North Carolina

Number of Victims

The total number of victims sterilized in North Carolina was over 7600 (Winston-Salem, “Lifting the Curtain on a Shameful Era”).  Of this number, females represented approx. 85% of those sterilized, while men only represented 15% (State Library, “Statistics,” p. 1).  By the later 1960s, the sterilization of men was virtually halted as women made up 99% of those sterilized (Sinderbrand, p. 1).  Blacks represent 39% of those sterilized overall.  But by the later 1960s, blacks made up 60% of those sterilized, even though they were only a quarter of the population (Sinderbrand, p. 1).  Of those sterilized up to 1963, 25% were considered mentally ill and 70% were mentally deficient.  In each of these categories, females account for over 75% of the sterilizations.  Of all the states, North Carolina ranked third in the United States for number of people sterilized.

Period during Which Sterilization Occurred

Sterilizations started in 1929 with the passage of the sterilization law and continued through 1973, when the last recorded sterilization is known to have occurred. 

Temporal Pattern of Sterilization

Picture of a graph of sterilization rates in North Carolina

After the passage of the sterilization law in 1929, sterilization law began at fairly slow rate.  It was not until about 1938 that sterilizations began to increase at a steady rate.  After WWII, sterilizations accelerated and peaked in the two years between 1950 and 1952, with 704 sterilizations (State Library, “Statistics”, p. 1).  This makes North Carolina unique, as its peak sterilizations occurred after WWII when most other states had ceased performing operations.  After 1960, the rate of sterilization began to slow and continued to decrease from a rate of about 250 a year in 1963 to 6 per year in 1973.  From 1950-1963 there were an average of about 300 sterilizations per year.  In the peak years (the 1950s) there were about 7 sterilizations for every 100,000 residents of the state per year.

Passage of Laws

The very first sterilization law was passed in 1919 but to our knowledge it was never used.  Many feared that the law was unconstitutional and therefore the state feared putting it into practice (Paul, p.420).  But then in 1929, The North Carolina General Assembly passed its true sterilization law stating, “the governing body or responsible head of any penal or charitable institution supported wholly or in part by the State of North Carolina, or any sub-division thereof, is hereby authorized and directed to have the necessary operation for asexualization or sterilization performed upon any mentally defective or feeble-minded inmate of patient thereof” (State Library, “History”, p. 1).  It also stated that the operation had to be in the best interest of the mental, moral or physical improvement of the individual, or for the public good.  In 1933, North Carolina enacted the sterilization law that remained for the rest of the eugenics movement there.  This law “provided for notice, hearing, and the right to appeal” (Paul, p. 421).  The passage of this law also created the North Carolina Eugenics Board, which will be discussed in a later section.  The passage of the 1929 sterilization law made North Carolina the 17th state out off 33 to pass one.  This law remained effective until 1973, when the last recorded sterilizations were performed (State Library, “History,” p. 1).  Finally, on April 4, 2003, the North Carolina Senate voted unanimously to overturn the 74-year-old eugenics law (“Bill to Overturn Eugenics Law Passes State Senate,” p. 1). 

Groups Identified by the Law

As stated in the original sterilization law of 1929, the groups targeted for sterilization were identified as “mentally ill, mentally retarded, and epileptic” (Paul, p. 421).  However, the law also stated that the purpose of sterilization is to protect impaired people from parenthood who would become seriously handicapped if they were to assume parental responsibilities (Paul, p. 421).

Process of the Law

Under the sterilization law, the North Carolina General Assembly gave the governing body or executive head of any penal or charitable public institution the authority to order sterilization of any patient or inmate whose operation they considered would be in the best interest of the individual and of the public good.  It also gave the county boards of commissioners authority to order sterilization at the public’s expense of any “mentally defective or feeble-minded resident upon receiving a petition from the individual’s next of kin or legal guardian” (State Library, “History”, p. 1).  All the orders for sterilization had to be reviewed and approved by the commissioner of the Board of Charities and Public Welfare, the secretary of the State Board of Health, and the chief medical officers of any two state institutions for the feeble-minded or insane.  In the reviewing process, they looked at a medical and family history of the individual being ordered for sterilizations to help decide whether the operation would be performed or not.  They also considered whether it was “likely that the individual might produce children with mental or physical problems” (State Library, “History”, p. 1).


In 1933, under the new law, the General Assembly created the Eugenics Board of North Carolina to review all orders for sterilization of “mentally diseased, feeble-minded, or epileptic patients, inmates, or non-institutionalized individuals” (State Library, “History”, p. 1).  This centralized board included five members: the commissioner of the Board of Charities and Public Welfare, the secretary of the State Board of Health, the chief medical officer of a state institution for the feeble-minded or insane, the chief medical officer of the State Hospital at Raleigh, and the attorney general.  In the hearings of patients or inmates in a public institution, the head of that institution was the prosecutor in presenting the case to the Eugenics Board.  In hearings of individuals who were non-institutionalized, the county superintendent of welfare or another authorized county official acted as the prosecutor.  However, in both hearings, the prosecutor provided the board with a medical history signed by a physician familiar with the individual’s case. The petition for the hearing was sent to the individual being ordered or to their next of kin or legal guardian.  In the situation where this person could not represent or defend themselves at the hearing, the next of kin, guardian, or county solicitor stepped in to represent them.  If the board decided to order the sterilization, the order had to be signed by at least 3 members and then returned to the prosecutor.  This decision could be appealed by the individual to the county superior court and then further appealed to the state supreme court.  If the appeal was successful, any petitions for sterilization were prohibited for one year, unless the individual, or his or her guardian or next of know requested sterilization (State Library, “History”, p. 1). 

Precipitating Factors and Processes

Eugenics in the 1950s was largely a southern movement, as most other states were weaning off from sterilization.  Very little sterilization occurred in the 1930s in North Carolina (and in the other southern states) because the Great Depression resulted in funding crises that didn’t allow for sterilization to occur in full force in the south.  Therefore, sterilization picked up pace after WWII, especially during the mid-1950s (Castles, p. 1).


One factor leading to the acceleration after WWII was the race issue.   Race has always been a very loaded issue in the south, as slavery was prominent there.  When slavery was legal, white slave owners encouraged the reproduction of their slaves in order to create bodies to work and sell.  However, this changed in the 1950s when slavery was abolished and the civil rights movement was gaining speed.  By the 1950s, some white people were becoming anxious about supporting blacks through welfare.  The heads of the agencies of welfare departments agreed on the value of sterilization for reducing general welfare relief and ADC (Aid for Dependent Children) payments (Winston-Salem, “Wicked Silence”).  The state believed that blacks accounted for the majority of illegitimate births that were “subsidized” by ADC.  The state threatened to remove welfare benefits if they person did not submit to the operation.  The fears about the rising cost of the ADC program was the major factor in leading to the shift in racial composition of those targeted for sterilization.  As the attention shifted away from the structural causes of poverty and crime to placing the blame for urban poverty and social unrest on blacks, sterilization of blacks was easily facilitated (Schoen).  It became necessary to control the reproduction of ADC recipients, as a result, the percentage of blacks sterilized rose from 23% in the 1930s and 1940s to 59% between 1958-60 and finally to 64% between 1964 and 1966 (Schoen, p. 108).


Sterilization also accelerated because it expanded to include the general population when the state gave social workers the authority to submit petitions for sterilization.  Therefore, the amount of eligible people increased drastically.  “The North Carolina Board-which initially targeted those who were deemed mentally ill- expanded its program to include the general population.  In fact, “the majority of those sterilized had never been institutionalized, and 2,000 were younger than 19” (Wiggins, p. 1).  In addition, the fight against poverty in North Carolina led to sterilizations in the general population.  As this fight intensified, a new policy was created that led to an increase in the number of non-institutionalized people who were sterilized.  Sterilizations of the non-institutionalized rose from 23% between 1937 and 1951 to 76% between 1952 and 1966 (Schoen, p. 109). 

Groups Targeted and Victimized

Women, including wives, daughters, sisters and unwed mothers, were largely overrepresented.  They were labeled as either “promiscuous, lazy, or unfit” (Wiggins, p. 1), or more commonly, as “sexually uncontrollable” (Schoen, p. 110).  Overall, women made up 84.8% of sterilizations (State Library, “Statistics”, p. 1).  However, more interesting is that the sterilization of men virtually halted in the 1960s, with only 2 sterilizations in 1964, and 254 sterilizations of women (State Library, “Sterilizations”, p. 1).  Therefore, after 1960, women accounted for 99% of sterilizations (Sinderbrand, p. 1).  While many white women were sterilized, the state began to focus on sterilizing black women as they became the majority of the welfare population.  Black women were seen as highly uneducated, poor, and as having higher fertility rates than their white female counterparts.  As the amount of black women on welfare increased, “the public association between ADC and black female recipients was particularly close” (Schoen, p. 109).  Black women were presumed to have uncontrollable sexual behavior, and as these racial stereotypes were reinforced, black women became an even larger target for controlled reproduction through sterilization. 


Social class also played a role in who was targeted after WWII, as women on welfare, usually living in socially isolated places, were overrepresented.  The reason for this was to prevent “poor” and “unfit” women from reproducing children with mental or social ills (Wiggins, p. 1).  They were generally ordered for sterilization by social workers and lived outside of institutions.  The poor were not only targeted for their “social ills” but also because they were easier to sterilize.  They would often not be released until they or a family member agreed to have them sterilized (Wiggins, p. 1).


Finally, race also played a role in those targeted for sterilization.  During the Civil Rights Movement, petitions were sent to the state’s eugenics board for black women (Winston-Salem, “Wicked Silence”).  Overall, by the later 1960s, 60% of those sterilized were young, black women (Wiggins, p. 1).  Overall, blacks represent 38.9% of sterilizations.  This is because sterilizations of blacks were concentrated in a shorter period of time and because minorities only made up quarter of North Carolina’s population (State Library, “Statistics”, p. 1).  From the years 1960 to 1962, of the 467 sterilization ordered by the board, 284 (61%) were black (Winston-Salem, “Wicked Silence”).  In addition, blacks were targeted because the amount of welfare recipients who were black grew from 31% in 1950 to 48% in 1961 (Schoen, p. 109).  It was seen as necessary to sterilize those recipients of welfare to decrease the growing financial burden on the state. 


There are two stories that were made public by two black women who were sterilized against their will at a young age in North Carolina.  The first is Elaine Riddick, who had been sterilized at the age of 14 by a state order in North Carolina in 1968 after giving birth to a baby after being raped.  When she was operated on she was not informed that she was being sterilized.  She only discovered this years later when she was trying to get pregnant with her husband.  She was part of the lower class and the consent form had been signed by her illiterate grandmother and neglectful father.  She blames the sterilization for ending her marriage and is still affected by the surgery, saying, “I felt like I was nothing.  It’s like, the people that did this; they took my spirit away from me” (Sinderbrand, p. 1).


The second story is of Nial Cox Ramirez, who was sterilized at the age of 17 after several instances of pressure from social workers to get sterilized after becoming pregnant.  She eventually complied because they threatened to take her family off of welfare, but she was never informed of the consequences of the surgery.  She was assured she would be able to become pregnant again, but learned otherwise when she attempted to conceive years later.  Like Riddick, her marriage fell apart.  When she sued the state of North Carolina in 1967, it was dismissed as a technicality (Wiggins, p. 1).  These women were only 2 of those who fell under the categories of the groups targeted, and suffered as a result. 

Other Restrictions Placed on Those Identified in the Law or with Disabilities in General

There are no other known restrictions placed on those identified in the law. 

Major Proponents

Dr. William Allan was North Carolina’s initial promoter of negative eugenics.  He wrote his first study on eugenics in 1916 and by the end of his life he had written 93 papers.  He had his own private practice until 1941, when he started the medical genetics department at Bowman Gray.  He thought that hereditary diseases could be halted by prevention and based much of his work on field studies and surveys.  He pushed for a statewide bank of genetic information that would catalog peoples’ genetic backgrounds to see if they were prospective parents.  He continued to push for this until his death in 1943 (Winston-Salem, “Forsyth in the Forefront”).


Picture of Dr. C. Nash Herndon. (Photo origin: Winston Salem Journal,  Against Their Will,  available at  http://media.gatewaync.com/wsj/photos/specialreports/againsttheirwill/graphics/parttwo_herndonsmall.jpg)

Dr. C. Nash Herndon followed in the footsteps of Allan when he took over the department at Bowman Gray after his death.  He conducted surveys of those with disabilities in an effort to find links of hereditary diseases.  He was president of the American Eugenics Society from 1953-1955 and president of the Human Betterment League of North Carolina.  He was the greatest contributor in pushing the eugenics movement forward in North Carolina after WWII (Winston-Salem, “Forsyth in the Forefront”).


James G. Hanes was the founder of the Human Betterment League of North Carolina in 1947.  The league changed the face of eugenics in North Carolina by giving the board new legitimacy.  In 1957, the league had sent out more than 575,000 pieces of mail promoting the sterilization program and helped lead to the increasing number of sterilizations on blacks and women outside of institutions in the following years (Winston-Salem, “Selling a Solution”).


“Feeder Institutions” and institutions where sterilizations were performed

Picture of the Bowman Gray School of Medicine (Photo origin:  Winston Salem Journal,  Against Their Will,  available at http://media.gatewaync.com/wsj/photos/specialreports/againsttheirwill/graphics/parttwo_bowman.jpg)

The Bowman Gray School of Medicine housed a program for eugenic sterilizations starting in 1948.  It was aimed at the eugenic improvement of the population of Forsyth County.  It consisted of a systematic approach that would eliminate certain “genetically unfit strains from the local population” (Winston-Salem, “Forsyth in the Forefront”).   It expanded the program throughout North Carolina.  The school received much philanthropic support for research of genetic ideas.  Today, school officials condemn eugenic research, as the dean of the school, Dr. William B. Applegate, states “I think that the concepts and the practice of eugenics is wrong and unethical and would in no way be approved or condoned in modern medical times” (Winston-Salem, “Forsyth in the Forefront”).  The school is now part of the Wake Forest University Baptist Medical Center-one of the most respected academic medical centers in the country.  Although officials of the school condemn eugenics there is no mention of the program for eugenic sterilizations on the medical center’s website.


Pictrue of Caswell Training Center Buliding  (Photo origin: North Carolina Department of Health and Human Services, available at http://www.dhhs.state.nc.us/mhfacilities/images/Caswell-Center.jpg)

The Caswell Training School was founded in 1911 and was North Carolina’s only school for the mentally retarded until 1958.   It was built in Kinston, North Carolina after the people of Kinston offered free electricity and gas for the school if it located itself there (Noll, “Public Face,” p. 9).  Many local areas fought to have an institution built in their areas because the prospect of new jobs outweighed the negatives associated with the institutions. In 1912, superintendent Dr. Ira Hardy said the facility was not only designed to house the feeble-minded and decrease their threat, but also to train them for a productive life outside the institution (Noll, “Public Face,” p. 5).  However, he did not remain superintendent for long, as in 1914 Dr. C. Bank Nairy became the new superintendent.  He also spoke of control and helping patients, but in addition he focused the institution on “protecting” the patients.  Similar to other institutions, the sterilization of women became a focus and McNairy stated that the protection, care, and training of these “poor, unfortunate, fiends, yet irresponsible enemies of themselves, society, and the state” were the duty of Caswell Center (Noll, Feeble-Minded, p. 131).  The protection the institution offered came also in the form of segregation and sterilization. Caswell Center put many of its residents to work in the later years.  The center claimed a three-fold purpose to this work: first to train the child, second to keep him out of mischief, and third to conserve the amount of money that would be paid for help to carry on the work (Noll, Feeble-Minded, p. 132).  These “high-level” patients were utilized by the center as farm and maintenance workers to decrease the facility costs.  By 1935, 300 patients worked in the dining room and sewing rooms (females) and on the farm (males).  However, male residents were often released much earlier after sterilization than were their female counterparts.  From 1914-1919, 52.1% of men were discharged within three 3 years while only 31% of females were (Noll, Feeble-Minded, p. 132).  These numbers reflect the attitudes in the South towards sex roles and mental disabilities. Living conditions at the training school were subpar, as well as the amount of staff on hand.  In 1955 there were only 11 teachers and one psychologist for a resident population of 1800.  In the mid-1950s, the Caswell Training School sterilized about 50 people per year.  It drew its residents from the most impoverished and socially isolated sections of the white North Carolina population.  Admission to the institution was heavily class based, as low economic status went hand-in-hand with institutionalization (Noll, Feeble-Minded, p. 112).  The school is still open today and is now called the Caswell Developmental Center (Castles, pp. 1-3).  It offers residential services, care arrangements, and medical treatments to patients (Noll, “Public Face,” p. 5).  The center embraces its heritage with a museum and accessible archives, which is not common as many institutions remain ambivalent of their past (Noll, “Public Face,” p. 14).  The museum serves to show the facility’s role in mental health policy and the archives are there to help researchers and show how progress has been made in the treatment of mentally retarded persons.  However, the fact that the Caswell training school played a central role in North Carolina’s sterilization program receives limited recognition (Noll, “Public Face,” p.16).  The Caswell Training School’s website does not mention the sterilizations that occurred there in the past.


The Stonewall Jackson Training School was founded in 1907 and was North Carolina’s first juvenile detention facility.  This was mostly a school for boys, but a few girls were sterilized there over its history, all of whom were labeled as “mentally retarded”.  The boys who were sent there had only “minor scrapes” with authorities, not for mental illness.  In 1948, seven boys out of 300 were targeted for sterilization because they were ready for discharge.  These boys were deemed “feebleminded” as a justification for the operation.  These were the only boys sterilized at this school (Winston-Salem, DETOUR: In ’48 State Singled out Delinquent Boys).  The building still exists but does not remain in operation today.  There is no commemoration at the sight or mention of the past.


The Goldsboro Training School, also known as the O’Berry Center, it opened in 1957 as the first institution for black mentally retarded citizens.  It had 150 clients were transferred to it from Cherry Hospital, at which point the treatment of the patients was limited to academics and vocational training.  It is still operating today with approximately 430 clients, but it is no longer limited to blacks (Castles, pp. 12-14).  The center’s website refers to the institution's history of dealing with Black mentally retarded citizens.


Blacks were opposed to sterilizations one two levels: those who knew about its racial bias and those who didn’t.  The sterilization program was only whispered about in the black communities, and any evidence that race played a part in those who were sterilized wasn’t made public or scrutinized.  Therefore, the eugenics board was allowed to proceed with few hurdles (Winston-Salem).  Those blacks knew about the racial bias involved with sterilization tried to push for their rights.  In 1959, State Senator Jolly introduced a bill that would authorize the sterilization of an unmarried woman who gave birth for the third time.  This bill was contested by group of blacks.  However, the senator's response was "You should be concerned about this bill.  One out of four of your race in illegitimate".  Blacks that demanded to be heard were ruled out of order by the white-controlled legislature (Winston-Salem, "Wicked Silence"). 


Many college students were also in opposition to the sterilizations.  In 1960, students from N.C. A&T State University began sit-in movement against states progressive attitude or race relations.  However, this gained little speed or recognition by the state to make any changes.  Also, at Shaw University in Raleigh from 1968 to 1972, student activists tried to educate blacks about the issues and threats of sterilization.  However, they lacked detail of the issues, and therefore this gained little momentum as well (Winston-Salem, “Wicked Silence”).


Today, North Carolina is trying to amend for its past, making it one of the only states to do so thus far.  In April 2003, the sterilization law was unanimously voted to be overturned by the North Carolina Senate.  A few weeks later, a law was then signed by Governor Easley to officially put an end to forced sterilizations in North Carolina.  Soon after, on April 17, 2003, Easley issued a public apology, stating, “To the victims and families of this regrettable episode in North Carolina's past, I extend my sincere apologies and want to assure them that we will not forget what they have endured" ("Easley Signs Law Ending State’s Eugenics Era," p. 1).  Then, in December 2005, the National Black Caucus of State Legislators passed resolution calling for federal and state programs to identify victims nationwide and get them health care and counseling (Sinderbrand, p. 1).  However, these current efforts to find sterilized victims are difficult due to budget constraints and high costs of a publicity campaign.  Therefore, efforts to find victims through "free media" is being employed, such as posting info on bulletins, offices, health departments, libraries, schools, billboards, and city buses etc. (Sinderbrand, p. 1).


Castles, Katherine. 2002. "Quiet Eugenics: Sterilization in North Carolina's Institutions for the Mentally Retarded, 1945-1965." Journal of Southern History 68: 849-78.


Noll, Steven. 2005. “The Public Face of Southern Institutions for the ‘Feeble-Minded.’” The Public Historian 27, 2: 25-42.

Noll, Steven.  1995.  Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900-1940.  Chapel Hill: University of North Carolina Press.


Paul, Julius. 1965. “Three Generations of Imbeciles are Enough: State Eugenic Sterilization Laws in American Thought and Practice.” Washington, D.C.: Walter Reed Army Institute of Research.


Reynolds, Dave. 2003a. "Bill To Overturn Eugenics Law Passes State Senate." Inclusion Daily Express: International Disability Rights News Services (April 4).


Reynolds, Dave. 2003b. "Easley Signs Law Ending State’s Eugenics Era." Inclusion Daily Express: International Disability Rights News Services (April 17).


Schoen, Johanna. 2005. Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare. Chapel Hill: University of North Carolina Press.


Sinderbrand, Rebecca. 2005. "A Shameful Little Secret." Newsweek 33 (March 28).


State Library of North Carolina. "Eugenics in North Carolina." Available at < http://statelibrary.dcr.state.nc.us/dimp/digital/eugenics/index.html. >


Wiggins, Lori. 2005. “North Carolina Regrets Sterilization Program.” Crisis 112, 3: 10.


Winston-Salem Journal. Against Their Will. Available at <http://againsttheirwill.journalnow.com/>.