The history of forced sterilization in the United States runs from 1907, when Indiana passed the first compulsory sterilization law, through the 1970s, during which more than 30 states authorized the surgical sterilization of people held in hospitals, asylums, and prisons. Over 60,000 people were sterilized under these statutes. The Supreme Court upheld the practice in 1927 in Buck v. Bell and has never formally overturned that decision, though later rulings, state repeals, and federal consent regulations have dismantled the system it endorsed. A handful of states have since apologized and paid compensation to surviving victims.
How State Sterilization Laws Worked
Indiana enacted the country’s first compulsory sterilization statute in 1907, aimed at people confined to state institutions whom officials labeled mentally deficient or criminally inclined.1National Human Genome Research Institute. Eugenics: Its Origin and Development Over the next several decades, more than 30 states followed. These laws gave state officials authority to order vasectomies or tubal ligations on patients and inmates classified as mentally ill, intellectually disabled, epileptic, or habitually criminal.
Virginia’s Eugenical Sterilization Act of 1924 became the most influential model. A state hospital superintendent petitioned a board of directors, which held a hearing and, if it concluded the patient was likely to produce children the state considered “socially inadequate,” approved the surgery. Surgeons who performed the procedures received legal immunity from malpractice claims.
California ran the largest program. The state sterilized roughly 20,000 people under its eugenic laws between 1919 and 1952, about one-third of all officially reported sterilizations nationwide.2PubMed Central. California’s Sterilization Survivors: An Estimate and Call for Redress State governments defended these programs as exercises of police power meant to protect public health and reduce the cost of institutional care. Fewer people in state-funded facilities meant lower taxes, and that argument helped keep the laws in place long after the underlying science had collapsed.
Buck v. Bell and the Supreme Court’s Approval
The legal foundation for state sterilization programs was Buck v. Bell, 274 U.S. 200 (1927). Carrie Buck, a young Virginia woman the state classified as “feeble-minded,” had been selected for sterilization under Virginia’s 1924 Act. Officials claimed her mother and daughter were also intellectually disabled, building a narrative of hereditary deficiency across three generations.3Justia. Buck v. Bell, 274 U.S. 200 (1927)
Justice Oliver Wendell Holmes Jr., writing for an 8-1 majority, upheld the order. He reasoned that the principle behind compulsory vaccination reached far enough to justify sterilization, and that society could demand this sacrifice the way it demanded military service. Holmes ended with the sentence that has followed the case ever since: “Three generations of imbeciles are enough.” Later scholarship showed Carrie Buck was not intellectually disabled at all; her institutionalization had more to do with her social circumstances than any genetic condition.
The ruling held that the Fourteenth Amendment’s due process protections did not stop states from ordering eugenic sterilizations. States that had hesitated to enforce their statutes now had clear judicial cover. Virginia alone sterilized approximately 8,000 people between 1927 and 1979.
How the Laws Were Dismantled
The Supreme Court began cutting into the legal ground under eugenics in Skinner v. Oklahoma, 316 U.S. 535 (1942). Oklahoma’s Habitual Criminal Sterilization Act authorized forced sterilization of people convicted of three or more felonies involving “moral turpitude,” but exempted white-collar offenses such as embezzlement. The Court struck it down on equal protection grounds, holding that marriage and procreation are “fundamental to the very existence and survival of the race” and that any state sterilization law must survive strict scrutiny.4Justia. Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942)
Skinner did not overrule Buck v. Bell. The Court framed the case around unequal treatment of different classes of felons, not the constitutionality of eugenic sterilization itself. But by recognizing procreation as a fundamental right subject to the highest level of judicial review, the ruling made it much harder for any sterilization statute to survive a challenge. Griswold v. Connecticut in 1965 established a constitutional right to privacy in reproductive decisions, and later cases continued to expand protections for bodily autonomy.
State legislatures repealed their sterilization statutes over the second half of the twentieth century. Indiana’s 1907 law stayed on the books until 1974.1National Human Genome Research Institute. Eugenics: Its Origin and Development Virginia’s program ran until 1979. By the late twentieth century, no state was actively enforcing eugenic sterilization, though some statutes remained on the books unrepealed for years after enforcement had stopped. Buck v. Bell has never been formally overturned and technically remains precedent, but its reasoning has been so thoroughly contradicted by later reproductive rights and equal protection decisions that no modern court would rely on it.
Eugenics Beyond Sterilization
Sterilization was the most physical expression of eugenic policy, but the same thinking shaped other areas of law. The federal Immigration Act of 1924, known as the Johnson-Reed Act, capped annual immigration at two percent of each nationality already in the United States as recorded in the 1890 census.5Office of the Historian. The Immigration Act of 1924 (The Johnson-Reed Act) Choosing the 1890 census suppressed the quotas for Southern and Eastern Europeans, and a separate provision barring anyone ineligible for citizenship effectively shut out nearly all Asian immigration. Supporters described the law in Congress as a way to prevent biological degradation of the American population. The quota system remained in force until the Immigration and Nationality Act of 1965.6United States House of Representatives: History, Art, & Archives. Immigration and Nationality Act of 1965
States also imposed eugenic marriage codes. Couples had to obtain a medical certificate from a licensed physician attesting to their physical and mental health before they could get a marriage license. Doctors screened for conditions lawmakers considered hereditary threats, including epilepsy, mental illness, venereal disease, and chronic alcoholism. If the physician found a disqualifying condition, the state refused the license. In some jurisdictions, marrying without the certificate could bring fines or annulment. Most of these statutes were repealed during the mid-to-late twentieth century.
Federal Consent Rules That Replaced the Old System
In response to the eugenics era and documented coercion in federally funded programs during the 1960s and 1970s, the federal government adopted strict informed consent regulations for any sterilization procedure performed with federal funding. Under 42 CFR Part 50, Subpart B, a person must be at least 21 years old and mentally competent when consent is obtained.7eCFR. 42 CFR 50.203 – Sterilization Requirements Consent must be voluntary, and the patient must be told that refusing will not affect any federal benefits.
A mandatory 30-day waiting period separates the date of consent from the date of surgery, with a maximum window of 180 days. The only exceptions are premature delivery or emergency abdominal surgery, when the waiting period shrinks to 72 hours. The person who obtains consent and the physician who performs the procedure must both sign certifications confirming that the patient understood the information and agreed voluntarily.8eCFR. 42 CFR 50.205 – Consent Form Requirements If an interpreter is used, that interpreter must also certify accurate translation. Under the old regime, a superintendent’s petition and an internal board hearing were all that stood between a patient and an irreversible surgery.
Compensation for Surviving Victims
A few states have formally acknowledged their roles through apologies and, in some cases, payment. Virginia’s governor issued a formal apology in 2002, more than two decades after the state’s program ended in 1979. North Carolina established the Justice for Sterilization Victims Foundation in 2010 to compensate people forcibly sterilized under its Eugenics Board program; the claims deadline passed in 2014.9North Carolina Department of Administration. Office of Justice for Sterilization Victims
California, the state that sterilized the most people, launched its Forced or Involuntary Sterilization Compensation Program in 2022 with $7.5 million in funding. The program covered two groups: people sterilized in state hospitals or developmental institutions between 1909 and 1979, and people sterilized in state prisons after 1979 without proper consent.10California Victim Compensation Board. Recovery From Forced Sterilization Of the total, $4.5 million was designated for direct payments split among eligible applicants, with the rest allocated to administration and commemorative markers at sterilization sites. Payments were exempt from state income tax and did not affect recipients’ Medicaid or Social Security benefits.11Governor of California. California Launches Program to Compensate Survivors of State-Sponsored Sterilization The application window closed on December 31, 2023, and final payments were required to be issued no later than January 1, 2026.
Many survivors died before any state acknowledged what had been done. California’s decision to include sterilizations performed in state prisons after 1979 is a reminder that coerced sterilization did not end cleanly when the old eugenic statutes were repealed.