In one of the most powerful scenes in State of Eugenics, a documentary about North Carolina’s decades-long eugenics campaign, Nial Cox Ramirez shares that the doctor who sterilized her in 1965 said the procedure was needed if she wanted to continue receiving public assistance to care for her family. While sorting through her medical records onscreen, Ramirez adds that the doctor said the procedure was reversible and that she could have children later; they “were just stopping it for now.”

Her doctor lied.

What happened to Ramirez also happened to about 7,600 North Carolinians between 1933 and 1974, and it wasn’t only in North Carolina. Some 30 states, including the so-called progressive state of California, enacted similar programs—all federally funded, aimed at population control, and championed at the time as a way to “help” marginalized people. The programs targeted poor people, people with disabilities, and immigrants, such as Mexican women in Los Angeles.

Dawn Sinclair Shapiro, whose film aired nationally on Sunday and can be viewed online as part of PBS’ Reel South series, told Rewire in a phone interview that she wants State of Eugenics “to be a tool to inform the debate [about such programs and how to remedy their effects]—but it really hinges on if state officials are ready and willing to have these conversations.”

As Rewire reported in May, 77 percent of all those sterilized in North Carolina were women; about 2,000 were people 18 and younger. Before the 1960s—when Black people became the majority of those sterilized—poor, rural white girls were the primary targets of authorities and women reformers.” Segregation had “shielded some Black women from the eugenicist’s scalpel,” explains Rebecca Kluchin, a health-care historian, in the film because they were excluded from white health-care institutions. After the racial segregation era of Jim Crow, North Carolina’s Black population became eligible to receive public assistance, which also meant it became a target population for sterilization. Starting in the 1960s, Black women made up a significant percentage of those sterilized under the state’s eugenics campaign.

Before the Winston-Salem Journal published a five-part series on North Carolina’s eugenics program in 2002, few had ever heard of the issue, even though it was hiding in plain sight. For years, Ramirez had been vocal about what happened to her.

While in her 20s, Ramirez, aided by Gloria Steinem and attorney Brenda Feigen as part of the early work of the American Civil Liberties Union’s Reproductive Freedom Project, filed a lawsuit against the state during the 1970s. Historians in Shapiro’s film largely credit Ramirez with successfully shutting down North Carolina’s eugenics program, though compensation for the program’s victims were not provided until much later.

Twenty-five years after the lawsuit was filed, a researcher walked into the North Carolina state archive and got microfilm of the state’s entire eugenics history. These documents would eventually make international headlines by way of the Winston-Salem Journal’s reporting. It would also lead to hard-won legislation, championed for years first by former state Rep. Larry Womble (D-Forsyth) and then U.S. Sen. Thom Tillis (R-NC), which would allocate $10 million to compensate survivors of the eugenics program.

“Another aspect of this film is the tale of two politicians, these two men who crossed party lines to help get survivors compensated, which is amazing if you think about it. Because every two years for 40 years there was a conversation about whether the budget should include money for victims, and the answer was always no,” Shapiro told Rewire.

The first of these checks went out in October 2014, though major delays of additional payments have been reported.

Most of the 30 states that participated in eugenics programs have yet to acknowledge the extent of their campaigns or fully explore how their actions altered the lives of tens of thousands of people, let alone have public conversations about compensating victims. So far, only Virginia and North Carolina that compensate survivors.

During a January 11 panel discussion at Winston-Salem, North Carolina’s Wake Forest University—featuring Shapiro, Womble, and other key figures in the effort to shed light on the sterilization program locally—Womble had a lot to say about redemption and state accountability. Namely, that he did not believe that compensation for eugenics sterilization victims meant that justice had been served.

“This story is a bird’s-eye view into injustice done by a government against its own people,” Womble said at Wake Forest, growing increasingly emotional. “I don’t believe that justice was served because … what [victims] got was a drop in the bucket for everything they’ve been put through. Their bloodlines were cut off, and it was done by their own government. Victims I’ve spoken to, some of them weren’t at all concerned with money. They were concerned with restoring their dignity. We have a lot to pay for in this country.”

And while it’s easy to think this is a practice of the past, sterilization stories are still emerging. In 2013, the Center for Investigative Reporting found that doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without the necessary state approvals. One-third of those sterilizations were performed without appropriate signoffs from health-care providers or the observance of mandated wait times between consent and the actual surgery.

Shapiro said in a phone interview with Rewire that the rhetoric used to justify these dangerous programs still exists and will need to be tackled to truly end them in this country.

“Things like eugenics campaigns [were] first established through belief systems based on what people are valued and what people are not valued, and this is perpetuated through rhetoric,” Shapiro said. “It’s this belief that people of value know better for other people’s lives …. Progressives behind [the] eugenics campaigns really presented it like they we’re doing poor or disabled people a favor. I’ve [even] had recent conversations with liberal friends who say … if you’re on public assistance, it’s in the public’s interest for you to stop having children.”

“Absolutely, we are still living with the vestiges, the rhetoric, and the belief systems that lead to sterilization abuse,” Shapiro concluded.