The Greatest Modern Threat to Genuine Reproductive Freedom

Elizabeth Liagin


United States government documents contain much information about the coercive nature of many of the world's population control programs. Sanctions by private employers pressure wage-earners into undesired sterilizations. In many cases, the use of force is overt. A new sterilization technique, quinacrine pellets installed in the uterus, poses further threats to reproductive choice and to women's health. The human rights violations from all these practices are widespread and disproportionately harm the rights of women.

European Plans to Boost the Birthrate

In a bold attempt to boost falling fertility rates, the French cabinet proposed a special budget of 19 billion francs to pay "second child" family allowances. According to an April 29, 1994 report from Reuters news service, the enormous appropriation would be used to expand an existing program giving three-year subsidies to parents upon the birth of a child. Under the then current policy, government payments were given only to parents of three or more children. The new program, however, would make family aid available to parents upon the birth of a second child.

Measures like this are quickly becoming the norm in many industrial nations, where leaders are openly campaigning to increase rates of population growth. France, under its Ninth Economic Plan, formally adopted the goal of increasing the number of births to replacement level, which would give France a significant number of additional births each year.

Under a campaign launched by West Germany in 1984, parental bonuses were adopted with the explicit hope of increasing the number of German births by 200,000 per year. The German state of Brandenburg is willing to pay couples $650.00 for having a baby; births fell from 38,000 in 1989 to 12,000 in 1993.[1] Switzerland, Norway, and several other countries also provide incentives to encourage larger families. In fact, the European Parliament in 1984 called for the adoption of pro-natalist policies by member states.

These activities may seem strange and incredibly unfair at a time when tremendous pressure is placed on women and men in developing countries to reduce the size of their families. This is especially true when one recognizes that the wealthy nations adopting programs to encourage births are, individually and as a whole, far more densely populated than are those countries which have been targeted for population reduction programs.

In Britain, for example, a square kilometer of land contains no less than 330 persons on the average, close to thirty times the 13 inhabitants per square kilometer who make up Somalia. In the Netherlands, the ratio of people to land is even higher, with 359 persons occupying the same space. Japan and Israel have roughly 326 and 220 persons, respectively, for every square kilometer of land, whereas there are just 41 in Kenya, 19 in Mozambique, ten in both Algeria and Sudan, and barely two in Namibia and Mauritania.[2]

There are important differences in the ways these demographic goals are pursued in the northern and southern hemispheres, as well. Western pro-natalist policies are not coercive. They simply remove economic barriers which are thought to make people opt for small families. The payments may encourage additional births from people who otherwise feel unable to care for a large family, but are not likely to affect the fertility choices of couples who do not want more children.

Linking Wages and Sterilization

Population curbs in developing countries are far less benevolent. They are aimed not at people who truly desire smaller families, but rather apply pressures to change existing fertility preferences.

One of the most frightening birth prevention policies now found in several nations is the use of sanctions by private employers. The Kaum Ho Tire Industrial Company in South Korea, for example, has a "personnel management policy" that targets new employees for education about the "benefits and specifics" of family planning, recounts a World Bank study published in 1988.[3] According to this report, The Private Sector and Family Planning in Developing Countries, the company offers incentives for the use of birth control in the form of "priorities for houses and loans (and) paid holiday after a vasectomy." (p. 83) Company-provided maternity care, on the other hand, is withheld after the birth of a third child, and promotion restrictions are in force for workers having large families. The Bank report adds that "those with more than 4 children must leave the firm."(p. 83)

Few people would argue that an activity is coercive if employees are routinely and as a matter of formal policy punished by the loss of their means of earning a living for having exceeded a specified number of children.

This report shows that these employment-based fertility reduction campaigns are becoming common practice in much of the developing world. In the Philippines, for example, workers at the Hawaiian-Philippine Company are visited at home by family planning motivators and are obligated to attend lectures on the "need" for birth control as part of their work schedules. At the same time, the workers are promised paid leave for undergoing permanent surgical sterilization (p. 82).

Several large companies in India have similar programs. The Alembic Group of Industries, Ltd., in Bombay uses hired promoters to encourage sterilizations among workers, and requires that those refusing to be sterilized attend orientation sessions until they change their minds. A staff social worker performs the task of tracking employees "in need" of family planning, according to the World Bank report, and the company pays rewards to those workers to submit to surgical sterilization (p. 82).

Another large Bombay employer, Godrej and Boyce Manufacturing, offers both paid leave and bonus money to employees who choose sterilization, while delivering specific punishments to those having three or more children. According to the same World Bank report, "Disincentives (include) no maternity benefits after 3 children, no housing for those with 3 or more children unless the worker was sterilized, and the fourth child would not be admitted to the company school."(p. 80) The situation is similar for workers at major plants in many parts of India.

Some projects in other countries put the pressure directly on motivators instead of employees. For example, family planning "field workers" in Bangladesh are given "expected targets" to meet (p. 84). They receive referral fees for every employee brought to a clinic either for sterilization or for the insertion of an intrauterine contraceptive device (IUCD).

The Family Planning Association of Sri Lanka works with labor unions to discourage births, employing thirty trained, professional family planning advocates to convince skeptics at participating work sites to undergo sterilization. Employees are required to complete questionnaires and to take part in unspecified "motivational activities," and companies offer cash awards to those accepting sterilization. According to the World Bank report, the thirty paid motivators are "given 4 days/month to educate their fellow employees."(p. 83)

It can be all but impossible for employees to stand up to such pressure. Even those who stubbornly resist an employer's incessant "motivational" exercises may find the "incentive" payments the only option available to them in a financial emergency. Where working conditions and wages are generally less than fair, it is easy to see how the need for "sterilization bonus" money or paid holidays might lead workers to opt for procedures they do not want. One can only imagine the tactics that paid sterilization recruiters might adopt to meet quotas or to increase commissions. The Progressive ran several articles from different authors on this subject under the heading "Population Patrol" that show both how widespread this is and the fact that human rights groups are noticing this as a major problem.[4]

Western Involvement

Moreover, many of these "private sector" population projects are funded by government "aid" dollars from the West. For instance, the Pathfinder Fund, which masterminded the Bangladesh target-setting activity, is the beneficiary of a five-year contract with the United States Agency for International Development (USAID), worth an almost incredible $136 million (U.S.). USAID has also backed a family planning "benefit" package for workers at Lectrol Lima and MIOLPO in Peru (p. 85) and an experimental activity at the Lever Borthoter plant in Nigeria to evaluate the reactions of workers to various tactics for persuading them to undergo sterilization (p. 86). The U.S. has provided financial assistance to employment-based family planning promotional activities in Bolivia, Indonesia, Brazil, Thailand, Ghana, and the Dominican Republic, among other places (p. 80-89).

These factory schemes are almost certain to be an important part of international population control in the future. If "company" policy becomes sufficiently harsh to generate adverse publicity or worker reaction, developed country donors are in a position to deny their involvement on the grounds that it is the policy of the company rather than their policy. Indeed, the World Bank report suggests the role of the aid donor is primarily to initiate such activities, and often to provide the supplies and services themselves, leaving the selection of incentives and the persuasion of workers to company management (p 97). For instance, a USAID-funded "private sector" project in Zimbabwe works to convince firms and insurance companies that it makes good business sense to include family planning as part of an employee benefit package (p. 89). Another USAID project in Nigeria has the specific goal of demonstrating to management at Gulf Oil that the "Company would see net financial benefits from adding family planning to on-site health services," in the words of the World Bank document (p. 89).

The exact nature of the gain promised to employers is not stated, either in the World Bank's report or in USAID literature, but certain facts seem obvious. Clearly, staff with few or no children can live on substantially less money, reducing the pressure on corporations to pay better wages. Moreover, the worker who takes a paid "holiday" to undergo surgical sterilization will not need or request parental leave later on. Companies may also hope to maximize employee attendance by limiting the number of children workers have to care for in the event of sickness or some other emergency situation. Above all, many large companies are likely to see the long-term goal of population control as being in their own self-interest because they feel threatened by the growth of the laboring classes.

It is quite possible that coercive factory-based birth control programs in the developing world will produce their intended result. When workers who depend on wages for all their basic needs are threatened with the loss of their jobs, whether explicitly or implicitly, they will not regard family planning as optional but rather as compulsory; something they cannot refuse, regardless of their feelings about the matter. This, more than anything else, can be seen as an assurance that programs of this kind will become more and more common in the years to come.

On the other hand, pro-natalist "welfare" programs in Europe will probably fail. It is far more difficult to motivate people to have children in an anti-natalist culture than it is to impose birth restrictions on others. The fascist governments in Germany and Italy also attempted to boost fertility in the years before World War II by linking monetary rewards to above-average family size. They found that, while state payments did produce a surge in annual births, they had no impact on completed family size. In other words, the incentives succeeded at getting couples to have children sooner but not in persuading them to have more.

However, even though the Nazis were unable to encourage procreation among Germans, they ran a highly effective population control campaign against Jews and Eastern Europeans.

Changing Attitudes Toward Fertility, at Gunpoint

According to the United Nations, the use of contraceptives in the southern hemisphere has increased five-fold in the past quarter century because of the intervention of foreign aid donors and international institutions. However, this rapid transition to lower fertility has not been achieved through entirely voluntary means, and there is no reason to suggest that future targets will be met any differently.

China's "one-child" policy is credited with having a major impact on the overall drop in worldwide fertility; but this population program has been effective mainly because it relies on compulsory abortions and sterilization.[5] Persons refusing to observe the mandatory family planning rule have been subjected to detainment, physical and psychological violence, the destruction of homes, and other "incentives" designed to ensure compliance.

The decline of birthrates in other parts of Asia has been almost as remarkable, and in this region, too, coercive tactics appear to be the factor that makes the most difference. In several Asian nations, for example, substantial cash "rewards" have been offered by family planning associations to persons who agree to undergo permanent sterilization--a financial incentive that many of the poorest people have found irresistible when faced with hunger and no alternative source of relief.

A report prepared by Australian Senator Bryan Harradine describes an Indonesian campaign of forced intrauterine device insertions that employs police raids to "motivate" reluctant users. The intra-uterine contraceptive device, or "IUCD," sometimes called the "loop" or the "coil," is an object placed inside of a woman's womb which causes her to be sterile until it is removed. The IUCD has an exceptionally high complication rate. Users have been reported to suffer from infections, extreme blood loss, complicated pregnancies, permanent infertility, and death. In the United States, the IUCD, or IUD, is now rarely available because of excessive litigation by women whom it injured. Says the Senator Harradine's report:

In a subdistrict of West Java, people in "difficult" villages were told by field workers that if they refused contraceptives they would have to join the transmigration program to the outer islands. In other cases, unwilling villagers were picked up by military or police personnel and taken to the village head office to have contraceptives inserted. The authors (of the report in the March 1993 Inside Indonesia) said that during their field trip in 1990, IUCDs were inserted at gunpoint to those who continued to resist."[6]

Deception, Lack of Informed Consent, and Substandard Care

Because many family planning workers are rewarded according to the number of clients they bring to clinics, competitions

among them is ensured. An article about the Indian sterilization campaign in the British medical journal Lancet explained,

Local authorities are under pressure to achieve set targets and the doctors are paid on a case basis . . . inducements (cash and otherwise) are routinely sanctioned to candidates for sterilization, and the motivator is similarly rewarded; the organization structure is insufficient, and informed consent is certainly not obtained. Many gynaecologists pride themselves on the number of sterilizations they do.[7]

The Lancet article goes on to report that many operations are performed by inexperienced and incompetent providers. In one case, a doctor slashed open a woman's bladder in an attempt to perform a sterilization, while another inserted a "loop" (intra-uterine contraceptive device) into the bowel of a patient. Improperly done sterilization surgeries, the writers noted, can be expected to cause between 4,000 and 5,000 ectoptic (tubal) pregnancies, a potentially life-threatening situation for a woman.

The nature of this problem as a feminist concern is made clear in Ms., in an article written by an activist from India:

In 1951, India became the first launch an official national family planning program--and it has been a spectacular failure. But the government's Action Plan threats to women's reproductive freedom, including the introduction of Norplant...India's family planning program was founded on the neo-Malthusian ideology that dominates population control theory and practice worldwide--that rapid population growth is the primary or even sole cause of poverty... The natural corollary is that the poor, guilty of "overbreeding," are responsible for their own misery. The Indian family planning program focuses on the country's poor majority--while poverty thrives. Far from attempting to create the conditions that would enable people to opt for smaller families, and having long given up on persuasion, the program uses bribery, deception, and coercion to get people to test and "accept" contraceptives. The program's strategies have been largely determined by its financiers, mostly private and government sources in the United States, such as the U.S. Agency for International Development ...Targets and incentives--which have led to abuse, corruption, and unreliable statistics--became part of the program in 1961, under the direction of U.S. advisers...Now, under the guise of "wider choice," Norplant is to be introduced into the program on a limited basis, even though the implant has been incompletely--and often unethically--tested in India...These technologies increase women's vulnerability to contraceptive abuse and decrease their control over their own fertility...Indian feminists deplore the fact that women are currently paying the price--with their bodies--for development and population control policies framed by people who know little about their lives and care even less.[8]

A physician from Kenya who appeared in a 1986 video production produced in the United Kingdom says that contraceptives are forced on women in Kenya who are unaware of what is being done to them. "Recently I had a case where a woman had a coil put in her," Dr. Mary Chore begins. "She had taken her sick child to the clinic and had also complained of abdominal pains. The doctor in that clinic just decided to put a coil in her without informing her what was happening. For the last two years she has not been able to conceive and herself and the husband are very concerned-- they didn't know what was happening. They came to us, we started our investigations, only to find that she had a coil inside of her for the last two years which she did not know was there."[9]

In all of these instances, providers of birth control were merely trying to keep up with targets set for them under population control schemes dictated by Western governments. Resulting violations of human rights will almost surely be attributed to local government officials, rather than to those Western "aid" donors who make the adoption of population policies a prerequisite to other forms of development assistance.


Technicians have found a way to sterilize women without surgery, and human rights advocates fear that the new procedure will also allow them to sterilize women without their knowledge or consent. The sterilization agent in this procedure is a small pellet containing the drug quinacrine hydrochloride. The quinacrine pellet is placed inside a woman's uterus where it inflicts injury so that the growth of scar tissue takes place. The scar tissue, in turn, blocks the Fallopian tubes and thereby blocks the natural reproductive process. In its newest form, the sterilization pellet can be inserted during a single clinic visit, utilizing instruments that are already available in most family planning clinics to insert intrauterine contraceptive devices (IUCDs).

According to an article published in the Lancet medical journal, tests of the new sterilization technique have recently been concluded on 32,000 Vietnamese women. Scientists who participated in the experimental program in Vietnam concluded that quincrine is "safe and acceptably effective for female sterilization."[10]

Not everyone is in agreement about the safety or the effectiveness of quinacrine as a birth control method. This drug is known to cause a variety of side-effects, including digestive disturbances and even toxic psychosis, a form of chemically-induced insanity. A medical text on experimental sterilization methods warns that high-dose quinacrine treatments can cause nervousness, nervous system disorders, hallucinations, and psychotic episodes. The same book, Female Transcervical Sterilization, reports that 60 women were treated with the chemical sterilization agent in Mexico, and that every single one of them experienced side effects.[11]

Reports published in medical journals over the past ten years suggest that quinacrine may cause a number of other complications, including inflammation of the uterus and cancer. Tests on 25 women in Malaysia produced frequent complaints of irregular or unusual bleeding, says a report in the Malaysian Journal of Reproductive Health.[12] About 13 percent of 112 women in Chile who were used to test the drug complained of side effects, according to a publication from Netherlands called Advances in Contraception. Follow-up studies showed the group to have 8 cases of malignancy in 6 anatomical sites, prompting researchers to undertake more study of a possible association between the use of quinacrine pellets and malignancy.[13]

Moreover, chemical sterilization can also fail. During the recent Vietnamese trials, for example, more than 800 pregnancies occurred among test subjects, giving the non-surgical sterilization method a failure rate between 2 and 3 percent. Several of the women who participated in the Vietnamese experiments and who became pregnant after undergoing quinacrine treatments had their reproductive organs removed.[14] Research done between 1979 and 1986 in India, however, produced a far higher pregnancy rate, 58 percent.[15]

Nonetheless, it would be difficult to underestimate the potential impact of this form of "easy" sterilization procedure in parts of the developing world where western-financed population control programs have produced only marginal results. To successfully end a client's reproductive life, a "family planning" worker need only use those medical instruments that already are widely available throughout the developing world, and the procedure can be performed in a few minutes under conditions not dramatically different from a clinical exam.

Opportunity for Abuse

Because quinacrine is simple to administer, irreversible, and quite inexpensive, the potential for abuse is substantial. An article in the International Journal of Gynecology and Obstetrics, for example, acknowledges that one of the most intriguing features of quinacrine is the fact that it can be used to accomplish sterilization on a massive scale. If the method were introduced into India's national family planning program, the writers argue, one million additional sterilization procedures could be performed there every year.[16]

Quinacrine sterilizations would be especially attractive to donors who want to launch large-scale sterilization campaigns in place where there are insufficient numbers of doctors to do surgical sterilizations. In a study prepared in 1985 by the Association for Voluntary Surgical Contraception, a major U.S. government population contractor, researchers claim that the chemical sterilization can be done effectively by paramedics, thus cutting costs even further.[17]

The fact that quinacrine inflicts damage to a woman's reproductive system is beyond debate. Indeed, it is precisely this action that causes the internal organs to produce scar tissue sufficient to interfere with normal procreation. The idea of inducing sterility by injuring female organs is far from new. Early scientific studies of such procedures are recorded in the history of Germany, just prior to the rise of Hitler. In a comprehensive study of Nazi medicine called Racial Hygiene: Medicine Under the Nazis, author Robert N. Proctor writes:

Anticipating the importance of mass sterilization [among hated racial groups], physicians developed techniques that would allow more rapid sterilization on an outpatient basis. In the late 1920s, the gynecologist Felix Mikulicz-Radecki perfected a method of "operationless" sterilization of women involving the scarification of fallopian tube tissue through injections of carbon dioxide. Though simpler than tying the tubes, this procedure was by no means risk free. In a 1935 study of sterilizations using this technique, Mikulicz-Radecki found that thirty-three patients died of complications (most commonly, lung embolisms) arising from the operation.[18]

As Proctor notes, the purpose at that time was to accomplish wholesale sterilizations at minimal cost. Little has changed.

The Questionable Intentions of Donors

It takes little digging to uncover the extent to which the U.S. government and other donors of aid to the developing world will go in order to reduce population growth in the southern hemisphere.

In India, for instance, the U.S. quietly approved activities connected with a "population emergency" declared by Indira Gandhi in the mid-1970s. During that notorious campaign, at least 6.5 million men were rounded up and subjected to surgical sterilization procedures, and not fewer than 1,774 of them died.[19]

Since then, more inventive schemes have been attempted. In Bangladesh, for example, USAID, the World Bank, and other donors have bankrolled programs that provide "incentive" payments to persons who allow themselves to be sterilized. In other words, impoverished farm laborers, having neither social services nor unemployment payments to rely upon during times of hardship, may find the sterilization payment the only alternative to starvation.

USAID denies that the payment of such bribes makes the program involuntary. "Bangladeshis who become sterilized do so of their own free will; they are not coerced," says a 1986 evaluation of the Bangladesh sterilization campaign, produced for USAID by the International Science and Technology Institute (ISTI), a U.S. government contractor.[20] However, the same evaluation acknowledges complaints of inadequate client screening and improper consent procedures under the incentive system. It also concedes that, as part of a United Nations supplemental food distribution program, "local officials [in some parts of Bangladesh] decided to require that women must have had a sterilization in order to receive food supplies." It admits, too, that in 1983, military vehicles were used to recruit and transport sterilization clients to family planning centers, an activity which resulted in still more accusations of coercion. Nonetheless, the 1986 USAID report defends the practice of offering payments both to sterilization clients and to "recruiters" or "motivators" on the grounds that far fewer sterilizations are likely to take place in the absence of such "benefits." "Bangladesh is a conservative, predominantly Muslim society," says this ISTI evaluation. "Obstacles to providing family planning services are enormous."[21]

The report also contends with charges raised incessantly by health activists, and even by some other donor governments, that the emphasis on birth control is inappropriate in a society where other human needs are so widely neglected. "Family planning services cannot be deferred until such time when good health care, education and employment opportunities for women and men, and old-age security may have become widely available," the ISTI evaluation explains.[22]

Sterilization Targets

The world was horrified in April, 1977, when Dr. Reimert Ravenholt, the head of USAID's population office, publicly hinted that the Agency intended to sterilize one quarter of all women in the developing world in order to protect a "strong U.S. commercial presence" overseas.[23] Since that remark was made, the goal has nearly been reached. A November 1990 report on female sterilization as a form of population control, prepared by Johns Hopkins University under contract to USAID, discloses that 123 million women in developing countries have been surgically sterilized. The same study reveals that slightly more than 137 million women have undergone surgical sterilization worldwide.[24] If these figures are correct, it would mean that about 90 percent of all female sterilizations in the past 25 years have taken place in the so-called "third world." Germaine Greer, in her commentary on Dr. Ravenholt's remark and his career, said that "in this observer's view, he and some of his colleagues and clients ought to be subjected to a peace crimes tribunal, but the compiling of the dossier and the framing of the charges would cost fortunes such as are at the disposal only of the great cartels."[25]

Varying degrees of coercion, including compulsory sterilization, are advocated by many leading proponents of population control. "Several coercive proposals deserve serious consideration," writes Paul Ehrlich, a Stanford University biologist, "mainly because we may ultimately have to resort to them unless current trends in birth rates are rapidly reversed by other means." Among those tactics Ehrlich offers are plans like one suggested in India to "vasectomise all fathers of three or more children," or to adopt an alternative program for "sterilizing women after their second or third child." The latter, he points out in his 1970 book, Population, Resources, Environment, would be possible "only in countries where the majority of babies are born in maternity hospitals and clinics, and where the medical corps is adequate." An even more bizarre recommendation in Ehrlich's book is the addition of "a sterilant to drinking water or staple foods." Still another suggestion is the use of a "sterilizing capsule that can be implanted under the skin," which would be removed only "with official permission, for a limited number of births." If all these measures fail, writes Ehrlich, "laws could then be written that would make bearing a third child illegal and that would require an abortion to terminate all such pregnancies. Failure to obtain the abortion could be made a felony, as could aiding and abetting over-reproducers."[26]

The utility of a low-cost non-surgical sterilization method to the Ehrlichs and Ravenholts of this world, a method that could theoretically be disguised as a mere medical exam, is painfully apparent. If sterilizations in India were to be increased by a million per year, as the writers of the 1989 article in International Journal of Gynecology and Obstetrics insist will be possible, it could be only a matter of a decade or two before births would virtually cease in that country.[27]

One needs little imagination to envision the flood of inexpensive non-surgical sterilization supplies that would be unleashed on the developing world once a useful product has been developed, and all of this will be in the hands of hirelings who are accountable only to the foreign donors. Already, more than $4.5 billion is expended each year on population control programs in the southern hemisphere, counting that portion of developed loan funds reserved for the purpose. Aid donors and their spokespersons within the population organizations have called for annual population control spending to be doubled by the end of the century. The impact of such an increase will be greatly magnified by the introduction of a new sterilization technique that costs only a fraction of what is spent on surgery.

Will this happen? Internal documents from the U.S. government and other sources give reason for pessimism. A 1982 report, included in a computer database of USAID project summaries, states that "surgical sterilization is inadvisable in areas having primitive operating conditions and no skilled paramedical personnel," but that the quinacrine alternative "is seen as a safe and deliverable method that has the potential to meet the great increase in sterilization needs in the 1980s."[28]

Even more importantly, a formerly-classified National Security Council memorandum, considered to be the definitive statement on the U.S. interest in population control, acknowledges the "necessity" for some kind of subtle coercion in overseas population programs. "It is clear that the availability of contraceptive services and information is not a complete answer to the population problem," says the 1974 NSC study, adding that America's "over-all assistance strategy should increasingly concentrate on selective policies which will contribute to population decline as well as other objectives."[29] Implementation of such a foreign aid strategy, it adds, may well involve "mandatory programs," such as "food rationing" to gain the cooperation of developing country leaders.

Still worse is a follow-up report, done for the NSC by an inter-agency task force in May of 1976. It describes a "successful" family planning program as one in which "leaders have made their positions clear, unequivocal, and public, while maintaining discipline down the line from national to village levels, marshalling governmental workers (including police and military), doctors, and motivators to see that population policies are well administered and executed."[30]

History of Coerced Sterilization

The European history of sterilization campaigns has already been alluded to. In the United States, sexual sterilization has been a public policy issue at least since the turn of the century. In the early 1900s, sterilization was advocated primarily on punitive grounds. That is, it was something to be inflicted as a penalty for certain types of detested behavior, including both crime and "pauperism." Indeed, the sterilization of "unfit" types was not only intended to prevent these unfortunates from breeding more of "their own kind," as sterilization advocates were so fond of saying. It was also to serve as a deterrent to others who might be tempted to engage in such "vices" as gambling, drunkenness, race-mixing, labor-organizing, engagement in radical activities, or just plain living on the dole.

In order for sterilization to serve as a viable deterrent to such behavior, however, it would have to be done somewhat publicly. In other words, people would have to be aware of the penalty and have a full understanding that it could be applied to them under certain circumstances. Between 1907 and 1931, thirty states passed laws requiring the sterilization of persons under certain circumstances. By early 1933, some 15,156 persons, over half of them in California, had undergone a sterilization operation.

Early birth controllers quickly recognized a potential problem in this approach, and it was soon acknowledged by movement leaders that the only way to curtail the reproduction of these "inferior strains" would be through widespread voluntary, or semi-voluntary, sterilization. They understood, too, that the widespread public perception of sterilization-as-punishment was a major obstacle to promoting conscious acceptance of the procedure.

In 1933, one doctor broke with the past to address the "question of proper administration of sexual sterilization laws" in an article which appeared in the Birth Control Review. "The punitive human sterilizations acts have rightly been criticized by the opponents of selective sterilization," wrote E.A. Whitney. Thus it might be necessary to remove the determination as to the "necessity" for sterilization from judges to doctors and social scientists. "The physician in attendance is the one best fitted to judge as to the need," he explained. However, the purpose was to remain the same. Concluded Whitney: "all forward-looking citizens should seriously consider the necessity of dealing with the rising tide of degeneracy. One factor of proven worth is selective sterilization. Its greatest field of usefulness is in selected individual cases of mental, physical or social inadequacy of hereditary origin."[31]

The transmission of authority from courts to scientists, of course, served to blur the disciplinary perception of the operation, and gave some latitude to those claiming the procedure served "humanitarian" objectives. Under this formula, sterilization was no longer to be seen by the public as a "penalty," but rather as a "cure," thus opening up a door of opportunity for propaganda campaigns aimed at replacing costly social services with efforts to set reproductive limits among certain classes of people.

However, it was left to another author in the same journal to re-define the compulsory sterilizations of the past as voluntary. Indeed, in a commentary published in the Birth Control Review several months before Whitney's, another medical doctor, C. O. McCormick, offered what is essentially a precursor to today's debate over the "voluntary" nature of sterilization. He advised that persons to be sterilized under a eugenic scheme belong to one of two groups, namely "those upon whom sterilization should be made compulsory, and those who should solicit it voluntarily." The real administrative question, of course, was how to get those who "should solicit it voluntarily" to do so. The answer is not given, but the results were, from McCormick's point of view, encouraging. He writes: "Experience in California shows that eighty percent of the compulsory cases are voluntary."[32]


If reproductive freedom is to mean anything at all, it cannot be appropriated only by those who wish to avoid having children. If it is, it becomes a euphemism only. It can then be used to conceal the actual involuntary nature of efforts to induce people not to have children.

This aspect of reproductive freedom is especially important to women. While men have certainly been subjected to involuntary sterilization in the form of vasectomies, women bear the brunt of the intra-uterine devices, Norplant and the quinacrine treatments as well as surgical sterilizations. Women are the ones who, by definition, do the greatest part of the necessary work of reproduction, and efforts to reduce the population must necessarily focus more resources on them.

When such resources empower women or give them greater choices, then they are worthwhile regardless of the impact they have on population limitations. After all, some women may decide that greater affluence allows them the luxury of more children than they would permit themselves under conditions of poverty. Efforts to give women greater rights world-wide are crucial, whether the impact is to make them opt for smaller families, larger ones, or remain the same. Furthermore, the improvement of women's conditions should not be held hostage to whatever impact such activity has on population numbers.

The World Bank has explicitly indicated that population control is more important than reproductive freedom: "As with most other human rights, the fact that people have the right to determine the number and spacing of their children, does not mean that the government can never infringe it."[33] When resources are not used for empowerment, but rather compel women to use "services" for which they have no desire, then genuine reproductive rights are clearly threatened. The extensive nature of this danger under current conditions world-wide should cause alarm among feminists and other human rights advocates.

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