ATLANTA - Nial Cox Ramirez remembers every detail of what happened to her in 1965, even though she has been trying hard to forget.

Ramirez had a choice to make, and it was a wrenching decision for an an 18-year-old who had just had her first child.

Her options? Sign a form from the Eugenics Board of North Carolina "consenting" to be sterilized, or have welfare payments for her mother and six brothers and sisters cut off.

"To sit and think about it literally eats you - slow, real slow. It eats you piece by piece," Ramirez said recently. "That's why I don't want to go back there. Because it's a hell within a hell that you going through. It's like a cancer that eats."

Ramirez, now 56, lives outside Atlanta. She is still trying to make sense of what happened.

"Why me? That's what I want to know. Why me? Why you want to bother me?" she asks.

In the thousands of pages of sealed records of the eugenics board reviewed by the Winston-Salem Journal, some of the answers that Ramirez has been searching for can be found.

On July 1, 1961, Sue Casebolt took over as the executive secretary of the eugenics board. Before the month was over, she was pushing a new agenda that would target girls like Ramirez.

     I now propose to have as my objective as Executive Secretary
     to work to promote earlier use of the (sterilization) program;
     that is, after the first rather than third of (sic) fourth child,
     which would result in prevention of problems requiring staff time,
     money, and use of other needed community resources.
     To this I plan to use all resources available to secure information
     as to persons who need to be offered the service.
     A few of these are: Mental Health Clinics. 2. County Health Officers.
     3. Public Welfare records such as APTD and ADC.
     — Eugenics board minutes, 1961.

Emotional blackmail
In her tidy home, Ramirez opened up and talked at length about her life. She was warm and friendly - until she started talking about the sterilization.

"I tried to bury it. I tried to get rid of it. I tried to forget all about it," she said. "But it comes right back fresh, just like it was yesterday."

It was 1964, and Gov. Terry Sanford and President Lyndon Johnson were pushing their visions of a new South.

But the word hadn't gotten to Plymouth, the river town in Eastern North Carolina where Ramirez grew up. It hadn't gotten to the housing project where she lived with her mother and six brothers and sisters.

After Ramirez got pregnant by her boyfriend, a white woman from the Washington County Department of Public Welfare started making more frequent visits.

"She came almost every other day, carrying her little pocketbook and her little briefcase," said Ramirez, referring to social worker Shelton Owens Howland. "And she goes all into details. Every little detail. She would always tell me, 'Your family is going to starve because of what you did. If you don't do this, we going to take this check away from (your mother)'."

"I was so disgusted with her," Ramirez said. "And really, if I knew how to have a gun, I would have shot her. Because it doesn't make any sense."

It didn't make any sense to Ramirez, but what happened to her was hardly an accident.

     I plan a tickler file on all persons whose names reach me
     regardless of age in order that they may be picked up
     as they reach the child bearing age.
     — Casebolt, Eugenics board minutes, July 27, 1961

But Casebolt was only part of a chorus that had been calling for a stronger sterilization program. And for years, there had been suggestions of targeting the black community. In a 1950 book on the North Carolina eugenics program, it was taken as fact that poor blacks had more mental problems than other groups.

     There is need for special education among the lower-class Negro groups,
     since it is here that fertility is highest and mental defect more prevalent.
     — Sterilization in North Carolina,Moya Woodside, University of North Carolina Press

The sterilization program had been conceived in 1929 as a tool to be used in state institutions, and for the first 20 years, the majority of sterilizations took place in state hospitals and schools for the disabled and the delinquent.

But as members of the mental-health community began to wake up to the fundamental flaws of the sterilization program, the state Department of Public Welfare turned out to be an even more enthusiastic partner. North Carolina was the only state in the nation where social workers had the power to initiate sterilizations in the general population.

     ... the Honorable David Henderson,
     representative from Mecklenburg County,
     wished the board to consider
     the possibility of expanding the provisions
     of the eugenics legislation.
     He wishes consideration to be given
     to the possible sterilization of families, who,
     while receiving financial assistance,
     continue to have more children.
     — Eugenics board minutes, 1951

Officially, the final decision on sterilization petitions in North Carolina rested with the five members of the eugenics board. In practice, however, social workers at the county level had tremendous power - and that was obvious to Ramirez.

"I don't know if she (Howland) hated black people or what," Ramirez said. "But she had this attitude, this nasty way of talking. Like you're nobody, and she's somebody. She (was) God, and I'm a little rat running around on the floor."

In the sterilization petition, Howland wrote that Ramirez was argumentative and lazy and had been told that the welfare department "would not assume the responsibility of supporting all the children she would bring into this world.... Our agency is thoroughly convinced that the only way to keep a family of this type from reproducing itself is to rely on sterilization."

Howland, who now lives outside the state, declined repeated requests to comment for this story.

Comments from Elsie Davis, a Fayetteville social worker who was working in the 1960s, echo Ramirez's impression that many social workers carried an inherent bias.

"The expectation was that black people were not able to take care of themselves," Davis said in a previously unpublished interview done in 1989 by Johanna Schoen, an assistant professor at the University of Iowa. "They were all illiterate, retarded. So it was consensus that these women don't have any rights. So we can say to them that they can't have any children."

"It was a system rather than the individual, who didn't have any rights at all," Davis said, and records from the eugenics board are filled with examples of the bureaucracy that she spoke of.

     On August 23, I visited the Bladen County Welfare Department....
     The Health Officer had tabulated all out of wedlock pregnancies for 1962,
     and indicated an interest in having the younger mothers evaluated ...
     and it was felt that to begin with the younger ones
     who have a longer reproductive period
     would be helpful to all concerned.
     — Eugenics board minutes, 1962

Pressure from all sides
Ramirez gave birth to a daughter, Deborah, in November 1964. The pressure from the welfare department continued.

"There was another lady up in the courthouse on the second floor," Ramirez said. "(She said) 'That's good for you. That's good. You should have that (sterilization). You shouldn't have any more kids.'"

Trying to cope with a newborn child and the poverty of her family, she had to make her choice.

"And what am I supposed to do?" she said, her voice cracking. "Why should my family - my sisters and brothers - starve for something I did?"

With the memory came tears.

Soon, a final petition for sterilization was sent to the eugenics board. Ramirez's life was summarized in one paragraph that was almost all opinions, not medical or psychological fact. It read, in part:

     Nial Ruth usually runs errands and buys the groceries
     but takes no responsibility about the house.
     She has worked at field work but becomes quite argumentative
     and thinks she is never paid enough.
     She does not get along well with her siblings.

On Feb. 10, 1965 - three months after Deborah was born - Ramirez was sterilized by Dr. A.M. Stanton at the Washington County Hospital in Plymouth. Ramirez said she asked Stanton not to do the operation but report that he had. Stanton told her that he couldn't do that, she said.

After the fact, Ramirez said, some people quietly questioned the decision to perform the operation.

"The nurses was nice. Some of the nurses was good, and they would say, 'We're sorry this is happening to you.' Some of the nurses even said (it was wrong.)

"They may have it in their heart that it's not right, but they're not going to walk up there and say, 'Doctor, what you're doing is not right.' They whisper it to you, but they just saying it to you. They don't want nobody else to know that they saying anything, anything at all about it."

The black community wasn't any help either, she said.

While recovering in the hospital, Ramirez said, she thought that Stanton hadn't just been told to do the operation - he wanted to do it.

"I used to have nightmares of that stupid doctor, that stupid caseworker come walking with her case ... it's like the devil coming with the pitchfork. But thank God I don't have those dreams no more. That's one thing God took away."

Stanton, who still lives just outside Plymouth, said recently that he did the sterilization because he was asked to do so. "I just complied with the eugenics board, that's all," he said.

Getting away
In the late '60s, Ramirez moved to New York. She worked at Hempstead General Hospital for 12 years as a nurse's aide, she said, until she broke her ankle and had to go on disability. "I took care of my daughter, I sent money home to my mother," Ramirez said. "So how can a crazy person hold a job? And I worked in a hospital with sick people."

Deborah lived with her grandmother at first, but Ramirez soon brought her to New York.

"Everybody was proud, tell me what a good mother I am. How I take good care of my child. Crazy people don't do that. Retarded people don't do that," she said.

Deborah Chesson, 38, lives with her mother, and the two look after each other's needs. Deborah graduated from Elizabeth City State University, and now works for a computer company.

After living in New York for a few years, Ramirez in 1973 became the first woman to file a lawsuit against North Carolina's eugenics board and the social workers and doctors who supported it, charging that the sterilization had violated her constitutional rights.

The early publicity about the lawsuit contributed to a decision by the legislature to disband the eugenics board, but Ramirez lost the case in the end.

Ramirez finds comfort in her faith, but even with prayer and reflection she still wants North Carolina to apologize for its sterilization program.

"What they did to me was wrong," she said. "It was really, really, wrong."

Ramirez has been one of the few to speak out about what happened to her, but in the records of the eugenics board there are more suggestions of a system that had gone wrong for many black women, and for whites, too. Instead of in-depth discussions about individual cases, there are phrases that read like gossip, not science.

     Because her family is quite casual
     in it's (sic) approach to life,
     the welfare department feels that she should have
     the sterilization operation before she is allowed to leave
     the Murdoch School permanently.
     — Eugenics board petition for a 17-year-old white woman, 1962

     There is indication that this girl will continue to be sexually promiscuous.
     She is not capable of giving children the care they need.

Stanton said that cases had to be rated individually, but that the sterilization program "was probably a good thing.... I think some people did it on purpose (had children) to get a little bit of extra money from the welfare department."

Ramirez wants to forgive the eugenics board and Stanton, perhaps because she believes that it will help hasten her own healing.

"And Doctor Stanton, wherever you are - I hope God blesses you," she said. "In your heart of hearts you know what you did was wrong. Think about it. Would you like it to be done to your daughters? You was an M.D. You don't got to do what the social workers tell you. Doctor, you went to school to save lives.... And you're the reason that I can't trust doctors."

"If I was a doctor, I would say 'No, I'm not going to do that. This is a young girl - she's just growing up. Why would I do that to her?'"

• Kevin Begos can be reached in Washington at (202) 662-7672 or at kbegos@mediageneral.com

• John Railey can be reached at 727-7288 or at jrailey@wsjournal.com