When Doctors Took ‘Family Planning’ Into Their Own Hands
Dolores Madrigal remembered being told that her sterilization could be reversed. Jovita Rivera and Georgina Hernández said they were bullied by doctors and nurses who declared their children burdens on California taxpayers. Melvina Hernandez did not find out that her tubes had been cut until four years after her son was born.
In 1975, these four women were among the 10 plaintiffs who filed a class-action lawsuit in federal court claiming that the Los Angeles County U.S.C. Medical Center was systematically sterilizing Spanish-speaking mothers who delivered their babies via cesarean section.
Madrigal v. Quilligan was, from its outset, the kind of striking David-versus-Goliath story that Hollywood and history books usually love — Erin Brockovich with an East L.A. twist. It was championed by a Latina fresh out of law school, and backed by the marginalized feminist wing of a growing Chicano activist movement. It was directed against some of most the powerful institutions in the state, including the Department of Health and the University of Southern California. The events in the trial even had a famous setting: For decades, Los Angeles County hospital served as an exterior shot for the soap opera “General Hospital.” And the claims were disturbing — that the hospital had made a practice of misleading women about sterilization and coercing them into giving consent.
Yet when Virginia Espino, a historian, began researching the case in 1994, almost all these details had been lost and forgotten. For years, Espino could not even obtain complete copies of the court documents at the County Hall of Records. “They said that it was lost, missing, somebody had borrowed it,” she told me. “They couldn’t find it.” And until Espino teamed up with her friend, the Academy-Award-nominated filmmaker Renee Tajima-Peña (“Who Killed Vincent Chin?”), the public had never heard any of the plaintiffs describe their own experiences with the ill-fated suit. The documentary that sprang from their collaboration — “No Más Bebés” (“No More Babies”), which is being broadcast on PBS tonight — aimed to change that.
Madrigal v. Quilligan revolved around two fundamental questions: Did obstetricians at County Hospital perform tubal ligations on their patients without proper consent? And did doctors single out Latinas for the procedures?
When the suit came to trial in 1978, Judge Jesse W. Curtis ruled that neither of these charges was true. “This case is essentially the result of a breakdown in communications between the patients and the doctors,” Curtis wrote. “Misunderstandings” occurred because the women were, primarily, Spanish-speakers. Some of them, including Dolores Madrigal and Consuelo Hermosillo, had even signed consent forms for their procedures. Their emotional distress at being sterilized, Curtis wrote, was caused by their “cultural background” as immigrants from rural Mexico who believed that a woman’s worth is tied to her ability to raise a large family — not by their sterilizations. Dr. E.J. Quilligan, the head of County Hospital’s obstetrics unit (and a pioneer in lifesaving fetal-monitoring technology) told a reporter, “We were practicing good medicine.”
The disconnect between Curtis’s ruling and Tajima-Peña’s portrayal of the same events in “No Más Bebés” may be due, in part, to changes in our notions of what “consent” should mean. As Dr. Karen Benker, the only physician to testify against the hospital, explained to me last fall, the notion of “voluntary informed consent” barely existed during the early 1970s. (The National Research Act, which required doctors to get “voluntary informed consent” from the subjects of their experiments, wasn’t passed until 1974, after the abuses of the “Tuskegee Study of Untreated Syphilis in the Negro Male” were made public.) Asking a woman to consider and sign off on an irreversible contraceptive procedure in the midst of her worst labor pains? In 1973, amid federal initiatives to encourage birth control and family planning, that might be construed as “good medicine.”
And “No Más Bebés” suggests that the environment at County Hospital made coercion and deception very possible, even if it wasn’t authorized. According to the film, more than 1,000 babies were born there every month during the 1970s, with no clear protocol for their delivery. Women labored on gurneys in the hallways, assigned to no particular doctor. One night, Benker told me, she saw a medical resident hold a hypodermic needle filled with painkiller in front of an African-American woman in labor and say: “You want this? You want the pain to go away? Well, sign this [sterilization consent] paper!”
According to Benker, the patients in County’s obstetrics unit were mostly low-income African-American and Mexican-American women. If the rates of sterilization were highest among Latinas, that could have been a result of practical realities, not deliberate policy. “I think it was easier to coerce or to trick who people who didn’t speak English well or who didn’t read English well,” she told me, “or whose immigration status might have made them feel afraid.”
Disturbed by the situation, another resident in County’s obstetrics unit, Dr. Bernard Rosenfeld, quietly copied the medical records for hundreds of sterilizations. Eventually, he passed this documentation along to Antonia Hernández, a recent graduate from U.C.L.A. Law School who worked at the Los Angeles Center for Law & Justice, a legal advocacy group just a few blocks away from County Hospital. She and her colleagues joined forces with the Chicana feminist organization Comisión Feminil, led by a legal secretary named Gloria Molina, to build a case on the foundations laid by the recently decided Roe v. Wade. If a woman had a civil right to terminate a pregnancy, they argued, she also had a civil right to procreate.
Like many of the plaintiffs that Hernández and Molina persuaded to join Madrigal v. Quilligan, Consuelo Hermosillo initially wanted nothing to do with the case. Her sterilization at County hospital had become a secret so painful that she and her husband never shared it with anyone. They did not even discuss it when they were alone. But after Hernández showed her the evidence Rosenfeld had gathered, Hermosillo joined the suit, without telling her husband, in hopes that would help protect other women — perhaps even her two daughters. She told a baby sitter she was going to work and rode a bus alone to the courthouse, angry, ashamed and afraid.
After Judge Curtis’s ruling, Hermosillo’s silence cemented. She never built friendships with the other plaintiffs. Some of them, she’d learned, were being beaten and castigated by their husbands for being sterilized. Her husband didn’t do that. But Hermosillo had no one to confide in either. Once, she told me, she accompanied her son to a funeral for his friend’s mother and was surprised by the photographs at the wake: Until that moment, she had no idea that the deceased was also one of the “Madrigal Ten.”
Though the hospital won, Madrigal changed state laws and buttressed the careers of several prominent Latino politicians. In its wake, the California Department of Health revised its sterilization guidelines to include a 72-hour waiting period and issued a booklet on sterilization in Spanish. The California State Legislature unanimously repealed its sterilization law, which had legalized over 20,000 nonconsensual procedures since 1909. Hernández went on t
o become the president of the Mexican American Legal Defense Fund; Molina later became the first Chicana elected to the Los Angeles City Council.
“What interested me about this case,” Tajima-Pena told me, “is how you have well-meaning policy and some very well-meaning doctors, and how women could still be abused.” Where Espino sees a history of “backdoor eugenics,” Tajima-Pena is more persuaded by the sociologist Elena Gutiérrez’s argument that the sterilizations at County Hospital were a result of a “perfect storm” of pressures: fears about a global “population bomb” mixing with prejudice against welfare use and illegitimacy, accelerated by a rush of federal funding for family planning through the War on Poverty.
“To sort of claim that we’re part of a greater goal of sterilizing the Mexican population that immigrates to Los Angeles,” Dr. Michael Kreitzer, a defendant in Madrigal v. Quilligan, says in the film — “I’m offended by that. That’s not what we did. That’s not what we discussed. That’s not what anybody even intimated.”
“It’s not like these evil old white guys are the problem,” Tajima-Peña told me, the day before “No Más Bebés” screened at the NYC Doc festival in November. “We’re all the problem. Because we all have this really complicated, maybe misguided thinking about what reproductive freedom really means.” Such beliefs are still common even among progressives, she pointed out. When she and Espino showed rough cuts of the film to friendly audiences before its June debut, people would find out that one of the plaintiffs, Maria Hurtado, had five children and say, “Well, she already had five kids.”
But Espino is not the only historian to look at Madrigal v. Quilligan and think of eugenics. Alexandra Minna Stern, a professor at the University of Michigan, has documented that, by the 1940s, California accounted for 60 percent of sterilizations performed nationwide. The operations, she found, always disproportionately affected African-Americans and foreign-born residents — including immigrants from Italy, Poland, Scandinavia, Russia and Germany. Mexican-Americans were long singled out for special attention. In Stern’s book “Eugenic Nation,” Madrigal v. Quilligan appears as “a concluding link in California’s protracted history of eugenics.”
“That concept of ‘we’re being threatened by this overbreeding subpopulation’ seems to be a very powerful strain in our culture,” Benker says. Two years before Hernández filed Madrigal v. Quilligan in California, the Southern Poverty Law Center filed Relf v. Weinberger in Washington. That case, which revolved around the sterilization of two African-American sisters, 14 and 12 years old, at a family-planning clinic in Alabama, revealed that more than 100,000 poor people were being sterilized every year under federally funded programs. According to the S.P.L.C., “Countless others were forced to agree to be sterilized when doctors threatened to terminate their welfare benefits unless they consented to the procedures.”
You can detect the same strain in the arguments once used to support Proposition 187 in California, which barred unauthorized immigrants from using some state services, and in the justifications for denying Mexican-American children birth certificates in Texas. It runs through the current movement to repeal the 14th Amendment. “No Más Bebés” is an investigation into what happened at one hospital during the early 1970s, but the larger questions it raises are still with us today: Who do we believe is allowed to create citizens in our country? Does it matter what they look like? Does it matter which languages they speak?
Marcela Valdes is a journalist specializing in Latin American culture.
Co-published with The New York Times Magazine.