Survey for people who were previously in women's prisons
The purpose of this survey is to understand the scope of forced sterilizations happening in women's prisons in order to better advocate for reproductive justice and provide resources and support to survivors.

If you do not wish to answer a question, feel free to skip. This survey is completely anonymous, unless you wish to stay in touch.
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What is your age?
Clear selection
What is your gender identity?
Clear selection
What is your ethnicity?
Check all that apply.
What years were you housed in prison or a CA state institution?
Check all that apply.
Which CA state institutions were you housed in?
If you were housed in more than one institution, please list them.
Do you have reason to think that you, or someone you know, were sterilized while doing time in prison or jail?
Sterilization includes hysterectomy, oophorectomy (ovaries removed), tubal ligation (tubes tied).
Did you, or someone you know, ever have abdominal surgery while you were in prison?
e.g. hernia repair, ovarian cyst removal, biopsy, getting an appendix removed, etc.
Clear selection
How old were you, or the person you know, at the time of surgery?
If you didn't have surgery, skip this question.
What was the date of the surgery (if you remember)?
If you didn't have surgery, skip this question.
Do you remember the name of your OB/GYN doctor(s)?
If yes, please feel free to share the name. If not, or if you did not have surgery, skip this question.
Do you remember the name of the person who performed your reproductive or abdominal surgery?
If yes, please feel free to share the name. If not, or if you did not have surgery, skip this question.
If you had an outside surgery, do you remember the name of the hospital and/or the city where it was located?
If you did not have an outside surgery, please skip this question.
Were you given any medication that affected your sex drive?
Clear selection
If yes, were you told what that medication was?
Did you ever give birth while you were in prison or jail?
Clear selection
How did you give birth?
If you didn't give birth while you were in prison or jail, skip this question.
Clear selection
How old were you when you gave birth in prison or a state institution?
If you didn't give birth while you were in prison or jail, skip this question.
What was the date of birth (if you remember)?
If you didn't give birth while you were in prison or jail, skip this question.
Did any medical staff or doctor ask you if you wanted to be sterilized prior to surgery or giving birth?
If you didn't give birth while you were in prison or jail, skip this question.
Clear selection
Do you remember the name of your OB/GYN doctor(s)?
If yes, please feel free to share the name. If not, or if you did not give birth while you were in prison or jail, skip this question.
Do you remember the name of the person who performed your surgery or delivery?
If yes, please feel free to share the name. If not, or if you did not give birth while you were in prison or jail, skip this question.
If you had an outside surgery, do you remember the name of the hospital and/or the city where it was located?
If you did not have an outside surgery, please skip this question.
Is there anything you would like to share about your story publicly?
If so, who should we attribute the quote to? It's okay to remain anonymous. If you do not wish to share anything about your story publicly, please skip this question.
Would you like for us to stay in touch with you?
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If yes, please list your name and the best way to stay in touch (your phone number and/or email):
Please check if you are interested in the following:
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