It’s 1960, and newly-married Jane Forrester has just gotten a job as a social worker for Grace County in North Carolina. She wants to help disadvantaged families, so this seems like a good fit. The work is harder than she thought it would be. Her clients live in tiny, primitive shacks in the middle of nowhere. They need so many basic things – food, clothes, shoes, indoor plumbing, and medical care. They are all on welfare, and it’s up to Jane to monitor them for signs of unreported income, or neglect or abuse of their children.
Jane quickly becomes attached to the Harts – grandmother Nonnie, 17-year-old Mary Ella, her 2-year-old son Baby William, and 15-year-old Ivy. They live in an old cabin on a tobacco farm, and are given free rent in exchange for working on the farm. The little family doesn’t function well. The grandmother has diabetes that she does not manage well, Mary Ella has a low IQ, William is mentally underdeveloped, and Ivy is sneaking out at night to meet a boy.
The job quickly becomes unpleasant. Jane’s husband disapproves of her working. Her co-workers complain that she is getting too emotionally attached her clients. And worst of all, she finds out it’s her job to order the sterilization of Ivy.
At that time, social workers in North Carolina could petition to have a person – man or woman – sterilized if they had serious medical conditions, a low IQ, or were simply sleeping around. These folks were all on welfare assistance, and more babies meant more cost to the taxpayers.
Jane finds out that Mary Ella has been lied to by the previous social worker, who had her surgically sterilized, while saying her appendix was removed. Now it’s Ivy’s turn. But Jane has a hard time believing that it’s necessary to lie and manipulate her client into doing something she may not want to do.
Although this book is fictional, the background of the story is true. In their attempt to “help” people that they deemed inferior, the Eugenics Sterilization Program in North Carolina sterilized more than 7,000 people. The program began in 1929, continued through the Great Depression and World War II, and was not closed down until 1975. It began mostly with people who were institutionalized, then shifted over to people collecting welfare. It was often done without the patient being told the truth about what was happening, supposed for their own good. Is it ever necessary to lie? That is the question of this book.