In the 1970s I was the youngest member of the State Board of Directors of an Alabama Mental Health Facility. The women that I remember receiving involuntary sterilization were women who had been committed to institutions for the insane. Not all were sterilized, only those, both white and black, whom it was determined to be totally and permanently insane, including the criminally insane.

I sat in on hearings with Psychiatrists, Psychologists, and counselors and studied familial records and there were strong indicators that many of those patients had other relatives who had suffered from the same type of mental health problems. It was thought that those patients had a higher than average probability of producing a child that would suffer from insanity at some point in their life. I believe that is when sterilization was used to prevent the cycle from continuing. I haven't read any reports about North Carolina but the time frame suggests there was something else also involved in addition to welfare programs. This is not a pretty topic and the author of the story on North Carolina may not have wanted to reveal the ugly parts.

While the men and women were segregated, there were surprising numbers of men and women who managed to get together and have sex, even through a chain link fence, often with women becoming pregnant. The baby was born at the institution and then handed over to DHS or family members if they could find anyone to take it.