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Basis of Distrust

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Vernellia R. Randall
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African Americans' distrust of the health care system is built out of a history that includes experimentation, the Sickle Cell Screening Initiative, Family Planning/Involuntary Sterilization, and the participation of the medical system in the justification of racism and discrimination in society. (18)

A. Experimentation and Teaching Materials 

The distrust of the American health care system is grounded in the knowledge that the health care system has been built on bodies of African Americans. For instance, the nineteenth century marked the rise of modern U.S. medicine. The advances in medicine were legion: 

Advances in basic sciences such as pathology, histology, physiology and pharmacology; the introduction of the statistics and the numerical methods which forever changed the nature and scope of clinical medicine and public health; the clinical acceptance of vaccination for smallpox; introduction of the stethoscope; . . . controlling puerperal fever; rapid advances in clinical schools . . . laboratory medicine . . . and publication of Percival's CODE OF MEDICAL ETHICS. (19)

However, during the same period the American health care system evidenced a lack of attachment to esoteric research and pure science that resulted in American physicians performing "bold, occasionally brilliant, clinical medical feats which were not being performed anywhere else on earth." (20)  Then and today it seems to be of little importance that those "bold, occasionally brilliant . . . medical feats" occurred on Blacks and the poor. Understanding the extent of the experimentation is important for understanding the basis of the distrust of African Americans. Slaves served both as instructional material for teaching medical students and as a source of entertainment at medical conventions. (21) Fo r instance, enslaved albinos and Siamese twins were often displayed at medical society meetings as freaks and sports. (22)

1. Experimentation During Slavery 

In the 1800s, Dr. McDowell successfully performed the removal of an ovarian tumor, a dangerous and radical surgery which he perfected on slaves. (23) In 1800, hundreds of slaves, including two hundred slaves of Thomas Jefferson, were inoculated with smallpox to test the safety of a new vaccine. (24) Dr. Crawford Long, probably the first physician to use ether agent as a general anesthetic, conducted a large percentage of his early experiments on slaves. (25) To determine which medication would allow a person to withstand high temperatures, Dr. Thomas Hamilton placed slaves in an open-pit oven which was constructed to contain heat with only the slaves' heads above ground. (26) Dr. Walter F. Jones used a group of slaves to test a remedy for typhoid pneumonia which involved pouring five gallons of boiling water on the spinal column. (27) Slaves actually suspected physicians of killing slaves or letting them die for purposes of dissection. (28) While these rumors were never documented, slaves' bodies were dug up and sold to medical schools. (29) Dr. Alexander Somervail, after accidentally discovering how to relieve the suppression of urine, tested his theory on other Black patients. (30) Robert Jennings is credited with the development of a successful vaccination against typhoid infection that resulted from his successful experimentation on thirty slaves and free Blacks. (31) Dr. P.C. Spencer, who gained notoriety with his discovery of an efficient and relatively safe technique for treating painful bladder stones, perfected his technique by performing the painful experimental surgery on slaves. (32) Dr. Marion Sims--considered the father of gynecological surgery--perfected the techniques for gynecological surgery on slaves. (33) He addicted the women to narcotics in order to sedate and immobilize them post-operatively. (34) Furthermore, he performed the surgery repeatedly on the same women. (35) Though the social norms have changed dramatically, Sims is still revered as a hero and an icon; the complete picture of him as a person who abused and exploited slaves is usually never portrayed. (36)

2. Post-slavery Experimentation 

The most well known post-slavery experiment is the Tuskegee Syphilis Experiment which the United States engineered from 1932 through 1972. (37) The Tuskegee Experiment involved four hundred African American men in a government-sponsored study to research the effects of untreated syphilis. (38) While the men were not deliberately exposed to syphilis, as some rumors maintained, they were never told that they were not being treated or that effective treatment was available. (39) Furthermore, even though the experiment was regularly reported over the course of the forty years, there was no outcry from the medical establishment. (40) The effects of the Tuskegee Syphilis Experiment of maintaining and strengthening the distrust in the health care system can not be underestimated. The Tuskegee study served to reinforce the belief in the African American community that the distrust of the medical system was not merely an historical issue. (41)

The Tuskegee Syphilis Experiment is not the only evidence of post-slavery abuse. In 1963, the United States Public Health Service, the American Cancer Society, and the Jewish Chronic Disease Hospital of Brooklyn, New York, participated in an experiment in which three physicians injected live cancer cells into twenty-two chronically ill and debilitated African American patients. (42) The patients did not consent, nor were they aware that they were being injected with these cells. (43) In 1972, twenty women, primarily poor, young, and Black, were bused from Chicago to Philadelphia to receive abortions in an outpatient clinic where a new experimental medical device, called the Super Coil, was being used to induce the abortion. (44) A complication of using Super Coil was uncontrollable bleeding that would eventually lead to shock and would require a total abdominal hysterectomy. (45) During the 1970s, the government collected blood samples from seven thousand Black youths. Parents were told that their children were being tested for anemia, but instead, the government was looking for signs that the children were genetically predisposed to criminal activity. (46) A similar experiment was performed on six thousand young men--approximately 85 percent of whom were Black--housed in Maryland state institutions for abandoned or delinquent children. (47) The children's confidentiality was not protected and the blood-test results were passed to the courts to use as they saw fit. (48) At least eighty-two charity patients were exposed to full-body radiation at the University of Cincinnati Medical Center. (49) The patients were exposed to radiation ten times the level believed to be safe at the time; twenty-five patients died. Three-quarters of the patients in the study were Black men and women. The consent signatures were forged. (50) Many women of color have been sterilized without their informed consent so that medical residents could gain additional experience in performing tubal ligations and hysterectomies. (51)

3. Prison and Military Abuse 

One area of significant post-slavery abuse has been the experimentation that has occurred in prisons. Because African Americans make up forty-four percent of all prisoners--almost four times our proportion in the general population-- we are overrepresented in any prison abuse. (52) In 1962, at least 396 inmates at the Ohio State Prison were injected with live cancer cells so researchers could study the progression of the disease. (53) Between 1963 and 1971, radioactive thymidine, a genetic compound, was injected into the testicles of more than one hundred prisoners at the Oregon State Penitentiary to see whether the rate of sperm production was affected by exposure to steroidal hormones. (54) Throughout Alabama between 1967 and 1969, inmates were used in flawed blood plasma trials. The study was managed by Dr. Austin R. Stough at Kilby, Draper, and McAlester prisons. There was no informed consent, and no accurate records were kept. (55) At a California medical facility between 1967 and 1968, prisoners were paralyzed with succinylcholine, a neuromuscular compound. Because their breathing capacity was shut down, many likened the experience to drowning. When five of the sixty-four prisoners refused to participate in the experiment, the institution's special treatment board gave "permission" for prisoners to be injected against their will. (56) In 1990, 1.7 million soldiers--twenty-two percent of whom were Black--were forced to take experimental vaccines under federal law. The law stipulates that soldiers cannot refuse to participate in the government's medical experiments. (57)

The above instances of slavery and post-slavery abuses are cited not because they are the only instances of experimentation and abuse of African Americans, but because they are some of the most famous. (58) While many Blacks may not be able to give you the details of the experimentation and abuse, the instances are a part of the collective Black consciousness which still influence African Americans' reaction to the health care system. 

B. Sickle-Cell Screening 

The debacle of sickle-cell screening in the 1970s also increased the distrust of the medical system, as did medical experimentation. (59) Although sickle- cell disease has been described since 1910, it did not become a priority for federal or private funding until the 1970s. (60) In the 1970s, large scale screening was undertaken with the goal of changing African American mating behavior. (61) Unfortunately, the initiative promoted confusion regarding the difference between carriers and those with the disease. (62) This confusion resulted in widespread discrimination against African Americans. (63) Some states passed legislation requiring all African American children entering school to be screened for the sickle-cell trait, even though there was no treatment or cure for the sickle-cell disease. (64) Some states required prisoners to be tested, even though there would be no opportunity for them to pass on the trait. (65) Job and insurance discrimination were both real and attempted. (66) The military considered banning all African Americans from the armed services. African American airline stewardesses were fired. Insurance rates went up for carriers. Some companies refused to insure carriers. (67) During that period, many African Americans came to believe that the sickle-cell screening initiative was merely a disguised genocide attempt, since often the only advice given to African Americans with the trait was, "Don't have kids." (68)

C. Family Planning and Involuntary Sterilization 

Family planning initiatives have been described as another attempt to reduce the Black population. (69) This view is not without credibility. The fact is that the historical roots of family planning and birth control have been centered in controlling the population growth of African Americans. Margaret Sanger, considered the "mother of family planning and reproductive freedom," supported and promoted the use of reproductive technology to diminish the reproductive liberty of African Americans. (70)

We do not want word to go out that we want to exterminate the Negro population and the [Negro] minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members. (71)

Throughout United States history, family planning and birth control have been used to limit the population size of African Americans. In the 1930s, the government funded the first birth control clinics as a way of lowering the Black birthrate: 

In 1939, the Birth Control Federation of America planned a "Negro Project" designed to limit reproduction by blacks who "still breed carelessly and disastrously, with the result that the increase among Negroes, even more than among whites, is from that portion of the population least intelligent and fit, and least able to rear children properly." (72) In fact, the early birth control movement included strong factions advocating eugenics or compulsory sterilization. (73)

In the 1960s, the government expanded the subsidization of family planning clinics as a way to reduce the number of persons on welfare. (74) In so doing, the number of clinics were proportional to the number of Blacks and Hispanics in a community. (75)

In the 1970s, some doctors would only deliver babies or perform abortions on pregnant African American women if the women consented to sterilization. (76) Other women were threatened with the withdrawal of their welfare benefits if they did not agree to sterilization. (77) In a case brought by poor teenage African American women in Alabama, a federal district court found that an estimated 100,000 to 150,000 poor women were sterilized annually under federally funded programs. (78)

In the 1970s and 1980s, Public Assistance officials tricked African American welfare recipients into having their teenage daughters sterilized. (79)   A 1982 study determined that only twenty-five percent of White women were sterilized, compared to thirty-four percent of African American women. (80) African American women of all marital statuses were more likely than White women to use sterilization as a contraceptive method. (81) Further, African Americans in the South have the highest rates of hysterectomy and tubal ligation in the United States. (82)

Today, some individual doctors encourage African American women to be sterilized because they view the women's family sizes as excessive and believe that they are incapable of using contraceptives. (83) Furthermore, the federal government still subsidizes sterilizations for women eligible for Medicaid coverage, though it will not pay for abortions. (84) Thus, African Americans' distrust of family planning is justified. 

D. Participation in Justifying Racism 

Louis Agassiz, Samuel George Mortion, Samuel Cartwright, and Josiah Clark were the leading U.S. academic physicians to advocate the theory that Blacks were biologically inferior to Whites. (85) In fact, many physicians used their science to create elaborate theoretical systems to justify the difference in the medical treatment of Blacks and Whites. (86) They advocated for the establishment of uniquely Southern-oriented medical education to address the unique diseases of Black slaves, such as drapetomania--the disease causing negroes to run away. (87) Furthermore, it is important to illustrate that these men did not represent the lunatic fringe. Their ideas were widely held and accepted. For instance, Oliver Wendell Holmes, Dean of Harvard's Medical School from 1847 to 1853, believed in and promoted the scientific value of the work of these "scientists." In fact, Holmes held such regard for Samuel Morton's work that he considered Morton's research "permanent data for all future students of Ethnology . . . ." (88)


FN18. Id. at 347-50. 

FN19. MICHAEL BYRD & LINDA C. CLAYTON, RACE AND HEALTH CARE, BLACK HEALTH IN THE JACKSONIAN AND ANTEBELLUM PERIODS, 1812-46: GROWTH, CHANGE AND MANIFEST DESTINY (1996) (unpublished manuscript, on file with the Saint Louis University Public Law Review). 

FN20. Id. 

FN21. Dula, supra note 1, at 347-48; see also TODD L. SAVITT, MEDICINE AND SLAVERY: THE DISEASES AND HEALTH CARE OF BLACKS IN ANTEBELLUM VIRGINIA 282 (1978). "Slaves and the free poor of both races had little choice in the matter; the former had to abide by the master's decision, and the latter, by the physician's (since treatment was without charge)." Id. Access to medical facilities were often expanded to Blacks in order to have a constant flow of Blacks to be used as subjects for clinical instruction. Id. For example, in Virginia in 1853 through 1854, there was a proposal to establish the "Virginia Free Hospital" solely for Blacks. Id. at 285. Even though the proposal was never put into effect, "the state legislature deemed the [Medical College of Virginia's] need for clinical material sufficiently important enough to appropriate $30,000 toward the construction of a new hospital in 1860." Id. at 286 (citation omitted). 

FN22. Dula, supra note 1, at 347-48. 

FN23. BYARD & CLAYTON, supra note 19, at 19. 

FN24. Dula, supra note 1, at 348. Jefferson's efforts to sanction smallpox vaccination began in the spring of 1801 when he received some untested cowpox vaccine from Dr. Benjamin Waterhouse of Boston and forwarded a portion of it to a Washington physician. SAVITT, supra note 21, at 294-95. Although the physician's results with the vaccine were unsuccessful, Jefferson nevertheless decided to conduct his own experiment by vaccinating two hundred slaves belonging to him, his son-in-law, and his neighbors. Id. at 295. 

FN25. BYRD & CLAYTON, supra note 19, at 24. 

FN26. Dula, supra note 1, at 348; see also PATRICIA A. TURNER, I HEARD IT THROUGH THE GRAPEVINE: RUMOR IN AFRICAN-AMERICAN CULTURE 67-70 (1993); GLADYS- MARIE FRY, NIGHT RIDERS IN BLACK FOLK HISTORY 170-212 (1975); SAVITT, supra note 21, at 293-301. 

FN27. SAVITT, supra note 21, at 299. 

FN28. Dula, supra note 1, at 348. 

FN29. Id. 

FN30. SAVITT, supra note 21, at 300. 

FN31. Id. at 298-99. 

FN32. Id. at 301. 

FN33. BYRD & CLAYTON, supra note 19, at 20; Diana E. Axelsen, Women as Victims of Medical Experimentation: J. Marion Sims' Surgery on Slave Women, 1845-1850, 2 SAGE 10-13 (1985). 

FN34. BYRD & CLAYTON, supra note 19, at 20-23. 

FN35. Id. In fact, one slave, Anarcha, underwent twenty-nine major experimental surgeries over several years. Id. 

FN36. Id. See generally GEORGE A. BENDER, GREAT MOMENTS IN MEDICINE 236-44 (1966) (depicting the forerunners of gynecologic sciences); ALBERT S. LYONS, M.D. & R. JOSEPH PETRUCELLI, II, M.D., MEDICINE: AN ILLUSTRATED HISTORY 523, 531 (1987); DEBORAH K. MCGREGOR, SEXUAL SURGERY AND THE ORIGINS OF GYNECOLOGY: J. MARION SIMS, HIS HOSPITAL, AND HIS PATIENTS (1989) (discussing Dr. Sims, his origins, and the birth of gynecology). 

FN37. Dula, supra note 1, at 348-49; Stephen B. Thomas & Sandra Crouse Quinn, The Tuskegee Syphilis Study, 1932 to 1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community, 81 AM. J. PUB. HEALTH 1499 (1991). 

FN38. Dula, supra note 1, at 348-49. 

FN39. Id. 

FN40. Id. at 348; Jean Heller, Syphilis Victims in U.S. Study Went Untreated for 40 Years, N.Y. TIMES, July 26, 1972, at A1. 

FN41. On July 23, 1973, attorney Fred Gray filed a $1.8 billion class action civil suit in the United States District Court of Alabama on behalf of all the Tuskegee Experiment participants. Thomas & Quinn, supra note 37, at 1502. In the complaint, the plaintiffs demanded $3 million in damages for each living participant and a similar amount for the heirs of the deceased. JAMES H. JONES, BAD BLOOD: THE TUSKEGEE SYPHILIS EXPERIMENT 216 (1981). Among the defendants named in the complaint were the U.S. Government, U.S. Public Health Services, the Center for Disease Control, and the State of Alabama. Id. In December 1974, the U.S. Government agreed to pay a sum totaling $10 million in an out-of-court settlement. Id. at 217. The plaintiffs agreed to cease further action for a cash payment of $37,000 to each living syphilitic alive on July 23, 1973; $15,000 to the heirs of the deceased; $16,000 to every member of the living controls alive as of July 23, 1973; and $5,000 to the heirs of deceased controls. Id. All participants and heirs had a three-year statute of limitations during which to file claims. Id. Unfortunately, in spite of attempted efforts by the Public Health Service to locate surviving participants and heirs, many of the four hundred syphilitic actives were never located. Id. 

FN42. Harriet A. Washington, Tuskegee Experiment Was But One Medical Study That Exploited African-Americans [sic] Infamous Research, BALT. SUN, Mar. 19, 1995, at 1F. 

FN43. Id. 

FN44. Id. 

FN45. Id. 

FN46. Id. 

FN47. Id. 

FN48. Id. 

FN49. Id. 

FN50. Id. 

FN51. Deborah Larned, The Epidemic in Unnecessary Hysterectomy, in SEIZING OUR BODIES: THE POLITICS OF WOMEN'S HEALTH 202 (Claudia Dreifus ed., 1977). See generally Andrea Asaro, The Judicial Portrayal of the Physician in Abortion and Sterilization Decisions: The Use and Abuse of Medical Discretion, 6 HARV. WOMEN'S L.J. 51, 93-101 (1983) (analyzing the relationship between the judiciary and physicians in abortion and sterilization cases); Dick Grosboll, Sterilization Abuse: Current State of the Law and Remedies for Abuse, 10 GOLDEN GATE UNIV. L. REV. 1147, 1153-56 (1980) (discussing the historical perspective and current state-of-law involving low-income sterilization abuse). 

FN52. Washington, supra note 42, at 1F. 

FN53. Id. 

FN54. Id. 

FN55. Dr. Stough was expelled several times from hospitals and prisons after men became sick and died from a variety of diseases stemming from his experiments. Id. 

FN56. Id. 

FN57. 21 C.F.R. s 50.23(d) (1995). 

FN58. JONES, supra note 41 (discussing discriminatory medical practices in the United States as "race medicine"). See generally Robert M. Veatch, Ethical Principles in Medical Experimentation, in ETHICAL AND LEGAL ISSUES OF SOCIAL EXPERIMENTATION 22-24 (Alice M. Rivlin et al. eds., 1974); Franz J. Ingelfinger et al., The Poor, in NATIONAL ACADEMY OF SCIENCE, EXPERIMENTS AND RESEARCH WITH HUMANS: VALUES IN CONFLICT 150 (1975). 

FN59. Dula, supra note 1, at 349; Leslie Roberts, One Worked; The Other Didn't, 247 SCIENCE 18 (1990) (reporting that charges of racism were leveled at those who advocated that African Americans with sickle-cell anemia avoid having children). 

FN60. Dula, supra note 1, at 349; see also Todd L. Savitt & Morton F. Goldberg, Herrick's 1910 Case Report of Sickle Cell Anemia: The Rest of the Story, 261 JAMA 266, 266-71 (1989); Robert B. Scott, Health Care Priority and Sickle Cell Anemia, 214 JAMA 731, 731-34 (1970). 

FN61. Dula, supra note 1, at 349. 

FN62. Id. 

FN63. Id. 

FN64. Id.; see also PHILLIP REILLY, GENETICS, LAW, AND SOCIAL POLICY 67-68, 77- 78 (1977) (highlighting the danger of legislative misunderstanding of genetics); Charles F. Whitten, M.D., Sickle-Cell Programming--An Imperiled Promise, 288 NEW ENG. J. MED. 318, 318-19 (1973) (discussing the negative aspects of the implementation of the sickle-cell testing program); Ira M. Rutkow & Jeffrey M. Lipton, Some Negative Aspects of State Health Departments' Policies Related to Screening for Sickle Cell Anemia, 64 AM. J. PUB. HEALTH 217, 217-21 (1974) (analyzing the results of a survey mailed to all state Departments of Health). 

FN65. Dula, supra note 1, at 349; see also Rutkow & Lipton, supra note 64, at 219. 

FN66. Dula, supra note 1, at 349. 

FN67. Id.; see also Lori B. Andrews, Confidentiality of Genetic Information in the Workplace, 17 AM. J.L. & MED. 75, 107-08 (1991) (discussing the employment discrimination in the 1970s faced by African Americans with the sickle-cell trait); Larry Gostin, Genetic Discrimination: The Use of Genetically Based Diagnostic and Prognostic Tests by Employers and Insurers, 17 AM. J.L. & MED. 109, 138-39 (1991) (discussing Smith v. Olin Chem. Corp., 555 F.2d 1283 (5th Cir. 1977), in which an employer fired a worker with sickle-cell anemia because of concerns about the worker's health). 

FN68. Dula, supra note 1, at 349; see also James E. Bowman, Genetic Screening Programs and Public Policy, 38 PHYLON 117, 117-42 (1977) (discussing genetic screening programs, criticizing many of them as disguised scholarly research and labeling them as covers for racism). Genocide has been defined to include acts such as "imposing measures intended to prevent births within the group." Convention on the Prevention and Punishment of the Crime of Genocide, Dec. 9, 1948, art. II(d), 78 U.N.T.S. 277. According to the Convention, "group" includes a national, ethnic, racial, or religious group. Id. In 1986, the United States ratified the Genocide Convention. 132 CONG. REC. S2327-50 (1986). 

FN69. See ROBERT G. WEISBORD, GENOCIDE? BIRTH CONTROL AND THE BLACK AMERICAN (1975) (discussing the view held by some Blacks that family-planning programs are a potential means of race genocide); see also KAY MILLS, THIS LITTLE LIGHT OF MINE: THE LIFE OF FANNIE LOU HAMER 274 (1993) (discussing Black activist Fannie Lou Hamer's view of abortion and birth control as a form of genocide); William A. Darity & Castellano B. Turner, Family Planning, Race Consciousness and the Fear of Race Genocide, 62 AM. J. PUB. HEALTH 1454, 1454-56 (1972) (discussing the view held by some Blacks that family-planning programs are a potential means of race genocide). 

FN70. LINDA GORDON, WOMAN'S BODY, WOMAN'S RIGHT: A SOCIAL HISTORY OF BIRTH CONTROL IN AMERICA 281-83, 332-33 (1976). By 1919, the influence of the eugenics campaign on the birth control movement headed by Margaret Sanger was clear. Sanger stated the following in an article published in the American Birth Control League's journal: "More children from the fit, less from the unfit--that is the chief issue of birth control." Id. at 281. 

FN71. Id. at 332-33 (citation omitted). 

FN72. Dorothy E. Roberts, Crime, Race and Reproduction, 67 TUL. L. REV. 1945, 1970-71 (1993) (citation omitted); see also GORDON, supra note 70, at 332 (stating that the "Negro Project" was intended to regulate the "mass of Negroes . . . particularly in the South, [who] still breed carelessly and disastrously, with the result that the increase among Negroes, even more than among whites, is from that portion of the population least intelligent and fit, and least able to rear children properly."). 

FN73. Charlotte Rutherford, Reproductive Freedoms and African American Women, 4 YALE J.L. & FEMINISM 255, 273 (1992). Sanger promoted the use of sterilization, abortion, and contraception to eliminate "human weeds." See GEORGE GRANT, GRAND ILLUSIONS: THE LEGACY OF PLANNED PARENTHOOD 63, 65 (2d ed. 1992) (relating the Margaret Sanger story). In addition, other eugenicists were a significant part of the American Birth Control League. GORDON, supra note 70, at 82-83. 

FN74. Dula, supra note 1, at 349-50. 

FN75. Id. at 350. 

FN76. Roberts, supra note 72, at 1971; see also Walker v. Pierce, 560 F.2d 609, 613 (4th Cir. 1977) (reversing judgment against a doctor who required Medicaid recipients to consent to undergo tubal ligation before he would deliver their third child), cert. denied, 434 U.S. 1075 (1978); Laurie Nsiah-Jefferson, Reproductive Laws, Women of Color, and Low-Income Women, 11 WOMEN'S RTS. L. REP. 15, 30-31 (1989) (setting forth statistics demonstrating the disproportionate sterilization of minority women, particularly Black women). 

FN77. Roberts, supra note 72, at 1971; see also Cox v. Stanton, 529 F.2d 47 (4th Cir. 1975) (reversing dismissal of a claim brought by a Black woman who was permanently sterilized after she agreed to temporary sterilization when threatened with termination of welfare benefits). 

FN78. See Relf v. Weinberger, 372 F. Supp. 1196, 1199 (D.D.C. 1974), vacated, 565 F.2d 722 (D.C. Cir. 1977) 

FN79. Dula, supra note 1, at 350. 

FN80. Nsiah-Jefferson, supra note 76, at 31. 

FN81. Id. 

FN82. Id. 

FN83. Roberts, supra note 72, at 1971. 

FN84. See, e.g., Rutherford, supra note 73, at 274. Compare 42 C.F.R. s 441.253 (1994) (authorizing federal funding for sterilizations) with 42 C.F.R. ss 441.202-.203 (1994) (denying federal funding for abortions unless the life of the mother is endangered). 

FN85. BYRD & CLAYTON, supra note 19, at 65-73. 

FN86. Id. 

FN87. Id. 

FN88. Id.


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Professor Vernellia R. Randall
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