Abstract
No Más Bebés chronicles the coerced sterilization of Mexican immigrant women at Los Angeles County–USC Medical Center in the late 1960s and early 1970s and the historic civil rights lawsuit (Madrigal v. Quilligan) that followed. Doctors failed to obtain informed consent before performing tubal ligations on these women, who were poor and mostly Spanish speaking, during emergency cesarean sections. The film moves between depicting the abuses these women suffered and their efforts to challenge this injustice, providing broader social and historical context, and offering firsthand accounts of these events. The film includes interviews with five of the women impacted and several of their family members, along with the involved doctors and lawyers, and reporters, academics, and activists.
The interviews with the five women are the focal point of the film. Conducted in the women’s homes, these interviews sensitively capture the depth of the pain these women endured, while also going beyond their suffering to convey their joy, humor, and resilience. For instance, Maria Hurtado is interviewed alongside her husband, Salvador Hurtado. She recalls the first time they danced together (disclosing with a sly smile that she likes the “hanky-panky,” but that her husband is more of a “Puritan”), and the film shows the two of them dancing outside their house during the interview. As Maria and Salvador speak about their decision to come to America to pursue opportunity for their family, Salvador sings a moving ballad, the words “how I have longed for you” taking on layers of meaning in light of their loss. Another woman, Maria Figueroa, shares through tears the anguish she suffered after finding out about her sterilization; one day, she says, her “mind broke,” and she found herself climbing the railing of an overpass, planning to jump onto the busy highway below. She descended from the railing after a passerby urged her to think about how her death would affect her three children. The film, and the women’s lives, seem to alternate between the joy they find in mothering the children they have and their longing for the children they cannot have.
The doctors featured in the film vary in their perspectives of what happened, but, juxtaposed with the powerful testimony of the women, it is chilling to hear several of them (including Dr. Quilligan, the supervisor of the Obstetrics and Gynecology Department) insist that they did nothing wrong. As described by the women and by Bernard Rosenfeld, a doctor who blew the whistle on the hospital, doctors hastily obtained their signatures on consent forms (which, written in English, the mainly Spanish-speaking women were unable to understand) during the late stages of labor. In pain and struggling to process the information that they must undergo major surgery to save both their own lives and those of their babies, they scribbled their signatures on the papers. One woman recalls a nurse grabbing her hand and signing her name for her when she insisted that she couldn’t make the decision without her husband. Doctors failed to explain the consequences of the sterilization procedure. As one woman explains, when translated from English to Spanish, the phrase tie and cut was simplified to tie, leading the women to believe that the procedure was reversible. And the translation of the term sterilization led some to think of the procedure as “cleaning” their wombs, rather than preventing them from having future children.
Without absolving the doctors of their individual responsibility for violating these women’s fundamental rights, the film provides insight into the broader circumstances that enabled these abuses. Because MediCal did not exist at the time, poor women had no option other than the overcrowded county hospital. As one doctor describes, the hospital was chaotic, and in the maternity ward, women labored on gurneys in hallways. Another doctor remembers arriving in Los Angeles with little understanding of Latino cultures and being thrown into the work of serving this population with very little training in cultural sensitivity. At the same time, in the 1960s, doctors were trained to view population control as part of their professional mandate, and ideas about the environmental necessity of limiting population growth combined dangerously with biases against immigrants, people of color, and poor people.
Alongside these challenges, the film portrays the hopeful mood of the emerging civil rights movement, which formed the context for the women’s courageous legal challenge against the doctors and the hospital, the county of Los Angeles, the state of California, and the U.S. government. A young Chicana lawyer, Antonia Hernández—a self-described “kid out of East LA” who was fresh out of law school at the time—represented the women in the landmark civil rights case, after being contacted by Rosenfeld. Hernández recalls driving the streets of East Los Angeles searching for the women, with no information about them except for old hospital records. Women graciously spoke with Hernández and the legal team, though many were hesitant to participate in the case. In many cases, they found out for the first time that they had been sterilized through this contact. The 10 women who ultimately became plaintiffs were a mere fraction of the many women who had been sterilized without their consent. Though the women sadly lost the case, they were nevertheless empowered through collectively taking on powerful institutions, and the case did lead to improvements in requirements for informed consent.
While providing students with historical knowledge about an important yet little-known historical event, the film also provides opportunities for analytic discussions about social inequalities, social institutions, and the fundamental sociological concepts of structure/agency. This film could be used in introductory sociology courses, along with more advanced undergraduate courses and graduate courses on the sociology of health and medicine, law, race, the body, and reproductive justice.
The film is a particularly useful tool for teaching about inequalities in the health care system. In a class discussion following the film, instructors might ask students to brainstorm the various social factors that allow people to access (or keep them from accessing) sensitive, competent, and respectful health care. For instance, the film highlights the role of language (including having doctors who speak one’s language and medical documents available in one’s language), economic privilege (the women were unable to access health care elsewhere), and culture (doctors failed to understand the cultural significance having large families held for the women). While such discussion will enable students to grasp the production of medical inequalities on a conceptual level, the film’s emotion-laden first-person accounts allow students to simultaneously grasp the personal impacts of medical inequalities. As Nowakowski and Sumereau (2015) argue, emotional narratives can be a powerful entry point into deep learning about medical sociology.
I recommend using students’ emotional reactions to this film as a resource for learning, rather than attempting to distance academic discussion of medical inequalities from these emotional responses. These emotional responses can provide an entry point for self-reflection, which, in turn, can allow students to bridge the individual and the structural. To facilitate these connections, I recommend using an exercise where students are prompted to write a self-reflection (which they would not be required to share or turn in) about their last medical experience. The prompt might include questions such as the following: Were you able to successfully communicate your needs and concerns to the medical professional? How did the medical professional respond? What was the outcome of the visit? Ultimately, this activity will allow students to reflect on the ways their medical experiences have been similar to or different from the experiences of the women in the film and to consider how social factors account for these differences.
While the film may enable students to see how inequalities are reproduced within medical institutions, there is a risk that the film’s historical focus may allow students to persist in beliefs that such harms are comfortably contained in the past. I recommend combining the film with examples of more recent events, including the abuses of the reproductive rights of incarcerated women in California and Tennessee in the past decade (see Hawkins 2017; Ohlheiser 2013; Schwarz 2014). On the other hand, because the civil rights case was ultimately unsuccessful, the film does not promote a neatly-tied-together progress narrative but instead leaves the impression that much work remains to be done. At the same time, for students in the United States, the film’s depictions of events that took place in the United States may disrupt ideas that such abuses cannot or do not happen close to (or at) home. The film is a particularly powerful teaching tool for instructors in California; it resonated with many of my students who hailed from Los Angeles.
This film is also useful in introducing students to the reproductive justice movement, a movement led by women of color, which defines reproductive justice as “1. the right not to have a child; 2. the right to have a child; and 3. the right to parent children in safe and healthy environments” (Ross and Solinger 2017:9). For students who have thought of “reproductive rights” as interchangeable with “abortion rights,” this film powerfully demonstrates how some women, particularly women of color, have been denied the right to have children. In the film, a Chicana activist discusses how white feminists advocating for reproductive justice at the time of the film’s events rejected Chicana activists’ call for a 72-hour waiting period prior to sterilization procedures, failing to understand that the availability of “on-demand sterilization” could have the unintended consequence of leading to coercive sterilization. In this vein, the film will enable students to understand the concept of “intersectionality” more deeply, by providing a concrete example of how the intersections of race and gender shape the meanings of reproductive justice as well as experiences in medical institutions.
This film also offers opportunities to delve deeply into the fundamental sociological concepts of structure versus agency. Students might be asked to consider how structure and agency shaped the actions of both the doctors and the women and to think more broadly about how structure and agency play into the perpetuation and challenge of racism and other social inequalities. For more advanced undergraduate students and for graduate students, the film’s narrative choices can be used to spark a more complex discussion about the politics of representation. Arguably, the film succeeds in portraying a devastating injustice without reducing those harmed by the injustice to victims. The film also documents the important roles played by individuals such as Antonia Hernández and Bernard Rosenfeld without relying on tropes about the roles of individual “heroes” or “saviors” in bringing about social change. Ultimately, this film strikes a chord that is at once somber and hopeful, and is both a sensitive tribute and a versatile teaching tool.