These documents have not previously been released to the public. Some are from private library collections; others were obtained under the Open Records Act before the records were closed. (See “A victory for the right to know” for an update on the availability of these records.)

1968 pamphlet published in Law & Society Review
Julius Paul was the first researcher to note the 1960s revival of harsh eugenics laws.

Sterilization brochure, circa 1949
Part of a campaign to soften the image of eugenics

Sketch for a sterilization poster, circa 1948
Part of a campaign to soften the image of eugenics

Gamble stock donation
Gamble organized and funded local eugenics chapters in six states.

Human Betterment Association minutes
In 1957 the Human Betterment Association convinced the National Association of Social Workers to share its 23,000 member mailing list.

Letter from Nelson Rockefeller, 1951
Wealthy supporters of sterilization helped the new campaign.

Protest letter from Georgia
Many family members protested about operations in Georgia, to little avail.

N.C. memo on tracking children for sterilization
Helped by the University of North Carolina at Chapel Hill, the Eugenics Board had a program to identify children for sterilization.

N.C. memo on tracking Negro children
Helped by the University of North Carolina at Chapel Hill, the Eugenics Board had a program to identify children for sterilization.

Human Betterment Association recap of meetings with social workers
The group build a network of supporters who would refer people for sterilization outside of eugenics programs.

Mecklenburg County (N.C.) letter to Human Betterment Association
Mecklenburg County was especially active in promoting sterilizations.

Mother who wanted her daughter sterilized, New York City, 1955
Family members sometimes asked for sterilization, just out of fear.

John F. Kennedy letter, 1959
In the mid-1950s, concerns about world population began to emerge.

Learn more about eugenics

Journalist Kevin Begos will discuss the Indy‘s eugenics series and his forthcoming book Thursday at 12:20 p.m. on WUNC’s The State of Things, hosted by Frank Stasio. You can also listen to it online at; the show is also archived on that website.

And check the Indy‘s Triangulator blog on Wednesday for a report on the Governor’s Task Force to Determine the Method of Compensation for Victims of North Carolina’s Eugenics Board.

That group will meet Wednesday at 10 a.m. to hear updates on archive policies of the now-abolished N.C. Eugenics Board’s patient files and program records. Many of these records were once available under the Open Records Act but were subsequently closed.

Earlier this month, Begos, on behalf of the Indy, successfully pressured the governor’s office to open these records to the media and to scholars, as long as victims’ names were redacted.

Editor’s note: This is the second story in a three-part series about the American eugenics movement after World War II. The series focuses on the wealthy benefactors and various promoters of eugenics, including ministers, bankers, journalists and politicians (part 1); the advertising and public relations machine behind the movement (part 2, below); and the racial aspects of eugenics (part 3).

Sen. John L. Sanford was a Democrat, a Catholicand fed up. “When you have a woman who has seven or eight illegitimate children and she keeps on having them at the expense of the taxpayers it’s time to do something about it,” Sanford, a Maryland lawmaker, told the Washington Star in early 1960.

His legislation called for the sterilization of any woman with more than two illegitimate children. She could also be subject to a three-year prison term, a $1,000 fine, a declaration that she was “morally unfit for the care, custody and control of any of her existing children,” a permanent ban from receiving welfare payments and having the state remove existing children from her care.

Sanford’s bill passed the Maryland Senate 23-3, but it never became law. It was one of many similar efforts that appeared throughout the country in the same era. In 1956 a Virginia legislator suggested that any woman with more than one illegitimate child should prove why she shouldn’t be sterilized. North Carolina debated compulsory sterilization laws in 1957 and 1959. Mississippi legislators began proposing sterilization of unwed mothers in 1958, and politicians or public officials in Illinois, Wisconsin, California, Iowa and Georgia also discussed similar laws. Across the nation, eugenic sterilization was shifting from targeting poor whites, immigrants and the “feebleminded” in institutions to overwhelmingly targeting minorities.

The question is why.

In a cruel twist, the very social programs that were designed to fight poverty did what the eugenics movement had never been able to accomplish: generate accurate lists of hundreds of thousands of poor people around the country.

In many cases, that brought the people into a system that considered sterilization one way to fight poverty. Or, as some politicians quickly realized, a way to limit the cost of fighting poverty. State and local governments paid for operations, and by the late 1960s the federal government stepped in. Julius Paul, a researcher at the Walter Reed Army Medical Center, was perhaps the first to note that a surge in public demand for compulsory sterilization had returned for the first time since the early 1930s.

But the racial shift would never have happened without a change in how society viewed sterilizationwhich is now called having the tubes tied or a vasectomy. In the 1940s most doctors refused to perform the operation even for patients who clearly wanted it. That’s where Dr. Clarence Gamble and the eugenics group Birthright played a key role. They worked on making sterilization more acceptable to the general population. Through advertising and TV and radio appearances, Birthright and Gamble tried to polish the hard edges of their message: There were far too many people unfit to be parents.

Birthright began as a tiny fringe group in New Jersey, but in the late 1940s it moved to space in the New York Academy of Medicine, a highly respected institution. The next year its members further cemented its positive reputation by furnishing information on sterilization to the Population Division at the United Nations, and Gamble had an article on sterilization published in the Journal of the American Medical Association.

In 1950 Birthright changed its name to the friendlier-sounding Human Betterment Association. Gamble hired a New York City advertising firm to help with the makeover, and soon talented graphic artists were sketching, copy was being polished and downtown printers were shipping hundreds of thousands of copies of sterilization “literature” all over the nation.

The 42nd Street firm J.M. Mathes also helped place articles in newspapers and magazines, according to records of the campaign. “Dear Dr. Gamble: Enclosed is a tear sheet from the New York Post of Sunday, November 7, in which I think you will be considerably interested! Success at last! Local magazine circles seem to be quite impressed as this appears to be the first time that sterilization has been considered favorably by the popular press,” an account representative wrote.

Gamble, astute about stroking the media, wrote back asking if it would “be helpful to have letters of commendation sent the Editor? We might get the sterilization enthusiasts to send some.”

Gamble’s New York contact noted the images of candidates for sterilization weren’t of sufficient quality. “In spite of the retouching, however, the feebleminded one left much to be desired. We very much need some good, well lighted professional pictures for such purposes. It isn’t possible to do an effective job with ‘snaps’ the social workers take for case records.”

Although the creepy brochure titled “You Wouldn’t Expect” was designed in New York, it was imprinted with different return addresses to make it look like a local production from Iowa, North Carolina or other states.

Another draft for a poster to promote sterilization read:

America Needs More Little Girls Like This

Who are happy healthy and intelligent

And Fewer Little Girls Like This

Who are doomed from birth to empty meaningless lives

Paul Popenoe, a Human Betterment Association director and prominent backer of eugenics, turned to TV in the 1950s, says Edward Larson, a Pulitzer Prize-winning historian and the author of Sex, Race and Science: Eugenics in the Deep South. “You get people like Popenoe, re-creating himself and becoming the guest on Art Linkletter’s House Party, trying to advise people on how to raise their children. But if you really look at those old tapes it really was eugenical thinking. But he was able to package it for television.”

The Human Betterment Association insisted its push for sterilization had no overt racial bias, the mention of which is absent from thousands of pages of its records and correspondence. But the association was naive about how potent a force racism would become. Knowingly or not, it helped enable a vastly expanded network of people who might impose sterilization on the unwilling. Frustrated by delays and limitations in working with state eugenics boards, the group built a network of hundreds, or perhaps thousands, of doctors and social workers who would perform the operation. Many of those operationsbut not allsimply represented the growing numbers of Americans who wanted a safe, permanent form of birth control.

Birth control was controversial in the mid-20th century. The debate wasn’t over abortion, but whether even married couples had the right to use any form of birth control at all. A 1942 editorial from the Lowell Sun in Massachusetts showed a common view. “Birth control is in itself a negation; it is in essence negative. It accomplishes nothing; no good comes of it; it is wholly unproductive. It is against the law of God; it is contrary to the laws of nature. The mere thought of its practice is repugnant, utterly repugnant, to the rational human mind … And where is there the husband or wife who claims such omnipotence that he or she would unnaturally challenge the will of the Almighty to create a child?”

According to that logic, even the use of foams, condoms or the rhythm method was immoral, and women who had six or eight children were supposed to keep having more. Such views enraged Gamble, and in fact, on that issue history has come down on his side.

This debate over voluntary sterilization was a key point for the Human Betterment Association. Alongside support for eugenics that most now find repugnant, the group was in the vanguard of fighting for the now basic right of access to birth control.

But the support for voluntary sterilization helped to gloss over abuses. Its carefully crafted press releases and public statements mistakenly imply that virtually everyone sterilized under state laws agreed to the operation. However, numerous protest letters in Georgia suggest otherwise. One Atlanta woman wrote to the superintendent of Milledgeville State Hospital, baffled about her sister’s order for sterilization. “She has always cared for or associated very little with men, and in the two odd years she was married never became pregnant so I am at a loss to understand the reason for the operation.” The superintendent wrote back that he would “be delighted” to explain the purpose of the operation if the sister visited the institution. Despite the sister’s continued objections, the 38-year-old woman was sterilized the following year.

And though there were public reports about the activities of state eugenics programs, extreme details were kept secret. In North Carolina a previously unpublished 1953 memo suggests building “a file on children ten years of age and under whose IQ’s fall below 50. I would further suggest that follow-up letters be written when the child becomes twelve years of age. We will have this information available for whatever use we may wish to make of it.” North Carolina also compiled lists of “the names of feebleminded Negroes in your county, over 12 years of age, for whom a petition has not yet been filed with the Eugenics Board.”


Through advertising, public relations campaigns and speaking engagements, the Human Betterment Association expanded by telling different people what they wanted to hear. Its leaders spoke about birth control and voluntary sterilization to some, and about involuntary sterilization to others. And so just five years after the group had launched a national campaign, the number of sterilizations began to soar in states where it was concentrating. Gamble ultimately organized and funded local eugenics chapters in six states. North Carolina was documented in the 2002 Winston-Salem Journal series Against Their Will, but similar efforts took place in Georgia, Iowa, Nebraska, Arkansas and Texas. In many of the states Gamble provided seed money in the form of Procter & Gamble stock (see story, this page).

By 1950 more than 180,000 pamphlets promoting eugenic sterilization had been mailed just in North Carolina and Iowa. More than 100 U.S. colleges had requested 12,000 copies of a questionnaire designed to promote higher birth rates among the upper classes. Requests for publications on eugenics came in from Northwestern University, the Los Angeles Public Library, Skidmore College, the University of New Mexico and dozens more institutions. In one month praise for the new eugenics campaign came in from a school superintendent in Oregon, the Department of Social Work at Florida State University, the University of Texas and Stanford University.

The Human Betterment Association was able to attract respected and influential supporters, including Nelson Rockefeller. The future vice president and governor of New York helped solicit funds for the new sterilization project.

In Georgia, Dr. Lombard Kelly, dean of the state Medical College in Augusta, agreed to be president of that eugenics chapter. In Arkansas, minutes of the group from 1952 show that “5,419 copies of Why Fear Sterilization, 3,436 copies of Speaking of Sterilization and 1,290 copies of Human Sterilization had been mailed to Nurses, Ministers, Attorneys, State and County Officials, Social Workers and to Doctors, by request, in the state.”

More often than not, public notice of the campaign was positive. A Dec. 2, 1949, newspaper clip from Salt Lake City noted that “Utah sterilized a greater proportion of its residents in 1947 than any other state in the nation. The Utah program for sterilization of the feeble minded and insane which led to this record is praised as an ‘important achievement in public health’ in an article appearing in a recent issue of the Rocky Mountain Medical Journal. It was written by Dr. Clarence J. Gamble of Milton, Mass. Dr. Gamble added, however, that even Utah is failing to keep up with the number of feeble minded added to the population each year. He estimated that there are more than 6,370 feeble minded persons in the state – or 12 times the 539 who have been sterilized since Utah’s law became effective in 1925.”

While many people and organizations gladly bought in to the eugenics message, Gamble’s aggressive tactics caused problems, too. The Planned Parenthood Federation of America directed its affiliates to have nothing to do with groups working for sterilization, suggesting there was particular concern about Gamble. Even his highly selective biography (which omits virtually any mention of the eugenics campaign) notes that he “was never able to appreciate that others had needs, motivations and goals of their own which might conflict with whatever he wanted done at the time.”

One of Gamble’s letters to the Georgia eugenics chapter, sent while he was on vacation in Cape Cod, gives a glimpse of such behavior. “What do we need to do to make possible more sterilizations per year? What’s the present bottleneck? Perhaps you can tell me this most accurately if you apply it to Augusta. How can more of the feebleminded there be operated on?” Gamble demanded.

In April 1957 the Human Betterment Association convinced the National Association of Social Workers to share its 23,000-member mailing list. Gamble offered to pay for half the mailing costs, and the board noted that “this unusual opportunity to present the Association’s program was one which must not be missed.” (But in 1961, NASW changed its position and declined to let its mailing list be used.)

The group also started a pilot program in Philadelphia, meeting one-on-one with hundreds of social workers to determine how willing each was to recommend sterilization for people on public assistance. Just as Cold Spring Harbor Laboratory and the Carnegie Institute played major roles in promoting the pre-World War II eugenics movement, the new Human Betterment Association became a source for public officials all around the country.

In North Carolina, Mecklenburg County appears to have had a particularly close tie. One result of the new outreach was a surge in “off the record” sterilizations. The old system of eugenics was terribly flawed, relying on faulty science and simplistic IQ tests. But the eugenics that began to emerge in the 1950s was in some ways even worse. In many cases there were no tests, or even vague standards, and the decision on who was or wasn’t fit for parenthood often came down to how much money people had.

But the turmoil in sexual politics that began in the 1950s played a role, too. A 1955 memo from New York City showed that even the possibility of interracial sex could provoke hysterical responses. “A mother wished her 17-year-old daughter sterilized before the girl went to a mixed-race camp. A neurologist at the Neurologist Institute recommended that the girl be sterilized. The Department of Gynecology and Obstetrics did not know how to handle the case as the girl was a minor … After long deliberation with administrative heads and legal advisors, the hospital decided against sterilization.”

As tensions over race continued to build, another force emerged to energize those who wanted to sterilize the poor. For decades the eugenics movement had suggested that certain groups were unfit and provided varying definitions of the term. But in the late 1950s came a simpler rallying cry: too many people in the world, period. Dixie Cup Company founder Hugh Moore published The Population Bomb in 1954, warning that the growth in human population was unsustainable. That argument found a wider range of support among politicians and the general public than any of the earlier ones made by supporters of eugenics.

In the spring of 1959 the executive director of the Human Betterment Association wrote to then Sen. John F. Kennedy, asking him to speak out on birth control. On June 5, Kennedy wrote back, saying, “I too have been concerned with the population explosion and I do believe that satisfactory means must be found to retard the growth of population, particularly in some areas of the world.”

There was no discussion of sterilization in the correspondence, and certainly no mention of eugenics. But racial tensions and fears about the world population and the rapidly growing availability of sterilization combined to create a perfect climate for sterilizing poor people in the 1960s. Before long, a Nobel Prize winner was openly suggesting that blacks had lower IQs than whites and that the less intelligent should be sterilized. Major newspapers and magazines all over the country gave extensive coverage to the crackpot idea, suggesting that it had merit. As activists pushed for clearer laws to prevent abuse of sterilization, aides in the Nixon White House decided the issue was too controversial and kept the new rules locked in a warehouse.

As a charitable organization, eugenics group, leader received tax breaks

The wealthy Americans who bankrolled the post-World War II eugenics movement believed they were helping society, but they were helped tooby receiving federal tax credits that, in effect, financially rewarded them for pushing involuntary sterilization.

To the U.S. Treasury Department, the New Jersey eugenics group Birthright was just another charitable organization, formed “to foster all reliable and scientific means for improving the biological stock of the human race,” according to a 1943 letter from the government.

But Birthright was embarking on a nationwide campaign to sterilize people deemed unfit to have children. Much of the group’s seed money came from Dr. Clarence Gamble, an heir to the Procter & Gamble fortune and a Harvard Medical School researcher, who received tax breaks for his contributions.

In 1943, the Gamble Family Trust donated $10,000 to Birthright to launch the new eugenics movementand evidence shows that Gamble was quite aware of the tax benefits of his eugenics gifts. “The market value of the stock is deductible from income for tax purposes, and it can be sold by the charitable organization without tax on the profits,” Gamble wrote in a 1946 letter to James Hanes of Hanes Hosiery in Winston-Salem, regarding funding for a local eugenics group in North Carolina.

Gamble built his fortune after inheriting an even million dollars in stock on his 21st birthday in 1915the equivalent of about $22 million in 2011. The one condition his father imposed was that Gamble give at least 10 percent of his income to church or charitable groups each year.

When Gamble donated shares of Procter & Gamble stock to eugenics groups, he could legally claim a write-off for his gift and use that credit to reduce the taxes he owed on other income. Such donations wereand arecompletely legal.

Yet, some of Gamble’s colleagues in the eugenics movement believed he abused the tax system by continuing to take dividend payments on the stock he donated as charitable gifts. Marion Olden, a Birthright founder, said that she mailed Gamble interest payments on a stock donation. “You know that was crooked, that was cheating the government on his income, you see …” Olden said in a previously unpublished interview done by William Van Essendelft in the 1970s.

Other members of the groupcalled Birthright at the timesimply complained that Gamble was trying to exercise too much control over what was partly his own donation, so it’s unclear whether he actually did anything wrong.

But some state tax officials questioned whether promoting eugenics was really a charitable cause. Gamble organized and funded a series of state eugenics chapters in the late 1940s and early 1950s, as the Texas Betterment League noted. “On June 19, 1952, our Treasurer, Mr. R.W. Fender, received $1,613.19 from Dr. Clarence Gamble of Procter & Gamble from the sale of stock given by Dr. Gamble. This amount assured the organization of adequate funds for our work.”

The league’s first attempt to gain charitable status was rejected by the Texas Secretary of State. “We are returning herewith the application for the above proposed corporation in order that the purpose clause specify in reasonable detail just how the corporation purports to be benevolent, charitable, educational and missionary,” an August 1952 letter noted.

However, the league revised its mission: “Specifically, its purpose is to disseminate to the public medical and scientific information concerning the transmission by mentally defective parents to their descendants of hereditary insanity or feebleness of mind; to inform them of the devastating effect upon society of the continued transmission of such hereditary mental diseases to posterity; to point out the means and methods by which medical science can prevent such transmission, and to encourage the use of such methods.”

The Texas Secretary of State’s Office then approved the league’s charitable status.