Latinas and Sterilization in the United States

This article appeared in the National Women's Health Network Women's Health Activist newsletter for the May/June 2008 Feature Article

Surgical sterilization (also called “tubal ligation”) was introduced in the 1930s and has become a very popular form of permanent birth control. It is the most frequently used birth control method worldwide, chosen by over 10 million women internationally; in the U.S., it is second-leading form of family planning and the preferred method among Latina women. The reasons women choose sterilization are extremely varied and personal, and research has shown that women of color choose sterilization at much higher rates than White women do.

This popularity belies the complicated history of sterilization among women of color, however, and especially among Latinas. In the 1960s and 1970s, a significant number of women in the U.S. (primarily low-income women, women of color, women receiving care from Indian Health Services and institutionalized women) were sterilized under coercive conditions. They were approached during childbirth by doctors who withheld information about the surgery’s permanence and/or falsely advised that sterilization was necessary. Some women were threatened by hospital staff that, unless they consented to be sterilized, their welfare benefits would be cut off or they would be forced to leave the hospital before giving birth.

These abuses were fueled by fears of over-population, specifically population growth among communities of color in the United States. Mexican-origin women in particular were stereotyped as having large families and pouring across the border to drain the U.S.’ financial and social resources. Fears about over-population, welfare dependency, increased spending for public services, and illegitimate childbearing fueled stereotypes about both women of color and immigrant women, and led health professionals and State policymakers to intimidate “undesirable” women into agreeing to surgical sterilization.

In the mid-1970’s, Mexican-origin women in Los Angeles who were fed up with coercive sterilization practices began to organize. With support from legal and grassroots activists, 10 working-class, low-income, monolingual Spanish-speaking Mexican-origin women filed suit against obstetricians who had coerced them into sterilization within hours of giving birth in the L.A. County General Hospital. In 1978, the judge ruled against the women in the case known as Madrigal v. Quilligan, stating that the doctors had acted in good faith and without intent to harm.

Despite the loss in the courts, the lawsuit and the women’s willingness to speak out generated increased public awareness and activism in California. Mexican-origin women in L.A. learned that over 100 women had been forcibly sterilized for medically unnecessary reasons – and demonstrated against the L.A. County General Hospital. Women began coming forward, telling their stories, and mobilizing to end sterilization abuse. They called on the U.S. government to establish a mandatory waiting period before sterilizations could be performed with public funds to make sure that women would not be coerced into making this irreversible health care decision. Latinas were at the forefront of this activism, including Dr. Helen Rodriguez-Trias, a noted Puerto-Rican activist (and former NWHN board member) who founded the Committee to End Sterilization Abuse (CESA) in New York City 1973. Puerto Rican women in the Young Lords Party and the Committee for Abortion Rights and Against Sterilization Abuse (CARASA) also worked to protect Latinas from coercive sterilization practices. Activists insisted that a waiting period was crucial to women’s ability to protect themselves against coercion during childbirth, as well as counseling from an unbiased source, and accurate information in the woman’s preferred language. Responding to activists’ demands, New York City instituted reforms in all city hospitals on November 1, 1975.

As a result of this hard work, in February 1979, the Department of Health, Education and Welfare (DHEW) implemented new guidelines based on the New York City reforms. The guidelines applied to any sterilization performed with public funds and mandated a 30-day waiting period to ensure adequate consideration of the procedure and to prevent women from being pressured to make a decision in an intimidating environment or stressful situation. DHEW guidelines required an approved consent form to be signed by the person seeking sterilization, the physician performing the operation, and an interpreter. DHEW also mandated that women receive an oral explanation (in her preferred language) about the procedure (including its risks, benefits, and irreversibility) and alternative family planning methods. Finally, DHEW prohibited health care providers from performing the procedure on individuals who were incapable of providing informed consent, including minors, institutionalized people, and the mentally incompetent. (This regulation was not welcomed by some national pro-choice organizations that were used to opposing government restrictions on women’s choices. NWHN was one of the few national women’s groups that supported the HEW Sterilization Regulations.)

It is important to recognize the ways coercive sterilization practices have affected Latina women and other communities of color. While the procedure remains a safe and viable option for long-term birth control, we must work to ensure that women are being presented with choices for all their reproductive health decisions. Understanding and knowing this complex history is the first step to “salud, dignidad y justicia!”

With this history in mind, the National Latina Institute for Reproductive Health (NLIRH) has started a sterilization project and is interested in learning more about women of color’s experiences. The information available today is either outdated or focuses on statistics rather than women’s stories and voices. We’d love to get your input -- see the box for more information! (NLIRH would like to thank Board Member, Dr. Elena Gutierrez, for her support and expertise on this important issue, highlighted in her new book Fertile Matters: The Politics of Mexican-Origin Women’s Reproduction.)

By Jessica Gonzalez-Rojas and Taja Lindley
National Latina Institute for Reproductive Health