In 1968, researchers found that one-third of all Puerto Rican women of childbearing age were surgically sterilized. This ignited the U.S. reproductive rights movement and the political demand to end forced sterilization in Puerto Rico. However, Puerto Rican women’s reproduction has been tied to identity and nationalism since the United States assumed governance of Puerto Rico in 1898. Latin-x have a long and complex history with birth control and surgical sterilization. Chicanas and puertorriquenas have been subjected episodically to unwanted sterilizations in state institutions and public clinics while also struggling to access safe and affordable birth control, including surgical sterilization.

The history of surgical sterilization and U.S. colonialism in Puerto Rico is complex and nuanced. Historian of reproductive politics and U.S. Empire Laura Briggs summed it up well when she wrote, “for liberals as much as conservatives, the future wealth or poverty, strength or weakness of the Puerto Rican nation was located symbolically and literally in women’s wombs.”

I’m Elizabeth

And I’m Marissa

And we are your historians for this episode of Dig.

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Elizabeth: Our episodes in this series discuss eugenics and the various forms these “scientific” ideas have taken over the years. We sometimes talk about eugenics as something in the past, yet today’s episode argues that in fact eugenics has in fact made its way to the present day and affects both discourse and practice in who is deemed a fit body, a fit parent, or a fit citizen. Just recently, California prisons are said to have authorized sterilizations of nearly 150 female inmates between 2006 and 2010. The state paid doctors to perform tubal ligations that former inmates say were done under coercion.

Marissa: In the early 20th century America, social reformers, politicians, and scientists were successful in passing numerous sterilization laws across the country. These laws were based on theories of human heredity and the fear that conditions like poverty, criminality, feeblemindedness, and even sexual “deviance” were inheritable traits. Those that advocated for sterilization viewed it as a necessary public service that would protect society, and taxpayers, from those deemed inferior or dangerous. The rise of medical professional “experts” and ideas about inheritance and deviance were important in shaping the ideas that ultimately affected public policy. In fact, historian Molly Ladd-Taylor found that sterilization laws were actually fiscally expedient. Eugenic laws essentially became part of the bureaucracy of government social policy- with concerns over welfare costs and state institution budgets. These fiscal anxieties were just as important in getting sterilization laws passed as were fears about hereditary defects.

Elizabeth: The first sterilization law passed in the United States was in Indiana in 1907. It applied mostly to men. This eugenic statute was confined to institutional inmates classified as “criminals, idiots, imbeciles, or rapists.” However, as the physical embodiment of the future, women soon became the prime target of eugenic fears and controls. By 1910 Washington, California and Connecticut had their own sterilization laws on the books. By 1937 there were 31 states plus Puerto Rico that had eugenically motivated sterilization laws on the books. Between roughly 1920 and 1937 there was a lot of upheaval regarding these laws and the Indiana law, which was the first in the nation, was repealed in 1921.

A black and white photograph of a map showing states with compulsory sterilization laws
A map of compulsory sterilization laws in the United States, 1927
Public Domain / Wikimedia Commons

Marissa: Codification through the federal government came in 1927. The U.S. Supreme Court handed down its first ruling, which established the precedent for compulsory sterilization in Buck v. Bell. This ruling held that a Virginia sterilization law was constitutional and did not violate the equal protection clause of the Fourteenth Amendment. The statute provided for the sterilization of any inmate of a state institution when sterilization was considered to be in the best interests of the patient and of society.

Elizabeth: Dr. Albert Sidney Priddy, superintendent of the Virginia State Colony for Epileptics and Feebleminded, wanted to test the law new sterilization law Virginia recently passed. He filed a petition to sterilize Carrie Buck, an 18-year-old patient who he claimed had a mental age of 9. Priddy claimed that Buck’s mother had a mental age of 8. He also claimed that Carrie’s mother had a history of prostitution and immorality and had three children out of wedlock. Carrie was one of those children and was adopted by the Dobbs family. She lived with the Dobbses for 14 years before the family had her committed to the institution because they said she was incorrigible, was “feeble-minded,” and was pregnant with an illegitimate child.

Marissa: But Carrie’s pregnancy was not caused by any “immorality” on her own part. In the summer of 1923, while her adoptive mother was away, her adoptive mother’s nephew raped Carrie. The family had her committed in order to save their reputation. Unfortunately for Carrie, Dr. Priddy had deemed Carrie’s mother feeble-minded because of her alleged promiscuity, and so could use the hereditary argument to have Carrie committed and sterilized. Legal scholar Paul Lombardo sums it up this way: “Doctor Priddy’s motives in proposing a sterilization program had less to do with thinning the ranks of the mentally and physically bereft than they had to do with satisfying his own strong and unique sense of morality. Priddy was obsessed with placing checks on sexuality and propagation. This obsession focused on eradication of the ‘moral delinquents’ whose unlicensed pregnancies he identified as the cause of poverty, crime, disease, and the myriad afflictions of society.”

Elizabeth: So let’s just chew on that a bit. This idea of promiscuity, or in the case of Carrie Buck, being the child of a supposedly promiscuous mother, was used as an indication of “feeblemindedness.” It played on this fear of the procreating mother who wasn’t supported by a protective patriarch who would provide for her offspring. Essentially, if a woman dared to have sex before marriage, there must be something wrong with her – she “must” be feeble minded to do something so sinful. And the fear was that these feeble minded women are just going to keep having babies while, “good” white, middle-class “new women” are out riding their bicycles and going to college and soon we’ll be overrun with “imbeciles.”

Marissa: Ok, so we’ve set the stage a bit for what is happening on the American mainland so now let’s turn to Puerto Rico. During the Great Depression of the 1930s, the island of Puerto Rico experienced high levels of poverty and unemployment – as much of the globe did- and of course in mainland America too. Yet, a mainland fear of “overpopulation” in Puerto Rico drove a lot of the rhetoric around talk of stimulating the economy.

Elizabeth: In the spring of 1932, the tension between the Puerto Rican Nationalist Party and U.S. colonialist accounts of “overpopulation” on the island were played out in the pages of Margaret Sanger’s Birth Control Review. The magazine published the article, “Porto Rico’s Population Problem,” by a mainland writer who warned that overpopulation on the island was out of control and that birth control should be administered by force if necessary. He also suggested the U.S. military would be forced to cull the island’s population by bullet if its unruly population wasn’t managed.

black and white cover of the Birth Control Review
The cover of the July 1919 issue of The Birth Control Review
Public Domain / Wikimedia Commons

Marissa: The secretary of the Nationalist party shot back the next month in the pages of Birth Control Review, stating:

“As a Porto Rican who feels himself a freeman, I cannot help taking exception to the article. The author does not tell your readers that it is directly at the door of American capitalism that the blame must be laid for everything that is wrong in Porto Rico today. . . . He does not tell that in thirty-four years of American intervention, the people have been dispossessed of their land and brought to the condition of paupers. . . Our real problem lies in the actual control by American capital of practically all our wealth. . . We may, and we may not enact birth control laws (I think we would) as soon as the American flag is lowered from our public buildings. The main thing is that it be lowered, the sooner the better.”[1]

Elizabeth: So this is a really amazing example of how arguments over birth control, literally what happens inside of women’s bodies, is an argument about economics, poverty, nationality, and U.S. political and military intervention all at the same time.

Marissa: Mainland fears of overpopulation meant that the goal of the government was to “fix” unemployment and poverty by controlling family size. Demographers in the American Child Health Association figured that there were 176,650 “too many children” in Puerto Rico and led to extreme poverty. But those that were counting “extra” children glossed over the fact that the 1898 invasion of the island by U.S. forces had undermined the Puerto Rican economy.

Elizabeth: In 1937, Law 116 was passed, which instituted a population control program modeled on many U.S. state eugenic programs. The law authorized a Eugenics Board that ruled on compulsory sterilizations. However this board — unlike other Eugenic Boards in states like North Carolina or California who sterilized literally tens of thousands of women and men (mostly people of color I might add) — the Puerto Rican Eugenics Board only ordered ninety-seven involuntary sterilizations during its existence. So, it begs the question as to why such a high amount of women of childbearing age were sterilized in Puerto Rico and along the East Coast diaspora in New York and Boston, if only 97 people were sterilized involuntarily by the Puerto Rican Eugenic Board? That is where the “answers” get complicated.

Marissa: The population control program was part of a larger effort to catalyze economic growth in Puerto Rico. U.S. government funds and contributions from private individuals supported the program. U.S. policy promoted the use of permanent sterilization and encouraged the practice through door-to-door campaigns with visits from health workers. Additionally, it was thought that if more women were sterilized, they would have more time to work, and thus help the economy since women were considered part of the cheap labor force. Industrial employers started favoring sterilized women for employment.

Elizabeth: Clarence Gamble, the inheritor of the Gamble fortune (as in Proctor & Gamble, makers of Oral-B, Swiffer, Head and Shoulders…) was a devout eugenicist and worked effectively in the southern United States and in Puerto Rico to institute sterilization among those of the “unfit” who in his mind, inhibited social progress. Funded by Roosevelt’s Puerto Rican Reconstruction Administration, Gamble hired and organized fieldworkers to run birth control clinics, where they tested and practiced sterilization and new forms of birth control. Later one of those forms was the pill, which we talk about in our episode Birth Control Before Roe v Wade. In the 1930s and 1940s Gamble made sterilization mandatory in these clinics. If a woman had three living children, she would have to submit to being sterilized if she wanted to be admitted to the clinic to either give birth or have access other healthcare. 

Marissa: In 1939, Roosevelt’s Interdepartmental Committee on Puerto Rico proposed to lower the birth rate to at least the level of the death rate. They stated that “all other endeavors to improve the health conditions of Puerto Rico must be organically tied to, and made contingent upon, effective birth control work.” Laura Briggs finds that Gamble was frustrated in his efforts to fund massive state sponsored sterilization campaigns. He heard the charges from the Catholic Church that there was a mass sterilization campaign against Puerto Rican women, and because it’s Gamble and he’s a eugenicists, he’s like, oh really? Where can I find these people and give them money to do more of this?

Elizabeth: But archival letters show that there was no state run, systematic program for sterilization. In fact, Puerto Rican officials found that “the demand for sterilization is very much a lay drive,” and they were nervous that if a larger sterilization campaign was implemented, the shortage of hospital beds would increase across the island.[2] However, Gamble also established over 20 sterilization clinics throughout the mainland South and Midwest. The North Carolina project was one of Gamble’s most active. In 1949 alone, 249 people were sterilized at the clinic. African- Americans were disproportionately targeted and by 1964, African Americans accounted for 65% of all women sterilized in the state.

Marissa: Sterilization in Puerto Rico is not a binary event between coercion and choice. Struggles over birth control and sterilization on the island lived in a number of different, and often incompatible beliefs. One, that poverty was caused by overpopulation. Two, that birth control was a genocidal, American plot against Puerto Ricans. And three, that the future prosperity of the island lay in smaller, “modern,” positive eugenics designed families.

Elizabeth: These competing ideas and beliefs lived among what Laura Briggs describes as three competing nationalisms. The first was the nationalism of the Puerto Rican Nationalist Party, which envisioned a return to a pre-American Puerto Rico. This vision was of a pre-American agrarian utopia, where strong patriarchs provided for healthy families. The movement identified women with motherhood, which in turn became “the insides of nationhood.” Within women– the mothers of the nation– future citizens were created, both physically and through culture. In the 1930s the Nationalist movement argued that the existence of birth control on the island was part of a U.S. federal policy of genocide, a position taken up by the Catholic Church throughout the next several decades. The Church conducted a continuous crusade against sterilization and its supporters, saying that there was a genocidal mass sterilization policy being carried out in Puerto Rican clinics and hospitals.

Marissa: A contrasting ideal of nationalism was the North American version that wanted protection against dark-skinned “others.” This was a nationalism derived from “hard” eugenics, which feared the reproduction of the lower classes, Puerto Ricans in general, and, indeed, all non-whites. So this is like your Reagan-era “welfare queen,” type of argument.

Elizabeth: And the third competing nationalism was associated with missionaries, social workers, public health professionals—both Puerto Rican and North American. This nationalism argued that good families were key to the success of the island. So families needed to be proactive in limiting their size. This idea suggested that reducing large families, the number of irregular marriages, and the high maternal and infant mortality rates of rural subsistence farmers and the working class was paramount to improving the economic status of the island.

Marissa: However, all of these positions were never mutually exclusive. The Nationalist Party and the Catholic bishops both opposed any type of birth control. However, many of the vocal feminist leaders and birth control supporters on the island were members of the Nationalist movement, even though so much of the Nationalist rhetoric focused on women as the mothers of the nation. 

Elizabeth: Briggs finds “What emerges from all this boundary-blurring among supporters of birth control is not so much ideological muddiness as a group of strong minded and pragmatic women, most but not all of whom were Puerto Rican, who championed birth control as an unmitigated good thing in the face of ongoing attempts by both colonialist and nationalist men to manipulate woman, and woman-as-mother, as a symbol.”[3]

the cover image of the documentary La Operacion, 1982
The cover of the documentary, La Operacion

Marissa: Many Puerto Rican feminist activists supported birth control and sterilization clinics and many Puerto Rican women took advantage of them. In Ana Maria Garcia’s 1982 film entitled La Operacion, which explores sterilization in Puerto Rico, one women tells the interviewer “We didn’t have much money and the doctor told me I couldn’t have many children. I talked to my husband, and got sterilized…Nobody forced me.” However, right after she says this, the film’s voiceover says “In 1937, sterilization was approved by Governor Blanton Winship, based on the principles of eugenics, advocating the breeding of the fit and the weeding out of the unfit, namely the poor and unwhite.” So in this account, any agency by Puerto Rican feminists, or the woman herself, is erased. Puerto Rican women’s groups advocated for the passage of the sterilization bill in the first place, which also legalized other birth control methods, like the diaphragm. So… it’s complicated. Access to healthcare was not easy on the island. Women did not have a lot of choices. Dr. Helen Rodriguez-Trias, founder of the New-York based Coalition to End Sterilization Abuse (CESA) aptly stated that “Women make choices based on alternatives, and there haven’t been many alternatives in Puerto Rico.” So it’s an example of how women exert agency within constraints.

Elizabeth: However, the violence of forced sterilization was becoming glaringly clear to many mainland feminists and those concerned with social justice. The 1973 case, Relf v Weinberger showcased these fears and the violence enacted on the poor and women of color through sterilization. Mary Alice Relf was 14 and Minnie Relf was 12 when they were sterilized by a federally funded program. Their mother, who was illiterate, signed an “X” on a piece of paper, and expected that her daughters would receive birth control shots. Instead, the sisters were surgically sterilized. The Southern Poverty Law Center filed a lawsuit on behalf of the Relf sisters. The district court found an estimated 100,000 to 150,000 poor people were sterilized annually under federally-funded programs. Countless others were forced to agree to be sterilized when doctors threatened to terminate their welfare benefits unless they consented to surgical sterilization.

Marissa: Relf v Weinberger ruled that there was “uncontroverted evidence” that “an indefinite number of poor people have been improperly coerced into accepting a sterilization operation.” Through increases in Medicaid-funding and the passage of the Family Planning Services and Population Research Act of 1970, the Nixon administration widely offered sterilization to low-income Americans, primarily women of color. Archives show that many of the doctors performing these procedures did not follow informed consent protocols and deemed the sterilizations “involuntary as a matter of practice.”

Elizabeth: Dr. Pinkerton-Uri found that thousands Native American Indian women had been sterilized without their consent. Pinkerton-Uri also found that the Indian Health Service had “singled out full-blooded Indian women for sterilization procedures.” In total, it is estimated that as many as 25-50% of Native American women were sterilized between 1970 and 1976.

Elizabeth: Iris Lopez explained how the film, La Operación, has both strengths and weaknesses when exploring sterilization in Puerto Rico during the 1950s and 60s. She says, “The strength of this film is García’s powerful rendition of the history of sterilization in Puerto Rico and her presentation of Puerto Rican women’s stories. But because none of the women in her film clearly states that she was sterilized because she wanted fewer children, this lends itself to a pronatalist interpretation, that it is natural and good for all women to have children. The only exception is an older Puerto Rican woman who excitedly inquires in the street about how she can get sterilized when she finds out that other woman in her town have had la operación.” Lopez says that based on her own research “among Puerto Rican women in New York City, this woman’s experience is more representative of the majority of sterilized Puerto Rican women.” La Operacion “represents most Puerto Rican women as victims of sterilization abuse. Even though one woman in the film explicitly states that no one forced her to get sterilized, all these women are cast as helpless victims.”[4]

Marissa: Briggs argues that the “mainland feminist effort to articulate an anticolonialist politics with women at the center inadvertently recapitulated the terms of a U.S. colonialist narrative: Puerto Rican women are victimized and need to be saved.”[5] Essentially, the co-existence of agency and constraints does not reduce anyone to a helpless victim but also, just because Puerto Rican women make decisions about their own fertility, does not mean they are exercising complete reproductive freedom. So it goes back to the idea that Dr. Rodriguez-Trias said, “Women make choices based on alternatives, and there haven’t been many alternatives in Puerto Rico.” Essentially, women do what they can with what they have. “Even though poor women are targets of population control they do not follow population policy blindly; most women exercise a certain degree of agency.”[6]

Elizabeth: By 1976 the U.S. Department of Health, Education, and Welfare (HEW), which is now Health and Human Services (HHS), found that 37.4% of all women of childbearing age in Puerto Rico were sterilized. Astoundingly, a study in 1965 found that 95% of all women sterilized in New York City were Puerto Rican.[7] Unquestionably, sterilization was unethically carried out in Puerto Rico as a form of population control, not to ameliorate overpopulation, but Puerto Rico’s dependence on the United States. Yet, close examination shows how Puerto Rican women negotiated their own reproduction through sterilization to cope with poverty, lack of access to quality health care, and experiences with sexism.

Marissa: The state’s goal to lower the rate of population growth converged with Puerto Rican women’s needs to control their fertility, increasing the rate of sterilization among Puerto Rican women on the island and in the United States. Puerto Rican women make reproductive decisions but choosing between sterilization and continuing to have children under adverse conditions, or getting sterilized as a last resort after having more children than they desire, does not constitute full reproductive freedom or choice. Puerto Rican feminists are reframing the forced sterilization narrative and showing how “the wombs of Puerto Rican women are intensely politicized,” while writing the women themselves almost completely out of the picture.

Elizabeth: Historian Johanna Schoen complicates our understanding of choice and coercion and how “the state alternatively offered and denied poor women access to birth control, sterilization, and abortion.” All at the same time, thousands of poor women of color, in Puerto Rico and the mainland, particularly the South, were being forcibly sterilized, while thousands more sought access to birth control or surgical sterilization because they wanted to control their fertility and they were denied. On the whole, it was difficult for poor women to access birth control on their own terms — to have reproductive rights. These complex negotiations skirted the line between choice and coercion.

Marissa: That’s all for today. Please follow us on Twitter, and Facebook and join our Facebook group, Dig History Pod Squad. Thanks for listening and leave us a five star review if you liked it.

Sources:

Laura Briggs, “Discourses of “forced sterilization” in Puerto Rico: The Problem with the Speaking Subaltern,” differences: A Journal of Feminist Cultural Studies, 10.2, 1998: p30+.

Laura Briggs, Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico (Berkeley: University of California Press, 2002)

Laura Doyle, “The Long Arm of Eugenics,” American Literary History, Vol. 16, No. 3, 2004: 520-535.

Molly Ladd-Taylor, “The ‘Sociological Advantages’ of Sterilization: Fiscal Politics and Feebleminded Women in Interwar Minnesota,” in Mental Retardation in America: A Historical Anthology, eds. S. Noll and J. Trent (New York: New York University Press, 2004) 281-299.

Jane Lawrence, “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly Vol. 24, No. 3, 2000: 400-419.

Paul A. Lombardo, “Three Generations, No Imbeciles: New Light on Buck v. Bell,” 60 New York University Law Review, Vol. 30, 1985: 30-62.

Iris Lopez, Matters of Choice: Puerto Rican Women’s Struggle for Reproductive Freedom (New Brunswick: NJ: Rutgers University Press, 2008)

Iris Lopez, “Sterilization and the Ethics of Reproductive Technology: An Integral Approach,” S&F Online, Barnard Center for Research on Women, 9.1-9.2, Fall 2010/Spring 2011, http://sfonline.barnard.edu/reprotech/lopez_01.htm, accessed April 14, 2019.

Johanna Schoen, Choice and Coercion: Birth control, Sterilization, and Abortion in Public Health and Welfare (Raleigh, NC: The University of North Carolina Press, 2005)

Footnotes:

[1] Quoted in Briggs, 78.

[2] Briggs, “Discourses of ‘forced sterilization’ in Puerto Rico: The Problem with the Speaking Subaltern,” differences: A Journal of Feminist Cultural Studies, Vol. 10, No. 2, 1998.

[3] Briggs, 77.

[4] Iris Lopez, “Sterilization and the Ethics of Reproductive Technology: An Integral Approach,” S&F Online, Barnard Center for Research on Women, 9.1-9.2, Fall 2010/Spring 2011, http://sfonline.barnard.edu/reprotech/lopez_01.htm, accessed April 14, 2019.

[5] Briggs, “Discourses of ‘forced sterilization’ in Puerto Rico.”

[6] Iris Lopez, “Sterilization and the Ethics of Reproductive Technology: An Integral Approach.”

[7] Doyle, “The Long Arm of Eugenics,” 532.


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