Exerpts from “Organizing for Change: Sterilization Abuse” by Katharine Krase:
Since the United States assumed governance of Puerto Rico in 1898, population control has been a major effort. The U.S., worried 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 women with access to alternative forms of safe, legal and reversible contraception, U.S. policy promoted the use of permanent sterilization. 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 “la operacion.” These coercive strategies denied women access to informed consent.
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 to sterilize women. 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. Dr. Helen Rodriguez-Trias, M.D. summarized the situation in Puerto Rico: “Women make choices based on alternatives, and there haven’t been many alternatives in Puerto Rico.”
During the 1950s and 1960s private agencies, such as the International Planned Parenthood Federation, and the Puerto Rican government carried on a federally-funded population control campaign on the island – it’s approach: sterilize as many Puerto Rican women as possible. To this end, public health workers were recruited to encourage Puerto Rican women to undergo sterilization procedures at minimal cost or free of charge.
Thousands of sterilizations were performed in public hospitals by doctors who explicitly encouraged their patients to undergo sterilization procedures rather than use other forms of birth control. “Many physicians thought, and still think,” says J.M. Stycos, that contraception methods are too difficult for lower class Puerto Ricans and regarded post-partum sterilization as “the most feasible solution to the [population] problems” (see CPRD article for quote). In fact, hospitals in Puerto Rico are substantially dependant on United States government funding and human resources. Training for many Puerto Rican medical professionals was carried on by US doctors, and many of the doctors who staffed Puerto Rican hospitals and performed sterilization procedures were from the United States mainland.
Puerto Rico is only one of many United States population control programs throughout the “third world.” Many of these programs are financed by the Agency for International Development. In addition to government subsidized sterilization procedures, some AID programs offer cash incentives — in Costa Rica the AID program “Family Planning Insurance” offers money in return for sterilization.
In 1968, a Puerto Rican demographer reported that more than 1/3 of the women of childbearing age in Puerto Rico had been sterilized – a rate tht indicated they were over ten times more likely to be sterilized than were women from the United States (Roberts 1997: 94). More than one-third of the women in the 1968 study didn’t 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.(Krase 1996)
1920 – Public controversy regarding “Neo-Malthusianism” in Puerto Rico – the island was seen as badly “over-populated” and various solutions were proposed for how this “over-population” could to be controlled. (López 1984)
1930s – Sterilization procedures were introduced into Puerto Rico, along with other contraceptive methods (CPRD article)
1934 – 67 birth control clinics were opened with federal funds channeled through the Puerto Rican Emercency Relief Fund (CPRD article)
1936 – 23 birth control clinics were opened by the private Maternal and Childcare Health Association (CPRD article)
1937 – A law was approved permitting sterilization for health and economic reasons. This law was primarily aimed at low-income women.(López 1984)
1940s – Mass migration of Puerto Ricans to the mainland US sparked by the new jobs in the burgeoning factories and plantations, caused a back lash among American whites who feared this influx of ethnically and often racially different people. (Fuentes 1987)
1948 – Operation Bootstrap program (“Operación Manos a la Obra”) began – Puerto Rico experienced a rapid transformation of its economy from a rural agricultural to one based on tourism and industry. This program led to skyrocketing unemployment and created an economic crisis due to a burgeoning workforce. Government solutions to this crisis included sterilization (long-term solution) and emigration (short-term solution) programs. (López 1984)
1949 – The Commissioner of Health in Puerto Rico was quoted in El Mundo as saying he would favor the use of district hospitals once or twice a week to perform fifty sterilizations a day. (CPRD article)
1950s – Population Control takes on prominance as an issue for US foreign policy. Puerto Rico was used as a laboratory for some of the first scientific experiments in birth control (the pill was field-tested there for the first time in the late 1950s). (Fuentes 1987)
1952 – The Population Council was formed in the United States by John D. Rockefeller (CPRD article)
1954 – The Family Planning Association of Puerto Rico (a private institution) was established (CPRD article)
1950-1958 – Dr. Clarence Gamble (heir to the Proctor & Gamble fortune), mastermind of the ‘Negro Project’ in the US South implemented a similar “experiment in population control” in Trujillo Alto, Puerto Rico. (Roberts 1997:77)
early 1960s – The US began funneling funds to Puerto Rican clinics and eventually sterilization, alongside strict migration controls, became twin pillars of a wide-ranging US policy to control the Puerto Rican population. So successful was the approach that the growth rate of the Puerto Rican population fell from 2.7 per cent in the 1950s to 1.7 in 1980.(Fuentes 1987)
1954-1964 – The Family Planning Association of Puerto Rico subsidized sterilization in private facilities for 8,000 Puerto Rican women (CPRD article)
1956-1966 – The Family Planning Association of Puerto Rico subsidized sterilization in private facilities for 3,000 Puerto Rican men (CPRD article)
1968 – a study by Puerto Rican demographer Dr. lose Vasquez Calzada shows that more than 1/3 (35.3%) of the women of childbearing age in Puerto Rico had been sterilized – at that time, the highest rate in the world. (CPRD article; Roberts 1997: 94)
1973 – The Family Planning Association of Puerto Rico’s November financial statement declared that the organization received $750,000.00 of its $900,000.00 budget from the United States Federal Department of Health, Education and Welfare (CPRD article)
1974 – The Puerto Rican Health Department created an auxiliary section of Family Planning headed by Antonio Silva. Silva’s department was created to direct an aggressive program of population control with the explicit aim of lowering the Puerto Rican birth rate(López 1984)
1981 – more than 39% of all Puerto Rican women of childbearing age had been sterilized (López 1984)
Esperanza went to her doctor at the end of July to ask about birth control. She and her husband already have two children and do not want to have another just yet. He works in the cafeteria at Hartford Hospital in Connecticut. The job is steady, but it doesn’t pay a great deal and it is a struggle to pay the bills and keep a roof over their four heads.
The doctor, a private practitioner, didn’t spend too much time talking about temporary birth control methods. He just suggested that sterilization would be the answer to Esperanza’s prayers. What he didn’t tell her was that it was permanent. He said that if he tied her fallopian tubes, they would simply come untied after five years and she would be able to have children again.
That all sounded good to the young Puerto Rican woman. She hoped for a more prosperous future and, after all, lots of women she knew had already had Ia operación – they call it la operación, the operation, because it is so common. So Esperanza agreed to become operada. Two weeks after she was sterilized, Esperanza learned the truth.
‘It happens all the time,’ says Dr Joseph Millerick, head of the obstetrics and gynaecology department at Hartford Hospital. ‘It’s not as bad as ten years ago. But Puerto Rican women who were sterilized in Puerto Rico still often want to have the operation reversed. They believe reversal is simple.’ But reversal operations, which are rarely successful, cost thousands of dollars – beyond the reach of the vast majority of women who want them. (Fuentes 1987)
Documenting La Operación
Filmmaker Ana María García produced a 1982 documentary, La Operación, to document the sterilization of Puerto Rican women. The film focuses on conveying the intensely personal realities of sterilizations for the women affected within the sociological context of the factors that led to massive sterilization programs targeting women on the island. According to García, “The film really isn’t just about sterilization, although that is its focus. Its wider context is the colonization of Puerto Rico and the politics of population control. Sterilization and emigration were the results of a political and economic situation forced on Puerto Rico by the United States.” García shows sterilization as one component of US policies in Puerto Rico (along with emigration) that sought to lower unemployment and decrease social tensions created by the rapid industrialization associated with Operation Bootstrap.
Excerpt of an interview with Ana María García by journalist Iraida López:
López: As you demonstrate in the film, many women who were sterilized were poorly informed about the consequences of the operation. But there are others who consciously chose sterilization as a contraceptive measure. How do you interpret this?
García: These women were responding to a series of conditions in their personal lives, as well as to the situation in Puerto Rico. The radical transformation of the island’s economy was done in a very short period of time. This disrupted people’s lives. At the same time, sterilization was legal and accessible. You could find it around the corner, sold as commonly and cheaply as fresh bread. This pushed women towards certain choices. Also, there weren’t many other contraceptive options. The best-known contraceptives were the diaphragm and spermicides, which often aren’t used very effectively and aren’t very attractive to many Hispanic women. I can only speculate that sterilization gave some women the opportunity to take control of their lives under circumstances in which — because of their condition as women in a colonized situation — control of their lives was in someone else’s hands.
Committee for Puerto Rican Decolonization. undated. “35% of Puerto Rican Women Sterilized.” available online at the CWLU Herstory Website Archive: <http://www.uic.edu/orgs/cwluherstory/CWLUArchive/puertorico.html> Accessed on: November 24, 2007.
Fuentes, Annette. 1987. ”They call it la operación.” New Internationalist, issue 176 – October 1987. <http://www.newint.org/issue176/call.htm> accessed November 19, 2007.
Krase, Katherine. 1996. “Organizing for Change: Sterilization Abuse.” First published in the Jan/Feb 1996 newsletter of the National Women’s Health Network. Available online at the Our Bodies Ourselves Health Resource Center. <http://www.ourbodiesourselves.org/book/companion.asp?id=32&compID=55&page=1> Accessed: November 19, 2007.
López, Iraida. 1984. “Not many options for contraception: An Interview with La Operación’s Ana María García.” Originally published in the Boletin del Circulo de Cultura Cubana. Translated by Kimberly Safford. Republished in English in Jump Cut, no. 29, February 1984, pp. 38-39. Available online: Accessed on November 24, 2007.
Roberts, Dorothy. 1997. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Pantheon Books. pg. 93.
Safford, Kimberly. 1984. “La Operación:Forced sterilization.” Jump Cut, no. 29, February 1984, pp. 37-38. Available online: Accessed on November 24, 2007.
last updated: November 24, 2007