Sterilization of Women in Puerto Rico

I am grateful to CLORE for inviting me to submit brief comments in anticipation of its showing of the film La Operacion on Monday, November 8.

In 1937, contraception was legalized in Puerto Rico. Nick Thimmesch, Birth Control in Puerto Rico, 30 Family Planning and Fertility Control 252, (1968). Before and after passage of this legislation, the Catholic Church waged strong opposition to the availability of birth control. Id. at 258. At the other extreme, in the wake of the 1937 law, hospitals strongly pushed sterilization of women as the primary means of controlling fertility. Id. at 256; Charles W. Warren, et al., Contraceptive Sterilization in Puerto Rico, 23 Demography 351, 352 (1986). In fact, the statute authorized the Commissioner of Health to “issue a license to teach and practice eugenic principles [to qualified doctors and nurses] in public institutions and centers.” Thimmesch, supra, at 255.

Puerto Rican women were thus yanked in opposite directions: by the Catholic Church to bear large families, and by a new campaign not only to limit childbearing but to relinquish altogether their ability to procreate. The same law that legalized contraception also imposed heavy punishments for abortion. Id. Given the harshness of these penalties, one wonders whether some women felt compelled to undergo sterilization as the surest means to avoid unintended pregnancy. Cultural norms favoring male virility, id. at 256, may also have made it unlikely that male partners would participate in, or tolerate their partners’ use of, non-permanent methods of contraception. Industrialization and the increased movement of women into the workforce also played a role in the prevalence of sterilization. Harriet B. Presser & Sunita Kishor, Economic Development and Occupational Sex Segregation in Puerto Rico: 1950-80, 17 Population and Development Review 53, 61 (1991).

The social and political forces underlying Puerto Rico’s remarkably high sterilization rate among women from the late 1930s to the mid-1960s and beyond are undoubtedly complex and multi-faceted. The bare fact remains, however, that during this period mass numbers of Puerto Rican women were sterilized. In fact, data from a 1965 survey showed that “31.9 percent of all ever-married women 20-49 years of age were sterilized.” Warren, et al., supra, at 352. As late as 1986, one article pointed out that “for at least the past 20 years, Puerto Rico has had the highest prevalence rate of contraceptive sterilization in the world.” Id at 351. The sheer numbers raise questions as to how well-informed women were about the procedure and its alternatives, and the extent to which they felt coerced to undergo “la operacion.”

The complex history of the regulation of female fertility in Puerto Rico echoes a pervasive tendency of government and other third parties to try to control women’s reproductive choices. This tendency is especially acute when it comes to women of color. Sterilization, in particular, is a procedure that has been the subject of horrific eugenic programs intended to limit childbearing among “undesirable” populations, including women of color.

Two Supreme Court decisions have addressed examples of eugenic programs. In Buck v. Bell, the Court upheld the forced sterilization of Carrie Buck, a woman alleged to be “feeble minded.” In a now-famous, chilling passage, Justice Holmes proclaimed, “It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. . . . Three generations of imbeciles are enough.” 274 U.S. 200, 207 (1927). In Skinner v. Oklahoma, the Court invalidated an Oklahoma law that provided for the sterilization of “habitual criminals,” which it defined as persons sentenced to imprisonment after having been convicted at least twice for “felonies involving moral turpitude.” 316 U.S. 535, 356 (1942). The Court noted, “The power to sterilize, if exercised, may have subtle, far-reaching and devastating effects. In evil or reckless hands, it can cause races or types which are inimical to the dominant group to wither and disappear.” Id. at 541.

In her book, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (1997), Dorothy Roberts documents the history of the eugenics movement in the United States and in particular its focus on limiting childbearing among women of color. Id. at 56-103. Even today, the United State is not free of governmental impulses to prevent women of color from bearing children. Roberts’ book discusses the numerous ways in which recent and current welfare and criminal law policies have targeted women of color by penalizing or attempting to prevent their childbearing.

Sterilization is an important means of controlling fertility, and is an option that should be available to all women. As with all reproductive choices, however, it must be one that women are able to choose without coercion from their partners, the government, religious authorities, or other outside forces. La Operacion thus serves as an important reminder of the critical and continuing importance of reproductive freedom in all of its dimensions.

--Caitlin Borgmann