on the condition that they would submit to sterilization immediately afterwards. pierce successfully defended himself against all lawsuits, and the south carolina branch of the american medical association (ama) unanimously supported pierce's actions. relf v. weinberger in 1973, one particular case brought attention to the issue of forced sterilization. twelve-year-old minnie lee relf was sterilized without her consent or consent of a parent in a federally funded department of health, education, and welfare (hew) health clinic—the montgomery family planning clinic—in montgomery, alabama. the official plaintiff was lee's sister katie relf, and the defendant was caspar weinberger, secretary of the department. the case challenged a state eugenics statute that authorized the procedure for "mentally incompetent" individuals without requiring the individual's consent or that of a guardian. caseworkers had diagnosed lee as mentally retarded and thus were able to apply the statute, although the basis for their diagnosis was extremely questionable. as a result both lee and another sister, mary alice, received tubal ligations without their consent. their mother, who was illiterate, unknowingly authorized the procedure by signing an "x", under the false impression that her daughters were receiving routine birth control injections. the district court decided in favor of the relf sisters, declared certain hew regulations covering sterilizations to be "arbitrary and unreasonable", and prohibited hew from providing federal funds for the sterilization of "certain incompetent persons". the district court also ordered hew to amend its overall regulations. during the course of the litigation, hew withdrew the challenged regulations. the court of appeals held that the case was rendered inconsequential by hew's actions and remanded the case back to the district court for dismissal. anti-sterilization efforts the issue of forced sterilization came to the forefront of activists' and scholars' minds in the 1960s and 1970s when evidence of widespread sterilization abuse on women of color was uncovered. disproportionate numbers of black women, among other minority groups like puerto ricans and native americans, were receiving sterilizations, and many were completed in federally-funded clinics. in the 20th century, 32 states had federally-funded sterilization programs in place. anti-sterilization efforts in the 1970s came as the result of several high-profile sterilization abuse scandals. in 1972, president nixon failed to enact hew sterilization regulations that would have ended forced sterilization at federally-subsidized. this failure was exposed in 1973 due to relf v. weinberger. it was later revealed that between 100,000 and 150,000 poor women had been sterilized using federal dollars. regulations were quickly put in place after the national welfare rights organization sued hew in 1974. these regulations "prohibited the sterilization of anyone less than 21 years of age, required a 72-hour waiting period, and protected a woman from losing her aid to families with dependent children (afdc) support if she did not agree to sterilization". hew, however, then created a program through which states were reimbursed for sterilizations of poor women. the committee to end sterilization abuse (cesa) was founded in 1974 to combat abusive sterilization of women of color. it had a strong "anti-imperialist orientation" that attracted a multiracial membership, including white, puerto rican, and black women. in 1975, a coalition of groups formed an umbrella organization called the advisory committee on sterilization. members of the coalition included cesa and the national black feminist organization, a group committed to addressing the double burden of racism and sexism faced by black women. the coalition formed to advise the new york city health and hospital's corporation (hhc) on how to prevent forced or coerced sterilization within municipal hospitals. the advisory committee created a set of guidelines that mandated a 30-day waiting period and required: that consent not be given at the time of abortion or childbirth; that there be counseling on other fertility control options; that information on sterilization be given in the patient's native language; that the idea for sterilization must originate with the patient; that women could bring a patient advocate and another person of their choosing to accompany them through the process; and that the patient present written understanding of sterilization with an emphasis on its permanence. in 1975, these guidelines were passed by hhc and enforced within municipal new york city hospitals, and in a 1977 city council vote they were extended to all nyc hospitals. in 1978, the nadler bill, named for state assemblyman jerrold nadler, was passed in the new york state legislature which outlined a set of sterilization regulations similar to the original ones passed by the hhc. cesa disbanded after the passage of the nadler bill, and with the hew sterilization regulations in place, anti-sterilization efforts took the back burner for many feminist activists, though contemporary groups such as incite! and sistersong continue to address sterilization within the black community. in 2013, north carolina became the first state to compensate its victims of forced sterilization with a payment of $50,000. in north carolina, 7,600 people were sterilized between 1929 and 1974, 85% of them female and 40% of them nonwhite. virginia became the second state to provide payments in 2015, giving each living victim $25,000. organizations in the 1980s and 1990s, black women active in mainstream white-led reproductive rights organizations founded their own organizations, such as the national black women's health project and african american women evolving. national black women's health project (nbwhp) the first national conference on black women's health issues was held at spelman college in 1983. the conference led to the foundation of the national black women's health project (nbwhp) with the intent of bringing african-american women's voices on health and reproductive rights to national and international attention. founded by health care activist byllye avery and health educator lillie allen, and incorporated as a nonprofit organization in 1984, the nbwhp was the first reproductive justice organization for women of color. the organization changed its name in 2003 to the black women's health imperative "to reinforce the need to move beyond merely documenting the health inequities that exist for black women and to focus on actionable steps to eliminate them". based in atlanta, georgia, the nbwhp had established chapters in 22 states by the end of 1989 and popularized its message through conferences, workshops, and publications. the nbwhp participated in the 1985 united nations world conference for women in nairobi, kenya. in 1990, nbwhp opened a public policy–based office in washington, d.c. to more actively promote public policies that improve black women's health, such as advising president clinton's abortion rights policies and regulation. by then, the nbwhp had moved from being a grassroots organization to advertising black women's health through public policy on a national stage. african american women evolving (aawe) african american women evolving (aawe) started in 1996 as a project within the chicago abortion fund, a predominantly white abortion rights organization. aawe was committed to holistic community health education and promoting black women's health. after organizing chicago's first conference on black women's health, aawe became an independent organization in 1999, incorporating under the national network of abortion funds. the organization later changed its name to black women for reproductive justice (bwrj). bwrj conducted several surveys on african-american women's reproductive health and made that data publicly available. a predominantly grassroots organization, bwrj emphasized making health care information and options available to african-american women in illinois. the organization also worked on policy recommendations and advised, inter alia, the national abortion reproductive rights action league (naral).