Female Sterilization in Puerto Rico

There are a number of examples in post Civil War America of eugenic programs but none as effective and widespread as the mass female sterilization in Puerto Rico. Beginning in the years following WW I, a program was initiated by the United States government, the medical community and the local government of Puerto Rico, to name a few, which resulted in the unprecedented sterilization of 1/3 of the female population by 1965, and the continued use of sterilization on a broad scale by Puerto Rican women as a form of birth control (Presser 1980).

The island of Puerto Rico is over 80% Catholic and providing services to prevent pregnancy was a felony until the 1930’s. The historic and social conditions -- medical, legal, and political -- that were conducive to this mass sterilization movement are important and of interest. For decades the United States has blamed overpopulation for economic problems, unemployment, and poverty in Puerto Rico, while ignoring the fact that they (the U.S.) have played an enormous role in generating and solidifying these conditions (Michaelson 1981). As a result, non-official programs with the intent of distributing birth control information and educating specifically poor families about the need for such practices were implemented in the1920’s (Presser 1973). Incredibly, as overpopulation was being blamed for economic crisis in the 1920’s, "less than 2% of the population owned 80% of the land" (Hartmann 1995 p.247). Strong opposition from the Catholic Church, unfavorable legal status of birth control, a disinterested public, and insufficient federal funding from the U.S., prevented these earlyn programs from becoming successful.

In 1937, 23 birth control clinics were opened by a private organization and a bill was signed that made it no longer a felony to advertise contraceptives or provide services to prevent pregnancy (Presser 1973). Another bill was signed authorizing the "Commissioner of Health in Puerto Rico to regulate the teaching and dissemination of eugenic principles, including contraception, to health centers and maternal hospitals" which was followed by the opening of 160 birth control clinics, private and public (Presser 1973 p.25). Then came law #136, passed by the U.S. government, which legalized sterilization for other than strictly medical reasons (Garcia 1985). Underlying the legal jargon was the advocacy of weeding out the "unfit". It was then that sterilization was introduced to Puerto Rican women by physicians as a means of birth control. By 1939 the government was actively supporting birth control clinics and the distribution of contraceptives (Presser 1973). This was timely and convenient for the recent arrivals of U.S. manufacturing companies that needed cheap labor, i.e. women who could be "freed" from childcare for employment (Hartmann 1995). The United States, who previously had been stingy with money provided to P.R. for birth control education and programs, now was sending enormous amounts and government funds "encouraged women to accept sterilization by providing it at minimal or no cost" (Hartmann 1995 p.248). In fact, the Family Planning Agency of Puerto Rico receives 750,000-900,000$ of its budget from the US Department of Health, Education and Welfare, and that amount has increased accordingly in the last 25 years (Big Mama Rag 1977 p.9). In terms of the ratio of sterilized persons, these actions set in motion the most intense and successful eugenic population control program in U.S. history.

U.S. opinion was echoed in the words of the first North American governor appointed to Puerto Rico when he declared that there were too many Puerto Ricans, specifically poor laborers, and not enough wealthy land and business owners (Garcia 1985). By 1930 unemployment had reached 37%, sugarcane planters were complaining of the "excess population" and U.S. corporations were flourishing in this land of cheap labor and tax breaks. A few years later, as WW II ravaged Europe and devastated the textile industry there, sweat shops clamored to hire P.R. women to provide what Europe was unable to. Propaganda film clips shown in the United States in the 40’s, 50’s, 60’s and 70’s further reinforce the position that the U. S. took toward P.R. -- showing 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 P.R (Garcia 1985). To the U.S., Puerto Rico was a source of cheap labor, high profit, tax-free business opportunities as well as a testing area for a population control program. Puerto Rico’s removed geographical location, a population of non-Northern European, Catholic people, and media promotion of "overpopulation" hysteria, all worked together to make this eugenics program acceptable to the U.S. majority -- whom historically had been resistant to eugenic programs.

Of the three components -- political, legal, and medical -- that made this program possible, the medical community was by far the most influential and first hand at implementing the program. The physicians pushing for sterilization as a means of birth control believed that contraceptive methods were too complicated for lower class Puerto Rican women to understand, in effect, they were "too dumb" -- to the physicians sterilization seemed to be the most feasible solution to the "problem" (Presser 1973). Many private clinics were established in the 1940’s for the sole purpose of performing sterilizations and it was common practice to persuade women upon delivering a child to accept sterilization soon after giving birth, when the woman was in a position of reduced capacity to effectively make such a decision due to medication, pain and exhaustion (Presser 1973). "By the1950’s demand for sterilization far exceeded the facilities . . . and roughly one-sixth of all Puerto Rican women were sterilized" (Presser 1973 p. 41). "La operacion" was the term that came to identify the widely available and the popular means of birth control.

Women in Puerto Rico "were no doubt eager for birth control" but the fact is that it was not voluntary, in the context of being informed and being provided other options of non-permanent birth control (Hartmann 1991 p.248). The targeted women were often unaware of the irreversibility of sterilization and pressure was put on them to accept the operation in exchange for longer hospital stays after childbirth. Physicians in Puerto Rico were and are held in high regard and as proponents of sterilization as birth control for the poor and uneducated, used that status to influence the decision of the woman. As stated in an interview in Big Mama Rag with a Puerto Rican woman, "doctors in Puerto Rico are viewed by most people as being almost holy" (1977 p.3). Other forms of contraceptives were not readily available to the lower class and not advocated by the medical establishment (Paul 1995). Hartmann notes that the Catholic Church held a somewhat more mild opposition to sterilization in comparison to contraceptives and abortion-sterilization could be justified for medical reasons (1995). Physicians often made medical records appear as if the sterilization was necessary for the health of the woman, almost never was it documented as a means of birth control (Presser 1973). This no doubt also played a role in a population that is almost completely Catholic. In an interview with two Puerto Rican women in Big Mama Rag, one woman states "at the beginning of the sterilization program, the church sort of subtly endorsed it"(1977 p. 9). And, as mentioned previously, even though the government did not admit a formal policy, it actively supported and encouraged sterilization. According to Garcia, Vincente Acevido, a previous mayor, says families are ‘limited to three children’ -- and there is no official policy? (Garcia 1985). He states the lack of population growth according to the 1970 census is a great achievement (Garcia 1985). With these influential social forces exerting pressure on a targeted sector of the female population, one can see that the sterilization movement clearly was not a voluntary decision in most cases.
Ana Maria Garcia created a documentary film about sterilization in Puerto Rico entitled "La Operacion" which reinforces, through interviews with sterilized women and hospital/government/agency officials, this film confirms that the sterilization process was not completely voluntary.

In the film, Dr. Helen Rodriguez-Trias states that population control was indeed a social policy in P.R. that targeted a group that was believed "shouldn’t have children" by other groups (Garcia 1985). According to one interview, each and every female in one extended family had been sterilized. The elder woman wept, saying that the family would end with no more women able to have children (Garcia 1985). Another woman, only 22 years old, was told by her doctor that sterilization was the only choice for birth control. She was given no other advice, information or options (Garcia 1985). Yet another woman believed that the procedure was reversible and that no surgery was involved. Even though the doctor knew her desire to have more children later, she was not told the truth. She concedes that she went through with the procedure on her own, but she is sad because she is young and would like to have another child – she states that if she would have known the truth, she would not have agreed (Garcia 1985).

In one town alone, Barceloneta, 20,000 women were sterilized between 1956 and 1976 (Garcia 1985). There were no restrictions on age, health or the number of children one already had. One woman from Barceloneta recounts the story of how she saw a woman going into the hospital with a suitcase and was curious. She said, innocent of what was going on there, that she wanted to go to the clinic with a suitcase and stay too. So she asked and they told her all she had to do was agree to a procedure -- so she did -- to get a stay in the hospital (Garcia 1985). By 1958, the total birth rate of Puerto Rico was on the decline and varying geographically, 10-42% of the women in towns and cities were sterilized (Garcia 1985).

As is evident from these interviews, some women chose to be sterilized but were in no way informed about the procedure, that it was indeed surgery, or sadly, its irreversibility. If it is said ‘if I had only known, I would not have done it’ than how can this possibly be an informed and consensual choice? This deceit was in no way limited to a few cases, as the statistics of young women sterilized illustrate. 2/3 between the ages of 20-29, 92% before the age of 35, with the average standing at the ripe old age of 26 (Big Mama Rag 1975).

In addition to the medical establishment and governmental funding, sterilization was promoted in other, not so obvious manners. Public schools drilled that having small families practically guaranteed financial stability and the capability to "have more" -- like the nice pictures of the white, happy, American families, with picket fenced homes shown in the text books (Garcia 1985). A small family meant ‘progress’. This was an attractive setting the average Puerto Rican rarely had seen before and was led to believe that they had to get sterilized to have a good and prosperous life. In the late 40’s and early 50’s, it had become ‘in style’ to get sterilized and volunteers traveled across the island, preaching birth control as a means to prevent abortion (Garcia 1985).

Not only was this island used as a testing ground for a population control program, but as a laboratory for the pill as well. In 1956, the first birth control pills were tested on Puerto Rican women living in government housing-they were 20 times stronger than the pills used in the U.S. 30 years later (Garcia 1985). Many women became ill, and as Garcia has shown, were completely in the dark that they were being used as guinea pigs for a potentially dangerous drug. Nurses, like doctors, are influential and respected persons in Puerto Rican society. They came to the doors of these women and told them to take these new pills as part of a family planning program -- again the influence of a person of status was used to target a specific portion of the population (Garcia 1985). Dr. Helen Rodriguez-Trias confirms the allegations that Puerto Rican women were unknowingly used as a "laboratory for development of birth control technology" (Garcia 1985). The medical community and pharmeceutical companies have contributed and fueled, probably more than any other group, the eugenics program in Puerto Rico.

Although opposition to sterilization and birth control, mostly from the Catholic Church, accused the government of promoting national genocide, there was still no "official" program or policy on sterilization. And the government responded that obtaining and/or utilizing these services was the right and free will of the individual (Presser 1973). The clinics weren’t even termed birth control clinics, they were called places of "maternal health" or "maternal education" (Presser 1973 p. 36) and were also located in the factories where women worked (Garcia 1985). Factory owners were persuaded by the P.R. Family Planning Assoc. to give women time off to visit the clinics, so they would not have to pay maternity leave and/or lose workers to motherhood! (Garcia 1985). In 1964 the government endorsed a new plan to turn existing health centers into birth control clinics. Even as an official policy was denied, there was clear support, financial and otherwise, from the medical establishment, U.S. government, the P.R. government, pro-industrialists, American scholars, and family planning agencies such as the International Planned Parenthood Federation (Michaelson 1981). Munoz Marin, founder of the Popular Democratic Party and former governor in Puerto Rico, "announced his support for a family planning program which . . . would be purely voluntary, even if it must be carried out with the ‘necessary muscle’" (Michaelson 1981 p.197). This is a curious statement and further alludes to the fact that the population control measures instituted in Puerto Rico were not ‘voluntary’.

As mentioned previously for birth control measures to be eugenic in purpose, they have to be targeted to a specific portion of the population. Evidence to support the fact that the sterilization program in Puerto Rico was indeed aimed at the poor and uneducated, a class of people, has been cited. "People applying for housing, or welfare, or food stamps, find themselves receiving orientation, education, and motivation towards sterilization" and "those that suffer the most from a condition of excess population are the groups with the least income and smallest amount of education" (Big Mama Rag 1975 p.3) This program was operated in an open fashion and a recruitment campaign was admitted to and it was said that 10,000-12,000 births were prevented, with the goal of 100% of childbearing age women to be sterilized. This is an incredible and clearly genocidal comment (Garcia 1985). By 1980, Puerto Rico had the highest incidence of female sterilization in the world. In 1977, Dr. Richard T. Ravenholt, a population officer for AID stated, "if U.S. goals were met, one-fourth of the world’s women would be sterilized to prevent revolutions that would interfere with multinational corporations financial success" (Garcia 1985). This is a ludicrous statement and implies that pregnant women and or mothers are the source of revolutions that would impede the almighty dollar! The U.S. Agency for International Development (AID) increased its budget for birth control in Latin America 1968-1972 by a whopping 100 million dollars while ate the same time reducing health care assistance by the same amount (Garcia 1985). Americans like to believe, that Americans are the ultimate humanitarians and concerned with human rights violations and equal rights for women across the globe, concerned for the ‘less fortunate’ people. This is simply not true. The U.S. is not concerned for the welfare of impoverished people, or their rights, health or economic status. They are concerned about their own monetary interests, political well being, and "safeguarding the superior white civilization from the crude and inferior" (Big Mama Rag 1975 p. 3). In the 70’s inflation rose and unemployment skyrocketed in P.R., half of the population was on food stamps, despite the significant decline in fertility rates and population growth. While reported in the Big mama Rag, that "indeed the working class . . . is being reduced . . .with the highest rate (43%) occur[ing] among the 4k-5k per year income bracket",the sterilization program did not solve the economic or social problems for the island (1975 p.3). The people of Puerto Rico still suffer the same economic and social problems and now they also carry a burden of sadness for what has been done to the female population and additionally, the family. Over 60% of the population lives below the poverty level and unemployment has doubled again in the last 10 years. While at the same time U.S. profits from Puerto Rico have grown by 500%!! (Garcia 1985). Oppression and exploitation of the Puerto Rican people has been common practice and the eugenic program has been the most serious extension of U.S. policy toward Puerto Rico.

It is difficult to say what the future will hold for Puerto Rico on a socio-economical level, but certain is the long range effect of a eugenic program that has lasted half a century. Mass sterilization efforts, although not as rigorous, have been implemented in other Latin American countries such as Colombia, with the help and funding of the United States and agencies like Planned Parenthood International using misleading propaganda and playing on the fears and aspirations of the poor and uneducated.

References Cited

"Forced Sterilization Plan Revealed." Big Mama Rag Feb. 1975: 3
Garcia, Ana Maria

1985 Film-La Operacion. L.A. Film Project
Hartmann, Betsy

1995 Reproductive Rights and Wrongs. Boston: South End Press
Krauss, Elissa

1975 "150,000 People Sterilized Annually" Big Mama Rag May 1975: 4
Michaelson, Karen L.

1981 And the Poor Get Children. New York and London: Monthly Review Press
Paul, Diane B.

1995 Controlling Human Heredity: 1865 to the Present. New Jersey: Humanities Press
Presser, Harriet B.

1973 Sterilization and Fertility Decline in Puerto Rico. Berkeley: Institute of International Studies, University of CaliforniaPresser, Harriet B.

"Puerto Rico: Recent Trends in Fertility and Sterilization"Family Planning Perspectives March-April 1980: v.12 #2Reilly, Philip R.

1991 The Surgical Solution: A History of Involuntary Sterilization in the United States. Baltimore and London: The John Hopkins University Press

"Sterilization: The ‘American Way’ to Fight Poverty"North Star 18 Nov. 1978: 5 v. 5 #1

"You Can’t Get an Abortion in Puerto Rico. . ." Big Mama Rag may 1977: 9