“We go in for excessive bleeding and come out missing body parts! How does that make sense?”

For more than two years, Carmen Worthy, an incarcerated woman in California, experienced vaginal bleeding between 19 and 22 days per month. “The whole ordeal was painful and my body was weak,” Worthy told Rewire News Group via email. It wasn’t until her hemoglobin dropped to dangerously low levels that prison medical staff started to take her seriously, “which was so messed up as well.”

First, the prison doctor suggested Worthy try the birth control pill, but it gave her headaches and nosebleeds. After that, the only option presented to her was surgery, which the doctor told her would make the bleeding stop. Worthy felt she had no choice but to agree.

Her uterus was removed.

“I felt like I had been raped all over again, knowing they had violated my body,” Worthy said. “It’s like we have no rights over our body … It’s almost as if they looked at our prison time and sentence and decided for us not to populate.”

Earlier this year, Worthy found out through her inmate advisory council—a group of elected representatives who give their fellow incarcerated people a voice in prison administration—that California had introduced a two-year program to compensate survivors of forced or involuntary sterilization. But when Worthy applied for compensation, she was denied.

Worthy isn’t alone. So far, the state has denied more than three times the number of applicants it has approved. With the program coming to a close at the end of the year, advocates worry that few of the survivors the program was meant to reach will actually benefit from it.

A leader in eugenics

Between 1909 and 1979, California ran the most active eugenics program in the United States. During this period, more than 20,000 people living in state-run institutions and deemed “feeble-minded” were sterilized. They were disproportionately disabled, Black, Indigenous, Latinx, and Asian. Many were institutionalized primarily because they were poor.

Despite the repeal of the state’s formal eugenics law in 1979, the practice of coerced sterilization continued in California’s prisons. In 2013, a Reveal investigation found that nearly 150 women received tubal ligations—in other words, had their tubes tied—in violation of state policy at just two California prisons between 2006 and 2010. A state audit produced after that exposé confirmed that 144 incarcerated women received tubal ligations between 2005 and 2013.

However, tubal ligation is only one type of sterilization procedure. The 2020 documentary film Belly of the Beast argued that far more women have been sterilized in California prisons. Filmmakers combed through state and prison records to find evidence that nearly 1,400 people may have been sterilized between 1997 and 2013.

So, after several failed attempts, California passed a law in 2021 creating a program to compensate survivors of forced and involuntary sterilization. A total of $4.5 million was allocated to victim compensation, and another $1 million has been set aside to install commemorative markers and plaques acknowledging the history across the state.

The reparations law “importantly positioned these programs in the prison system as continuing the same work that they were doing in the eugenics program for so many decades,” said Jennifer James, an associate professor at the University of California, San Francisco. “Perceived criminality,” she said, was one of the major reasons people were targeted for sterilization in eugenics programs.

“The state broadly finds new ways to enact these same policies,” James continued. “It is the same thing that was justified during slavery—the removal of children from their parents. It’s the same thing we see with the Native boarding schools. And it’s the same thing we see with the eugenics programs, and in forceful sterilizations in prison.”

An attempt at reparations

Nearly a decade ago, North Carolina and Virginia undertook efforts to compensate survivors who were sterilized under their state eugenics programs. California is the first state to attempt to pay reparations to survivors of contemporary coercive sterilization.

However, since applications in California opened on January 1, 2022, only a fraction of potentially eligible people have been approved for compensation. As of this summer, only about 100 applications, for a total of $1.45 million in reparations payments, had been approved.

According to California Victims Compensation Board spokesperson Ray Aspuria, as of October 24, the board had received 510 applications for forced or involuntary sterilization compensation. Only 108 were approved; 355 were denied. The deadline for survivors to apply is December 31, 2023.

At the time of the program’s launch, it was estimated that about 600 survivors of California’s historic eugenics program were still alive. But by the state’s own acknowledgment, reaching this aging population has been difficult.

The same is true for incarcerated and recently incarcerated people, said James, who has been conducting interviews with those applying to the program. And because of poor recordkeeping, it is virtually impossible to know exactly how many people were sterilized in California prisons.

“A lot of people don’t know what happened to them,” James said. “They were never told. Especially people who were incarcerated, who were sterilized—if they continued to be incarcerated throughout their childbearing years, they might not have had a way to ever know.”

Applying to the program requires documenting your story—something many survivors are unable to do.

“That is a considerable burden placed on individuals who have been through a trauma at the hands of the state, [and] may not trust the state because of that, many of whom have limited literacy, and many of whom have limited access to technology,” James said.

While applicants can request a paper application, most of the information about the program is online. Even worse, California has reached out to notify people who may have been sterilized—but because so many of those people never knew what happened to them, that letter from the state may have been the first time they learned the truth.

“The program wasn’t designed in a way that was centered on the fact that these are survivors of trauma,” James said. “Even just the language being very legalistic: ‘You are denied; you can appeal.’ It sounds quite like the things that people might have faced when they went to trial and lost, and ended up in prison.”

Making reparations truly reparative

Another disturbing fact about sterilizations in California prisons is that several doctors were repeat offenders. One in particular, James Heinrich, oversaw a significant increase in sterilizations when he was the OB-GYN at Valley State Prison, which has since been converted into a men’s prison.

In addition to the tubal ligations they originally reported, Reveal found that Heinrich ordered other types of sterilizations 378 times, including “hysterectomies, removal of ovaries, and a procedure called endometrial ablation, which destroys the uterus’s lining.” (People who had endometrial ablation do not qualify for compensation under California’s program, because while it makes getting pregnant extremely unlikely, it is not technically considered a sterilization procedure. However, it is typically only performed on people who do not want to have more children.)

An incarcerated trans man who asked to be identified by his nickname, Greenie, was one of Heinrich’s patients.

“Both of my ovaries were removed without my knowledge,” he wrote, also via email. “I went through horrible ups and downs back then mentally, which now I know was from my hormones being way off balance.”

Greenie was able to document that he had refused a follow-up appointment with Heinrich because the doctor had him “cut for no reason,” and obtained his medical records—a challenge, given that Madera Community Hospital, where many of the surgeries actually took place, closed last year (though with state assistance, it may soon reopen).

Still, the state rejected Greenie for compensation.

“I feel that the state should provide all of us who were under Dr. Heinrich’s care that went out for surgeries reparations, period,” he said. “It doesn’t make sense that he would have picked and chosen who he sterilized.” He plans to reapply.

Given the challenges reaching eligible people, and the high number of denials for reasons beyond applicants’ control, James would tend to agree.

“Could it be both? Could the state say, ‘We will proactively send a check to everyone we identify, but also if we didn’t identify you, come forward and you could potentially receive payment?’” she said.

“Obviously, the harm is not something that can ever be made up for with any financial compensation. There’s no amount of money that makes it OK.”

Still, successful applicants have received potentially life-changing sums. It’s a step—but only a start.

Questions about consent

Following all the explosive revelations, California lawmakers banned sterilization as a form of birth control for incarcerated people in 2014. The state now produces annual reports on medically necessary sterilization procedures, and one of those reports revealed that a tubal ligation not deemed necessary was performed on an incarcerated person as recently as 2020. According to the state, that person consented to the procedure and it was performed without prison officials’ knowledge.

Clearly, the ban hasn’t stopped all sterilizations—but such a ban may not be a real solution, anyway.

The question of “consent” in a carceral context is incredibly thorny. How can anyone give free and informed consent if they aren’t free?

“Can it be informed consent if you are shackled? Can it be informed consent if you cannot leave the room, if you cannot seek a second opinion, if there’s a police officer standing over you?” James said. “In any other circumstance, I would say, of course that’s not informed consent. But it also feels dangerous to assert that, because I think people who are incarcerated should have the right to informed consent.”

For example, James said, an incarcerated person who actually wants a tubal ligation should be able to get one. They shouldn’t have their reproductive decisions restricted by the state because of its own past bad actions.

But on the opposite side of that coin, many survivors of coerced sterilization in California have been denied reparations because their medical records say they consented to whatever procedure they had. That’s what happened to Worthy, the incarcerated woman whose uterus was removed. Her procedure took place in 2019 and was described as medically necessary—but her experience casts doubt on the idea that she gave true informed consent.

“When the denial came, I was upset,” she said. “Confused once again. And so many questions, like how can they do this to me and make it my fault?”

In her research, James has certainly come across obvious violations of informed consent. But so many other cases are more complex. There are ripple effects that the program fails to account for as well. Many people whose cellmates or other acquaintances were sterilized, James said, reported delaying care for their own health issues to avoid the same fate.

“I think if a patient wants to claim that they consented, that’s great, and I will believe them,” James said. “But the idea that an outside person could say there was informed consent—I don’t think you can know that.”

Worthy wants people to know what has happened in California prisons—and that so many have still been denied reparations.

“It’s just so sad, because even though we are criminals/inmates, we’re still human,” she said.