The Role of Fertility Control in Socio-Economic Development
By Melissa Gormley
Current campaigns and rhetoric against immigrant groups within the United States, are partly related to historic movements and responses to fear of the "other." In an attempt to curb the entrance of immigrants, the United States established social and economic programs to assist countries in the development of stable and well-functioning governments. Population control and economic assistance on the island of Puerto Rico constitute one example of the integral relationship between the pervading American concern with the depletion of social resources, population policy, and economic reform. The United States cannot directly implement policy changes within the borders of most sovereign countries, but Puerto Rico, due to its subordinate relationship with the United States, presents an interesting and somewhat contradictory case study of social policy and economic reform. As maintained by anthropologist Nancy Scheper-Hughes,
It would take class and political conflict and economic emergencies (such as the new labor requirements of a more advanced stage of urban industrialization) to provoke state interest in the regulation of fertility and control of population, including a concern with child mortality and child survival, which in recent years have achieved the status of 'master' social and political problem in the developing world.1
In the 1940s and 1950s, Puerto Rico was undergoing many social and economic changes, and the United States government was under pressure to correct the state of the island's affairs.
In the late 1940s and 1950s, a sterilization program, l'operacion as it was referred to by many Puerto Ricans, was introduced into Puerto Rico by the International Federation of Planned Parenthood (IPPF). This program was funded and implemented by the United States through its economic and political ties with the island. The IPPF is a private organization, with one of its biggest contributors being the United States.2 Many studies make the claim that the sterilization program was designed to meet the needs of Puerto Rican women, while others have argued it was used as a method of social control and cultural imperialism during a period of economic depression that eventually led to massive migration from the island of Puerto Rico to the United States. Men, women, and entire families, some with relatives in the U.S. and some without, made their way to New York City with the hopes of finding jobs and economic stability. This paper is not an argument as to the "success" or popularity of the sterilization program, but instead a closer examination of the reaction of the United States.
The U.S. governments concern with the economic stagnation of the island and the subsequent massive migration of Puerto Ricans to the United States came to be known as the "Puerto Rican Problem."3 Governmental records, newspapers, and the popular press played an important role in both societal concern for the social and economic problems on the island and governmental policy designed to stem the massive migration to the United States.
Reproductive policy, geared toward both the United States and to Latin America, played an important role in the implementation of population control and fertility programs in Puerto Rico. These programs on the island were based on scientific studies and received funding equal to that of more developed countries. However, Puerto Rican women were treated as citizens of a third world country. The sources that examined Puerto Rican reproductive policy fall into two extremes; primarily, there are the purely statistical sources that do not include personal testimonies and portray women's experiences as numbers and percentages. The second set of sources emphasizes the radical political ideology that made the sterilization program a mechanism of the American quest for economic and cultural domination. These sources are not as numerous and rely on the firsthand testimonies of women who underwent l'operacion. Sources that examine Puerto Rican experiences are essential to the recovery of personal stories and histories of the women affected by reproductive policy.
Reproductive policy can be difficult to understand without first examining the numerous definitions surrounding the aspects of such policies. Fertility control is the regulation over the reproductive system as a whole, not just as it applies to child bearing, whereas birth control is the regulation of the number of children via management or prevention of contraception through a variety of methods. These methods include, but are not limited to, the use of oral contraceptives and the condom. Population control, as its name implies, is the direct control of a country's, or community's, or segment of society's population. Population control can be achieved by the aforementioned methods of birth control and has been a comprehensive component of reproductive policy in Latin America and the Caribbean. Many of these definitions overlap and play important roles in the examination of family planning programs.4
The focus of reproductive policy in Latin America and the Caribbean has been to curb the "population explosion" often associated with the political unrest and instability of the region. Current literature as examined in this paper supports the argument that population control is inextricably linked to national economic development and social stability. For example, in the 1920s and 1930s the Colombian government instituted a framework that gave the state the power to intervene in women's reproductive health to improve the economic and social welfare of society virtually unchallenged. Currently, sterilization in Colombia is the second most popular family planning method, surpassed only by the use of oral contraceptives.5 However, Colombia and Puerto Rico, with assistance from the United States, are the only two countries in the region in which the government has included population planning as an integral part of their national development plan. Other Latin American countries have instituted various levels of support but not to the degree in which it has been included in Puerto Rico and Colombia. These countries that actively pursued population planning programs within the framework of national development have also advocated vigorous sterilization drives.
The structure of population control programs is twofold. The internal aspect includes family planning associations, doctors and other individuals in the medical and social service sector. Externally, foreign organizations such as the World Bank and the International Federation of Planned Parenthood play important roles within the framework of the population control programs by providing money and infrastructure. The emergence of population and birth control issues coincided with the establishment of the United States' foreign aid policies. Many Latin American and Caribbean countries viewed such a relationship between fertility, population policies, and foreign aid with suspicion. The colonial relationship between the United States and Puerto Rico did not allow the island government much freedom in the implementation of autonomous population and fertility control policies.
Puerto Rico was, and still is, an island of ambivalent identity. Many factors within the United States adversely affected the internal workings of the island and helped to prevent action on the part of the island's government officials. One of the largest concerns of Americans in the early 1940s, and one that would change the direction of Puerto Rican fertility policy, was the migration of Puerto Ricans into the United States, primarily New York City.
Public sentiment against the newly arrived Puerto Rican community in New York City ran very high and evoked strong and historically rooted feelings of animosity toward immigrant communities. The Jones Act passed in 1917 extended American citizenship to the residents of Puerto Rico. However, the granting of citizenship did not sever the island's cultural and ethnic heritage that remained connected to Spain and the Caribbean.6 Nor did citizenship endear the immigrants to native-born American citizens. Examination of various print media centered around the late 1940s and early 1950s illustrated the emergence of what came to be termed the "Puerto Rican Problem."77 In the eyes of American society, the great influx of Puerto Rican immigrants, regardless of their legal citizenship status, would create many problems. The fear was that the sheer numbers would produce a burden on already limited social resources, such as healthcare, education, and welfare. The language barrier also gave many New Yorkers a tangible reason to fear their new neighbors due to the Puerto Ricans' inability to communicate in English. Many Americans recognized, and were somewhat sympathetic to, the economic and social problems of the island; however, their sympathy stopped at the border.
Between 1910 and 1950 Puerto Rico's population doubled.8 The 1954 United Nations Demographic Yearbook indicated that Puerto Rico's population per square kilometer in 1953 was 251 persons. This figure was 31 times the average of ten Latin American countries and more than 12 times the average of the United States.9 The economic stagnation of the island could not sustain such a growth in population; and there was a fear that more and more people would immigrate to the United States, further exacerbating the perceived concern over the drain on social services. This initiated a population control program aimed at curbing the population explosion and reviving the economy, both with the intention of stemming the flow of people.
Beginning in 1943, the United States Congress authorized numerous investigations into the economic, political, and social conditions of the island. These Congressional accounts not only focused on the social and economic state of the island but also illustrated the concern over the depletion of resources as a consequence of the Puerto Rican migration problem. The report from the Congressional Record, 78th Congress, 1st Session, concluded that Puerto Rico was one of the most densely populated parts of the globe. The report also made it clear that the United States viewed Puerto Rico as both "its burden and responsibility."10 The management of Puerto Rican affairs was assigned to the Insular Affairs Committee of the House of Representatives. The president of the medical association linked the Committee's legislative action with various island projects related to sterilization in Puerto Rico. The president, in turn, oversaw social agencies related to fertility control and family planning such as the Family Planning Association of Puerto Rico.
While the U.S. government was aware of the island's deepening economic instability as early as 1943, popular concern would not emerge until later. Popular publications elevated the concern of the Puerto Rican migration problem. Life magazine fanned the flames of anti-Puerto Rican sentiment. An article devoted to examining the Puerto Rican community within New York offered this analysis:
Many of the Puerto Ricans now pouring into New York are illiterate. Many speak no English. All of them are desperately poor. Almost without exception these newcomers squeeze into East Harlem, complicating an already critical housing and relief situation.11
The magazine article went on to indicate that of these thousands of immigrants most take advantage of the liberal welfare system because as U.S. citizens they were eligible to receive benefits. In addition, the article scolded New York authorities for "belatedly - and so far ineffectually - looking for a solution."12
In 1949 Mayor O'Dwyer of New York City established a committee designed "to attack the dependency of the Puerto Rican group at the source."13 The Mayor's Advisory Committee on the Puerto Rican problem estimated New York's Puerto Rican population at 150,000 to 600,000, with 98 percent of all Puerto Ricans living in New York City.14 New York officials' concerns are further illustrated in the Congressional Report on the Mayor's Advisory Committee to the House of Representatives in March of 1950. In the opening paragraph it is stated that "The undersigned committee has been appointed by Honorable William O'Dwyer, mayor of the city of New York, to look into the problem of the city occasioned by the concentration of Puerto Rican immigrants, past and prospective."15 The New York City Advisory Committee on Puerto Rican Affairs wrote impassioned pleas to the House of Representatives for help in finding jobs for new Puerto Rican immigrants and, more importantly, in restricting the open-door immigration policy extended to Puerto Ricans.16
The combination of the New York Times reports, articles in national publications such as Life magazine, and Congressional reports illustrated the inherent racism as well as the concern of U.S. society and government with curbing feared economic instability, a population boom, and subsequent migration of Puerto Ricans to American shores. Representatives of Puerto Rico, on the island and in the United States, acknowledged and made attempts to stem the tide of anti-Puerto Rican literature and dispel many of the myths behind such rhetoric; but most of these attempts fell on deaf ears. The Honorable Vito Marcantonio included a transcript of a radio address in an open letter to the House of Representatives confronting the "nationwide circulation" of printed material about the "alleged problem of Puerto Rican migration."17 The letter addressed such issues as the relationship of colonial subordination of Puerto Rico to the United States, the historic vilification of immigrant groups, and the economic devastation the island suffered at the hands of American enterprise. The position of this letter was rare and inconsequential when compared to the vast amount of anti-Puerto Rican literature read by many Americans.
The United States' responsibility to the island and to the demands of society to stem the tide of immigrants from Puerto Rico called for a social and economic plan designed to meet both the needs of the island and of the United States. Puerto Rico's status as a free associated state permitted the implementation of a population program based on the Latin American model versus the programs of fertility control utilized within the United States and other developed countries. Puerto Rico, like most other Latin American and Caribbean countries, was viewed as a third-world country when compared to developed countries such as the United States and parts of Europe. The overall difference between fertility control programs in these different regions was the perceived fear of a population explosion, birth control options presented to women, their overall cost, and most important, the belief in free choice. Because of the Catholic Church and political ambiguity, birth control programs had a precarious existence in Puerto Rico.
In 1925, the Puerto Rican government began sponsoring formal birth control clinics. By the 1930s there was an introduction of small-scale sterilization clinics. The broad-based policy of these clinics was that sterilization be used only in instances to preserve the health of the mother. This ambiguous restriction was never challenged in court and was liberally interpreted by doctors and government officials. However, these clinics were also geared toward comprehensive family planning with an emphasis on women's healthcare, education, and access to various forms of birth control. In 1941, economic destabilization and a general lack of funds forced the government to suspend financial support of these clinics. By the late 1940s, with renewed interest and financial support from the United States, funneled through the Family Planning Association of Puerto Rico, the Puerto Rican government renewed its financial interest in the fertility planning of women on the island.18 While the island government did not offer official support, its silence allowed the establishment of sterilization programs in both publicly and privately funded hospitals and clinics. In the 1940s, a total of $14 million was spent on various healthcare programs, including fertility control programs; $12 million from domestic funds and $2 million from direct federal aid.19
The Puerto Rican and United States governments, in conjunction with the International Planned Parenthood Federation, encouraged women to undergo a sterilization procedure, l'operacion, by effectively subsidizing the cost of the procedure. Sterilization was appealing due to its relatively low cost and efficiency in regulating population figures. While the procedure was "voluntary," it was so only in the narrowest sense. In her book Reproductive Rights and Wrongs, Betsy Hartmann argues that the permanence and effects of the sterilization procedure were not clearly explained, nor were other forms of birth control advocated or offered at reasonable prices.20 The government focused on poor women, through the use of economic subsidies, by offering the sterilization procedure at little or no cost. The small size of the island and the infrastructure established by the public health clinics resulted in targeting lower income groups who were considered ignorant of their options in choosing an effective form of birth control. The attention given to the option of sterilization by the government, the public health structure, and the silence from the Catholic Church further facilitated the appeal of l'operacion. While the Catholic Church opposed birth control, its opposition to sterilization was relatively weak compared to its outcry against other forms of contraception such as the condom and abortion.21
One prominent demographic researcher, J. Mayone Stycos, summed up the prevailing opinion: "Many physicians thought, and still think, that contraceptive methods are too difficult for lower class Puerto Ricans and regarded post-partum sterilization as a feasible solution to the problem."22 After an extensive study of fertility and population control on the island, he published his findings in 1955. In his study, Family and Fertility in Puerto Rico: A Study of the Lower Income Group, Stycos discussed three factors that explain the high fertility rates on the island. First, birth control methods are not available to the poorly educated and impoverished communities. Second, these same populations are ignorant of birth-control methods when these are presented to them. Finally, these populations favor large families for economic and religious reasons. Stycos argued that even though the obvious solution to curb rising birth rates is to provide the (female) population with effective birth control, the lack of a significant decrease in birth rates when other forms were introduced validated the use of other forms of drastic fertility control such as sterilization.23
Tubal sterilization was a relatively simple procedure where the fallopian tubes were either cauterized or severed. There was no removal of the ovaries or uterus, thus keeping the women's reproductive organs intact. Post-partum sterilization was economically practical and appealing because it required a minimal hospital stay that usually overlapped the time necessary to recover from childbirth.24 Sterilization presented a popular option for public health officials because it was previously offered to women, and because the required infrastructure was in place to implement such a program. Many physicians fully supported the sterilization procedure due to its simplicity, effectiveness, and its legality. Sterilization was not prohibited under the law, but instead the law required sterilization to be used only for preserving the health of the mother. This was broadly interpreted by both doctors and government officials as a safe alternative to other forms of birth control. Physicians offered the procedure to women as a safe and effective form of birth control regardless of the women's state of health.25
In her study of sterilization and fertility control, Harriet Presser stated that by 1950 almost 7,000 women had been sterilized in government district hospitals alone. This figure did not include the number of procedures performed in clinics of private hospitals.26 In 1950, 17.8 percent of all hospital births were followed by a sterilization procedure.27 By the mid-1950s, approximately one-sixth of women living in Puerto Rico had undergone a sterilization procedure.28 While there are numerous statistical studies illustrating the results of the sterilization program, there are few studies that examine the regret among women who underwent the sterilization procedure and their personal experiences.
The lack of such studies calls into question the motivations behind the sterilization program. The issues of satisfaction and regret were ignored by researchers until recently. One prominent study conducted by Boring, Rochat, and Becerra surveyed women between the ages of 15 and 49. 21 percent of the 846 respondents expressed some regret regarding sterilization. The reasons ranged from their young age at the time of having the procedure done, absence of having given birth to daughters, and most importantly, someone else having made the decision for them.29 This study also addressed the point of promulgation of voluntary acceptance of the sterilization procedure. Personal experiences, while somewhat difficult to document, illustrated the dissatisfaction and lack of knowledge regarding the long term effects and permanence of the sterilization procedure.
The economic problems of the island were another important aspect in reducing immigration to the United States and the use of sterilization. The United States government implemented a program of economic stabilization known as Operation Bootstrap. This economic industrialization program placed an emphasis on curbing the out-migration, and it also supported the sterilization program in order to provide an unhindered labor force. In the 1940s, U.S.-based manufacturing industries began to relocate to the island, lured by the incentives of Operation Bootstrap, or Fomento, as it was known on the island. The incentives offered by the U.S. government in conjunction with official approval from the Puerto Rican government included worker training at government expense, tax breaks for corporations under the Internal Revenue Code 936, and new business loans at low interest rates.30
Coinciding with the fear of continued miration and the popularity of sterilization, between 1948 and 1965, approximately 1,027 new manufacturing plants were opened under the auspices of Operation Bootstrap. By 1960, 41,500 jobs had been created by Fomento industries.31 Female labor was seen as cheap and easily accessible, and a valuable source for the newly established manufacturing sector. Hartmann argued that sterilization "was perceived as a way to help 'free' them for employment, as opposed to, for example, providing good childcare facilities."32 This new economic plan, assisted by the sterilization program, would stabilize the economy, free up an inexpensive labor force, and curb migration to the United States. Although net incomes, wages, and the number of jobs grew, the population increased because of rural to urban migration, keeping the unemployment figures disproportionately high.33 This unexpected rural-to-urban migration became an overwhelming problem as individuals in the depressed rural sector flocked to the cities hoping to secure employment within the manufacturing sector. However, due to a lack of jobs, many of the rural migrants found their only option was to migrate to the United States to find work. The continuation of rural-to-urban migration and subsequent out-migration sustained the high numbers of Puerto Ricans relocating to the United States.
Concern over increased out-migration and an economic revitalization plan that required an inexpensive undeterred labor force were among of the motives for the implementation of an extensive sterilization program. Studies claim that the demand for sterilization was grass-roots based, but it cannot be ignored that doctors, private agencies, and governmental structures also favored sterilization, and made it affordable and very accessible to all women, especially the poor. Many of the studies examined give credence to the importance of migration from Puerto Rico to the United States. Presser stated that, "the heavy out-migration in the 1940s and 1950s was an important factor in population figures."34 American society's fear was dismissed as a far more removed concern. It is important to remember the lives of the women affected by the irreversible procedure. The most startling figure is that by 1968, one-third of all women in Puerto Rico had undergone a sterilization procedure, the highest rate anywhere in the world at the time.35 Ana Ortiz argued that the 1968 level of sterilization is maintained to the present day.36 The relationship between society's concern and a strong sterilization drive is not readily apparent; however, once the sources are examined and the consequences are weighed, it is indisputable that the United States' actions greatly affected the island. L'operacion was a tool of the United States government to implement economic programs and put an end to the poverty and social unrest while attempting to address the concerns of migration from the island to mainland.
1. Nancy Scheper-Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1992), 275. This is a reference from the "Child Survival Campaign" led by UNICEF. Return to essay
2. Betty Hartmann, Reproductive Rights and Wrongs: The Global Politics of Population Control and Contraceptive Choice (New York: Harper & Row Publishers, 1987), 114. Return to essay
3. Alida Malkus, "The Puerto Rican Problem," American Mercury 68 (February 1949): 200. Many sources use the term "Puerto Rican Problem" in reference to the migration of Puerto Ricans into New York. Malkus seems to be the first in coining the phrase. Return to essay
4. Helen I. Safa and Cornelia Butler, "Production, Reproduction and the Polity: Women's Strategic and Practical Gender Issues," in A. Stepan, ed., America's New Interpretive Essays, 1992. This study provides an in-depth analysis and concise description of the terms related to reproductive policy. Return to essay
5. Hartmann, Reproductive Rights and Wrongs, 233. Return to essay
6. Franklin W. Knight, The Caribbean: A Genesis of a Fragmented Nationalism, 2ed. (New York: Oxford University Press, 1990), 267. Return to essay
7. New York Times, September 12, 1949. Return to essay
8. M.J. Diepenhorst, Population Problems and Family Planning in Five Countries: A Transcultural Reconnaissance (Amsterdam, Netherlands: Koninklijk Institut voor de Tropen, 1982), 101. Return to essay
9. Rueben Hill, J. Mayone Stycos and Kurt W. Back, The Family and Population Control: A Puerto Rican Experiment in Social Change (Chapel Hill: University of North Carolina Press, 1959), 7. Return to essay
10. U.S. Congress. House. Authorizing Investigation of the Political, Economic, and Social Conditions in Puerto Rico, 78th Cong., 1st sess., 1943. Return to essay
11. "Puerto Rican Migrants Jam New York," Life, August 25, 1947, 25. Return to essay
12. Ibid. Return to essay
13. New York Times, September 12, 1949. Return to essay
14. Ibid.14 Return to essay
15. U.S. Congress. House. A Rational Approach to a Difficult Problem, Extension of Remarks of Hon. Arthur G. Klein, 81st Cong., 2nd sess., 1950. Return to essay
16. Ibid. Return to essay
17. U.S. Congress. House. Puerto Rican Migration, Extension of Remarks of Hon. Vito Marcantonio, 80th Cong., 1st sess., 1947. Return to essay
18. Harriet Presser, Sterilization and Fertility Decline in Puerto Rico (Berkeley: University of California Press, 1973), ch. 3 passim. Return to essay
19. Malkus, "The Puerto Rican Problem," 274. Return to essay
20. Hartmann, Reproductive Rights and Wrongs, 232. Return to essay
21. Presser, Sterilization and Fertility, 26. This quotation is also referred to in other books, articles, and studies to illustrate the patriarchal class system in place at the time of the sterilization program. Return to essay
22. J. Mayone Stycos, Family and Fertility in Puerto Rico: A Study of the Lower Income Group (New York: Columbia University Press, 1955), 201. Return to essay
23. Ibid. Return to essay
24. Presser, Sterilization and Fertility, 7. Return to essay
25. Ibid., 55. Return to essay
26. Ibid., 28. Return to essay
27. Stycos, Family and Fertility in Puerto Rico, 224. Return to essay
28. Presser, Sterilization and Fertility, 56. Return to essay
29. Catherine Chase Boring, Roger W. Bochat and Jose Becerra, "Sterilization and Regret Among Puerto Rican Women," Fertility and Sterility 49 (June 1988): 973. Return to essay
30. Knight, The Caribbean, 272. Return to essay
31. Ibid. Return to essay
32. Hartmann, Reproductive Rights and Wrongs, 232. Return to essay
33. Knight, The Caribbean, 273. Return to essay
34. Presser, Sterilization and Fertility, 44. Return to essay
35. Hartmann, Reproductive Rights and Wrongs, 232. Return to essay
36. Ana Ortiz, "Contraception and Colonialism: Puerto Rico and Beyond," Radical America 24 (1990), 41 .Return to essay