A history of reproductive surgery reveals institutionalized violence against racialized women

On Thursday, November 21, 2024, the UCLA Latin American Institute hosted a book presentation with Elizabeth O’Brien, a history professor at UCLA who recently published her new book Surgery & Salvation: The Roots of Reproductive Injustice in Mexico, 1770-1940 (UNC Press, 2023). The discussion was sponsored by the Center for Mexican Studies, the Latin American Institute, Department of History and was moderated exceptionally by Fernando Pérez-Montesinos.

 

The book examines the history of reproductive surgery in Mexico, from the end of the Spanish empire through the post-revolutionary 1940s. In doing so, the book creates the picture that modern opinions of reproductive healthcare and abortion are rooted in the surgical force against racialized women of the world. O’Brien traces the influence of religion, obstetric racism and notions of modernity on medical ideas about reproduction operations and eugenic sterilization. This account of history illuminates the theological, patriarchal and epistemological roots of violence against marginalized women today.

 

Approaching Election Day in 2024, many people in the U.S. worried about what another Trump term could mean for reproductive rights across the country. As a young woman living in California, I’ve had the privilege of taking my health and my choice of reproductive operations for granted. Though this isn’t my first time learning about reproductive injustice either, the biggest lesson O’Brien taught me was to restructure my mind to view the current debate between “pro-choice” and “pro-life” through a history of forced surgical interventions– a global movement of violence against women. 

 

The mid-19th century marked a global shift in medicine, and Mexican physicians were ahead in this innovation. Mexican doctors were on the forefront of surgical practices. This is exciting, yes, but we must not overlook the unethical practices of health institutions. In fact, medical doctors and students used public, beneficial care patients to experiment with medical technology for abortions. They would later offer this to patients who were able to pay for the procedure. 

 

Towards the end of the century, the eugenics theory was becoming more popular among intellectuals and completely shaped who fell victim to scientific racism in reproductive healthcare. People who could get pregnant were vulnerable to being categorized as a “problem to be solved,” instead of someone in need of healthcare. Thus giving rise to “salvational surgery” (the belief that medical interventions could redeem women, children and the nation), illustrative of the struggle between church and state. 

 

Between 1840-1870s, religious women who were trained for hospital care had the most power in healthcare facilities, such as Sisters for Charity, a liberal national modernization project at the time. The regime of President Porfirio Díaz (1877-1880) replaced the rule of the Church, so arguments for reproductive procedures were deeply religious, though anti-Catholic in nature, for the sake of surgical progress. 

 

There is a long history of this. Beginning in the 18th century, cesarean sections (c-sections) were only performed by priests to baptize the souls of unborn children. This form of abortion, which often resulted in the death of the mother, was justified with baptisms; the potential life of an unborn child’s soul took priority over living women. 

 

In the second half of the 19th century, Indigenous women still had little to no say in their health yet were subjected to predestined certain reproductive outcomes because of their social status. Additionally, the rise of a more modern medical class displaced nuns and traditional medicinal practices from hospital care in order to make way for their new “knowledge” of women’s bodies. Racialized Indigenous and mixed women in Mexico were stigmatized for the sake of male doctors’ justification of experimentation as medical progress.

 

This included the introduction of another surgical operation, following an emerging thought of hormones, in which surgeons began removing women’s ovaries when they were considered hysterical. Even though ending pregnancies was an established procedure, in 1869, the Catholic Church of Mexico decided that embryos were considered babies, therefore making abortion a crime. 

 

Contrary to what I can only assume the Catholic Church hoped would happen, the need for abortions did not cease to exist. Doctors simply did not talk about it in public in order to protect themselves and their studies. In private, women were still receiving medical herbs and speaking to their midwives or doctors in their home about ending pregnancies. To get away with performing an abortion, doctors called women hysterical in order for the church to allow for the abortion. Since the unwanted pregnancy was making them hysterical, the doctor had an obligation to remove it. 

 

However, under this notion, abortions were used to blame women for their own suffering (their “hysteria”) and were not actually procedures intended to help them or considered part of their right to healthcare. Of course, this also meant those who were able to receive an abortion were wealthy individuals who could afford to pay for a doctor in private. Reproductive surgery remained a method of exercising violence against poor, Indigenous and mixed women.

 

In 1907, the General Hospital was established in Mexico, giving the country the capacity to redeem the nation by assimilating Indigenous groups to “modern medicine.” The hospital would keep women behind barred windows, a phenomenon of that time that was also common in Europe, and force them to work to pay for their stay. Others were allowed to stay for free– only if they allowed doctors to perform procedures on them.

 

President Díaz (1884-1911) was enthusiastic about a science state; he wanted Mexico to develop an excellent public health and medical training system. While his dictatorship led to several advancements in technology across the state, the subjugation of Indigenous women as a result of his ambitions was immoral. 

 

A forced sterilization project, under his regime, collected women’s bodies for comparison in order to justify sterilization procedures for Indigenous women. The remains of Indigenous women who died in reproductive healthcare were collected and their pelvic bones were used for comparative anthropometry: “Mexican doctors always experiment with sterilization techniques on Indigenous women with small pelvises first. Following these preliminary experimentations, we then begin to use new surgical techniques on other women, as well” (Genaro Ramírez Elliot, 1932). Beliefs of maternal worth and fetal soul could only be reinforced by these surgical procedures that consisted of opening the body and seeing within. From these comparisons the doctors developed a theory of biological inferiority. They claimed, as evident by their shorter height compared to lighter skinned women, Indigenous women could not give birth without surgical intervention.

 

Scientific racism was disguised by salvation rhetoric, and these doctors were considered saviors. This “problem” revealed a scale of human worth that rendered Indigenous people worthless; it was believed that allowing them to reproduce threatened the worth of the nation. As “salvational surgery,” medical science continued to target Indigenous women into the 1940s under the guise that they were saving women from inflicting damage onto the greater body of Mexico. 

 

According to records unavailable outside Mexico’s Secretary of Health Archive, several thousand women racialized as Indigenous or mixed were sterilized; evidence suggested that at least some of those did not give consent to the procedure. In fact, Indigenous and mixed women were periodically kidnapped in order to conduct these surgical operations, justified by doctors pretending to be saviors. 

 

Forced reproductive surgeries is not a thing of the past. According to El Instituto Nacional de Salud Pública, between 2011-2016, about 33.4% of Mexican individuals with the ability to give birth (15-49 years old) experienced obstetric violence. A public report from the National Commission to Prevent and Eradicate Violence Against Women expanded on the previous study to reveal that at least 27% of Indigenous women in contact with public health services were sterilized without their consent. In 2014, 4 of every 5 Indigenous Mexican women were victims of this violence. 

 

Reproductive scholars have found that forced childbearing is similar to forced sterilization, for it implies that individuals should not be able to exercise their own reproductive rights. Forced pregnancies and forced sterilization alike have never been about women’s right to reproductive healthcare but rather the gene pool that doctors, intellectuals and politicians prefer most. 

 

In discussing Mexico, we must remember that this only represents a larger, global era of medical injustice. It is also not a simple story of a few “bad” medical doctors or individuals to be blamed for the violence; it is institutional violence, embedded in a public structure that guaranteed thousands of women would experience unnecessary violence.

 

I cannot reiterate the extent to which the United States is not exempt from this history. The institution of slavery, from the very beginning of U.S. history, was the emergence of forced childbearing. Black women did not have the legal right to consent. They were branded as hypersexual tempresses, who were always consenting, in order to justify the actions of rapists (often white slave owners). 

 

Furthermore, J. Marion Sims, considered the “father of gynecology,” performed repeated experimental reproductive surgeries on enslaved Black women without using anesthesia. Sims performed at least 30 experimental fistula surgeries on Anarcha, Betsey and Lucy among other enslaved women, which he justified with pseudoscience; it was falsely asserted that Black people had thicker skin than Whites and experienced less pain. 

 

In the 1927 case Buck v. Bell, the US Supreme Court decided, 8 to 1, to uphold a state’s right to forcibly sterilize a person considered unfit to procreate. The case centered around Carrie Buck, a young victim of sexual assault who was deemed “feebleminded” in Virginia court (reministent of claims of ‘hysteria’ in Mexico). As a result, as many as 70,000 Americans were forcibly sterilized. These women were often labeled as “mentally deficient,” promiscuous, or were either disabled, poor and minorities. 

 

Historically, white American men in positions of leadership have used their power to control the bodily autonomy and reproductive rights of Black and Brown women in a cluster of attacks on reproductive freedom.

 

It is a living history of violence against women. 

 

According to the CDC, Black mothers in the U.S. die from pregnancy or childbirth-related causes at almost three times the rate of white mothers. All three pillars of reproductive autonomy (fundamental civil rights to abortion, procreation and parenting) were simultaneously attacked during Trump’s first term in office— especially in regards to the coerced sterilization in ICE detention centers. Not only did the Trump Administration’s “zero tolerance” policy forcibly separate migrant families, but the appointment of Former Office of Refugee Resettlement Director Scott Lloyd blocked migrants from accessing abortion or reproductive healthcare, even teen migrants whose pregnancies were the result of rape.

No doctors, especially in the United States, are working within a system with an emphasis on moral alliance. They are working within a system with a goal of funding itself and growing its knowledge to support its existence and improve the prestige of the nation. The deaths of thousands of women and the forced removal of individuals’ reproductive organs is the outcome of this kind of system that has politicized reproductive bodies for their political projects. 

 

In entering a second Trump Administration— led by a sorry-excuse-for-a-human who is steering the miseducated and the indoctrinated away from the pursuit of our nation’s democratic ideals— our freedoms, liberties and way of life are under threat. I urge you all to not solely bear witness to the attempted erasure of progress but to urgently build strength within yourselves and between each other as a collective.