Compulsory sterilization

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Compulsory sterilization, also known as forced or coerced sterilization, programs are government policies which force people to undergo surgical or other sterilization. The reasons governments implement sterilization programs vary in purpose and intent. In the first half of the 20th century, several such programs were instituted in countries around the world, usually as part of eugenics programs intended to prevent the reproduction of members of the population considered to be carriers of defective genetic traits.

 

Other bases for compulsory sterilization have included general population growth management, sex discrimination, "sex-normalizing" surgeries of intersex persons, limiting the spread of HIV, and reducing the population of ethnic groups. The last is counted as an act of genocide under the Statute of Rome. Some countries require transgender people to undergo sterilization before gaining legal recognition of their gender, a practice that Juan E. Méndez, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment cites as a violation of the Yogyakarta Principles.

Compulsory sterilization has been proposed as a means of human population planning.

Affected populations

In May 2014, the World Health Organization, OHCHR, UN Women, UNAIDS, UNDP, UNFPA and UNICEF issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement. The report references the involuntary sterilization of a number of specific population groups. They include:

• Women, especially in relation to coercive population control policies, and particularly including women living with HIV, indigenous and ethnic minority girls and women. Indigenous and ethnic minority women often face "wrongful stereotyping based on gender, race and ethnicity". (based on nothing)
  • Funding of welfare mothers by HEW (Health, Education, and Welfare) covers roughy 90% of cost and doctors are likely to concur with the compulsory sterilization of welfare mothers. Threats to cease welfare occur when women do are hesitant to consent.
• Disabled people, often perceived as asexual. Women with intellectual disabilities are "often treated as if they have no control, or should have no control, over their sexual and reproductive choices". Other rationales include menstrual management for "women who have or are perceived to have difficulties coping with or managing menses, or whose health conditions (such as epilepsy) or behaviour are negatively affected by menses."
• Intersex persons, who "are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved", often as a "sex-normalizing" treatment.
• Transgender persons, "as a prerequisite to receiving gender-affirmative treatment and gender-marker changes".

The report recommends a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability and access to remedies.

As a part of human population planning

Human population planning is the practice of artificially altering the rate of growth of a human population. Historically, human population planning has been implemented by limiting the population's birth rate, usually by government mandate, and has been undertaken as a response to factors including high or increasing levels of poverty, environmental concerns, religious reasons, and overpopulation. While population planning can involve measures that improve people's lives by giving them greater control of their reproduction, some programs have exposed them to exploitation.

In the 1977 textbook Ecoscience: Population, Resources, Environment, the authors discussed in this encyclopedic textbook the possible role of a wide variety of formulations to address human overpopulation. This included the possibility of compulsory sterilization. A government might utilize sortition to select those to be sterilized in order to avoid accusations of bias or having any other adverse agenda. In Ecoscience, in the chapter entitled "The Human Predicament: Finding A Way Out", the authors speculate about pharmaceuticals that might be developed to sterilize people. Some partial fulfillments of these predictions are the birth control drugs in Norplant and Depo-Provera. One can further speculate about pharmaceuticals designed to permanently sterilize the gestating human fetus in utero.

By country

International law

The Istanbul Convention prohibits forced sterilization (Article 39). Widespread or systematic forced sterilization has been recognized as a Crime against Humanity by the Rome Statute of the International Criminal Court in the explanatory memorandum. This memorandum defines the jurisdiction of the International Criminal Court. Rebecca Lee wrote in the Berkeley Journal of International Law that, as of 2015, twenty-one Council of Europe member states require proof of sterilization in order to change one's legal sex categorization. Lee wrote that requiring sterilization is a human rights violation and LGBT specific international treaties may need to be developed in order to protect LGBT human rights.

Bangladesh

Bangladesh has a long running government operated civilian exploitative sterilization program as a part of its population control policy, where poor women and men are mainly targeted. The government offers 2000 Bangladeshi Taka (US$24) for the woman who are persuaded to undergo tubal ligation and for the man who are persuaded to undergo vasectomy. Women are also offered a sari (a garment worn by women in Indian subcontinent) and men are offered a lungi (a garment for men) to wear for undergoing sterilization. The referrer, who persuades the woman or man to undergo sterilization gets 300 Bangladeshi Taka (US$3.60). In 1965, the targeted number of sterilizations per month was 600–1000 in contrast to the insertion of 25,000 IUDs, which was increased in 1978 to about 50,000 sterilizations per month on average. A 50% rise in the amount paid to men coincided with a doubling of the number of vasectomies between 1980 and 1981. One study done in 1977, when incentives were only equivalent to US$1.10 (at that time), indicated that between 40 and 60% of the men chose vasectomy because of the payment, who otherwise did not have any serious urge to get sterilized. The "Bangladesh Association for Voluntary Sterilization", alone performed 67,000 tubal ligations and vasectomies in its 25 clinics in 1982. The rate of sterilization increased 25 percent each year. On 16 December 1982, Bangladesh's military ruler Lieutenant General Hussain Muhammad Ershad launched a two-year mass sterilization program for Bangladeshi women and men. About 3,000 women and men were planned to be sterilized on 16 December 1982 (the opening day). Ershad's government trained 1,200 doctors and 25,000 field workers who must conduct two tubal ligations and two vasectomies each month to earn their salaries. And the government wanted to persuade 1.4 million people, both women and men to undergo sterilization within two years. One population control expert called it 'the largest sterilization program in the world'. By January 1983, 40,000 government field workers were employed in Bangladesh's 65,000 villages to persuade women and men to undergo sterilization and to promote usage of birth-control across the country. Food subsidies under the group feeding program (VGF) were given to only those women with certificates showing that they had undergone tubal ligation. In the 1977 study, a one-year follow-up of 585 men sterilized at vasectomy camps in Shibpur and Shalna in rural Bangladesh showed that almost half of the men were dissatisfied with their vasectomies. 58% of the men said their ability to work had decreased in the last year. 2%–7% of the men said their sexual performance decreases. 30.6% of the Shibpur and 18.9% of the Shalna men experienced severe pain during the vasectomy. The men also said they had not received all of the incentives they had been promised. According to another study on 5042 women and 264 men who underwent sterilization, complications such as painful urination, shaking chills, fever for at least 2 days, frequent urination, bleeding from the incision, sore with pus, stitches or skin breaking open, weakness and dizziness arose after the sterilization. The person's sex, the sponsor and workload in the sterilization center, and the dose of sedatives administered to women were significantly associated with specific postoperative complaints. Five women died during the study, resulting in a death-to-case rate of 9.9/10,000 tubectomies (tubal ligations); four deaths were due to respiratory arrest caused by overuse of sedatives. The death-to-case rate of 9.9/10,000 tubectomies (tubal ligation) in this study is similar to the 10.0 deaths/10,000 cases estimated on the basis of a 1979 follow-up study in an Indian female sterilization camp. The presence of a complaint before the operation was generally a good predictor of postoperative complaints. Centers performing fewer than 200 procedures were associated with more complaints. According to another study based on 20 sterilization-attributable deaths in Dacca (now Dhaka) and Rajshahi Divisions in Bangladesh, from January 1, 1979 to March 31, 1980, overall, the sterilization-attributable death-to-case rate was 21.3 deaths/100,000 sterilizations. The death rate for vasectomy was 1.6 times higher than that for tubal ligation. Anesthesia overdosage was the leading cause of death following tubal ligation along with tetanus (24%), where intraperitoneal hemorrhage (14%), and infection other than tetanus (5%) was other leading causes of death. 2 women (10%) died from pulmonary embolism after tubal ligation; 1 (5%) died from each of the following: anaphylaxis from anti-tetanus serum, heat stroke, small bowel obstruction, and aspiration of vomitus. All 7 men died from scrotal infections after vasectomy. According to a second epidemiologic investigation of deaths attributable to sterilization in Bangladesh, where all deaths resulting from sterilizations performed nationwide between September 16, 1980, and April 15, 1981, were investigated and analyzed, nineteen deaths from tubal ligation were attributed to 153,032 sterilizations (both tubal ligation and vasectomy), for an overall death-to-case rate of 12.4 deaths per 100,000 sterilizations. This rate was lower than that (21.3) for sterilizations performed in Dacca (now Dhaka) and Rajshahi Divisions from January 1, 1979, to March 31, 1980, although this difference was not statistically significant. Anesthesia overdosage, tetanus, and hemorrhage (bleeding) were the leading causes of death. There are reports that often when a woman had to undergo a gastrointestinal surgery, doctors took this opportunity to sterilize her without her knowledge. According to Bangladesh governmental website "National Emergency Service", the 2000 Bangladeshi Taka (US$24) and the sari/lungi given to the persons undergoing sterilizations are their "compensations". Where Bangladesh government also assures the poor people that it will cover all medical expenses if complications arise after the sterilization. For the women who are persuaded to have IUD inserted into uterus, the government also offers 150 Bangladeshi Taka (US$1.80) after the procedure and 80+80+80=240 Bangladeshi Taka (0.96+0.96+0.96=2.88 USD) in 3 followups, where the referrer gets 50 Bangladeshi Taka (US$0.60). And for the women who are persuaded to have etonogestrel birth control implant placed under the skin in upper arm, the government offers 150 Bangladeshi Taka (US$1.80) after the procedure and 70+70+70=210 Bangladeshi Taka (0.84+0.84+0.84=2.52 USD) in 3 followups, where the referrer gets 60 Bangladeshi Taka (US$0.72). These civilian exploitative sterilization programs are funded by the countries from northern Europe and the United States. World bank is also known to have sponsored these civilian exploitative sterilization programs in Bangladesh. Historically, World Bank is known to have pressured 3rd World governments to implement population control programs. Bangladesh is the 8th largest country in the world by population, having a population of 163,466,000 as of 12 November 2017, despite being ranked 94th by total area having an area of 147,570 km².^[26] Bangladesh has the highest population density in the world among the countries having at least 10 million population. The capital Dhaka is the 4th most densely populated city in the world, which ranked as the world's 2nd most unlivable city, just behind Damascus, Syria according to the annual "Liveability Ranking" 2015 by the Economist Intelligence Unit (EIU).

Bangladesh is planning to introduce sterilization program in its overcrowded Rohingya refugee camps, where nearly a million refugees are fighting for space, after efforts to encourage birth control failed. Since 25 August 2017, more than 600,000 Rohingya Muslims have been fled from Rakhine state, Myanmar to neighboring Bangladesh, which is a Muslim majority country, following a military crackdown against Rohingya Muslims in Rakhine state, Myanmar. Sabura, a Rohingya mother of seven, said her husband believed the couple could support a large family.

“I spoke to my husband about birth control measures. But he is not convinced. He was given two condoms but he did not use them,” she said.

“My husband said we need more children as we have land and property (in Rakhine). We don’t have to worry to feed them,” she said. 

District family planning authorities have managed to distribute just 549 packets of condoms among the refugees, amid reports they are reluctant to use them. They have asked the government to approve a plan to provide vasectomies for men and tubectomies (tubal ligation) for women in the camps.

One volunteer, Farhana Sultana, said the women she spoke to believed birth control was a sin and others saw it as against the tenets of Islam. 

Bangladeshi officials say about 20,000 Rohingya refugee women are pregnant and 600 have given birth since arriving in the country, but this may not be accurate as many births take place without formal medical help. 

Every month 250 Bangladeshi people undergo sterilization routinely under government's sterilization program in the border town of Cox's Bazar, where the Rohingya refugee Muslims have taken shelter.

Canada

Two Canadian provinces (Alberta and British Columbia) performed compulsory sterilization programs in the 20th century with eugenic aims. Canadian compulsory sterilization operated via the same overall mechanisms of institutionalization, judgment, and surgery as the American system. However, one notable difference is in the treatment of non-insane criminals. Canadian legislation never allowed for punitive sterilization of inmates.

The Sexual Sterilization Act of Alberta was enacted in 1928 and repealed in 1972. In 1995, Leilani Muir sued the Province of Alberta for forcing her to be sterilized against her will and without her permission in 1959. Since Muir's case, the Alberta government has apologized for the forced sterilization of over 2,800 people. Nearly 850 Albertans who were sterilized under the Sexual Sterilization Act were awarded C$142 million in damages.

As recently as 2017, a number of Indigenous women were not permitted to see their newborn babies unless they agreed to sterilization. Over 60 women are involved in a lawsuit in this case.

China

In 1978, Chinese authorities became concerned with the possibility of a baby boom that the country could not handle, and they initialized the one-child policy. In order to effectively deal with the complex issues surrounding childbirth, the Chinese government placed great emphasis on family planning. Because this was such an important matter, the government thought it needed to be standardized, and so to this end laws were introduced in 2002. These laws uphold the basic tenets of what was previously put into practice, outlining the rights of the individuals and outlining what the Chinese government can and cannot do to enforce policy. 

However, recently accusations have been raised from groups such as Amnesty International, who have claimed that practices of compulsory sterilization have been occurring for people who have already reached their one child quota. These practices run contrary to the stated principles of the law, and seem to differ on a local level. An especially egregious example, according to Amnesty International, has been occurring in Puning City, Guangdong Province. The sterilization drive in this city was in accordance with regulations outlined by the government in the Population and Family Planning Law of 2002. This drive, also known as the Iron Fist Campaign, also is said to have used coercive methods in order to ensure that close to 10,000 women were sterilized, including detaining elderly family members. It is unclear whether support of the increase of the now 90% Han Chinese majority here plays a role.

The Chinese government appears to be aware of these discrepancies in policy implementation on a local level. For example, The National Population and Family Planning Commission put forth in a statement that, “Some persons concerned in a few counties and townships of Linyi did commit practices that violated law and infringed upon legitimate rights and interests of citizens while conducting family planning work.” This statement comes in reference to some charges of forced sterilization and abortions in Linyi city of Shandong Province. However, it remains unclear to what extent the government has prosecuted or disciplined the officials in charge of family planning in the country.

The policy requires a "social compensation fee" for those who have more than the legal number of children. According to Forbes editor Heng Shao, critics claims this fee is a toll on the poor but not the rich. There are cases registered in the Chinese legal system (cf. Si Bu Tuo Zhe Renmin) which could prove infractions in the field.

Denmark

Until June 11, 2014, sterilization was requisite for legal sex change in Denmark.

Germany

One of the first acts by Adolf Hitler after the Reichstag Fire Decree and the Enabling Act of 1933 gave him de facto legal dictatorship over the German state was to pass the Law for the Prevention of Hereditarily Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses) in July 1933. The law was signed by Hitler himself, and over 200 eugenic courts were created specifically as a result of this law. Under it, all doctors in the Third Reich were required to report any patients of theirs who were deemed intellectually disabled, characterized mentally ill (including schizophrenia and manic depression), epileptic, blind, deaf, or physically deformed, and a steep monetary penalty was imposed for any patients who were not properly reported. Individuals suffering from alcoholism or Huntington's Disease could also be sterilized. The individual's case was then presented in front of a court of Nazi officials and public health officers who would review their medical records, take testimony from friends and colleagues, and eventually decide whether or not to order a sterilization operation performed on the individual, using force if necessary. Though not explicitly covered by the law, 400 mixed-race "Rhineland Bastards" were also sterilized beginning in 1937. The sterilization program went on until the war started, with about 600,000 people sterilized.

By the end of World War II, over 400,000 individuals were sterilised under the German law and its revisions, most within its first four years of being enacted. When the issue of compulsory sterilisation was brought up at the Nuremberg trials after the war, many Nazis defended their actions on the matter by indicating that it was the United States itself from whom they had taken inspiration. The Nazis had many other eugenics-inspired racial policies, including their "euthanasia" program in which around 70,000 people institutionalized or suffering from birth defects were killed.

India

India's state of emergency between 1975 and 1977 included a family planning initiative that began in April 1976 through which the government hoped to lower India's ever increasing population. This program used propaganda and monetary incentives to, some may construe, inveigle citizens to get sterilized. People who agreed to get sterilized would receive land, housing, and money or loans. Because of this program, thousands of men received vasectomies and even more women received tubal ligations, both possibly reversible. However, the program focused more on sterilizing women than men. An article in The New York Times titled “For Sterilization, Target Is Women” states, “There were 114,426 vasectomies in India in 2002–03, and 4.6 million tubal ligations, the analogous operation on women, though ligation is a more complicated operation.” Son of the Prime Minister at the time Indira Gandhi, Sanjay Gandhi was largely blamed for what turned out to be a failed program. A strong backlash against any initiative associated with family planning followed the highly controversial program, the backlash of which continues into the 21st century.

Israel

In the late 2000s, reports in the Israeli media claimed that injections of long-acting contraceptive Depo-Provera had been forced on hundreds of Ethiopian-Jewish immigrants both in transit camps in Ethiopia and after their arrival in Israel. In 2009, feminist NGO Haifa Women's Coalition published a first survey on the story, which was followed up by Israeli Educational Television a few years later. Ethiopian-Jewish women said they were intimidated or tricked into taking the shot every three months, sometimes presented to them as vaccine. In 2016 Israel's State Comptroller concluded his inquiry into the affair by claiming that injections of Depo-Provera had not been forced on the women; however, the Comptroller had refused to hear complainants' testimony, and his probe into the role of the American Jewish Joint Distribution Committee (JDC), whose activists had looked after the women in the Ethiopian transit camps, left open questions, since the JDC official who had handled family programming in Ethiopia refused to give the Comptroller any information.

Japan

In the first part of the Shōwa era, Japanese governments promoted increasing the number of healthy Japanese, while simultaneously decreasing the number of people deemed to have mental retardation, disability, genetic disease and other conditions that led to inferiority in the Japanese gene pool.

The Leprosy Prevention laws of 1907, 1931 and 1953, permitted the segregation of patients in sanitariums where forced abortions and sterilization were common and authorized punishment of patients "disturbing peace". Under the colonial Korean Leprosy prevention ordinance, Korean patients were also subjected to hard labor.

The Race Eugenic Protection Law was submitted from 1934 to 1938 to the Diet. After four amendments, this draft was promulgated as a National Eugenic Law in 1940 by the Konoe government. According to Matsubara Yoko, from 1940 to 1945, sterilization was done to 454 Japanese persons under this law. Appx. 800,000 people were surgically processed until 1995.

According to the Eugenic Protection Law (1948), sterilization could be enforced on criminals "with genetic predisposition to commit crime", patients with genetic diseases including mild ones such as total color-blindness, hemophilia, albinism and ichthyosis, and mental affections such as schizophrenia, manic-depression possibly deemed occurrent in their opposition and epilepsy, the sickness of Caesar. The mental sicknesses were added in 1952.

Peru

In Peru, President Alberto Fujimori (in office from 1990 to 2000) has been accused of genocide and crimes against humanity as a result of the Programa Nacional de Población, a sterilization program put in place by his administration. During his presidency, Fujimori put in place a program of forced sterilizations against indigenous people (mainly the Quechuas and the Aymaras), in the name of a "public health plan", presented on July 28, 1995. The plan was principally financed using funds from USAID (36 million dollars), the Nippon Foundation, and later, the United Nations Population Fund (UNFPA). On September 9, 1995, Fujimori presented a Bill that would revise the "General Law of Population", in order to allow sterilization. Several contraceptive methods were also legalized, all measures that were strongly opposed by the Roman Catholic Church, as well as the Catholic organization Opus Dei. In February 1996, the World Health Organization (WHO) itself congratulated Fujimori on his success in controlling demographic growth.

On February 25, 1998, a representative for USAID testified before the U.S. government's House Committee on International Relations, to address controversy surrounding Peru's program. He indicated that the government of Peru was making important changes to the program, in order to:

• Discontinue their campaigns in tubal ligations and vasectomies.
• Make clear to health workers that there are no provider targets for voluntary surgical contraception or any other method of contraception.
• Implement a comprehensive monitoring program to ensure compliance with family planning norms and informed consent procedures.
• Welcome Ombudsman Office investigations of complaints received and respond to any additional complaints that are submitted as a result of the public request for any additional concerns.
• Implement a 72-hour "waiting period" for people who choose tubal ligation or vasectomy. This waiting period will occur between the second counseling session and surgery.
• Require health facilities to be certified as appropriate for performing surgical contraception as a means to ensure that no operations are done in makeshift or substandard facilities.

In September 2001, Minister of Health Luis Solari launched a special commission into the activities of the voluntary surgical contraception, initiating a parliamentary commission tasked with inquiring into the "irregularities" of the program, and to put it on an acceptable footing. In July 2002, its final report ordered by the Minister of Health revealed that between 1995 and 2000, 331,600 women were sterilized, while 25,590 men submitted to vasectomies. The plan, which had the objective of diminishing the number of births in areas of poverty within Peru, was essentially directed at the indigenous people living in deprived areas (areas often involved in internal conflicts with the Peruvian government, as with the Shining Path guerilla group). Deputy Dora Núñez Dávila made the accusation in September 2003 that 400,000 indigenous people were sterilized during the 1990s. Documents proved that President Fujimori was informed, each month, of the number of sterilizations done, by his former Ministers of Health, Eduardo Yong Motta (1994–96), Marino Costa Bauer (1996–1999) and Alejandro Aguinaga (1999–2000). A study by sociologist Giulia Tamayo León [es], Nada Personal (in English: Nothing Personal), showed that doctors were required to meet quotas. According to Le Monde diplomatique, "tubal ligation festivals" were organized through program publicity campaigns, held in the pueblos jóvenes (in English: shantytowns). In 1996 there were, according to official statistics, 81,762 tubal ligations performed on women, with a peak being reached the following year, with 109,689 ligatures, then only 25,995 in 1998.

On October 21, 2011, Peru's Attorney General José Bardales decided to reopen an investigation into the cases, which had been halted in 2009 under the statute of limitations, after the Inter-American Commission on Human Rights ruled that President Fujimori's sterilization program involved crimes against humanity, which are not time-limited. It is unclear as to any progress in matter of the execution (debido ejecución sumaria) of the suspect in the course of any proof of their relevant accusations in the legal sphere of the constituted people in vindication of the rights of the people of South America. It may carry a parallel to any suspect cases for international investigation in any other continent, and be in the sphere of medical genocide.

Russia

In 2008, the Perm Krai ombudswoman Tatyana Margolina reported that 14 women with disabilities were subjected to compulsory medical sterilization in the Ozyorskiy psychoneurological nursing home whose director was Grigory Bannikov. The sterilizations were performed not on the basis of a mandatory court decision appropriate for them, but only on the basis of the application by the guardian Bannikov. On 2 December 2010, the court did not find corpus delicti in the compulsory medical sterilizations performed by his consent. The order by the health minister of the Russian Federation that was issued in 1993 and neatly determined the procedure of forced abortion and sterilization of women with disabilities was repealed by the head of Ministry of Health and Social Development of the Russian Federation Tatyana Golikova in 2009. Therefore, now women can be subjected to compulsory sterilization without court decision, according to Tatyana Margolina, which may place some types of people within their nation at risk. In Russia, one of the supporters of preventive eugenics is the president of the Independent Psychiatric Association of Russia Yuri Savenko, who justifies forced sterilization of women, which is practiced in Moscow psychoneurological nursing homes, and states that “one needs a more strictly adjusted and open control for the practice of preventive eugenics, which, in itself, is, in its turn, justifiable.”

South Africa

In South Africa, there have been multiple reports of HIV-positive women sterilized without their informed consent and sometimes without their knowledge.

Sweden

The eugenics legislation was enacted in 1934 and was formally abolished in 1976. According to the 2000 governmental report, 21,000 were estimated to have been forcibly sterilized, 6,000 were coerced into a 'voluntary' sterilization while the nature of a further 4,000 cases could not be determined. The Swedish state subsequently paid out damages to victims who contacted the authorities and asked for compensation. Of those sterilized 93% were women.

Switzerland

In October 1999, Margrith von Felten suggested to the National Council of Switzerland in the form of a general proposal to adopt legal regulations that would enable reparation for persons sterilized against their will. According to the proposal, reparation was to be provided to persons who had undergone the intervention without their consent or who had consented to sterilization under coercion. According to Margrith von Felten: 

“

The history of eugenics in Switzerland remains insufficiently explored. Research programmes are in progress. However, individual studies and facts are already available. For example: The report of the Institute for the History of Medicine and Public Health "Mental Disability and Sexuality. Legal sterilization in the Vaud Canton between 1928 and 1985" points out that coercive sterilizations took place until the 1980s, it is unclear if the ethnographic impact has been duly investigated and if Hun-descendant French have been affected, as well as prehistoric human descendant communities. The act on coercive sterilizations of the Vaud Canton was the first law of this kind in the European context. Hans Wolfgang Maier, head of the Psychiatric Clinic in Zurich pointed out in a report from the beginning of the century that 70% to 80% of terminations were linked to sterilization by doctors. In the period from 1929 to 1931, 480 women and 15 men were sterilized in Zurich in connection with termination. Following agreements between doctors and authorities such as the 1934 "Directive For Surgical Sterilization" of the Medical Association in Basle, eugenic indication to sterilization was recognized as admissible. A statistical evaluation of the sterilizations performed in the Basle women's hospital between 1920 and 1934 shows a remarkable increase in sterilizations for a psychiatric indication after 1929 and a steep increase in 1934, when a coercive sterilization act came into effect in nearby National Socialist Germany. A study by the Swiss Nursing School in Zurich, published in 1991, documents that 24 mentally disabled women aged between 17 and 25 years were sterilized between 1980 and 1987. Of these 24 sterilizations, just one took place at the young woman's request. Having evaluated sources primarily from the 1930s (psychiatric files, official directives, court files, etc.), historians have documented that the requirement for free consent to sterilization was in most of cases not satisfied. Authorities obtained the "consent" required by the law partly by persuasion, and partly by enforcing it through coercion and threats. Thus the recipients of social benefits were threatened with removal of the benefits, women were exposed to a choice between placement in an institution or sterilization, and abortions were permitted only when women simultaneously consented to sterilization. More than fifty years after ending the National Socialist dictatorship in Germany, in which racial murder, euthanasia and coerced sterilizations belonged to the political programme, it is clear that eugenics, with its idea of "life unworthy of life" and "racial purity" permeated even democratic countries. The idea that a "healthy nation" should be achieved through targeted medical/social measures was designed and politically implemented in many European countries and in the U.S.A in the first half of this century. It is a policy incomparable with the inconceivable horrors of the Nazi rule; yet it is clear that authorities and the medical community were guilty of the methods and measures applied, i.e. coerced sterilizations, prohibitions of marriages and child removals – serious violations of human rights.

”

Switzerland refused, however, to vote a reparations Act.

United States

A map from a 1929 Swedish royal commission report displays the U.S. states that had implemented sterilization legislation by then

 

The United States during the Progressive era, ca. 1890 to 1920, was the first country to concertedly undertake compulsory sterilization programs for the purpose of eugenics. Thomas C. Leonard, professor at Princeton University, describes American eugenics and sterilization as ultimately rooted in economic arguments and further as a central element of Progressivism alongside wage controls, restricted immigration, and the introduction of pension programs. The heads of the programs were avid proponents of eugenics and frequently argued for their programs which achieved some success nationwide mainly in the first half of the 20th Century.

Eugenics had two essential components. First, its advocates accepted as axiomatic that a range of mental and physical handicaps—blindness, deafness, and many forms of mental illness—were largely, if not entirely, hereditary in cause. Second, they assumed that these scientific hypotheses could be used as the basis of social engineering across several policy areas, including family planning, education, and immigration. The most direct policy implications of eugenic thought were that “mental defectives” should not produce children, since they would only replicate these deficiencies, and that such individuals from other countries should be kept out of the polity. The principal targets of the American sterilization programs were the intellectually disabled and the mentally ill, but also targeted under many state laws were the deaf, the blind, people with epilepsy, and the physically deformed. While the claim was that the focus was mainly the mentally ill and disabled, the definition of this during that time was much different than today's. At this time, there were many women that were sent to institutions under the guise of being “feeble-minded" because they were promiscuous or became pregnant while unmarried.

Some sterilizations took place in prisons and other penal institutions, targeting criminality, but they were in the relative minority. In the end, over 65,000 individuals were sterilized in 33 states under state compulsory sterilization programs in the United States, in all likelihood without the perspectives of ethnic minorities.

The first state to introduce a compulsory sterilization bill was Michigan, in 1897, but the proposed law failed to pass. Eight years later Pennsylvania's state legislators passed a sterilization bill that was vetoed by the governor. Indiana became the first state to enact sterilization legislation in 1907, followed closely by California and Washington in 1909. Several other states followed, but such legislation remained controversial enough to be defeated in some cases, as in Wyoming in 1934. Sterilization rates across the country were relatively low, with the sole exception of California, until the 1927 U.S. Supreme Court decision in Buck v. Bell which legitimized the forced sterilization of patients at a Virginia home for the intellectually disabled. In the wake of that decision, over 62,000 people in the United States, most of them women, were sterilized. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma, 1942, complicated the legal situation by ruling against sterilization of criminals if the equal protection clause of the constitution was violated. That is, if sterilization was to be performed, then it could not exempt white-collar criminals.

After World War II, public opinion towards eugenics and sterilization programs became more negative in the light of the connection with the genocidal policies of Nazi Germany, though a significant number of sterilizations continued in a few states through the 1970s. The Oregon Board of Eugenics, later renamed the Board of Social Protection, existed until 1983, with the last forcible sterilization occurring in 1981. The U.S. commonwealth Puerto Rico had a sterilization program as well. Some states continued to have sterilization laws on the books for much longer after that, though they were rarely if ever used. California sterilized more than any other state by a wide margin, and was responsible for over a third of all sterilization operations. Information about the California sterilization program was produced into book form and widely disseminated by eugenicists E.S. Gosney and Paul B. Popenoe, which was said by the government of Adolf Hitler to be of key importance in proving that large-scale compulsory sterilization programs were feasible. In recent years, the governors of many states have made public apologies for their past programs beginning with Virginia and followed by Oregon and California. Few have offered to compensate those sterilized, however, citing that few are likely still living (and would of course have no affected offspring) and that inadequate records remain by which to verify them. At least one compensation case, Poe v. Lynchburg Training School & Hospital (1981), was filed in the courts on the grounds that the sterilization law was unconstitutional. It was rejected because the law was no longer in effect at the time of the filing. However, the petitioners were granted some compensation because the stipulations of the law itself, which required informing the patients about their operations, had not been carried out in many cases.  The 27 states where sterilization laws remained on the books (though not all were still in use) in 1956 were: Arizona, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Iowa, Kansas, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia and Wisconsin. Some states still have forced sterilization laws in effect, such as Washington state.

As of January 2011, discussions were underway regarding compensation for the victims of forced sterilization under the authorization of the Eugenics Board of North Carolina. Governor Bev Perdue formed the NC Justice for Sterilization Victims Foundation in 2010 in order "to provide justice and compensate victims who were forcibly sterilized by the State of North Carolina". In 2013 North Carolina announced that it would spend $10 million beginning in June 2015 to compensate men and women who were sterilized in the state's eugenics program; North Carolina sterilized 7,600 people from 1929 to 1974 who were deemed socially or mentally unfit.

The Congress of Obstetricians and Gynecologists (ACOG) believes that mental disability is not a reason to deny sterilization. The opinion of ACOG is that "the physician must consult with the patient’s family, agents, and other caregivers" if sterilization is desired for a mentally limited patient. In 2003, Douglas Diekema wrote in Volume 9 of the journal Mental Retardation and Developmental Disabilities Research Reviews that "involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage." The Journal of Medical Ethics claimed, in a 1999 article, that doctors are regularly confronted with request to sterilize mentally limited people who cannot give consent for themselves. The article recommend that sterilization should only occur when there is a "situation of necessity" and the "benefits of sterilization outweigh the drawbacks." The American Journal of Bioethics published an article, in 2010, that concluded the interventions used in the Ashley treatment may benefit future patients. These interventions, at the request of the parents and guidance from the physicians, included a hysterectomy and surgical removal of the breast buds of the mentally and physically disabled child.

The inability to pay for the cost of raising children has been a reason courts have ordered coercive or compulsory sterilization. In June 2014, a Virginia judge ruled that a man on probation for child endangerment must be able to pay for his seven children before having more children; the man agreed to get a vasectomy as part of his plea deal. In 2013, an Ohio judge ordered a man owing nearly $100,000 in unpaid child support to "make all reasonable efforts to avoid impregnating a woman" as a condition of his probation. Kevin Maillard wrote that conditioning the right to reproduction on meeting child support obligations amounts to "constructive sterilization" for men unlikely to make the payments.

148 female prisoners in two California institutions were sterilized between 2006 and 2010 in a supposedly voluntary program, but it was determined that the prisoners did not give consent to the procedures. In September 2014, California enacted Bill SB 1135 that bans sterilization in correctional facilities, unless the procedure shall be required in a medical emergency to preserve inmate's life.

Discussions have yet to begin regarding compensation for victims of forced sterilization in other states.

Puerto Rico

A political map of Puerto Rico

 

Puerto Rican physician, Dr. Lanauze Rolón, founded the League for Birth Control in Ponce, Puerto Rico in 1925, but the League was quickly squashed by opposition from the Catholic church. A similar League was founded seven years later, in 1932, in San Juan, Puerto Rico and continued in operation for two years before opposition and lack of support forced its closure. Yet another effort at establishing birth control clinics was made in 1934 by the Federal Emergency Relief Administration in a relief response to the conditions of the Great Depression. As a part of this effort, 68 birth control clinics were opened on the island. The next mass opening of clinics occurred in January 1937 when American Dr. Clarence Gamble, in association with a group of wealthy and influential Puerto Ricans, organized the Maternal and Infant Health Association and opened 22 birth control clinics.

The Governor of Puerto Rico, Menendez Ramos, enacted Law 116, which went into effect on May 13, 1937. It was a birth control and eugenic sterilization law that allowed the dissemination of information regarding birth control methods as well as legalized the practice of birth control. The government cited a growing population of the poor and unemployed as motivators for the law. Abortion remained heavily restricted. By 1965, approximately 34 percent of women of childbearing age had been sterilized, two thirds of whom were still in their early twenties The law was repealed on June 8, 1960.

1940s–1950s

Unemployment and widespread poverty would continue to grow in Puerto Rico in the 40s, threatening both U.S. private investment in Puerto Rico and acting as a deterrent for future investment. In an attempt to attract additional U.S. private investment in Puerto Rico, another round of liberalizing trade policies were implemented and referred to as “Operation Bootstrap.” Despite these policies and their relative success, unemployment and poverty in Puerto Rico remained high, high enough to prompt an increase in emigration from Puerto Rico to the United States between 1950 and 1955. The issues of immigration, Puerto Rican poverty, and threats to U.S. private investment made population control concerns a prime political and social issue for the United States.

The 50s also saw the production of social science research supporting sterilization procedures in Puerto Rico. Princeton's Office of Population Research, in collaboration with the Social Research Department at the University of Puerto Rico, conducted interviews with couples regarding sterilization and other birth control. Their studies concluded that there was a significant need and desire for permanent birth control among Puerto Ricans. In response, Puerto Rico's governor and Commissioner of health opened 160 private, temporary birth control clinics with the specific purpose of sterilization.

Also during this era, private birth control clinics were established in Puerto Rico with funds provided by wealthy Americans. Joseph Sunnen, a wealthy American Republican and industrialist, established the Sunnen Foundation in 1957. The foundation funded new birth control clinics under the title “La Asociación Puertorriqueña el Biensestar de la Familia” and spent hundreds of thousands of dollars in an experimental project to determine if a formulaic program could be used to control population growth in Puerto Rico and beyond.

Sterilization Procedures and Coercion

From beginning of the 1900s, U.S. and Puerto Rican governments espoused rhetoric connecting the poverty of Puerto Rico with overpopulation and the “hyper-fertility” of Puerto Ricans. Such rhetoric combined with eugenics ideology of reducing “population growth among a particular class or ethnic group because they are considered...a social burden,” was the philosophical basis for the 1937 birth control legislation enacted in Puerto Rico. A Puerto Rican Eugenics Board, modeled after a similar board in the United States, was created as part of the bill, and officially ordered ninety-seven involuntary sterilizations.

The legalization of sterilization was followed by a steady increase in the popularity of the procedure, both among the Puerto Rican population and among physicians working in Puerto Rico. Though sterilization could be performed on men and women, women were most likely to undergo the procedure. Sterilization was most frequently recommended by physicians because of a pervasive belief that Puerto Ricans and the poor were not intelligent enough to use other forms of contraception. Physicians and hospitals alike also implemented hospital policy to encourage sterilization, with some hospitals refusing to admit healthy pregnant women for delivery unless they consented to be sterilized. This has been best documented at Presbyterian Hospital, where the unofficial policy for a time was to refuse admittance for delivery to women who already had three living children unless she consented to sterilization. There is additional evidence that true informed consent was not obtained from patients before they underwent sterilization, if consent was solicited at all.

By 1949 a survey of Puerto Rican women found that 21% of women interviewed had been sterilized, with sterilizations being performed in 18% of all hospital births statewide as a routine post-partum procedure, with the sterilization operation performed before women left the hospitals after giving birth. As for the birth control clinics founded by Sunnen, the Puerto Rican Family Planning Association reported that around 8,000 women and 3,000 men had been sterilized in Sunnen's privately funded clinics. At one point, the levels of sterilization in Puerto Rico were so high that they alarmed the Joint Committee for Hospital Accreditation, who then demanded that Puerto Rican hospitals limit sterilizations to ten percent of all hospital deliveries in order to receive accreditation. The high popularity of sterilization continued into the 60s and 70s, during which the Puerto Rican government made the procedures available for free and reduced fees. The effects of the sterilization and contraception campaigns of the 1900s in Puerto Rico are still felt in Puerto Rican cultural history today.

Controversy and Opposing Viewpoints

There has been much debate and scholarly analysis concerning the legitimacy of choice given to Puerto Rican women with regards to sterilization, reproduction, and birth control, as well as with the ethics of economically motivated mass sterilization programs.

Some scholars, such as Bonnie Mass and Iris Lopez, have argued that the history and popularity of mass sterilization in Puerto Rico represents a government-led eugenics initiative for population control. They cite the private and government funding of sterilization, coercive practices, and the eugenics ideology of Puerto Rican and American governments and physicians as evidence of a mass sterilization campaign.

On the other side of the debate, scholars like Laura Briggs have argued that evidence does not substantiate claims of a mass sterilization program. She further argues that reducing the popularity of sterilization in Puerto Rico to a state initiative ignores the legacy of Puerto Rican feminist activism in favor or birth control legalization and the individual agency of Puerto Rican women in making decisions about family planning.

Effects

When the United States took census of Puerto Rico in 1899, the birth rate was 40 births per one thousand people. By 1961, the birth rate had dropped to 30.8 per thousand. In 1955, 16.5% of Puerto Rican women of childbearing age had been sterilized, this jumped to 34% in 1965.

In 1969, sociologist Harriet Presser analyzed the 1965 Master Sample Survey of Health and Welfare in Puerto Rico. She specifically analyzed data from the survey for women ages 20 to 49 who had at least one birth, resulting in an overall sample size of 1,071 women. She found that over 34% of women aged 20–49 had been sterilized in Puerto Rico in 1965.

Presser's analysis also found that 46.7% of women who reported they were sterilized were between the ages of 34 and 39. Of the sample of women sterilized, 46.6% had been married 15 to 19 years, 43.9% had been married for 10 to 14 years, and 42.7% had been married for 20 to 24 years. Nearly 50% of women sterilized had three or four births. Over 1/3 of women who reported being sterilized were sterilized in their twenties, with the average age of sterilization being 26.

A survey by a team of Americans in 1975 confirmed Presser's assessment that nearly 1/3 of Puerto Rican women of childbearing age had been sterilized. As of 1977, Puerto Rico had the highest proportion of childbearing-aged persons sterilized in the world. In 1993, ethnographic work done in New York by anthropologist Iris Lopez showed that the history of sterilization continued to effect the lives of Puerto Rican women even after they immigrated to the United States and lived there for generations. The history of the popularity of sterilization in Puerto Rico meant that Puerto Rican women living in America had high rates of female family members who had undergone sterilization, and it remained a highly popular form of birth control among Puerto Rican women living in New York.

Mexico

“Civil Society Organizations such as Balance, Promocion para el Desarrollo y Juventud, A.C., have received in the last years numerous testimonies of women living with HIV in which they inform that misinformation about the virus transmission has frequently lead to compulsory sterilization. Although there is enough evidence regarding the effectiveness of interventions aimed to reduce mother-to-child transmission risks, there are records of HIV-positive women forced to undergo sterilization or have agreed to be sterilized without adequate and sufficient information about their options.”

“A report made in El Salvador, Honduras, Mexico, and Nicaragua concluded that women living with HIV, and whose health providers knew about it at the time of pregnancy, were six times more likely to experience forced or coerced sterilization in those countries. In addition, most of these women reported that health providers told them that living with HIV cancelled their right to choose the number and spacing of the children they want to have as well as the right to choose the contraceptive method of their choice; provided misleading information about the consequences for their health and that of their children and denied them access to treatments that reduce mother-to-child HIV transmission in order to coerce them into sterilization.

This happens even when the health norm NOM 005-SSA2-1993 states that family planning is “the right of everyone to decide freely, responsibly and in an informed way the number and spacing of their children and to obtain specialized information and proper services” and that “the exercise of this right is independent of gender, age, and social or legal status of persons”.

Uzbekistan

According to reports, as of 2012, forced and coerced sterilization are current Government policy in Uzbekistan for women with two or three children as a means of forcing population control and to improve maternal mortality rates. In November 2007, a report by the United Nations Committee Against Torture reported that "the large number of cases of forced sterilization and removal of reproductive organs of women at reproductive age after their first or second pregnancy indicate that the Uzbek government is trying to control the birth rate in the country" and noted that such actions were not against the national Criminal Code in response to which the Uzbek delegation to the associated conference was "puzzled by the suggestion of forced sterilization, and could not see how this could be enforced."

Reports of forced sterilizations, hysterectomies and IUD insertions first emerged in 2005, although it is reported that the practice originated in the late 1990s, with reports of a secret decree dating from 2000. The current policy was allegedly instituted by Islam Karimov under Presidential Decree PP-1096, "on additional measures to protect the health of the mother and child, the formation of a healthy generation" which came into force in 2009. In 2005 Deputy Health Minister Assomidin Ismoilov confirmed that doctors in Uzbekistan were being held responsible for increased birth rates.

Based on a report by journalist Natalia Antelava, doctors reported that the Ministry of Health told doctors they must perform surgical sterilizations on women. One doctor reported, “It's ruling number 1098 and it says that after two children, in some areas after three, a woman should be sterilized.”, in a loss of the former surface decency of Central Asian mores in regard of female chastity. In 2010, the Ministry of Health passed a decree stating all clinics in Uzbekistan should have sterilization equipment ready for use. The same report also states that sterilization is to be done on a voluntary basis with the informed consent of the patient. In the 2010 Human Rights Report of Uzbekistan, there were many reports of forced sterilization of women along with allegations of the government pressuring doctors to sterilize women in order to control the population. Doctors also reported to Antelava that there are quotas they must reach every month on how many women they need to sterilize. These orders are passed on to them through their bosses and, allegedly, from the government.

On May 15, 2012, during a meeting with the Russian president Vladimir Putin in Moscow the Uzbek president Islam Karimov said: "we are doing everything in our hands to make sure that the population growth rate [in Uzbekistan] does not exceed 1.2–1.3" The Uzbek version of RFE/RL reported that with this statement Karimov indirectly admitted that forced sterilization of women is indeed taking place in Uzbekistan. The main Uzbek television channel, O'zbekiston, cut out Karimov's statement about the population growth rate while broadcasting his conversation with Putin. It is unclear if there is any genocidal conspiracy in regard of the Mongol type involved, in connection with genetic drain of this type through lack of their reproduction. 

Despite international agreement concerning the inhumanity and illegality of forced sterilization, it has been suggested that the Government of Uzbekistan continues to pursue such programs.

Other countries

Eugenics programs including forced sterilization existed in most Northern European countries, as well as other more or less Protestant countries. Other countries that had notably active sterilization programmes include Denmark, Norway, Finland, Estonia, Switzerland, Iceland, and some countries in Latin America (including Panama).

In the United Kingdom, Home Secretary Winston Churchill was a noted advocate, and his successor Reginald McKenna introduced a bill that included forced sterilization. Writer G. K. Chesterton led a successful effort to defeat that clause of the 1913 Mental Deficiency Act.

In 2015, the Court of Protection of the United Kingdom ruled that a woman with six children and an IQ of 70 should be sterilized for her own safety because another pregnancy would have been a "significantly life-threatening event" for her and the fetus.