The practice known as a mississippi appendectomy” is best described by which of the following?

She paid a price, however, with police beatings that left her permanently disabled. She lost a daughter because no hospital in Mississippi would treat a child of Fannie Lou Hamer. The Ku Klux Klan shot into a friend’s house 16 times while Hamer was staying there. Despite this, Hamer remained.

“Why should I leave Ruleville and why should I leave Mississippi?” she once asked a journalist. “You don’t run away from problems. You just face them.”

Hamer was born in 1917, the youngest of 20 children, and spent her life as a sharecropper with little formal education, though she loved to read. When she was twenty-seven, she married Perry “Pap” Hamer. They tried for a family, but Hamer had several miscarriages, so they adopted two girls. In 1961, a white doctor gave Hamer a hysterectomy without her consent while she was undergoing surgery to remove a uterine tumor. The practice was so commonly performed on poor Black women that it was nicknamed a “Mississippi appendectomy.”

In the summer of 1962, Hamer attended a meeting led by the Student Nonviolent Coordinating Committee and the Southern Christian Leadership Conference.

“I had never heard, until 1962, that Black people could register and vote,” she said. She was forty-five. The next day, Hamer was on a bus with 17 other people headed to the county seat in Indianola to register. Only she and one other person were allowed to take the literacy test. They had to answer questions about the Mississippi constitution and de facto laws of the state.

“I knowed as much about a facto law as a horse knows about Christmas Day,” Hamer said later. Both she and the other test-taker failed, but Hamer said she would return until she passed. It was no small task. At that time in Mississippi, if you registered to vote, your name and address ran in the paper for two weeks so the Ku Klux Klan and other white supremacists could terrorize you if you were Black. On their way home from Indianola, Hamer and the others were stopped by police, who said their bus was the wrong color, and fined $100. When Hamer finally made it home, the plantation owner already knew about what she’d done and told Hamer that if she didn’t withdraw her registration, she’d have to leave.

“I didn’t go down there to register for you,” Hamer replied. “I went down to register for myself.” She was forced to leave.

“Mrs. Hamer came into the Baptist church and said she had been ordered off the plantation,” recalled former SNCC organizer Dora Churnet in the New York Times. “We sang freedom songs together. Somebody played the piano and Mrs. Hamer said in that strong, authoritative voice. She said, ‘They kicked me off the plantation, they set me free. It’s the best thing that could happen. Now I can work for my people.’”

Hamer spent the rest of her life doing just that. Eventually, she passed the literacy test and paid the poll tax so she could vote. She also worked to register others.

“I guess if I’d had any sense, I’d a been a little scared,” she said. “But what was the point of being scared? The only thing [the whites] could do was kill me, and it seemed like they’d been trying to do that a little bit at a time since I could remember.”

At the 1964 Democratic National Convention, Hamer rose to national prominence. She and other activists had started the Mississippi Freedom Democratic party. Because Blacks were denied the right to vote in Mississippi, the MFDP argued, the state’s Democratic delegates were not legally elected. The group presented a report showing Blacks were denied the vote. The Mississippi delegates should not be allowed to vote at the convention, the report stated, and the MFDP delegates should be seated instead.

Hamer told the convention not only about her experience trying to register in 1962, but also about a 1963 jailhouse beating. Hamer had been working with other activists to register Black voters. The group was unjustly arrested and Hamer was put in a jail, where two other prisoners were forced to take turns beating her. She suffered permanent kidney damage, a blood clot behind her eye, and a permanent limp.

“All of this is on account of we want to register to become first-class citizens. And if the Freedom Democratic party is not seated now, I question America,” Hamer said at the conclusion of her brief but powerful testimony. “Is this America, the land of the free and the home of the brave, where we have to sleep with our telephones off of the hook because our lives be threatened daily because we want to live as decent human beings, in America?”

Lyndon Johnson thought he’d lose the South if he seated the MFDP, so not only would he not seat them, he pre-empted Hamer’s testimony by calling a White House press conference at the very time she was supposed to speak. Hamer’s testimony was rebroadcast during prime-time news shows, giving it an even wider audience. Still the Democratic party said it would seat Mississippi’s original delegates, but it offered the MFDP two at-large seats—with the stipulation that the delegates would be selected by the national party, not the MFDP—and a promise not to seat delegates from discriminatory polls at future conventions. Hamer, who was the vice chair of the party, rejected the offer.

“We had played by the rules, done everything we were supposed to do,” recalled John Lewis, who helped with the effort and later became a U.S. House representative. “We had arrived at the doorstep and found the door slammed in our face.”

The convention proved Hamer was a powerful orator, and she traveled the country to raise awareness about civil rights. She also ran for the Mississippi House of Representatives, founded the National Women’s Political Caucus, and started the Freedom Farm Cooperative, a 640-acre farm that offered Blacks economic opportunity denied them through sharecropping.

The year after the Essence article, at the 1972 convention, the Democratic party seated the interracial delegation from Mississippi.

In 1977, Hamer passed away, and the crowd at her funeral included civil rights luminaries. Andrew Young, the United States ambassador to the United Nations, gave her eulogy, saying, according to the New York Times, that the seeds of social change in America “were sown here by the sweat and blood of you and Fannie Lou Hamer.” Then the mourners sang Hamer’s favorite song: “This little light of mine, I’m going to let it shine, let it shine, let it shine, let it shine.”

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In 1961, civil rights leader Fannie Lou Hamer received a hysterectomy by a white doctor without her consent while undergoing surgery to remove a uterine tumor. Forced sterilization of Black women was so widespread it was dubbed a “Mississippi appendectomy.” (Wikimedia Commons)

As Amy Coney Barrett’s Supreme Court nomination has stirred up conversations of what her confirmation could mean for reproductive rights, many women are raising their voices fearful of not being able to have control over their own reproductive health.

The collective heartache of our nation sustained a surprising and overwhelming insult this year. As we fight for our reproductive freedom, we must also advocate for those whose voices are frequently dismissed.

Last month, a whistleblower complaint that described women being coerced into having unnecessary surgeries, including hysterectomies, without their knowledge and consent at the Irwin County Detention Center in Georgia. This week, 19 more women have spoken out that they were subject to medical abuse while they were detained there.

As a physician, it is fundamental to ensure that any patient we care for consents for treatment especially if surgery is involved. These allegations are shocking but unfortunately, not surprising given the amount of human rights violations that have been occurring in the last few years.

The idea that an improved human race could be built by encouraging healthy and intelligent people to reproduce more frequently is the core of the idea of eugenics. While we commonly associate that term with the atrocities in Nazi Germany leading up to WWII, the birth of eugenics started in America. And there is no better time to discuss the history of coerced sterilization in the United States.

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For over 70 years, sterilization was used not only to control the population phenotype of America but to also control who was deemed fit enough to care for future generations. The science and implementation of these ideas are credited to a man named Charles Davenport.

Davenport applied basic principles of genetics known at the time and applied it to humans in an effort to prove his theory that undesirable traits such as criminality, poverty, promiscuity and feeble-mindedness were genetically inherited. If he could limit the reproduction of these “undesirable” traits by sterilizing those who exhibited them, he theorized, it would be a benefit for the economic and social strains that the country was experiencing in the early 1900s.

After securing financial support from several well known financial moguls of the decade including the Rockefeller and Carnegie families, Davenport successfully launched a campaign based on public health concerns to limit the reproduction of those with traits deemed undesirable. The first sterilization law was accepted in 1907 in Indiana. A total of 31 states had laws for forced sterilization, up until 1978.

While today we know the science behind eugenics is flawed, Americans in Davenport’s era considered it a positive idea as it provided citizens with the false belief that they were acting in the best interest of the country.

Even the Supreme Court gave weight to coerced sterilization with its 1927 ruling in Buck v. Bell, where the sterilization of a 17-year-old with mental issues was upheld after she became pregnant as a result of rape. This ruling was the fuel that led to over 60,000 involuntary sterilizations in the United States from the early 1900s-1970s.

Horrifyingly, it seems that the atrocities committed in Germany against the Jewish people may have had some inspiration in American laws and policies. The Supreme Court ruling of Buck v. Bell was even used by defense lawyers during the Nuremberg trials to show the hypocrisy of trying to criminalize sterilization in Germany that was no different than that which was occurring in the United States. (A young Adolf Hitler had written to colleagues of Davenport’s praising the U.S. for its sterilization laws.)

While support for eugenics based involuntary sterilization significantly decreased in the U.S. after the war, it did not disappear, but morphed with careful planning, huge financial supporters, and growing racial tensions in the country. A campaign launched in North Carolina and Iowa highlighted the need to limit the reproduction of those who were unfit to do so.

The formation of Medicaid in the 1960s allowed further widespread use of involuntary sterilization in more non-discrete ways. Because the government was now involved, many institutions saw an opportunity to benefit financially from doing these procedures.

In the south, the high number of hysterectomies and sterilizations were referred to as “Mississippi appendectomies.” Compared to the 1930s and ’40s, where most sterilization occurred on institutionalized women, over 70 percent of sterilizations in the 60s and 70s were on non-institutionalized women. Informed consent and full disclosure were not at the forefront of many of these conversations.

Medicaid reform has helped quell the number of involuntary sterilizations, while informed consent and patient autonomy have come to the forefront of standard medical care in the United States. However, there are still many examples across the nation of women stating they never really understood why certain procedures or medications were given to them.

In 2013, a report found that 148 female prisoners in California were sterilized between 2006-2010 without proper consent.

In 2015, a Nashville District attorney was fired after it was revealed he had sterilization requirements as part of his plea deals.

In fact, the 1927 Buck vs Bell case has never officially been overturned.

While we have come a long way from our past, we are still not clearly out of the grip of racist ideals and problematic medical practices. The recent accusations brought forth by detainees are bringing back to light the shadows of our pro-eugenic history.

It’s time we fully reckon with our shameful legacy to help prevent more tragedy.