton F. 1869. Hereditary Genius: An Inquiry into Its Laws and Consequences. London: Macmillan
29. Galton F. 1883. Inquiries into Human Faculty and Its Development. London: Macmillan
30. Gamble CC. 1953. Permanent birth control by sterilization. In Third International Conference on Planned
Parenthood: Report of the Proceedings, November 24th–29th, 1952, Bombay, India, pp. 138–39. Bombay: Fam.
Plan. Assoc. India
31. Gosney ES, Popenoe P. 1929. Sterilization for Human Betterment. New York: Macmillan
32. Gould SJ. 1981. The Mismeasure of Man. New York: Norton
33. Grant M. 1918. The Passing of the Great Race. New York: Charles Scribner’s Sons
34. Grekul J. 2004. Sterilizing the “feeble-minded”: eugenics in Alberta, Canada 1929–1972. J. Hist. Sociol.
17:358–84
35. Griswold v. Connecticut, 381 U.S. 479 (1965)
36. Haave P. 2007. Sterilization under the swastika: the case of Norway. Int. J. Ment. Health 36:45–57
37. Haller M. 1963. Eugenics: Hereditarian Attitudes in American Thought. New Brunswick, NJ: Rutgers Univ.
Press
38. Haub C, Sharma OP. 2006. India’s population reality: reconciling change and tradition. Popul. Bull. Vol. 61,
No. 3, Popul. Ref. Bur., Washington, DC
39. Herd H. 1933. Sterilisation of the mentally defective. Lancet 222:783–86
40. Hillel M, Henry C. 1976. Of Pure Blood. New York: McGraw-Hill
41. Hofstadter R. 1959. Social Darwinism in American Thought. Boston: Beacon

366 Reilly
 GG16CH15-Reilly ARI 29 July 2015 13:44

42. Jian M. 2013. China’s brutal one-child policy. New York Times, Mar. 22, p. A23
43. Johansen BE. 2000. Stolen wombs: indigenous women most at risk. Native Am. 17(2):38–42
44. Kaback M, Lim-Steele J, Dabholkar D, Brown D, Levy N, Zeiger K. 1993. Tay-Sachs disease—carrier
screening, prenatal diagnosis, and the molecular era: an international perspective, 1970 to 1993. J. Am.
Med. Assoc. 270:2307–14
45. Kaelber L. 2011. Eugenics: compulsory sterilization in 50 American states. http://www.uvm.edu/∼lkaelber/
eugenics
46. Kemp T. 1957. Genetic-hygienic experiences in Denmark in recent years. Eugen. Rev. 49:11–18
47. Kevles DJ. 1985. In the Name of Eugenics: Genetics and the Uses of Human Heredity. New York: Knopf
48. Kitshaber J. 2002. Proclamation of Human Rights Day, and apology for Oregon’s forced sterilization of in-
stitutionalized patients. Speech, Salem, OR, Dec. 2. http://archivedwebsites.sos.state.or.us/Governor_
Kitzhaber_2003/governor/speeches/s021202.htm
49. Kluchin RM. 2007. Locating the voices of the sterilized. Public Hist. 29:131–44
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

50. Kluchin RM. 2009. Fit to be Tied: Sterilization and Reproductive Rights in America, 1950–1980. New
Brunswick, NJ: Rutgers Univ. Press
51. Krisch JA. 2014. When racism was a science. New York Times, Oct. 14, p. D6
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

52. Kuhl S. 1994. The Nazi Connection: Eugenics, American Racism, and German National Socialism. New York:
Oxford Univ. Press
53. Larson EJ. 1995. Sex, Race, and Science: Eugenics in the Deep South. Baltimore, MD: Johns Hopkins Univ.
Press
54. Lawrence J. 2000. The Indian Health Service and the sterilization of Native American women. Am. Indian
Q. 24:400–19
55. Lenz F. 1924. Eugenics in Germany. J. Hered. 15:223–31
56. Lombardo PA. 2008. Three Generations, No Imbeciles. Baltimore, MD: Johns Hopkins Univ. Press
57. Lombardo PA, ed. 2011. A Century of Eugenics in America. Indianapolis: Ind. Univ. Press
58. Ludmerer K. 1972. Genetics and American Society. Baltimore, MD: Johns Hopkins Univ. Press
59. Malthus TR. 1798. An Essay on the Principle of Population. London: J. Johnson
60. Medina J. 2014. Arizona Republican official resigns after comments about Medicaid recipients. New York
Times, Sept. 15, p. A20
61. Mickle v. Henrichs, 262 F. 687 (1918)
62. Mirovalev M. 2010. Uzbek women accuse state of mass sterilizations. Independent, July 17. http://www.
independent.co.uk/news/world/asia/uzbek-women-accuse-state-of-mass-sterilizations-2028987.
html
63. Miyaska M. 2009. Punishing paternalism: an ethical analysis of Japan’s leprosy control policy. Eubios J.
Asian Int. Bioeth. 19:103–7
64. Mozenski J, Mennuti M. 2013. Cell free DNA testing: Who is driving implementation? Genet. Med.
15:433–34
65. Muller-Hill B. 1988. Murderous Science. Oxford, UK: Oxford Univ. Press
66. Nott JC. 1843. The mulatto a hybrid—probable extermination of the two races if the whites and blacks
are allowed to intermarry. Am. J. Med. Sci. 6(11):252–56
67. Paul D. 1995. Controlling Human Heredity: 1865 to the Present. Atlantic Highlands, NJ: Humanities
68. Poe v. Lynchburg, 518 F.Supp. 789 (W.D. Va. 1981)
69. Popenoe P. 1933. The progress of eugenic sterilization. J. Hered. 28:19–25
70. Presser HB. 1969. The role of sterilization in controlling Puerto Rican fertility. Popul. Stud. 2:343–361
71. Proctor R. 1988. Racial Hygiene: Medicine Under the Nazis. Cambridge, MA: Harvard Univ. Press
72. Ralstin-Lewis DM. 2005. The continuing struggle against genocide: indigenous women’s reproductive
rights. Wicazo Sa Rev. 20(1):71–95
73. Reilly PR. 1991. The Surgical Solution: A History of Involuntary Sterilization in the United States. Baltimore,
MD: Johns Hopkins Univ. Press
74. Relf v. Weinberger, 372 F.Supp. 1196 (1974), vacated as moot 522 F.2d 722 (D.D.C. 1977)
75. Roberts D. 1997. Killing the Black Body: Race, Reproduction and the Meaning of Liberty. New York: Pantheon
76. Roe v. Wade, 410 U.S. 113 (1973)

www.annualreviews.org • Eugenics and Involuntary Sterilization 367

 GG16CH15-Reilly ARI 29 July 2015 13:44

77. Rubenfeld S, ed. 2010. Medicine After the Holocaust: From the Master Race to the Human Genome and Beyond.
New York: Palgrave Macmillan
78. Skinner v. Oklahoma, 316 U.S. 535 (1942)
79. Spencer H. 1864. Principles of Biology. London: Williams & Norgate
80. Stern AM. 2005. Sterilized in the name of public health: race, immigration, and reproductive control in
modern California. Am. J. Public Health 95:1128–38
81. Swed. Socialdep. 2000. Steriliseringsfrågan i Sverige 1935–1975. Statens Offentliga Utredningar (SOU)
2000:20, Swed. Socialdep., Stockholm. http://www.regeringen.se/sb/d/108/a/2864
82. Tavernise S. 2012. Whites account for under half of births in US. New York Times, May 7, p. A12
83. Thompson M. 1959. Prologue: A Minnesota Story of Mental Retardation Showing Changing Attitudes and
Philosophies Prior to September 1, 1959. Minneapolis, MN: Gilbert
84. Tsuchiya T. 1997. Eugenic sterilization in Japan and demands for a recent apology—a report. Newsl.
Netw. Ethics Intellect. Disabil. 3(1):1–4
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

85. Wall Str. J. 2013. North Carolina offers $10 million for victims of forced-sterilization program. Fox News,
July 27. http://www.foxnews.com/us/2013/07/27/north-carolina-offers-10-million-for-victims-
forced-sterilization-program
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

86. Williams et al. v. Smith, 131 N.E. 2 (Ind. 1921)

87. Witkowski JA, Inglis JR, eds. 2008. Davenport’s Dream: 21st Century Reflections on Heredity and Eugenics.
Cold Spring Harbor, NY: Cold Spring Harb. Lab. Press
88. Wong E. 2014. To temper unrest in western China, officials offer money for intermarriage. New York
Times, Sept. 3, p. A11
89. Wood HC. 1963. A prescription for the alleviation of welfare abuses and illegitimacy. J. Ky. State Med.
Assoc. 61:319–23
90. Woodside M. 1950. Sterilization in North Carolina. Chapel Hill: Univ. N.C. Press

368 Reilly
 GG16-FrontMatter ARI 22 June 2015 17:20

Annual Review of
Genomics and
Human Genetics

Contents Volume 16, 2015

A Mathematician’s Odyssey
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

Walter Bodmer p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 1
Lessons from modENCODE
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

James B. Brown and Susan E. Celniker p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p31

Non-CG Methylation in the Human Genome
Yupeng He and Joseph R. Ecker p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p55
Single-Cell Whole-Genome Amplification and Sequencing:
Methodology and Applications
Lei Huang, Fei Ma, Alec Chapman, Sijia Lu, and Xiaoliang Sunney Xie p p p p p p p p p p p p p p p p79
Unraveling the Tangled Skein: The Evolution of Transcriptional
Regulatory Networks in Development
Mark Rebeiz, Nipam H. Patel, and Veronica F. Hinman p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 103
Alignment of Next-Generation Sequencing Reads
Knut Reinert, Ben Langmead, David Weese, and Dirk J. Evers p p p p p p p p p p p p p p p p p p p p p p p p p 133
The Theory and Practice of Genome Sequence Assembly
Jared T. Simpson and Mihai Pop p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 153
Addressing the Genetics of Human Mental Health Disorders
in Model Organisms
Jasmine M. McCammon and Hazel Sive p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 173
Advances in Skeletal Dysplasia Genetics
Krista A. Geister and Sally A. Camper p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 199
The Genetics of Soft Connective Tissue Disorders
Olivier Vanakker, Bert Callewaert, Fransiska Malfait, and Paul Coucke p p p p p p p p p p p p p p p 229
Neurodegeneration with Brain Iron Accumulation: Genetic Diversity
and Pathophysiological Mechanisms
Esther Meyer, Manju A. Kurian, and Susan J. Hayflick p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 257
The Pathogenesis and Therapy of Muscular Dystrophies
Simon Guiraud, Annemieke Aartsma-Rus, Natassia M. Vieira, Kay E. Davies,
Gert-Jan B. van Ommen, and Louis M. Kunkel p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 281

v
 GG16-FrontMatter ARI 22 June 2015 17:20

Detection of Chromosomal Aberrations in Clinical Practice: From

Karyotype to Genome Sequence
Christa Lese Martin and Dorothy Warburton p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 309
Mendelian Randomization: New Applications in the Coming Age
of Hypothesis-Free Causality
David M. Evans and George Davey Smith p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 327
Eugenics and Involuntary Sterilization: 1907–2015
Philip R. Reilly p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 351
Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical,
Annu. Rev. Genom. Hum. Genet. 2015.16:351-368. Downloaded from www.annualreviews.org

Legal, and Social Issues

Mollie A. Minear, Stephanie Alessi, Megan Allyse, Marsha Michie,
and Subhashini Chandrasekharan p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p 369
Access provided by 217.138.57.82 on 02/22/23. For personal use only.

Errata

An online log of corrections to Annual Review of Genomics and Human Genetics articles
may be found at http://www.annualreviews.org/errata/genom

vi Contents