Over the course of several years, two women's prisons in California signed at least 150 pregnant women up for permanent sterilization to be performed after they gave birth, without following the required state approval procedure. And now, some women who underwent the procedure say they felt coerced into having a tubal ligation while incarcerated, according to a report from the Center for Investigative Reporting

Forced sterilization of institutionalized human beings — those in mental institutions, or in prisons, for example —  has a long and greusome history in the U.S., and in California in particular, where forced sterilization has been against the law since 1979. Because of this history, there are a number of laws in place to prevent institutions from performing the procedure without full, freely-given consent. It's against the law to pressure a female inmate to have the procedure during labor or childbirth, which just seems obvious. And you can't use federal funding to pay for the procedure in a prison, because of worries that the funding would make inmates feel like they had to do it. And in California, where state money can fund inmate sterilization procedures, each individual procedure must be approved by a medical review committee. In California's California Institution for Women in Corona or Valley State Prison for Women in Chowchilla (the latter is now a men's prison), that approval process wasn't happening between 2006 and 2010, and possibly for many years before that. 

According to CIR's report, some of the doctors performing the procedures — sometimes for inmates deemed likely to be repeat offenders, or those with many children — argued that they were doing so only in the event of a "medical emergency," a designation that would also allow them to bypass the review process. Others seemed unaware that there were restrictions on the procedures at all. One doctor, Dr. James Heinrich, who used to work at Valley State, defended the procedure as cost efficient: 

The 69-year-old Bay Area physician denied pressuring anyone and expressed surprise that local contract doctors had charged for the surgeries. He described the $147,460 total as minimal.  

“Over a 10-year period, that isn’t a huge amount of money,” Heinrich said, “compared to what you save in welfare paying for these unwanted children – as they procreated more.”

Of course, the inmates tell different stories: 

“As soon as he found out that I had five kids, he suggested that I look into getting it done. The closer I got to my due date, the more he talked about it,” said Christina Cordero, 34, who spent two years in prison for auto theft. “He made me feel like a bad mother if I didn’t do it.”

Cordero, released in 2008 and now living in Upland, Calif., agreed, but she says, “today, I wish I would have never had it done.” 

Some inmates interviewed for the piece were happy to have the procedure done, but noted that they weren't informed of the medical reasoning for having it — nor were they given alternate recommendations of less permanent equivalents, like a removable IUD. Those who refused the tubal ligation were not forced into undergoing the procedure, although one former inmate says that she was pressured to agree to a tubal ligation while strapped down and sedated in preparation for a C-section, in violation of the law. Medical care in the California prison system has been under the oversight of a receiver since 2006, when a judge ruled that the conditions amounted to cruel and unusual punishment. This latest news adds weight to the argument that all is not well there, still. The whole story is worth a read over at CIR