They
call it “La Operación.”

Because
it is so common, as common as what many American women now use –”The Pill.”
Because women getting the operation often thought it was reversible and just a
simple form of contraception with a hundred percent rate of success –that in a
couple years they can undo. Because the doctors at the public clinic tell them
it is as simple as tying their tubes now and untying them when they’re ready
for children. And the women at work tell them about how they or someone else
from their town just went to go get it done last week. Because their husbands
pressure them to get it –because they can’t afford to feed another mouth right
now or for the wife to take so much time off work. And, because everyone said
it was the best for their already existing children.

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This
was the life of a Puerto Rican woman.

Population
control has been a historically motivating force in U.S. policy for several
decades. One of the more appalling cases of population control through U.S.
policy is the history of forced sterilization in Puerto Rico. Puerto Rico was
surrendered to the United States by Spain in 1989. The U.S. government quickly
reined tight control over the newly acquired territory. It was not considered a
state with the rights of a state-level government. As a result, was only able
to elect a governor nearly sixty years later.

The
history of forceful population control in Puerto Rico started with Harry
Laughlin, the superintendent of the US Eugenics Records Office. Laughlin used a
“Model Eugenical Sterilization Law” to administrate mandatory sterilization to
socially inadequate citizens in both the United States and Puerto Rico. This transparently
discriminatory policy deliberately targeted groups of people, used as a means
of controlling “undesirable” populations, for sterilization and later inspired Hitler’s
own program of forced sterilization in Europe.

Sterilization,
a form of eugenics practice, was commonly executed in the United States in the
twentieth century on mental patients in state institutions, who were deemed
“undesirable” in society. Outside of the U.S., in developing countries in Latin
America and Asia especially, it was frequently used as a form of population
control (London et al, 1985). Puerto Rico enacted Law 116, in 1937. It was the
last eugenics sterilization law passed under United States territorial
jurisdiction. It soon became largely promoted as a Planned Parenthood contraceptive
in the U.S. territory for older women with three or more children, who couldn’t
afford to have anymore. This soon shifted over, with women going through this
operation getting younger and younger. They offered no alternatives.

By
the late 1980s, female sterilization became the most widely used contraceptive
method in Latin America (Herold et al, 1986). Studies showed that more than
forty-six percent of married women in Puerto Rico were sterilized for
contraceptive reasons (London et al, 1985). Meaning, it was more common for you
to meet a married Puerto Rican woman who was sterilized than not. As a result,
Puerto Rico has one of the highest rates of contraceptive sterilization in
Latin America. Why did sterilization as a form of contraception become so
popular with Puerto Rican women?

Firstly,
dependence on the method of sterilization for contraception rather than other reversible
methods among Puerto Rican women was strongly influenced by socio-demographic
factors. These factors include, but are not limited to, level of education,
marital status and husband’s occupation, place of residence, and place of birth.
Women with less than a high school education, the wives of blue-collar workers,
women living outside of major cities and those born in Puerto Rico are more
likely to rely on sterilization than those with a college education, wives of a
white-collar employee, women living inside of major cities and those born
outside of Puerto Rico.  

The
Puerto Rican government along with the International Planned Parenthood
Federation ran sterilization programs as a mean of birth control within US
government-funded clinics, and it was
estimated that by 1865 more than one-third of the married women in Puerto Rico,
aged twenty to forty-nine years were sterilized (Presser, 1973). It was thought
to have slowed down by the end of the 1960s. However, later research has shown
that this high rate continued to increase slightly through the 1970s (Herold et
al, 1986).

            Now, it was public knowledge to Puerto Rican women that
they should practice some form of contraception, in general. In fact, over
sixty-nine percent were practicing some form of contraception by 1982 (Herold
et al, 1986). However, the problem is that over forty percent of these women
relied on contraceptive sterilization, while only eight percent were using the
pill and a smaller percent (somewhere around four percent) were using condoms
as a form of contraception.

            Because of Puerto Rico’s relatively high density in
population and its high fertility rates, research into contraception as a form
of population control began early. By the time Law 116 was passed, there seemed
to be this push to have sterilization become an important method of birth
control (Briggs, 2002). However, it must be noted that male sterilization did
not have anywhere near the high level of acceptance witnessed in female
sterilization practices.

            To the U.S., Puerto Rico was home to opportunities for
cheap labor with high profit and tax-free business breaks, as well as a testing
ground for a population control program. The U.S. attitude towards Puerto
Rico can be summarized in the words of the first U.S. appointed governor in
Puerto Rico when he declared that there were too many Puerto Ricans, especially
poor laborers, and not enough wealthy land and business owners (Garcia, 1985).
By 1930, unemployment had reached thirty-seven percent in the U.S. territory,
promoting U.S. owned sugarcane planters to complain of excess population and
U.S. corporations to take advantage of this land of cheap labor and tax breaks.

Propaganda
paraded around the United States in the decades following continued to
reinforce this opinion that the U. S. took towards Puerto Rico –displaying the
poverty-stricken people and blaming these circumstances on the overpopulation
problem, stating that U.S. businesses along with sterilization programs would
cure the economic woes of the territory (Garcia 1985). Puerto Rico’s distant
geographical location, and continuous media promotion of
“overpopulation” hysteria, both worked together to make this eugenics
program acceptable to the United States majority –whom historically had been
resistant to eugenic programs.

The
medical community was probably the leading force when it came to implementing
the sterilization program. Physicians at these clinics continued to push
sterilization as a means of birth control –as it was thought that other
contraceptive methods were too complicated for lower class Puerto Rico women to
understand. To the physicians, sterilization seemed to be the most feasible
solution to this problem (Presser, 1973).

“La
Operación” soon became the term used to identify the widely available and
the popular means of birth control. Many private clinics were opened in the
1940’s for the sole purpose of performing sterilization procedures. It was
common for physicians to convince women shortly after delivering a child to
consent to sterilization when the woman was not in the right state of mind to efficiently
make such a decision (Presser 1973). The targeted women were frequently
ignorant of the consequences of sterilization and it was often stressed upon
them that acceptance of the operation meant longer hospital stay after
childbirth. It also didn’t help that physicians in Puerto Rico were and are
held in high regard and as advocates of sterilization as a means for birth
control for the poor and uneducated, they were able to use this status to sway
the decision of these women.

Furthermore,
along with the medical establishment and governmental funding, sterilization
was also encouraged by other, not so obvious social behaviors. Public schools
instilled the notion of having smaller families as guaranteed financial
stability and the means to have it all –like the nice pictures of the white,
happy, American families displayed in their textbooks (Garcia, 1985). Having a
small family meant progress towards a larger societal goal of economic
stability. It reinforced this idea that Puerto Rican women had to get
sterilized to have a worthy and prosperous life. In fact, it was arguably “in
style” to get sterilized and volunteers traveled across the island to promote
sterilization as a means of birth control. In a catholic dominated region, this
birth control was preached as a means to prevent abortion (Garcia, 1985).

Sterilization
was more customary for urban women and in women of lower socio-economic status
(Morales de Valle, 1982). One major motivator seemed to be high fertility rate
in these women. Sterilized women had higher fertility than unsterilized women,
four children compared to three, which indicated that too high fertility was an
important motivation to get sterilized. However, while high fertility was an
important motivation for sterilization, it had a negative effect on total
fertility rate in the long run (Morales de Valle, 1982). Puerto Rico’s total
fertility rate declined from 5.9 in 1940 to 2.9 in 1976 and it was largely due
to sterilization, nearly sixty percent (Morales del Valle, 1982).

The
primary success of eugenics in Puerto Rico was not only established by Law 116
but also by the U.S. colonization less than fifty years before (Briggs, 2002).
By 1925, due to the invasion of U.S. sugar companies and the consequent
devaluation of the peso and displacement of many farmers, over seventy percent
of the Puerto Rican population was landless with two percent owning eighty
percent of the land (Kinzer, 2007). US eugenicists grasped the opportunity from
the resulting poverty, blaming it on overpopulation, and targeting poor women
for sterilization and pharmaceutical testings (Briggs, 2002). It was no
surprise when, in 1976, the U.S Department of Health, Education, and Welfare
reported that over 37% of women of childbearing age in Puerto Rico had been
sterilized –majority of which were in still their twenties.

A
key encourager for this eugenics movement in the U.S. territory was American
Eugenicist, Clarence Gamble, President of the Pennsylvania Birth Control
Federation and founding member of the Human Betterment League. He was the main
advocate in the idea that the reducing of the birthrate among African Americans
in the South was the solution to the region’s poverty.  In 1939, Gamble began to fly in doctors from
Puerto Rica to the United States to learn the cutting-edge new sterilization
techniques (e.g. tubal ligation). However, that wasn’t the beginning of his
involvement in this population control movement. Earlier in the decade, he
began to staff birth control clinics, which were established by Franklin D.
Roosevelt’s Puerto Rican Relief Administration, with his own workers and used
them as places for recruiting applicants for sterilization (Briggs, 2002).

Many
of the women who consented to tubal ligation in these birth control clinics did
not fully comprehend that the procedure was permanent. Some clinics and
facilities supported and funded by Gamble were reported to have refused
admittance to pregnant women who had already given birth two or more times if
they did not consent to “La Operación.”
This, of course, is considered heresy since they could not do this legally.
However, this statement is consistent with many Puerto Rican women who recounted
that they were sterilized without any knowledge. And by 1968, approximately
thirty years into Gamble’s association with this population control movement in
Puerto Rico, women there had the highest sterilization rates in the world.

Under
the pretext of protecting women’s reproductive health, Gamble and his wife
continued to travel abroad researching contraceptive techniques in poor
communities in developing counties until his death in 1966. Gamble, along with
many other eugenicists, believed that population overgrowth was the cause of
poverty. But there has been research that has shown that population overgrowth
is just a symptom of poverty (Hartmann, 1999). He, along with his correspondent
Margaret Sanger, impacted the lives of many poor women in developing countries,
spreading their ideas of birth control worldwide.

Five decades of familiarity with sterilization had left a
lasting legacy in Puerto Rico. By 1968, thirty-five percent of all Puerto Rican
women of child-bearing age had been sterilized –many without fully
understanding the finality of the operation and others without any knowledge at
all. Despite this unbelievably high percentage, sterilization rates did not
decline. On the contrary, “La Operación” had become ingrained, even
institutionalized, amongst Puerto Rican women, whether they lived in the U.S.
territory or in the United States (Garcia, 1985). Nevertheless, while it seemed
to become a part of the Puerto Rican culture, the kind of women who actually
underwent this operation varied demographically.

The
popularity of the usage of female sterilization for Puerto Rican women varied
through several demographic factors, such as education, husband’s occupation,
place of residence, and place of birth. Education had a strong influence on the
type of contraceptive method a woman would use. According to the Puerto Rico
Reproductive Health Survey 1995-1996, fifty-five percent of women with less
than a high school education had been sterilized for contraceptive purposes,
while with those that were college-educated the percentage was less than half
that number (Dávila, 1998). Women living
in standard metropolitan areas, such as San Juan or Ponce, were less likely to
use sterilization for contraceptive reasons than those living in non-metropolitan
areas.

Another
demographic factor that showed significant variance was the place of birth for
these Puerto Rican women. Comparing women born on the island with those born
outside of Puerto Rico, there were large differences in dependence on
sterilization between the two groups (forty-nine percent compared to
twenty-eight percent, respectively) and in the use of other modern
contraceptive methods (sixteen percent and thirty percent, respectively)
(Herold, 1986). These Puerto Rican women tend to embrace the contraceptive
practices of the culture of where they lived in their formative years. For
example, women born on the island are more likely to use sterilization since
that is the method that dominated there. Women born outside of the U.S. territory
tend to have more diversity in their contraceptive choices.

The
husband’s occupation had an influence on contraceptive use similar to that of
women’s educational status (Herold, 1998).
Similarly, in the U.S., white-collar working families were better off than
those of blue-collar. This, of course, had to do with family income and
geographic locations. This, in turn, could arguably affect other demographic
factors. Or more accurately, is more directly connected to others, having
similar or the same effect on the women’s contraceptive use. Wives of
white-collar workers are less likely to use sterilization for protection and
more likely to use other forms of contraception than those of blue-collar
workers (Herold, 1986). However, it is
also reasonable to assume that the wives of white-collar employees are also
likely to have fewest children than the wives of blue-collar employees. In
contrast, there are no noteworthy differences in contraceptive use in terms of the
woman’s own work status (Herold, 1986). Employed
women depend on sterilization somewhat less than those that are not employed. This
dimension was not further explored in the public health survey.

Another
demographic factor that has been studied, but did not show a strong influence
on the use of sterilization for contraceptive reasons in Puerto Rican women is
religion. Contraceptive practice, in general, for Puerto Rican women has been
shown to vary little with religious belief (Herold,
1986). Catholics choose for sterilization somewhat less than women in
other religious groups, but the variances are minor. This result is supplemented
by the fact that there is a higher usage of other modern methods of fertility
regulation among Catholics. Thus, the percentage at risk of unplanned pregnancy,
and consequently, the use of sterilization did not appear to be influenced by
religion.

Nonconsensual
sterilization is arguably the by-product of a classist and racist society.
While sterilization was actively promoted as a means of birth control for
society as a whole, it seemed like poor, lowly educated Puerto Rican women were
the ones to use it consistently. It became a part of their culture. Whether
through outside influence from the United States or unwavering endorsement from
social norms in Puerto Rico, these women felt the need to use this final
solution.

Population
control in U.S. policy directed toward Latinas was not solely popular in Puerto
Rico. Forced sterilization of Latinas was also common in California. There was
a film called No Más Bebés, which emphasized how actually widespread racism
towards Hispanics allowed unethical medical practices to be performed right
here in the United States. Mexican American women were commonly sterilized
while giving birth in Los Angeles (Stern, 2005). The procedures happened during childbirth.

The
case of Madrigal vs. Quilligan was a federal class lawsuit where the plaintiffs
claimed they were sterilized without informed consent or under duress (Stern,
2005). In this court proceeding, one of the plaintiffs was explicitly told by
the doctors that her sterilization could be easily reversed. Another two
claimed to be pressured into agreeing after being forcefully criticized by the
doctors. At the end of the trail, the judge ruled that the neither of the
charges were factual, citing misunderstandings due to the women not speaking
English –the women mainly spoke Spanish. Racism in its truest form. This is
just one case of many that raise the question of whether these women were
actually forced into an agreement and if this eugenic movement was purposely
targeting Latinas.

The
blatant disregard for the reproductive rights of women to suit the politics of
white men, especially in the policies for population control, is intrinsically
apparent in the long history of female reproductive health in the United
States. Though at times considered necessary to achieve the desired population
balance, the history of sterilization suspiciously affected women of color and
lower class women more often than not. The institutionalized reinforcement of
sterilization made it quite easy for the U.S. eugenicist funded clinics to popularly
operate well into the 1970s in Puerto Rico.

So
how did sterilization become such an ingrained part in Puerto Rican women’s
decision-making process when planning for a family? Well, people make choices
based on alternatives. And as shown, there haven’t been many other alternatives
to contraceptive sterilization in Puerto Rico. Because of Puerto Rico’s
colonial link with the U.S., the territory’s birth control history is strongly
intertwined with the politics of birth control in the U.S. It would be
interesting to look further into the reasons why the United States thought
sterilization was the best possible solution to overpopulation in the territory
(and in other developing countries around the world).

The
history of forced sterilization of Puerto Rican women holds a complicated message
for the more modern practice of genetics and its impact on society. Though
separate from eugenics, genetics is only the matter of another form of science
waiting to be construed to fit the means of men. Ethically the issue of what
should be done to prevent the consequences of eugenic practices from
transferring over to genetics and happening all over again is extensive and
complicated. As shown from the practice of sterilization, humans are often
short-sighted from current socially upheld philosophies.