For as far back as my memory reaches, my grandmother, Obdulia Perez, had paper-thin skin with satiny wrinkles etched deep. She enjoyed bingo, cooking for her family and neighbors, writing poems in longhand, and reading the Bible. Despite a formal education that ended in second grade, she encouraged many of her progeny—myself included—to pursue education.

She was also one of over 200,000 Puerto Rican women to be coercively sterilized.

When Abuela boarded a carro público (taxi), rode to the health clinic in Arecibo, Puerto Rico, and was sterilized without her informed consent she was 40 years old. By that age, she already had four growing children—a robust family by her measure—making the government-backed operation only moderately devastating to her personal dreams. But Puerto Rico’s average age of sterilization back then was 26, and many women—with fewer children, if any—came to regret the irreversible procedure.

Indeed, though Abuela was one of a kind in my heart, she was one of many in regards to being sterilized. In 1954, the year of her operation, Puerto Rico’s state-run population control program was still gaining steam. By 1974, tubal ligations became so ubiquitous on the island that over a third of its women had received la operación—giving Puerto Rico the highest sterilization rate in the world.

What does a coerced sterilization look like? In Abuela’s case, it looked like accepting cash vouchers from clinicians (“They always throw in a candy to catch you,” Abuela would later say) for assenting to an impermanent form of family planning. I am guessing that the silence Abuela clung to for decades surrounding this incident was, in part, due to guilt. She had, after all, consented to most of it—just not the permanent part. Having accepted money may have compounded that guilt, though such incentives are now part of what defines coercion. So, in a way, perhaps Abuela felt complicit in her own duping and embarrassed by it. I also wonder if her silence was survival and wellness based, to not stir up lingering grief or trauma from the coerced procedure.

Whatever the reason, we heard of her operación only by chance, over two decades after it had happened. While giving her a therapeutic scoliosis massage, my mother saw a tiny scratch on Abuela’s abdomen. “What’s this scar?” mom asked, and Abuela was reticent to answer: la operación. If it weren’t for that happenstance, Abuela might’ve taken her secret to the grave.

Despite plentiful documentation, few people know of the United States’ prolific history of mass sterilization. In 1907 Indiana led the charge, putting the world’s first mass sterilization law on the books. Thirty other states followed its lead. Over 20,000 California residents were sterilized between 1909 and 1963. In Mississippi, the procedure was common enough to earn a nickname—the Mississippi Appendectomy. While many surgeries were implemented through deceptive tactics like those used on Abuela, forced operations were widespread, too. A woman might go to the hospital for an unrelated surgery and discover years later that her uterus had also been removed. A mother who had just delivered might be denied contact with her newborn until she consented to tubal ligation. A child institutionalized for depression or poverty might be anesthetized and operated on without any explanation at all.

Why were states so eager to get inside women’s bodies in this way? Puerto Rico’s colonial government blamed an impending population explosion, despite data showing healthy population numbers. North Carolina’s Eugenics Board stated that sterilization offered “humane, practical protection against threatened race degeneracy.” Meanwhile, California forms permitted operations due to “feeblemindedness.”

“Licentiousness” was an oft-given justification, reminding us of slut-shaming’s real roots and difficult outcomes. Never mind if the girl (many who underwent operations were minors) was impregnated through sexual violence.

Whatever the reasons stated, the reality of who was sterilized displayed some common threads. These were disproportionately poor and Black women. In California, Latino and Asian-American residents were targeted. The Indian Health Services performed thousands of coerced and forced sterilizations in the 1970s on tribal members across the nation. It is hard to encounter the data without feeling these campaigns were weeding-out efforts.

So far I’ve used past-tense verbs, but, unfortunately, present-tense applies, too. As recently as 2014, the number of women forcibly sterilized in California women’s prison was in the thousands. A pending class action lawsuit by 80 Saskatchewan women in Canada lists forced sterilizations as recent as last year.

For bringing these histories to light, we must thank whistleblowers like Helen Rodriguez Trías, the Puerto Rican physician who received a Presidential Citizens Medal for her work in public health. Or Connie Pinkerton-Uri, a Choctaw and Cherokee doctor whose 1974 study revealed that one in four Native American women had been sterilized without their consent. More recently, Dawn Wooten, a nurse at an ICE detention center, saw unnecessary removals of detainees’ reproductive organs and went public with what she witnessed at the hands of a single surgeon: “Goodness, he’s taking everybody’s stuff out. That’s his specialty, he’s the uterus collector.”

For some victims, speaking out has brought a measure of healing—while also stirring up the hidden loss and invisible grief that travels with them all their life. We must honor the courage of folks like Elaine Riddick, Consuelo Hermosillo, and Willis Lynch who never asked to be in this position. While the data can be alternately sickening and numbing, their personal testimony reminds us of the individual losses: these are bloodlines that end, ancestral wisdom that disappears, and oral histories that go silent.

As an adult woman myself, I have come to understand the difference between birth control and population control. Birth control, my individual right, means having information, choices, and full agency over my reproductive life and family planning. Population control is a social policy claiming moral authority to decide who merits populating this planet.

Being a writer means I believe in the power of bearing witness. We can fight back and seek redress, at least in part, by spreading the word. Let’s educate ourselves, face this grim history, and understand its continued proximity to our matriarchs and communities. Let’s step into the light and say #OurMothersToo.

A Timeline of US Forced and Coerced Sterilizations

Estimates of how many people were coercively or forcibly sterilized in the United States range from 60,000 to 150,000. Here’s a look at some moments in this history.

1907—Indiana becomes the first of 32 states to sponsor and encourage or force sterilizations through eugenics boards and other “race betterment” initiatives.

1927—In Buck v. Bell, SCOTUS permits states to sterilize institutionalized people to promote the “health of the patient and the welfare of society.” “Three generations of imbeciles are enough,” writes Justice Oliver Wendell Holmes in the decision. It turns out that Carrie Buck was a good student and did not even meet the state’s definition of “imbecile” at the time. The ruling is credited with paving the way for over 60,000 nationwide coerced state-paid sterilizations.

1954—A massive population control campaign gains steam in Puerto Rico in the 1950s and ’60s, run by the US and Puerto Rican government, resulting in sterilization of a third of the island’s women—the highest in the world—by 1974. This is the year my abuela got la operación.

1961—Fannie Lou Hamer, a prominent Black feminist and civil rights leader, receives a hysterectomy without her consent in Mississippi, one of hundreds in that state’s history of forced sterilizations.

1963—Some states slow their sterilization rates or repeal sterilization laws, but it is too late for many victims. By this year, state-by-state tallies for coerced or forced sterilizations include: 3,200 Georgia residents (starting in 1937); 2,300 Minnesota residents (starting in 1928); 3,700 Michigan residents (starting in 1929); and 3,000 Kansas residents (starting in 1913).

1973—The Relf sisters, age 12 and 14, are among those coercively sterilized in Alabama. Public awareness of their legal action leads to higher standards of informed consent for sterilization procedures nationwide.

1973–76—In this three-year window alone, the Indian Health Service performs 3,406 sterilizations, many of which are documented to be coerced or forced, including Jean Whitehorse who, during an appendectomy, is sterilized unnecessarily and without consent. Her Navajo name, Amá, means “many children.”

1979—By this year, over 7,300 Virginia residents have been sterilized after being deemed “mentally ill” and “mentally deficient.” The law allowed such cases starting in 1924.

1978—After whistleblower doctor Bernard Rosenfeld smuggles damning medical records out of Los Angeles County–USC Medical Center, a class action lawsuit, Madrigal v. Quilligan, is brought by 10 Mexican American women who were coerced into sterilization while undergoing c-sections.

1979—By this year, the state of California has performed approximately 20,000 forced or coerced sterilizations, disproportionately on Latino, Black, and Asian-American residents.

1997–2003—One thousand and four hundred women in California state prisons are forcibly sterilized. Even after the state bans sterilizations of inmates, they continue. (The PBS Independent Lens documentary Belly of the Beast streams through June on this topic.)

2008—Kelli Dillon, while serving a sentence in a California state prison, is sterilized under false pretenses of cervical cancer treatment. In reality, she did not have cancer.

2020—A hundred Saskatchewan women in Canada file a class action lawsuit after being sterilized without informed consent, against their will, or without even knowing.

2020—Forced hysterectomies in an ICE detention center in Georgia are revealed after whistleblower and registered nurse Dawn Wooten goes public with what she witnessed working in the facility.