In 1964, Nial Ruth Cox was 17 and pregnant. “When the welfare caseworker found out, she told my mother that if we wanted to keep getting welfare, I’d have to have my tubes tied temporarily,” she later recalled.

She found out five years after the procedure that the sterilization was not, as she had been told, reversible. Cox (who’s now Nial Cox Ramirez) would never be able to carry another child.

Cox was one of thousands of Black women subjected to forced sterilizations in the 20th century. As women of color-led feminist organizations like the Third World Women’s Alliance (TWWA) and the Committee to End Sterilization Abuse (CESA) tried to curb the practice, they faced opposition from Planned Parenthood, NARAL, and the National Organization for Women (NOW).

Half a century later, these same historically white abortion rights organizations are undergoing a crisis of diversity and inclusion.

Planned Parenthood’s New York division only just denounced founder Margaret Sanger, a birth control advocate who espoused racist eugenicist views. Staff members at Planned Parenthood, NARAL, and NOW have spoken out on pervasive racism, leading Planned Parenthood’s national office in Washington, D.C., to unionize. The divides extend to broader activist spheres. Earlier this summer, when young pro-choice Black women spoke of their commitment to Black lives, white feminists labeled them ungrateful for not celebrating a Supreme Court victory on abortion access.

Looking back to the battle around forced sterilization shows that fighting for reproductive justice—defined by SisterSong as the right to bodily autonomy, have children, not have children, and parent them in safe communities—must go beyond optical representation and outreach in majority-white organizations. Disagreements then and now illustrate a fundamental problem of prioritization: Who defines what it means to have choice?

In contemporary political vocabulary, “pro-choice” refers to the legal right to an abortion. But meaningful choice remains contested territory for marginalized communities whose material interests often oppose those of white, middle-class women. In the early 1970s, TWWA and CESA sought to define choice as “the freedom to have, and to not have, children.”

Used by the British in India, the Rockefeller Foundation in Colombia, and the United States in Puerto Rico and on Native reservations under the guise of “population control,” sterilization was an imperialist tactic. By 1969, 38 percent of women of reproductive age in Puerto Rico had undergone la operación. With eugenics-adjacent arguments, imperialist powers and U.S.-based NGOs identified population growth as the cause of poverty, instead of decades of exploitation and colonial looting.

Across Black and brown communities in the United States, medical professionals coerced poor women of color into sterilization procedures by labeling patients “mentally defective” or presenting English consent forms to non-English speakers. From their time as Student Nonviolent Coordinating Committee members, many TWWA founders had witnessed the extent of genocidal sterilization practices in the American South. By 1971, TWWA had over 200 members in two coastal chapters, with an alliance of Black, Puerto Rican, Indigenous, and Asian American women decrying the “triple jeopardy” of racism, sexism, and imperialism.

TWWA articulated a vision of reproductive freedom that centered autonomy over one’s body through economic justice, health care, and liberation from state oppression. They supported legalized abortion and access to contraception, while opposing government-funded sterilization campaigns. They responded to violence enacted on women of color, who made up 79 percent of those who died in illicit abortion procedures in New York City.

Fran Beal, a TWWA founder who herself underwent an illicit abortion as a teenager, wrote, “Rich white women somehow manage to obtain these operations with little or no difficulty. It is the poor Black and Puerto Rican woman who is at the mercy of the local butcher.”

CESA, a New York-based group of health-care workers, saw abusive sterilizations in government clinics that served poor Black and brown communities. In New York City, CESA and TWWA lobbied for informed consent, including a 30-day mandatory waiting period for sterilization procedures, mandatory counseling on family planning methods, access to information in native languages, and a requirement that the idea for sterilization must originate with the patient.

NARAL, Planned Parenthood, and NOW argued that the proposals prevented women from having a full range of reproductive options. The debate highlighted opposing interests, but for both groups, medical providers made the decisions. CESA member Dr. Helen Rodríguez-Trías recalled, “We got a lot of flack from white women who had private doctors and wanted to be sterilized. … They had been denied their request for sterilization because of their status (unmarried), or the number of their children.”

For CESA and TWWA, white feminist opposition came as no surprise. Beal argued that the exploitation at the center of the Third World movement was both unfamiliar and beneficial to middle-class white women. While a “free market” of access granted white women the ability to undergo sterilization, it endangered poor women who were being coerced into the same procedure.

Even when the Department of Health, Education, and Welfare imposed regulations for sterilizations in 1978, NARAL and NOW continued their opposition, citing limits to choice. CESA wrote, “When parents are too poor to clothe and feed their children adequately, can they freely choose to have another child? … When prisoners are told they will not be paroled unless they agree to be sterilized, that is not free choice. When ‘mentally deficient’ people are sterilized without their consent, on the excuse that they cannot make the decision themselves, that is not free choice.”

Today, historically white abortion rights organizations must reckon with their racist pasts. But they must also acknowledge that a close-minded notion of pro-choice politics is a legacy of their white supremacist founding. Violent policing and prisons, looming eviction crises, and lack of universal health care continue to limit choice for many. People of color have reimagined reproductive freedom to expand what choice is, who it serves, and how we can protect it. We all must follow their lead.

UPDATE: After the publication of this piece, it was reported that Dawn Wooten, a former nurse at the Irwin County Detention Center in Ocilla, Georgia, filed a whistleblower complaint alleging that a staggering number of hysterectomies had been performed on detained immigrant women.