Stern_Sterilization.pdf

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57SterilizationAlexandra Minna Stern
Latinas/os have a complex relationship to surgical
sterilization as well as to related long- acting forms of
birth control. For more than one hundred years, Latinas/
os— above all Chicanas and puertorriqueñas— have
been subjected episodically to unwanted sterilizations
in state institutions and public clinics. At the same
time, Latinas/os have struggled to obtain access to safe
and affordable birth control, including sterilization,
contraceptive technologies, and in recent years, long-
acting reversible contraception (LARC). This dueling
pattern of hypervigilant reproductive control and
structural exclusion from reproductive health services
has characterized, and continues to characterize,
Latinas/os’ fraught relationship to sterilization.
For much of the twentieth century, Latinas/os, like
all Americans, faced tremendous barriers to obtaining
elective sterilizations. Until 1969, women seeking the
procedure at the doctor’s office had to adhere to the
American Congress of Obstetricians and Gynecologists’
(ACOG) formula, in which age multiplied by number of
children had to be greater than or equal to 120 before
elective sterilization would be considered (E. Gutiérrez
2008). For example, to qualify for sterilization, a forty-
year- old woman needed to be the biological mother of
three children, and a twenty- year- old woman the bio-
logical mother of six children. In addition, two physi-
cians and one psychiatrist had to approve the opera-
tion. Except for the privileged few who had access to
a sympathetic private physician, Latinas were able to
obtain reproductive surgery only through programs es-
tablished under the auspices of population control and
neo- eugenic policies.
Starting in the 1930s, the United States oversaw the
initiation of such a program in Puerto Rico, whose
goals were to “fix” the island’s unemployment and de-
velopment problems by regulating family size (Briggs
2002b). The regulation of sexuality and reproduction
had a long history in Puerto Rico, connected to con-
cerns about female “decency” that characterized both
Spanish and U.S. colonialism on the island (Findlay
1999). Twentieth- century tubal ligation efforts, which
affected women neighborhood by neighborhood, house
by house, led to a situation in which approximately
one- third of puertorriqueñas had been sterilized by the
1960s. This population policy extended to the diaspora
on the East Coast as well, most notably at Lincoln Hos-
pital in the Bronx, where high numbers of postpartum
sterilizations, many nonconsensual, were performed on
Puerto Rican women. Overall, the high rates of steriliza-
tion of Puerto Rican women reflected an incongruous
convergence of imperialist neo- Malthusian population
programs, feminist support of the expansion of steril-
ization as an important birth control option, and the
constrained choices of women, many already mothers,
for whom tubal ligation was an available and sometimes
desired procedure (Lopez 2008).
Concurrent with the rise of sterilizations of Puerto
Ricans on and off the island, Chicanas on the West
Coast were subjected to sterilization abuse (E. Gutiér-
rez 2008). Hospitals in the Los Angeles area, supported
by the Los Angeles Regional Family Planning Council,
launched programs to sterilize Mexican- origin women
using funds newly available through the Department
of Health, Education, and Welfare (HEW) and emer-
gent Medicaid programs. Although the clinics perform-
ing these sterilizations at no cost did adhere to basic
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s t e r I L I z A t I o n a l e x a n d r a m i n n a S T e r n218
consent protocols, they offered these procedures only
to poor women, the vast majority of them Latinas. The
most egregious violations occurred in the early 1970s at
Los Angeles County- University of Southern California
(USC) Hospital where over two hundred Mexican- origin
and African American women were coerced into post-
partum tubal ligations (E. Gutiérrez 2008; Stern 2005b).
While under the duress of labor or sedated, women were
falsely told by the obstetric staff that their husbands
had already consented to the procedure, were commu-
nicated to only in English despite being monolingual
Spanish speakers, or simply told nothing at all. Even-
tually two sets of plaintiffs, all sterilized nonconsensu-
ally at that hospital, sought justice. Ten women, repre-
sented by Antonia Hernández and Richard Navarette
from the Model Cities Center for Law and Justice, filed
a class- action lawsuit seeking punitive damages and the
creation of federal safeguards for sterilization (Tajima-
Peña 2015). Represented by the law firm Cruz, Díaz,
and Durán, three other plaintiffs filed a civil suit for
$6,000,000 in damages. Despite powerful testimonies
and affidavits detailing an environment of coercion, the
courts decided against the plaintiffs. In Madrigal v. Quil-
ligan, the judge explained away this reproductive injus-
tice as the product of cultural misunderstandings and
asserted that the implicated physicians had not done
anything wrong or unethical. Yet these trials, as well as
legal and media attention to similar allegations involv-
ing African American and Native American women in
several regions of the country, raised the visibility of
the extensiveness of sterilization abuse (Nelson 2003).
Within several years, HEW instituted and revamped
regulations for women whose sterilizations were funded
through Medicaid or federal programs.
In preceding decades, Latinas/os had been subjected
to sterilizations in state institutions around the country
(Lira and Stern 2014). From the early 1900s to the 1980s,
thirty- two U.S. states maintained sterilization laws au-
thorizing reproductive surgeries— for women, salpin-
gectomies, and for men, vasectomies and sometimes
castrations— for those deemed unfit to procreate. These
eugenic sterilization laws impacted a wide cross- section
of people, including European and Asian immigrants,
people with intellectual disabilities and psychiatric
conditions, as well as poor and minimally educated
people who became entangled in the net of juvenile
or county court systems (Chávez- García 2012). In most
states, Latinas/os were not one of the primary groups
affected, largely due to their low numbers in Virginia,
North Carolina, and Michigan, three of the states with
the highest absolute sterilization rates. However, in Cali-
fornia, which had a considerable Latin American– origin
population, Latinas/os were significantly impacted, if
not explicitly targeted, by sterilization programs.
Review of recently obtained records from the state
of California demonstrates that Spanish- surnamed
patients were sterilized at over twice the rate of non-
Spanish- surnamed patients, with Latinas under eigh-
teen years of age bearing the brunt of disproportionate
sterilization rates (Novak et al. 2016). Notably, Spanish-
surnamed patients constituted 20 percent of those
sterilized in the state’s largest “feebleminded” home
and 19 percent in the largest psychiatric home during
the peak period of 1937 to 1948. At Pacific Colony, an
institution established to house “morons,” a class of
“feebleminded” the state found particularly worrying,
Spanish- surnamed patients were sterilized at an aver-
age rate of 25 percent from 1929 to 1952, with a peak of
36 percent in 1939. Records indicate that the vast ma-
jority of Spanish- surnamed patients were of Mexican
origin; they were sterilized at rates that far surpassed
their recorded census population, which never rose
higher than 6.5 percent between 1920 and 1950 (Lira
and Stern 2014).
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s t e r I L I z A t I o n a l e x a n d r a m i n n a S T e r n 219
Mexican- origin youth, both girls and boys, deemed
incorrigible, delinquent, or promiscuous, regularly
found themselves committed to the state’s juvenile
homes. It was not uncommon for them to be transferred
temporarily or permanently to institutions, such as So-
noma, where they were sterilized (Chávez- García 2012).
During the era of eugenic sterilization, both Latinos and
Latinas, often entire sibling groups, overwhelmingly of
Mexican origin, were sterilized in state hospitals and
homes. Again and again, Chicanas/os were explicitly
identified as degenerate and inferior by California eu-
genicists (L. Chavez 2004).
Yet Chicana/o families did not automatically accept
or acquiesce to recommendations from superintendents
that they or their family members be sterilized on ac-
count of mental, intellectual, or physical defects. In-
deed, Chicana/o parents were the most vocal opponents
of sterilization, protesting the operation for religious, le-
gal, and moral reasons (Lira and Stern 2014). In 1930, in
what appears to be the first instance of any challenge
to the state’s sterilization law, Concepción Ruíz and her
guardian sued in district court for damages after her
sterilization at Sonoma. In 1939, Sara Rosas García, the
mother of a young woman named Andrea sterilized at
Pacific Colony also sued the state, challenging the con-
stitutionality of the sterilization law. García secured le-
gal counsel from David C. Marcus, a Jewish American
lawyer with strong ties to the Mexican Consulate and
the National Association for the Advancement of Col-
ored People (NAACP), who wrote a compelling criticism
of Andrea’s sterilization as a violation of the equal pro-
tection clause of the Fourteenth Amendment and of due
process, given that there was no mechanism for patient
appeal. Although these two lawsuits failed, they are
small but salient illustrations of the resistance against
sterilization waged by Chicana/o parents who contested
juvenile court officers, wrote multiple letters refusing
the operation for one or more children, and sought sup-
port from the Catholic Church, the Mexican Consulate,
and local Mexican American civic organizations.
A sturdy thread of Latina/o resistance against non-
consensual sterilization runs from these early instances
of protests in the 1930s across the twentieth century to
the 1970s and 1980s, when Chicanas/os, puertorrique-
ñas, and their allies organized and marched against ster-
ilization abuse. It is no coincidence that the legislator
who spearheaded the repeal of California’s eugenic ster-
ilization law in 1979— after seventy years on the books—
was Art Torres, a Mexican American state assemblyman
from the very district where members of the commu-
nity were misled into reproductive surgeries at Los An-
geles County- USC hospital.
In the twenty- first century, the problem of steriliza-
tion abuse has not disappeared. In 2013, journalists and
legal advocates uncovered approximately 150 cases of
unauthorized sterilizations in two California women’s
prisons (Johnson 2013). Overwhelmingly affected were
women of color and poor women incarcerated for mi-
nor offenses whose contact with their children was
made contingent upon permanent birth control. Al-
though there is limited information about most of these
women, those who have spoken out about their experi-
ences are African American and Latina. Echoing argu-
ments from the eugenics era, in which fears of dysgenic
offspring were coupled with concerns about protecting
the public purse, the obstetrician contracted to perform
these operations for the prison system justified them as
cheaper “compared to what you save in welfare paying
for these unwanted children— as they procreated more”
(quoted in Johnson 2013).
For Latinas, sterilization abuse is not a relic of the
past but a potential reality, particularly in institutional
settings. Keen awareness of this possibility prompted a
group of reproductive justice advocates to issue a strong
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s t e r I L I z A t I o n a l e x a n d r a m i n n a S T e r n220
statement in 2013 about the continued need for safe-
guards, mostly established in the wake of the abuses
that unfolded in the 1970s, to protect poor women and
women of color (Reid 2014). These safeguards include a
thirty- day waiting period for any Medicaid- funded ster-
ilization, availability of bilingual consent forms, and
a prohibition on operations on minors. However, this
perspective is challenged by another group of feminists,
working largely in women’s health, who believe that
Medicaid requirements severely limit women’s access to
wanted sterilizations (Borrero, Zite, and Creinin 2012).
They argue that women of color and poor women are
unduly harmed by the bureaucratic demands of these
cumbersome requirements. Their recommendations are
supported by recent research that strongly suggests that
tubal ligation rates are higher among Latinas because
sterilization is their preferred form of birth control and
that Latinas face multiple obstacles to obtaining LARC
(Potter et al. 2012; White et al. 2014). Notwithstand-
ing, other studies show that Latinas are more likely to
express regret after sterilization, indicating that undue
pressure or significant miscommunication occurred at
some point in the process (Shreffler et al. 2015).
Sterilization and oral contraception are the two most
common forms of birth control, and tubal ligations
and vasectomies are requested by millions of men and
women across the demographic spectrum every year. It
is much more than a simple medical procedure, however,
since it has been caught up in struggles over reproduc-
tive control with multiple actors and stakeholders. For
Latinas/os this dynamic is further complicated by cross-
currents of colonialism, racism, and xenophobia, which
sit at the core of stratified reproduction. Sometimes
these dynamics have played out through tense gender
politics. For example, when Chicanos propounded mili-
tant ethnic nationalism in the 1960s and 1970s, many
Chicanas challenged their presumptive principal roles
as mothers and breeders of la raza, and gendered fissures
emerged in the Chicana/o movement. Largely because
of strong female leadership among Puerto Rican activ-
ists, a more comprehensive understanding of repro-
ductive control along feminist lines was incorporated
into political platforms and movement politics (Nelson
2003).
Latinas/os have had a wide diversity of experiences
with sterilization, ranging from being victims of co-
erced operations to overcoming significant economic
and administrative barriers to obtain permanent birth
control through reproductive surgery. These patterns
are the most pronounced for Latinas, whose contact
points with any form of birth control is likely to be con-
strained by racial biases, institutional inequities, and
intransigent political wrangling about women’s repro-
ductive bodies. Given deep- seated historical patterns
and the contemporary combative landscape of repro-
ductive politics in the United States, sterilization will
probably continue to be a troubled issue for Latinas/os,
particularly for those reliant on public health systems
or explicitly excluded from health coverage through the
Affordable Care Act because of undocumented or tenu-
ous immigrant status.
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