Nearly 35 years after ending the country's most active post-war sterilization program, North Carolina is the only state trying to make amends to thousands of people who cannot have children because of eugenics-inspired theories about social improvement.
Next week, victims and their relatives will tell their stories to a state task force considering compensation to victims of sterilizations that continued into 1974. Roughly 85 percent of victims were women or girls, some as young as 10. North Carolina has more victims living than any other state because a majority was sterilized after World War II, said Charmaine Fuller Cooper, director of the state Justice for Sterilization Victims Foundation.
Eugenics programs gained popularity in the U.S. and other countries in the early 1900s, but most abandoned those efforts after World War II because of the association with Nazi Germany's program aimed at racial purity. However, North Carolina's expanded, with sterilizations peaking in the 1950s and early 1960s. About 70 percent of the state's 7,600 sterilizations occurred after the war, state figures show.
Overt rationalization for the programs ranged from protecting the potential offspring of mentally disabled parents to improving the overall health and intellectual competence of the human race. Before the atrocities of World War II, it was seen by many — both blacks and whites — as a legitimate effort to improve society.
"Sterilization was always a cost-cutting measure," said Paul Lombardo, a professor at Georgia State University's College of Law. "The argument was, anybody who generates social costs shouldn't be allowed to have children."
In 1968, Elaine Riddick was like many others who were sterilized: poor, black and female.
Now living in Atlanta, Riddick plans to drive to Raleigh next week to tell the task force about her sterilization at age 14 following a rape. She said her grandmother gave the state permission for the procedure.
"My grandmother was worried about me. I didn't blame her," Riddick said.
Yet she said it was a traumatic experience that led to years of depression and physical problems. Riddick wants financial compensation from the state to pay for doctor bills and medicine.
Researchers estimate more than 60,000 people nationwide were sterilized during the 20th century as part of government programs. Even in states without sterilization laws, the procedures still occurred on local or informal levels. That means the real number could be 100,000 or higher, Lombardo said.
Among the 33 states with eugenics programs, North Carolina's was unique. The state had the most open-ended law in the country, allowing doctors and social workers to refer people living at home to the state Eugenics Board for possible sterilization. In every other state, Lombardo said, people had to be either institutionalized or jailed before they could be sterilized.
According to research done by University of Vermont professor Lutz Kaelber, North Carolina averaged about 300 sterilizations per year between 1950 and 1963.
It's not totally clear why support for sterilizations remained strong in North Carolina as it declined in nearly every other state.
The most obvious explanation is the influence of the Winston-Salem-based Human Betterment League, Fuller Cooper said. The nonprofit group aimed at social reform folded in 1988, but at its peak its members had the passion and financial backing needed to shape public policy, she said.
The North Carolina branch was organized by several wealthy and prominent citizens, including textile magnate James Hanes and tobacco czar R.J. Reynolds. The group's members drummed up support for sterilization through direct mail campaigns and other methods.
A league brochure from 1950 states: "You wouldn't give a responsible position to a person of little intelligence. Yet each day the feebleminded and the mentally defective are entrusted with the most important and far reaching job of all — the job of parenthood."
The Department of Social Services even established a psychology division to test individuals referred by social workers. Many received benefits such as special education or occupational training. Some with mental disabilities, mental illness or even epilepsy were deemed unfit to become parents.
"This wasn't just a bunch of evil people running around. Many of these people really wanted to alleviate suffering," Lombardo said.
Mary Kilburn, a retired psychologist who worked for the state Social Services Department from 1969 to 1980, said she and her co-workers believed "we were doing a really helpful thing."
She said it has been a shock to see their work vilified because so many families welcomed the procedure at the time.
Now in her mid-70s, Kilburn said she testified before the Eugenics Board twice in her career. In both cases, she said, parents had asked the state to perform sterilizations to protect daughters whose intelligence test scores were in the 30- to 40-point range, less than half of what was considered average.
"I looked at it not as something being done to them, but something being done for them," Kilburn said.
The experience of Delores Marks' mother was typical. A black woman with four children living on a farm near Goldsboro, she was sent to a psychiatric hospital in 1953 after showing signs of what Marks thinks was probably post-partum depression. After a few months at the hospital, she returned home to her family, having been sterilized.
"My father couldn't write, yet his signature was on the paperwork," Marks said. "They even had my mother's signature, even though they said she couldn't understand what was happening to her."
Marks didn't find out the full details of the procedure until after her mother died, when she and her sisters got the medical records from the state.
Marks said it had a damaging impact on her mother that lasted the rest of her life.
"I really and truly believe it was mind-altering," she said. "First my grandparents and then my sisters and I had to take care of her in our homes."
That's why Marks believes relatives of sterilization victims also should be eligible for compensation.
"It's almost like we lived this with her, because once they released her, it became our responsibility," she said.
At least seven states have offered formal apologies for involuntary sterilizations, including North Carolina in 2001, when then-Gov. Mike Easley also appointed an initial task force to the issue. But only North Carolina has so far set up a process to compensate individual victims. And with the state legislature struggling to close a budget gap, questions of fairness may be pushed aside by simple economics.
There's widespread agreement that the roughly 2,944 living victims of state-sponsored sterilization should be given money or other types of assistance, but it remains to be determined whether the state's compensation will extend to family members or individuals sterilized by local health departments or private hospitals that were not part of the state program.