Tragedy, Not Treatment: The Legal History of America’s Reproductive Injustice

April 29, 2026

Written by: Symphony Devine

Edited by: Sophia Jackson and Rafaela Drake

Abstract:

This article examines the current inequalities and the anti-Black historical grounding of the United States’ reproductive healthcare system, as well as detailing the acquiescence of these inequalities against Black women by the United States Judiciary and Healthcare systems. It first provides a biopic detailing the racially explicit history of J. Marion Sims’ modern gynecology, and then examines further Supreme Court rulings, historical lawsuits, and healthcare phenomena such as Buck v. Bell (1927), Skinner v. Oklahoma (1942), Relf v. Weinberger (1974), and the “Mississippi Appendectomy”. This article seeks to emphasize the historical and legal foundations for the current system that produces intense disproportionalities within cancer diagnosis and survival rates and hysterectomy procedures. Analyzing the “Black Maternal Health Momnibus Act,” reintroduced in March of 2026, provides a review of a legislative solution to the discriminatory reality Black women face in reproductive spaces.

Article:

The United States judiciary and healthcare system have a long, continuous history of failing to protect against the mistreatment of Black women in reproductive care. To fully conceptualize the magnitude of said injustice in the current reproductive healthcare infrastructure, it is imperative to analyze the history of the system. J. Marion Sims is known to many as “the father of modern gynecology.” Sims developed his surgical techniques, including several still used to date, by operating on a group of enslaved African women who had developed fistulas (an unusual opening developed between the vaginal wall and a nearby organ) after childbirth [1]. These procedures spanned from 1846 to 1849 [2] and were performed with no administered anesthesia due to the largely held belief that Black women were incapable of experiencing pain to the degree that White women could [3]. Studies published in the Proceedings of the National Academies of Science show that nearly half of White medical professionals were taught and, as of 2016, continue to endorse this mindset [4]. The first subject to undergo Sims’ brutal experimental treatments was an enslaved woman named Lucy; her story is critical to the history of modern gynecology. She signifies the beginning of non-consensual procedures endured by Black women as the foundation for a line of healthcare that they still fail to benefit from at the same level as their White counterparts. Ultimately, Sims’ procedures on Lucy were vastly unsuccessful and left her in extreme agony and with life-threatening blood poisoning. Despite Lucy's condition, Sims continued to perform procedures on this group of enslaved women, oftentimes drugging them so they were not able to resist his treatments [5].

This history is not limited to application and procedural practices; the nature of unfair treatment in reproductive health has been reinforced by jurisdiction. In 1927, Carrie Buck, a “feeble-minded” woman in the state of Virginia, was committed to a mental institution. Under state law, the forced sterilization of inmates was allowed to promote the "welfare of society” and preserve the “health of the patient” as long as there was approval given through a hearing. After having to undergo the aforementioned sterilization, Carrie Buck’s case was seen by the United States Supreme Court to answer the question: Did the Virginia statute violate the Due Process and Equal Protection Clauses of the 14th Amendment? The Court ultimately found that this Virginia Eugenics law did not violate the Due Process Clause, deciding that sterilization was justified in cases where individuals were seen as “unfit” and carried genetically unfavorable traits, such as Buck’s “feeblemindedness.” Justice Holmes, an associate justice of the court, commented that his decision was made to protect the future of the American nation because “three generations of imbeciles are enough” [6].

To date, the 1927 decision has never been formally overturned. Nevertheless, in the 1942 case Skinner v. Oklahoma, the Supreme Court held, in a unanimous decision, that Oklahoma’s Criminal Sterilization Act of 1935 violated the Due Process Clause of the 14th Amendment [7]. Under the Criminal Sterilization Act, an individual who had been convicted of three or more crimes was subject to sterilization. However, certain crimes, such as embezzlement, were exempt from the constraints of this law. The decision did not rule forced sterilization as an unconstitutional practice; it directly condemned the Oklahoma law for treating specific groups of criminals differently. This reasoning left major legal loopholes available for racially discriminatory eugenics. Although Carrie Buck was not a Black woman, her case, in conjunction with the uncovered ground in Skinner v. Oklahoma, was used to justify the forced sterilizations of Black women for decades to come. A 2025 amicus brief submitted to the Supreme Court directly cites Buck v. Bell as the case that upheld compulsory sterilization in the decades following its passing [8]. In North Carolina, a state that passed sterilization statutes similar to those of Virginia’s, Black women were sterilized at more than three times the rate of their White female counterparts and more than twelve times the rate of White men between 1950 and 1966 [9]. Relf v. Weinberger, a 1974 federal lawsuit, revealed that 100-150,000 “poor people” were being forcibly sterilized through programs that received federal funding, including the 12 and 14-year-old African- American Relf sisters [10]. Secondary historical analysis has found that around half of the 100-150,000 were Black individuals [11].

Another prevalent example of this practice of forced sterilization during the eugenics movement was a phenomenon named the “Mississippi appendectomy,” where many Black women were sterilized via a procedure known as a hysterectomy, which entails a full removal of a patient's uterus. An additional process of sterilization they endured is known as “tubal ligation” or having one's tubes tied, which is a surgical closure of the fallopian tubes to prevent the fertilization of an egg. In the majority of cases, the women who underwent this “appendectomy” were admitted for various surgical needs and unnecessarily sterilized without their consent or even knowledge that the procedure was being enacted. One of the most famous cases was activist Fannie Lou Hamer, who underwent surgery to remove a tumor and was unfortunately a victim of this non-consensual sterilization. This experience eventually caused her to become a civil rights activist and speak on the disparities of the Black female experience, and it was she who later coined the term “Mississippi appendectomy” [12].

Though not under the umbrella of the eugenics movement, this racially explicit background of reproductive health in America is still extremely present when analyzing the care that Black women receive. The National Health Institute names disparities in “healthcare system access and experience” as a contributing factor to the fact that Black women in the United States are 2-3 times more likely to be recommended and undergo the aforementioned hysterectomy procedure than White women, despite other solutions to their conditions oftentimes being available [13]. These racial discrepancies also present themselves in other facets of reproductive health, largely in reproductive cancers. The Center for Disease Control cited 2023 cancer data from the Office of Federal Cancer Statistics. According to these statistics, Black women have a disproportionate likelihood of mortality from female breast cancer, even though they are less likely than their white counterparts to develop breast cancer. The rate of female breast cancer reported in White women living in New York City was 149.5 per 100,000 people, compared to 136 per 100,000 people for Black female diagnoses. However, this difference does not translate to mortality rates, where Black women have a 22.5 per 100,000 person rate of death compared to the shocking 15.5 of White females. Additionally, across the United States, Black women were diagnosed considerably later, lowering the chances of recovery [14].

Specifically in the gynecological field of obstetrics, Black female maternal mortality rates are three times higher than those of White women, with eighty percent of overall pregnancy-related deaths being preventable based on 2024 data posted by the CDC [15]. Serena Williams, one of the most legendary and decorated athletes of our time, has used her platform to speak on these maternal disparities following her own postnatal experience in 2017. Following the birth of her firstborn daughter, Williams reported trouble breathing. She immediately concluded she was having a pulmonary embolism – a condition where a blood clot becomes stuck in an artery, blocking blood flow to the lungs – because of her prior susceptibility to such clots. However, when she requested imaging and blood thinners from her provider, she was dismissed, asserting that the pain medication might be deluding Williams’ disposition. Doctors partially complied, doing an ultrasound of her legs as opposed to chest imaging. When a CT scan was finally performed, due to her persistence, several blood clots were found [16]. Williams’ experience demonstrates that notoriety, unfortunately, can not even fight back against the inequalities of being a Black woman in America.

The culmination of these components poses the question: How are Black Women supposed to feel safe amidst healthcare systems that have not made necessary attempts to correct racist history and disparities in treatment? The Black Maternal Health Momnibus Act is a comprehensive package of bills proposed by the Black Maternal Health Caucus. They were introduced in the 118th Congress in 2023 by Representative Lauren Underwood of Illinois, Representative Alma Adams of North Carolina, and Senator Cory Booker of New Jersey. With over 200 million dollars in funding it has accumulated, the act aims to: invest in federal programs to address and spread awareness of maternal and infant health risks, promote maternal vaccinations, make investments in the social determinants of health that influence maternal health disparities, and improve data collection processes to better understand the causes of the maternal health crisis. The bills have been formally endorsed by the Planned Parenthood Federation of America, the NAACP, the National Medical Association, and more than 250 other foundations [17]. However, because the act was not adopted, it expired at the end of the 118th Congressional session [18]. As of March 2026, the act has been reintroduced in the Senate as a part of a bicameral effort led by New Jersey Senator Corey Booker [19]. Advocacy from constituents and public awareness of the act can compel Congress to cosponsor and prioritize this bill as an important first step of the United States legislative system to truly protect the health of its Black female citizens.

Endnotes

[1] Mayo Clinic, “Vaginal Fistulas: Symptoms and Causes,” February 23, 2024.

[2] L. Lewis Wall, “The Controversial Dr. J. Marion Sims (1813–1883),” International Urogynecology Journal 31, no. 7 (July 2020 2020): 1299.

[3] “Anarcha, Betsy, and Lucy,” Women & the American Story, New-York Historical Society.

[4] Janice A. Sabin, “How We Fail Black Patients in Pain,” American Association of Medical Colleges News, January 6, 2020.

[5] Equal Justice Initiative, “Medical Exploitation of Black Women,” August 29, 2019.

[6] Buck v. Bell, 274 U.S. 200 (1927).

[7] Skinner v. Oklahoma, 316 U.S. 535 (1942).

[8] Autumn Katz, Pilar Herrero, Amy Myrick, and Nikita Mhatre, “Brief of Amici Curiae Organizations Advancing Reproductive Rights, Health, and Justice in Support of Respondents,” Medina v. Planned Parenthood South Atlantic, No. 23-1275 (U.S. 2025).

[9] Alexandra Minna Stern, “Forced Sterilization Policies in the US Targeted Minorities and Those with Disabilities–and Lasted into the 21st Century,” Biopolitical Times, Center for Genetics and Society, September 9, 2020.

[10] Alexandra Minna Stern, “Forced Sterilization Policies in the US Targeted Minorities and Those with Disabilities–and Lasted into the 21st Century,” 2020.

[11] Dien Ho, “Narrating the Black Body in Under the Skin,” Cambridge University Press, 2022.

[12] Jack Lasky, “Mississippi Appendectomy,” Research Starters: Women's Studies and Feminism, Elton B. Stephens Company, 2023.

[13] National Institutes of Health, "Centers for Research on Health Disparities in Uterine Fibroids," Advisory Council Report on Uterine Fibroids, September 16, 2022.

[14] Centers for Disease Control and Prevention, “Cancer and African American People,” February 13, 2025, https://www.cdc.gov/cancer/health-equity/african-american.html.

[15] Centers for Disease Control and Prevention, “Working Together to Reduce Black Maternal Mortality,” April 8, 2024.

[16] Maya Salam, “For Serena Williams, Childbirth Was a Harrowing Ordeal. She’s Not Alone,” New York Times, January 11, 2018.

[17] Office of Representative Lauren Underwood, “Underwood, Adams, Booker Reintroduce Momnibus Bills to End America's Maternal Health Crisis,” March 18, 2026.

[18] U.S. Congress, H.R. 3305, 118th Cong. (2023).

[19] Office of Representative Lauren Underwood, “Underwood, Adams, Booker Reintroduce Momnibus Bills to End America's Maternal Health Crisis,” 2026.

Works Cited

Buck v. Bell, 274 U.S. 200 (1927).

Centers for Disease Control and Prevention. "Cancer and African American People." February 13, 2025. https://www.cdc.gov/cancer/health-equity/african-american.html.

Centers for Disease Control and Prevention. "Working Together to Reduce Black Maternal Mortality." April 8, 2024. https://www.cdc.gov/womens-health/features/maternal-mortality.html.

Equal Justice Initiative. “History of Racial Injustice: Medical Exploitation of Black Women.” August 29, 2019. https://eji.org/news/history-racial-injustice-medical-exploitation-of-black-women/.

Ho, Dien. “Narrating the Black Body in Under the Skin.” Cambridge University Press, 2022.

Katz, Autumn, Pilar Herrero, Amy Myrick, and Nikita Mhatre. “Brief of Amici Curiae Organizations Advancing Reproductive Rights, Health, and Justice in Support of Respondents.” Medina v. Planned Parenthood South Atlantic, No. 23-1275 (U.S. 2025). https://www.supremecourt.gov/DocketPDF/23/23-1275/351933/20250312143110486_23-1275%20Amicus%20Brief.pdf

Mayo Clinic. “Vaginal Fistulas: Symptoms and Causes.” February 23, 2024. https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/symptoms-causes/syc-20355762

National Institute of Child Health and Human Development. “Centers for Research on Health Disparities in Uterine Fibroids. ” Advisory Council Report on Uterine Fibroids. September 16, 2022. https://www.nichd.nih.gov/about/advisory/council/archive/202210/uterine-fibroids-GHD

Office of Representative Lauren Underwood. "Underwood, Adams, Booker Reintroduce Momnibus Bills to End America's Maternal Health Crisis." Press release, March 18, 2026. https://underwood.house.gov/media/press-releases/underwood-adams-booker-reintroduce-momnibus-bills-end-americas-maternal-health

Sabin, Janice A. “How We Fail Black Patients in Pain.” American Association of Medical Colleges News. January 6, 2020. https://www.aamc.org/news/how-we-fail-black-patients-pain

Salam, Maya. “For Serena Williams, Childbirth Was a Harrowing Ordeal. She’s Not Alone.” New York Times, January 11, 2018. https://www.nytimes.com/2018/01/11/sports/tennis/serena-williams-baby-vogue.html

Skinner v. Oklahoma, 316 U.S. 535 (1942).

Stern, Alexandra Minna. "Forced Sterilization Policies in the US Targeted Minorities and Those with Disabilities–and Lasted into the 21st Century." Biopolitical Times. Center for Genetics and Society, September 9, 2020. https://www.geneticsandsociety.org/biopolitical-times/forced-sterilization-policies-us-targeted-minorities-and-those-disabilities-and.

U.S. Congress. H.R. 3305, 118th Cong. (2023). https://www.congress.gov/bill/118th-congress/house-bill/3305.

Wall, L. Lewis. "The Controversial Dr. J. Marion Sims (1813–1883)." International Urogynecology Journal 31, no. 7 (July 2020): 1299–1303.

Women & the American Story. “Anarcha, Betsy, and Lucy.” New-York Historical Society. https://wams.nyhistory.org/a-nation-divided/antebellum/anarcha-betsy-lucy/