Legal segregation, racism, and the relative economic backwardness of Southern states, which resulted in smaller government revenues for social spending, largely spared African Americans the experience of compulsory eugenic sterilization in the pre-Second World War years. Segregation denied them access to most of the institutions where sterilization occurred and to the welfare programs that would have brought them into contact with the state. In the postwar period, this situation changed. During the 1950s and especially the 1960s, as the number of eugenic sterilizations of the mentally ill and handicapped decreased (but did not end), sterilization emerged from institutions and, in a new federal policy, targeted African Americans.

Four factors account for this shift. First, the legal basis for such sterilizations had been there for decades: since the early 1930s, for example, North Carolina authorized the sterilization of people outside institutions, which made it an exception in the United States. Second, Clarence Gamble’s bankroll helped Birthright, Inc. set up a network of birth control clinics throughout the South beginning in the 1930s. Third, the Civil Rights Act of 1964 established full rights of citizenship for African Americans. This entitlement included access to federal welfare programs, and, partly as a result of activist mobilization, African-American take-up rates for welfare rose. The result, in the 1950s and 1960s, was a perfect storm: large numbers of African Americans on welfare in some of the most conservative states, laws that made their sterilization legal, and social workers trained in a cultural context in which wealthy donors and foundations had propagated eugenic arguments for decades. Finally, the federal government allowed family planning funds, distributed from 1964, to be used for sterilization. Because of who implemented sterilization policy and how, the result was the coerced sterilization of African Americans across the United States.