Forced Sterilization of Native Americans: Late Twentieth Ce

Forced Sterilization of Native Americans: Late Twentieth Ce

Postby admin » Tue Oct 18, 2016 10:19 pm

Forced Sterilization of Native Americans: Late Twentieth Century Physician Cooperation with National Eugenic Policies
by Gregory W. Rutecki, MD



Many consider the plight of Native Americans an archetypal genocide. Centuries ago, the British suggested the response to their presence should be “extermination.”[i] Their soldiers then proceeded to knowingly decimate them with smallpox—a virus to which Native Americans had no immunity. Additional efforts over centuries to eradicate their population would follow. There would be a “Trail of Tears,” lethal attacks on Nez Perce men, women, and children to acquire their ancestral homeland, and a massacre at Wounded Knee—to name merely a few. The protracted policy directed against the United States of America’s indigenous peoples represented misguided governments, widespread greed, and enforcement by an at times ruthless, undisciplined military. A recent, albeit weakly publicized, continuation of this policy has been played out in a bioethical arena. Indeed, after the Nuremberg Trials and an explicit international consensus, this would be considered anathema. On view is the evil of forced abortions and sterilizations. This two-pronged approach to knowingly limit births in selected populations was emblematic of eugenic policy in the early to mid-twentieth century. Unfortunately, eugenic birth control had been resuscitated as late as the 1970s through voluntary physician complicity with an immoral national eugenic policy.

When she was 20 years old, a Native American woman underwent a total hysterectomy by an Indian Health Service (IHS) physician for unconvincing indications.[ii] Her experience came to light when she visited Dr. Connie Pinkerton-Uri, a physician of Native American heritage in the 1970s. Two other young women in Montana needed appendectomies and also received “incidental” tubal ligations. Were these merely aberrations or the first examples of a disturbing pattern? Bureau of Census Reports explicitly documented a steep decline in childbirth for diverse Native American tribes comparing birth numbers from 1960 through 1980.[iii] The three examples were, unfortunately, merely the tip of the iceberg.

On November 6, 1976, the Government Accounting Office (GAO) released the results of its investigation into similar events at four of twelve IHS areas (Albuquerque, Aberdeen, Oklahoma City, and Phoenix). Records verified that the IHS performed 3,406 sterilizations between 1973 and 1976.[iv] “Tip of the iceberg” is indeed an appropriate metaphor. Per capita, this figure would be equivalent to sterilizing 452,000 non-Native American women.[v]Albuquerque contracted out their sterilizations to local, non-IHS physicians; therefore their region inaccurately added zero procedures to the government count. Independent research estimated that as many as 25-50% of Native American women were sterilized between 1970 and 1976.[vi]Independent verifications were critical. The GAO did not interview a single women subjected to sterilization. The GAO also admitted that “contract” physicians were not required to comply with any federal regulations (including informed consent) in the context of these surgical procedures. Study of consent forms utilized revealed that three different forms were in use. It also appeared the “consent,” in many instances, was obtained through coercion.

What may be the most disturbing aspect of the investigations followed: it was physicians and healthcare professionals in the IHS who coerced these women. It was they who abandoned their professional responsibility to protect the vulnerable through appropriate, non-eugenic indications for surgery and informed consent prior to the procedures. On a Navaho reservation alone, from 1972-1978, there was a 130% increase in abortions (a ratio of abortions per 1000 deliveries increasing from 34 to 77).[vii] The same study demonstrated that between 1972 and 1978, sterilization procedures went from 15.1% to 30.7% of total female surgeries on that one reservation. Healthcare professionals’ coercive tactics included the threat of withdrawing future healthcare provisions or custody of Native American children already born—if consent for sterilization was withheld.[viii] The scandal of this replay of earlier twentieth century eugenic programs and genocidal tactics led to a congressional hearing (Senator James Abourzek, Democrat, South Dakota), but little else in terms of publicity, justice, or public outcry. It has also not been scrutinized from a careful bioethical perspective.

Although the travesty of forced sterilization and abortions targeting Native Americans occurred a generation ago, and has apparently ended, a revisit in 2009 is critical. First, the breech in ethics took place in America. The record for such immoral activities has already been questioned in light of California’s record with forced sterilization from 1909 through 1979, subsidized through federal funding.[ix] Approximately 20,000 similar operations were performed in that State (mostly on African-Americans and Latinos), a significant number of these occurring after the Nuremberg Trials. Secondly, if the centuries-long treatment of Native Americans is a protracted genocide, not merely archetypal, the addition of physicians to the armamentarium of genocide, especially at this late juncture, is ominous. Physicians in the IHS during the time in question were young. Since their generation, additional medical graduates have moved even further from the Hippocratic tenet of “do no harm.” Furthermore, the ever-increasing shift from a covenantal model for medical practice to a contract model is relevant to the ethics at hand. Physicians who performed abortions and sterilizations on Native American women were contracted and reimbursed in full for their work. Similar models for specialty care which is contracted and reimbursed in full exist today under the umbrella of managed care. Payment for medical technique removed from context of ethical considerations may tempt many physicians in an era of decreasing reimbursement rates. Erosion of Hippocratism inhabits every aspect of the tragedies of care for these Native American women, and serves as more than a warning to us of the danger of divorcing ethical conviction from medical care.

Editor’s Note: This essay served as the basis for a parallel paper presentation at CBHD’s 2009 summer conference, Global Bioethics: Emerging Challenges Facing Human Dignity.

[i] K.B. Patterson and T. Runge, “Smallpox and the Native American,” American Journal of the Medical Sciences 323 (2002): 216-222.
[ii] J. Lawrence, “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly 24 (2000): 400-419.
[iii] Ibid.
[iv] Ibid. Cf. K. Larson, “And Then There Were None,” Christian Century Jan (1997): 61.
[v] Bill Wagner, “Lo the poor and sterilized Indian,” America 136 (1977): 75.
[vi] B. Dillingham, “American Indian Women and IHS Sterilization Practices,” American Indian Journal 3 (1977): 16.
[vii] H. Temkin-Greener, S. J. Kunitz, D. Broudy, M. Haffner, “Surgical fertility regulation among women on the Navaho Indian Reservation, 1972-1978.” American Journal of Public Health 71 (1981) 403-407.
[viii] S. J. Torpy, “Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s.” American Indian Culture and Research Journal 24 (2000): 1-22.
[ix] A. M. Stern, “Sterilized in the name of Public Health: Race, Immigration, and Reproductive Control in Modern California.” American Journal of Public Health 95 (2005): 1128-1138;
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Re: Forced Sterilization of Native Americans: Late Twentieth

Postby admin » Tue Oct 18, 2016 10:28 pm

History of Forced Sterilization and Current U.S. Abuses
by Kathryn Krase
October 1, 2014



Historic state marker located on the east lawn of the Indiana State Library in Indianapolis / Photo: Indiana Historical Bureau

In 2013, thanks to the Center for Investigative Reporting, it came to light that dozens of female inmates in California had been illegally sterilized in recent years. The story was a salient reminder that forced sterilization, an issue that tends to be viewed as a tragic-but-past occurrence, continues today.

Sterilization abuse includes situations in which a woman does not know she is being sterilized as well as when she is coerced or deceived in order to obtain her consent to the procedure. Misinformation is a common tool; women are often told that their status — related to immigration, housing, government benefits, or parenting — will be negatively impacted if they do not consent to the procedure. Many women are told that the procedure is temporary or reversible.

Women in the United States and beyond have historically been subjected to coordinated efforts to control their fertility, including sterilization abuse. The burgeoning women’s movement in the 1960s, and growing concerns over limits to women’s reproductive rights at that time, helped focus concerns over sterilization abuse into action.


A 1965 survey of Puerto Rican residents found that about one-third of all Puerto Rican mothers, ages 20-49, were sterilized. To put this figure in context, women of childbearing age in Puerto Rico in the 1960s were more than 10 times more likely to be sterilized than women from the United States. These shocking findings suggested that systematic bias influenced the practice of sterilization, not just in Puerto Rico, but in the United States as well.

Dr. Helen Rodriguez-Trias, the first Latina to be elected president of the American Public Health Association, was a founding member of Committee to End Sterilization Abuse / Photo: National Library of Medicine

Since the United States assumed governance of Puerto Rico in 1898, population control had been a major effort. The United States, citing concerns that overpopulation of the island would lead to disastrous social and economic conditions, instituted public policies aimed at controlling the rapid growth of the population. The passage of Law 116 in 1937 signified the institutionalization of the population control program.

This program, designed by the Eugenics Board, was intended to “catalyze economic growth,” and respond to “depression-era unemployment.” Both U.S. government funds and contributions from private individuals supported the initiative.

Instead of providing Puerto Rican women with access to alternative forms of safe, legal and reversible contraception, U.S. policy promoted the use of permanent sterilization. The procedure was so common in Puerto Rico at the time that it was simply referred to as “la operacion.”

Institutionalized encouragement of sterilization through the use of door-to-door visits by health workers, financial subsidy of the operation, and industrial employer favoritism toward sterilized women pushed women towards having a hysterectomy or tubal ligation (i.e., “tying the tubes”). The coercive strategies used by these institutions denied women access to informed consent.

More than one-third of the women in the 1968 study did not know that sterilization through tubal ligation was a permanent form of contraception. The euphemism “tying the tubes” made women think the procedure was easily reversible.

Read: Recommended bibliography on the sterilization of Puerto Rican women >

Sterilization of Puerto Rican Women: A Selected, Partially Annotated Bibliography (Louis de Malave, 1999)


The colonial legacy of controlling women’s sexuality and reproduction continues to prevail with such policies as the testing of the I.U.D., birth control pills and the sterilization of women. In the case of sterilization, the subject of this bibliography, between the 1930s and the 1970s approximately one-third of Puerto Rico’s female population of childbearing age had undergone the operation, the highest rate in the world. So common was the practice that the words “sterilization” and “la operacion” (the operation) were used interchangeably. The massive sterilization of Puerto Rican females warrants that their experience be brought to the forefront, and there’s the hope that this bibliography will stimulates interest and further research in the subject.

The bibliography not only examines the experience in Puerto Rico but also Island-born Puerto Ricans who migrated to the mainland U.S. due to the Islands close political ties (Commonwealth status)with the U.S. It is also worth noting the U.S. Department of Health, Education and Welfare’s major role in providing partial funding to Puerto Rico’s sterilization program.

The bibliographical sources selected provide a multi-disciplinary approach to researching the subject. Some of the areas addressed are class structure, historical population control policies, political economy and ideology of health systems and governments (Puerto Rico and U.S.), and the socio-economic and psychological factors that motivated so many women (coerced or not) to undergo the procedure.

What follows is a selected, partially annotated bibliography divided by language, beginning with English language sources (the majority portion). Included are books, journal articles, dissertations, seminar/workshop papers (published and unpublished), documentary video (provides first-hand testimonies from women who have undergone the procedure and government officials involved in the family planning program). The Internet sites to a few English language abstracts are also included, particularly of published and unpublished papers from workshop The researcher, however, should keep in mind that given the constant changes that occur on the Internet, these sites may no longer exist or have a change in http locators.

A special acknowledgment of appreciation must be extended to Luis Villar, Academic Librarian-Ibero-American Studies, Bibliographer at the University of Wisconsin-Madison, for sharing his Internet expertise.

In English

Alvarado, Carmen and C. Tietze. “Birth Control in Puerto Rico.” Human Fertility 22, no. 1 (March 1947):15-17.
Aviles, Luis A. and Yamila Azize-Vargas. “Abortion in Puerto Rico: The Limits of Colonial Legality.” Reproductive Health Matters no. 9 (May 1997):56-65.
[Examines the impact of U.S. colonization of Puerto Rico on issues related to contraceptive practices, including sterilization, and accessibility to these services on the Island]
Back, K., R. Hill and J.M. Stycos. “The Puerto Rican Field Experience in Population Control.” Human Relations (1956):315-334.
Barrow, E. and J.A. Richardson. “Counseling Women for Tubal Sterilization.” Health and Social Work 3, no. 1 (February 1978):48-58.
[Examines the role of social workers in counseling women considering sterilization and provides statistics showing that a higher percentage of Puerto Rican women accept the operation than Black women in New York]
Bauza, Vanessa. “Puerto Rico: The Covert Campaign to Sterilize Women.” MS [new series] 5, no. 2 (September/October 1994):14.
[Discusses Puerto Rico’s campaign to sterilize women beginning in the 1930s through U.S. sponsorship, the involuntary sterilization of mentally ill and poor, and the failure to provide women with adequate information regarding the physical and psychological consequences of sterilization; ISSN: 0048-8318]
Boring, Catherine Chase. “Factors Associated with Sterilization Regret Among Puerto Rican Women.” Master’s thesis, Emory University, 1986.
______, R.W. Rochat and J. Becerra. “Sterilization Regret among Puerto Rican Women.” Fertility & Sterility 49, no. 6 (June 1988):973-981.
[Interview data from the 1982 Puerto Rico Fertility and Family Planning Assessment to examine the reason for sterilization regret among Puerto Rican women; ISSN:0015-0282]
Borras, Vickie A. “Birth Control Knowledge, Attitudes, and Practice: A Comparison of Working and Middle Class Puerto Rican and White American Women.” Ph.D. diss., Mass: University of Massachusetts, 1984.
[Interview data from Puerto Rican and white females residing in the Boston or Worcester, Massachusetts areas to determine differences in knowledge, attitudes and usage of birth control methods]
Briggs, Laura. “Discourses of `Forced Sterilization’ in Puerto Rico.” Differences 10, no. 2 (1998):30-66.
[History of political movements (particularly socialists) and scholarly works, beginning in the 1970s, concerning the high incidence of sterilization in Puerto Rico. Focus is on U.S. socialist feminists who, viewing sterilization as a form of colonial genocide along with Puerto Rican nationalism and pronatalism, inadvertently became associated with pronatalists and antifeminist groups like the Catholic Church, and alienated from Puerto Rican feminists who advocated sterilization as an acceptable form of birth control. Article includes bibliographical references]
“Contraceptive Programs: The Risk of Coercion.” Women’s Health Journal (January 1994):52-53.
[Examines sterilization abuse programs internationally including Puerto Rico]
Davila, A.L. “Sterilization and Contraceptive Practice in Puerto Rico, 1982.” [Esterilizacion y practica anticonceptiva en Puerto Rico, 1982] Puerto Rico Health Science Journal 9, no. 1 (April 1990):61-67.
[Analyzes female sterilization in Puerto Rico in relation to birth control policies, also describes patterns of contraceptive usage; ISSN: 0738-0658; Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
Davis, J.E. “Opening Address: Historical Setting of the Conference.” In Advances in Voluntary Sterilization, eds.
M.E. Schima [et al.]. (International Congress Series No. 284) Proceedings of the 2nd International Conferences, Geneva, Switzerland, 25 February-1 March 1973. Amsterdam, Netherlands, Excerpta Medica, 1974.
[Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
“Experience with Oral and intrauterine Contraception in Rural Puerto Rico.” In Public Health and Population Change, eds. M.C. Sheps and J.C. Ridley, 110-138. Pittsburgh, Penn.: University of Pittsburgh Press, 1965.
[Discusses the impact of religious protests against sterilization, resulting in alternative methods of birth control]
Gibson-Rosado, Erica M. The Sterilization of Women in Puerto Rico Under the Cloak of Colonial Policy: A Case Study on the Role of Perception in U.S. Foreign Policy and Population Control. Washington, D.C.: The John Hopkins University, 1993.
Gilbert, C.R. “Rincon Method of Sterilization.” American Journal of Surgery 80 (September 1950):345-348. [Discusses the Rincon method of sterilization, including the experience of Puerto Rico women on the Island and New York’s Spanish Harlem who have undergone the procedure]
Gonzalez, M. “La Operacion: An Analysis of Sterilization in a Puerto Rican Community in Connecticut.” In Work, Family and Health: Latina Women in Transition, Ruth E. Zambrana, 47-62. New York: Fordham University, 1982.
Greenberg, Karen Elfman. “Analysis of Factors Affecting Sterilization Rates for Puerto Rican Women Living in the Bronx, New York (New York City). Ph.D. diss., University of Maryland, 1992.
[Analyzed data on Puerto Rican women born on the island, the U.S. mainland, and those who migrated to and from U.S. and Puerto Rico to explain the high rates of sterilization]
Grio, R. [et al.] “Reconsideration and desire for Tubal Recanalization in Women Following Voluntary Sterilization.” [Pentimento e desiderio di ricanalizzazione tubarica dopo sterilizzazione volontaria nella donna] Minerva Ginecologica 44, no. 3 (March 1992):123-124.
[Includes a review of Puerto Rican women’s regret at having undergone the procedure; ISSN: 0026-4784; Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
Hatt, P. Backgrounds of Human Fertility in Puerto Rico. Princeton: Princeton University Press, 1952.
Henderson, Peta Murray. “Population Policy, Social Structure and Health System in Puerto Rico: The Case of Female Sterilization.” (Ph.D. diss., University of Connecticut, 1976.) Ann Arbor: University Microfilms International, 1980.
Kent, M. “Survey Report: Puerto Rico.” Population Today 15. no. 2 (February 1987):4.
[Examines study results of 1982 Fertility and Family Planning Assessment, which looked at sterilization among Puerto Rican men and women, in comparison with other forms of contraceptives, and between college and non-college educated women]
Krase, Kathryn. “Sterilization Abuse: The Policies Behind the Practice.” National Women’s Health Network. Network News (January/February 1996):1,4.
[Includes discussions on involuntary sterilization in Puerto Rico and New York City; ISSN: 8755-867X]
Lader, L. “The Future of Voluntary Sterilization.” In Foolproof Birth Control: Male and Female Sterilization, ed. L. Lader, 246-253. Boston: Beacon Press, 1973.
Laureano Cartagena, S.M. “Sterilization in Puerto Rico: From Massive and Imposed to Wanted and Not Available.” In We Speak for Ourselves: Population and Development, compiled by Panos Institute, [100-105(?)]. Washington, D.C.: Panos Institute, 1994.
Leon, Luz E. “Sterilization and Depression: A Study of Puerto Rican Women Living in New York.” (Ph.D. diss., Fordham University, 1996.) Ann Arbor, Mich.: University Microfilms International, 1996.
[Research on the association between female sterilization and depression, based on the Rogler theory on the effects of migration on mental health]
Lopez, Iris Ofelia. “Agency and Constraint: Sterilization and Reproductive Freedom among Puerto Rican Women in New York City.” Urban Anthropology and Studies of Cultural Systems 22, no. 3/4 (Fall 1993):299.
______. “Sterilization Among Puerto Rican Women: A Case Study in New York City.” (Ph.D. diss., Columbia University. 1984.) Ann Arbor, Mich.: University Microfilms International, 1985.
[Study is based on fieldwork and interviews with 128 sterilized and non-sterilized women in a Puerto Rican community in Brooklyn, seeking to examine the historical factors conditioning the high incidence of sterilization among Puerto Rican women in New York and the factors that continue to motivate these women to seek this service]
Lovler, R. “Health Agency Budget Cuts to Slow Sterilization by 50 Percent.” The San Juan Star (4 February 1975):3.
Lugo-Ortiz, Maria de Lourdes. “Sterilization, Birth Control and Population Control: The News Coverage of `El Mundo’, `El Imparcial’ and `Claridad’.” (Ph.D. diss., University of Wisconsin-Madison, 1994.) Ann Arbor, Mich.: University Microfilms International, 1994.
[Reviews newspaper coverage of the sterilization programs conducted in Puerto Rico from 1940 to 1975, revealing the newspapers’ ideology, which is described as coming from a male-dominant perspective while marginalizing women]
Mass, Bonnie. “Puerto Rico, a Case Study in Population Control.” Latin American Perspective 4, no 4 (Fall 1977):66-81.
“Operacion.” AVS News (December 1975):3.
[Provides official statistical information that appears to contradict the common believe that sterilization was an abuse directed at the poor. This articles instead indicates the majority of women who opted for sterilization came from the upper classes, those who could more readily afford the services. According to these reports, sterilization was not accessible to the lower classes until 1974 when a survey was taken by the Dept. of Health that indicated 83% of the population desired that sterilization be made available to them]
“Paging Gov. Muñoz Marin: “Sterilizing the Natives of Puerto Rico.” America [Amer. Press-N.Y.] 98 (8 February 1958):528.
Paniagua, M.E. [et al.]. “3. Medical and Psychological Sequelae of Surgical Sterilization of Women.” In Foolproof Birth Control: Male and Female Sterilization. Boston: Beacon Press. 1973.
[Survey of medical and psychological sequelae among samples of Puerto Rican women sterilized from 1956 through 1961]
Presser, Harriet B. “Contraceptive Sterilization as a Grassroots Response: A Comparative View of the Puerto Rican and United States Experience.” In Behavioral-Social Aspects of Contraceptive Sterilization, eds. S.H. Newman and Z.E. Klein, 25-48. Lexington, Mass.: Lexington Books, 1978.
[Describes trends in sterilization practice in Puerto Rico and the U.S,, including its popularity from demographic and social perspectives; analyzes the structural supports for constraints against sterilization; and provides suggestions for future research on these issues]
______. “Puerto Rico: Recent Trends in Fertility and Sterilization.” International Family Planning Perspectives 6, no. 1 (March 1980):20-25.; Family Planning Perspectives 12, no. 2 (March/April 1980):102-106.
[Examines the decline in fertility among Puerto Rican women between 1950 and 1977 and the correlation to sterilization and abortion]
______. Review of “Colonialism, Catholicism, Contraception: A History of Birth Control in Puerto Rico,” by Annette B. Ramirez de Arellano and Conrad Seipp. Hispanic American Historical Review 64, no. 3 (August 1984):556-558.
______. “The Role of Sterilization in Controlling Puerto Rican Fertility.” Population Studies 23, no. 3 (November 1969): 343-361.
[Analyzes sterilization data from the 1965 Master Sample Survey of Health and Welfare in Puerto Rico, which involved 1,071 women ages 20 to 49]
______. “Sterilization and Fertility Decline in Puerto Rico.” (Ph.D. diss., University of California-Berkeley, 1969); Ann Arbor, Mich.: University Microfilms International, 1974; Rev.ed.: Berkeley: University of California, Institute of International Studies, 1973 (Population Monograph Series, No. 13); Reprint: Westport, Conn.: Greenwood Press, 1976.
[Examines sterilization practice in Puerto Rico in 1965, when it was the primary form of contraceptive. Uses sample of 1,071 women 20-49 years of age, which includes the 1965 Master Sample Survey conducted by the Dept. of Health and Welfare as well as a sample of 127 sterilized and 127 non-sterilized women obtained from records at San Juan City Hospital in 1966]
“The Puerto Rico Experience: `La Operacion’: Sterilization in Puerto Rico.” In Caribbean Voices. From Conferences and from the Region, from the Issues Conference at Medgar Evers College, Brooklyn, N.Y. 55 min. N.Y.: Deep Dish TV, 1992. Videocassette.
[Episode of the television series Rock the Boat. Pt. 2 focuses on sterilization and Puerto Rico]
Ramirez de Arellano, Annette B. and Conrad Seipp. Colonialism, Catholicism, and Contraception: A History of Birth Control in Puerto Rico. Chapel Hill: University of North Carolina Press, 1983.
[Comprehensive history of the birth control movement in Puerto Rico, including information on sterilization]
Ramos-Bellido, Carlos Gil. “The Politics of Birth Control in Puerto Rico.” Ph.D. diss., University of California-Berkeley, 1977.
Robles, R.R. [et al.]. “Health Care Services and Sterilization Among Puerto Rican Women.” [Unpublished] Presented at the 115th Annual Meeting of the American Public Health Association, New Orleans, Louisiana, 18-22 October, 1987 Puerto Rico Health Science Journal 7, no. 1 (April 1988):7-13.
[Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
Ross, L. “Sterilization and `de facto’ Sterilization.” AMICUS Journal (Winter 1994):29.
Safa, Helen Icken. “Female Employment and the Social Reproduction of the Puerto Working Class.” International Migration Review 18, no 4 (Winter 1984):1168-1187.
Salvo, Joseph, Mary G. Powers, and Rosemary Santana Cooney. “Contraceptive Use and Sterilization Among Puerto Rican Women.” Family Planning Perspectives 24, no. 5 (September/October 1992):219-223.
[Comparative study of the contraceptive practices of Puerto Rican women residing in New York City with those residing in Puerto Rico; ISSN: 0014-7354]
Sanhueza, H. and R. Jaimes. “Contraceptive Progress in Latin America and the Caribbean.” [Adelanto anticonceptivos en America Latina y el Caribe] Proceedings of the IPPF/WHR Second Regional Medical Seminar held in Medellin, Colombia 25-26 November 1975. New York: International Planned Parenthood Federation, Western Hemisphere Region, 1976.
[Includes English and Spanish language collection of conference papers presented on the progress of family planning in respective Latin American countries]
Satterhwaite, A.P. “Experience with Oral and Intrauterine Contraception in Rural Puerto Rico.” In Public Health and Population Change, eds. M.C. Sheps and J.C. Ridley (current research issues), 474-480. Pittsburgh: University of Pittsburgh Press, 1965.
[Examines oral and I.U.D., methods of birth control in rural Puerto Rico but also addresses the issue of sterilization]
Scrimshaw, S.C. “The Demand for Female Sterilization in Spanish Harlem: Experiences of Puerto Ricans in New York City.” [Unpublished] Paper Presented at the 69th Annual Meeting of the American Anthropological Assn., San Diego, CA, 19 November 1970.
[Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
Speidel, J.J. “The Role of Female Sterilization in the Family Planning Program.” In Female Sterilization: Prognosis or Simplified Outpatient Procedures. Proceedings of a Workshop held at Airlie, Virginia, 2-3 December 1971, 89-103. New York: Academic Press, 1972.
[Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
Stroup-Benham, C.A. and F.M. Trevino. “Reproductive Characteristics of Mexican-American, mainland Puerto Rican, and Cuban-American Women: Data from the Hispanic Health and Nutrition Examination Survey.” Journal of the American Medical Association 265, no.2 (9 January 1991):222-226.
[Using data from the Hispanic Health and Nutrition Examination Survey, examines the reproductive characteristics of Hispanic females from age 15 to 45 residing in the U.S.]
Stycos, J. Mayone. Family and Fertility in Puerto Rico: A Study of the Lower Income Group. New York: Columbia University Press, 1955.
______. “Female Sterilization in Puerto Rico.” Eugenics Quarterly 1 (June 1954):3-9.
[Sterilization discussed as a means of remedying the problem of overpopulation in Puerto Rico. Examines geographic factors, education levels, etc., associated with those most frequently utilizing sterilization; also examines the prevailing attitudes toward the practice]
______, “Human Sterilization in Latin America.” [La esterilizacion humana en America Latina] [Unpublished] Paper Prepared for the 5th International Conference on Voluntary Surgical Contraception, Santo Domingo, Dominican Republic 5-8 December 1983.
[Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
______. “Sterilization in Latin America: Its Past and Its Future.” International Family Planning Perspectives 10, no. 2 (June 1984):58-64.
Twenty-eight State Sterilization Laws of the United States and Puerto Rico. New York: Human Betterment Assn. of America, 1951.
[Puerto Rico’s law approved May 13, 1937 appears as the last geographic area in the one-volume work]
Vazquez Calzada, Jose Luis and Z. Morales del Valle. “Female Sterilization in Puerto Rico and Its Demographic Effectiveness.” Puerto Rico Health Sciences Journal 1, no. 2 (June 1982): 68-79.
[A 1272 sample of women in Puerto Rico in 1976 were studied to determine changes in trends in female sterilization due to the use of other contraceptive methods; examines the demographic effectiveness of sterilization and high fertility as a motivation for sterilization]
Veatch, R.M. “Sterilization: Its Socio-cultural and Ethical Determinants.” In Advances in Voluntary Sterilization, eds. M.E. Schima [et al.]. (International Congress Series No. 284). Proceedings of the 2nd International Conference, Geneva, Switzerland 25 February-1 March 1973. Amsterdam, Netherlands, Excerpta Medica, 1974.
[Discusses ethical, social and cultural considerations of sterilization and lists four main value orientations affecting sterilization; Abstract: Available in the Popline Database accessible through the National Library of Medicine: ]
“Voluntary Sterilization 1973.” World Medical Journal 20, no. 4 (July/August 1973):66-69.
Warren, Charles W. [et al.]. “Contraceptive Sterilization in Puerto Rico.” Demography 23, no. 3 (August 1986):351-365.
[Study based on 1982 data from Fertility and Family Planning Assessment in Puerto Rico addresses two questions: Is the probability of becoming sterilized changing Puerto Rico’s fertility rate?; and, What is the impact of sterilization onfertility? ISSN: 0070-3370]
______. “Tubal Sterilization: Questioning the Decision.” Population Studies 42, no. 3 (1988):407-418.
[Examine international studies of the attitudes of sterilized women, with a particular focus on Puerto Rico, Panama, and U.S.
Whaley, S. Review of Morales. “Piecing a History Together: The Women of Boriken” [Puerto Rico], by Aurora Levins Morales. Women’s Review of Books 9, no. 10/11 (July 1992):8-9.
[Surveys Puerto Rico’s history from 1493 to 1954 and how it ties in with women’s issues, including controlling women’s sexuality and reproduction]
Women Under Attack: Abortion, Sterilization Abuse and Reproductive Freedom. New York: Committee for Abortion Rights and Against Sterilization Abuse, 1979.
Zambrana, R.E. Work, Family and Health: Latina Women in Transition. (Monograph No. 7) Bronx, N.Y.: Fordham University Hispanic Research Center, 1982.
[Ten papers examine background, characteristics, social roles, and socio-psychological needs of Hispanic women in the U.S. (particularly Puerto Rican women residing in New York City); includes paper on voluntary sterilization among women in a Connecticut community]

The practice of sterilization abuse was challenged by local coalitions. Puerto Rican women’s groups, along with the movement for Puerto Rican independence, took up the fight against the injustices of the campaign. The economically disadvantaged women of Puerto Rico lacked access to information that would make contraceptive alternatives available to them. By denying access to reproductive health services for the women who were most in need of them, U.S. policy exerted its control over the growth of the Puerto Rican population, as well as over the lives of many Puerto Rican women.

A warrior in the fight for women’s reproductive rights, Dr. Helen Rodriguez-Trias, summarized the situation in Puerto Rico: “Women make choices based on alternatives, and there haven’t been many alternatives in Puerto Rico.”


U.S. women also are not strangers to forced sterilizations. As early as 1907, the United States had instituted public policy that gave the government the right “to sterilize unwilling and unwitting people.”

Laws, similar to Law 116, were passed in 30 states. These policies listed the insane, the “feeble-minded,” the “dependent,” and the “diseased” as incapable of regulating their own reproductive abilities, therefore justifying government-forced sterilizations. Legitimizing sterilization for certain groups led to further exploitation, as group divisions were made along race and class lines.

Some states, notably including North Carolina, set up Eugenics Boards in the early 20th century. These boards reviewed petitions from government and private agencies to impose sterilization on poor, unwed, and/or mentally disabled women, children and men. North Carolina alone sterilized over 7,600 individuals between the 1930 and 1970s.

In the early 1970s, Rodriguez-Trias was invited by a New York University Law School student organization to give a short talk about Puerto Rican sterilization abuse after viewing a related film. After her talk, Rodriguez-Trias was approached by a handful of audience members. Some were hospital workers who recalled stories of minority and disadvantaged women who were coerced into signing sterilization consent forms; full information on the procedure and its alternatives was not provided.

The case of a young woman, incarcerated by the New York City Police, was brought up in discussion. While being detained, the woman discovered she was pregnant and wished to have an abortion. She was taken to a public city hospital for the procedure. During counseling for the abortion, sterilization was offered as the best prevention of future unwanted pregnancies. Uninformed and misled, the young woman signed the papers and later regretted the procedure. In response to the treatment of this young woman and the many other disadvantaged women who had been coerced into giving up their reproductive rights, Rodriguez-Trias and a handful of other New Yorkers formed CESA, the Committee to End Sterilization Abuse.

As awareness of abuses increased, the call for action became stronger. In 1974, the U.S. Department of Health, Education and Welfare (HEW) — now the Department of Health and Human Services — published guidelines for sterilization procedures. These guidelines established a moratorium on sterilization of women under the age of 21 and on others without the legal ability to provide consent. A 72-hour waiting period between the signing of a consent form and the procedure was mandated.

A written statement that women would not lose their welfare benefits if they refused the sterilization procedure and reserved a woman’s right to change her mind and refuse the procedure anytime up until the surgery, even after granting original consent, served as informed consent. However, studies conducted by the ACLU and the Center for Disease Control in 1975 showed that noncompliance with the guidelines was widespread.

In the 1970s, New York City public hospitals were bearing the brunt of regional complaints. These hospitals were the major source of health care for the city’s economically disadvantaged, and consequently provided reproductive services for many of the city’s poor women. The Health and Hospitals Corporation (HHC), the group that oversees the City’s hospitals, became an important tool in the study, identification, and monitoring of sterilization abuse practices.

In early 1975, the HHC called on members of CESA, including Rodriguez-Trias, and members of other reproductive rights organizations, to serve on an ad hoc Advisory Committee on Sterilization Guidelines. The goal of the advisory committee was to set guidelines, like the HEW guidelines, for the public hospitals of New York City. These local guidelines hoped to promote the successful monitoring of sterilization practices.

By identifying the weaknesses of the HEW guidelines, the advisory committee drafted a more effective set of regulations that were aimed at protecting the rights of women who were mistreated in the past. The committee’s guidelines required a 30-day waiting period between the signing of the consent and the procedure. During this time, HHC hospitals were required to offer counseling services. These services were to be provided in the language that the woman spoke, and would not be given by the doctors themselves, but by a counselor removed from the clinical experience.

As part of the consent, the patient described her understanding of the procedure and the alternatives available, so that there was no doubt that she understood the permanence of the procedure. The guidelines suggested by the advisory committee became effective HHC rules on Nov. 1, 1975.

The guidelines set forth by the HHC could only be applied to the city’s public hospitals. In response, Public Law #37 was passed by the New York City Council in April of 1977, making the HHC guidelines the law of the city, applicable to both public and private facilities. Failure to comply with these regulations would result in a penalty. Public Law #37 was unique in that past guidelines were expanded to include the regulation of the practice of sterilization on men as well as women.

Beyond New York City, groups in other regions were pursuing similar goals. In Los Angeles, a group of 10 Mexican-American women successfully sued the County Hospital for denying them informed consent. These women, who only spoke Spanish, were coerced into signing consent forms in English; some were in labor and others were under anesthesia at the time of providing consent. After successful settlement of this case, L.A. County became more militant about following informed consent guidelines for sterilization.

In response to regional action, HEW redesigned its national guidelines for sterilization practices to embody the provisions of New York’s Public Law #37 in 1978. The national guidelines received widespread support from CESA as well as over 100 other regional and national organizations but also faced opposition from organizations that saw the guidelines as limiting women’s access to sterilization as a choice for contraception.

In response to recognition of past government abuse in North Carolina, the state set up the Office of Justice for Sterilization Abuse in 2011. This government entity seeks to identify victims of forced sterilization at the hands of the State’s Eugenics Board, and compensate them for the state’s actions against them.


Latina women in Puerto Rico, New York City, and California were specifically targeted by the government for sterilization throughout the 20th century. Black women have also long been the targets of population control and have been disproportionately affected by sterilization abuse. In North Carolina, a state noted for its discriminatory sterilization practices in the 20th century, 65 percent of sterilization procedures were performed on black women, even though only 25 percent of the state’s female population is black.

An often-cited 1973 case example of racism and sterilization abuse involves the Relf sisters. Katie, Minnie Lee and Mary Alice Relf, ages 17, 14 and 12 respectively, were the victims of discriminatory policies and programs funded by the U.S. government. Since they were receiving government benefits, the Relf family was determined to be ideal candidates for the Montgomery Community Action Committee’s Family Planning Service.

Katie, under the age of consent in Alabama at the time, was offered and given a series of Depo-Provera contraceptive shots. At that time, the shots were still in the investigational phase and not yet approved for administration on adult women, let alone adolescents. Katie was also scheduled for insertion of an IUD (intrauterine device). All forms of contraception were provided to Katie without parental permission, which was required in Alabama at the time. Minnie Lee and Mary Alice received tubal ligations; their mother was under the impression they were being seen for routine inoculations.

The Relf lawsuit uncovered hundreds of thousands of similar cases in the region. Many of the women who were sterilized were sought out by these local federally funded centers, and threatened with the loss of government benefits for failure to comply. The women involved were overwhelmingly black women.

The court’s decision in the Relf case set guidelines for the use of federal funds for sterilization, and outlined the illegality of the use of coercion, especially through threats of loss of government benefits, for failure to participate in these programs.


Similar to the experiences of Puerto Rican women and Black women in the United States, Native American women were subjected to coercive population control practices through much of the 20th century. The Indian Health Service, functioning under the control of HEW and the United States Public Health Service, began providing family planning services to Native American families in 1965. Instituting similar practices to those experienced in Puerto Rico, as many as 25% of Native American women between 15-44 years old were sterilized by the 1970s.

In the early 1970s, two Cheyenne girls in Montana entered an IHS hospital, on two separate occasions, for emergency appendectomies. While sedated the physicians sterilized both girls, without consent from the patients themselves, nor from their parents.

In many Native American cultures children are important for tribal survival. A woman’s ability to procreate is often seen as an important way for her to secure her place within her tribe. Sterilization abuse not only took away women’s rights to control their fertility, but negatively impacted their social and emotional health.


The less fortunate and poorly educated continue to be denied the reproductive freedoms available to other women, and entitled by all.

Recent concerns regarding sterilization abuse involve incarcerated women. A 2013 report found that almost 150 women were illegally subjected to sterilization in California prisons between 2006-2010. The procedures were often discussed with women during childbirth, or other medical procedures, when they were most vulnerable.

Federal law, from the HEW guidelines of the 1970s, prohibits the use of federal funds for sterilization of any incarcerated woman. California state law allows state funds to be used on sterilization of incarcerated women, but special procedures for approval must be utilized prior to the procedure. In the cases found in the 2013 report, those procedures were not followed.

Rodriguez-Trias believed that although the organization of local groups was effective in the sharing of information as well as in applying pressure to policy makers, only with raised consciousness, informed consent, and the existence and accessibility to real alternatives, can freedom of choice become a reality for all women.
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Re: Forced Sterilization of Native Americans: Late Twentieth

Postby admin » Tue Oct 18, 2016 10:30 pm

1976: Government admits forced sterilization of Indian Women
by Native Voices



A study by the U.S. General Accounting Office finds that 4 of the 12 Indian Health Service regions sterilized 3,406 American Indian women without their permission between 1973 and 1976. The GAO finds that 36 women under age 21 had been forcibly sterilized during this period despite a court-ordered moratorium on sterilizations of women younger than 21.

Two years earlier, an independent study by Dr. Connie Pinkerton-Uri, Choctaw/Cherokee, found that one in four American Indian women had been sterilized without her consent. PInkerton-Uri’s research indicated that the Indian Health Service had “singled out full-blooded Indian women for sterilization procedures.”

THEME Federal-Tribal Relations
REGION California, Great Basin, Great Plains, Northeast, Northwest Coast, Plateau, Southeast, Southwest
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