The Relf sisters were two Black girls from Montgomery, Alabama — Minnie Lee, 14, and Mary Alice, 12 — who were surgically sterilized in June 1973 by a federally funded family planning clinic without their knowledge and without any real consent from their family. Their case, Relf v. Weinberger, exposed that federal money was paying for the sterilization of an estimated 100,000 to 150,000 poor Americans every year, and it forced the federal government to write the informed-consent rules that still govern sterilization procedures today.
Who the Relf Sisters Were
The Relfs lived in public housing in Montgomery on very little income. Their mother could not read or write. Mary Alice had an intellectual disability, a speech impediment, and a congenital arm difference she was born with. The family relied on social services, including a local family planning clinic funded by the federal Office of Economic Opportunity.
That dependence mattered. The clinic staff were authority figures the family trusted and could not afford to alienate. There was a third sister, Katie, who had also been enrolled in the clinic’s family planning program. All three girls had been given injections at the clinic, and their mother had been told the shots would prevent pregnancy temporarily and that her daughters could still have children later if they wanted to.
What Happened in June 1973
In June 1973, workers from the Montgomery Family Planning Clinic came to the Relf home and took Minnie Lee and Mary Alice to a medical facility. Both girls were given tubal ligations, a procedure that permanently ended their ability to have children. Neither girl understood what was being done. The family only learned what had happened afterward, when a nurse came by to check on the girls’ recovery.
No one told the family that the clinic had shifted from temporary birth control to permanent surgery. No one told them the operation could not be reversed.
How the Consent Was Obtained
Mrs. Relf, who could not read, was handed a document and asked to mark it with an “X.” Clinic staff told her the form authorized “shots” that would keep her daughters from having children “for some time.” The document actually authorized permanent sterilization.1Southern Poverty Law Center. Relf v. Weinberger Original Complaint
The clinic workers knew the mother was illiterate. They knew the girls were minors. They knew Mary Alice had an intellectual disability. Nothing about the situation resembled informed consent, and nothing about it was accidental.
The Lawsuit: Relf v. Weinberger
On July 17, 1973, the Southern Poverty Law Center filed a class action on behalf of the three Relf sisters and everyone else who had been sterilized the same way. The suit named Caspar Weinberger, then Secretary of Health, Education, and Welfare, and the Director of the Office of Economic Opportunity, in their official capacities.2Civil Rights Litigation Clearinghouse. Relf v. Weinberger
The core claim was that the federal government had built and funded a family planning system with no meaningful safeguards against coerced sterilization, and that the Relf sisters were only two victims of a much larger pattern.
Judge Gesell’s 1974 Ruling
On March 15, 1974, Judge Gerhard Gesell of the U.S. District Court for the District of Columbia ruled for the plaintiffs. The court found “uncontroverted evidence” that minors and mentally incompetent people had been sterilized with federal money, and that an unknown number of poor adults had been coerced into sterilization under threat of losing their welfare benefits. Gesell estimated that 100,000 to 150,000 low-income people were being sterilized every year through federally funded programs.3Justia. Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974)
The opinion described women on Medicaid being pressured during childbirth. One plaintiff, Mrs. Waters, was refused medical help by her attending physician unless she agreed to a tubal ligation after delivery.3Justia. Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974)
Gesell held that the family planning provisions of the Public Health Service Act and the Social Security Act did not authorize federal funds for sterilizing anyone legally incompetent to consent, whether because of age, mental capacity, or a judicial declaration. He called the existing regulations “arbitrary and unreasonable” for failing to require that patients be told, before consenting, that refusing sterilization would not cost them any federal benefits. He permanently barred federal funding for the sterilization of minors or mentally incompetent individuals and ordered the Department of Health, Education, and Welfare to rewrite its rules.3Justia. Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974)
The Rules That Came Out of the Case
HEW issued protective regulations in 1976 and strengthened them in 1978. Those 1978 rules, at 42 CFR Part 50 Subpart B, still govern federally funded sterilization today. A patient must be at least 21 and mentally competent when consent is given. At least 30 days must pass between the signed consent and the surgery, and the consent expires after 180 days.4eCFR. 42 CFR 50.203 – Sterilization of a Mentally Competent Individual Aged 21 or Older Federally funded programs are flatly prohibited from sterilizing anyone who is mentally incompetent or institutionalized.5eCFR. 42 CFR 50.206 – Sterilization of a Mentally Incompetent Individual or Institutionalized Individual
The consent document itself, HHS Form 687, carries a prominent warning that refusing sterilization will not cost the patient any federal benefits. The person obtaining consent must explain that the procedure is intended to be permanent and irreversible, describe the risks, and discuss temporary birth control alternatives. If the patient speaks another language, a certified interpreter must translate the whole form. Consent can be withdrawn at any time.6Department of Health and Human Services. Consent for Sterilization (Form HHS-687)
Every element of that form maps back to something the Relf clinic did wrong.
The Pattern the Case Exposed
What happened to the Relf sisters was not isolated. Coerced sterilization had for decades disproportionately targeted Black, Indigenous, and Latina women, and poor women generally. In 1961, civil rights activist Fannie Lou Hamer entered a Mississippi hospital for removal of a uterine fibroid and woke up having received a hysterectomy she never consented to. She called it a “Mississippi appendectomy,” a term for the routine, unindicated sterilization of Black women performed during surgery for something else.
Judge Gesell’s numbers gave the practice a scale. The coercion was often structural: agree to sterilization or lose Medicaid, lose welfare, or lose the physician’s willingness to deliver the baby.3Justia. Relf v. Weinberger, 372 F. Supp. 1196 (D.D.C. 1974) And the abuse did not stop in the 1970s. Between 2006 and 2010, more than 100 women incarcerated in California, primarily Black and Latina, were sterilized without proper consent.
What the Sisters Themselves Received
Nothing. As of 2022, neither Minnie Lee nor Mary Alice Relf had ever been paid any compensation for what was done to them. No formal apology has been issued by the city of Montgomery or the state of Alabama. Their case changed federal law and built the consent framework that has governed sterilization procedures for nearly fifty years, but the two girls at the center of it were left to live with the permanent result of a surgery they never chose and were never meant to understand.