Editing Compulsory sterilization (section)

====Puerto Rico====
[[File:Puerto Rico-CIA WFB Map.png|thumb|upright=1.75|A political map of [[Puerto Rico]]]]

Puerto Rican physician 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]].<ref name=Mass>{{Cite journal |last=Mass |first=Bonnie |date=1 January 1977 |title=Puerto Rico: a Case Study of Population Control |journal=Latin American Perspectives |volume=4 |issue=4 |pages=66–79 |doi=10.1177/0094582x7700400405 |pmid=11619430 |s2cid=416021}}<!--|access-date=October 11, 2014--></ref><ref name=Nick>{{Cite journal |last=Thimmesch |first=Nick |date=May 1968 |title=Puerto Rico and Birth Control |journal=Journal of Marriage and Family |volume=30 |issue=2 |pages=252–262 |doi=10.2307/349251 |jstor=349251}}<!--|access-date=October 11, 2014--></ref> A similar League was founded seven years later, in 1932, in [[San Juan, Puerto Rico|San Juan]] and continued in operation for two years before opposition and lack of support forced its closure.<ref name="Mass" /><ref name="Nick" /> 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]].<ref name="Nick" /> As a part of this effort, 68 birth control clinics were opened on the island.<ref name="Nick" /> The next mass opening of clinics occurred in January 1937 when American [[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.<ref name="Nick" />

The Governor of Puerto Rico, [[Blanton Winship]], enacted Law 116,<ref>{{Cite web |title=Forced Sterilization in Puerto Rico " Family Planning |url=https://stanford.edu/group/womenscourage/cgi-bin/blogs/familyplanning/2008/10/23/forced-sterilization-in-puerto-rico/ |url-status=live |archive-url=https://web.archive.org/web/20170721113445/http://stanford.edu/group/womenscourage/cgi-bin/blogs/familyplanning/2008/10/23/forced-sterilization-in-puerto-rico/ |archive-date=2017-07-21 |access-date=2017-07-25 |website=stanford.edu}}</ref> which went into effect on 13 May 1937.<ref>{{Cite web |title=Puerto Rico Revisited " Family Planning |url=https://stanford.edu/group/womenscourage/cgi-bin/blogs/familyplanning/2008/10/30/puerto-rico-revisited/ |url-status=live |archive-url=https://web.archive.org/web/20161208104209/http://stanford.edu/group/womenscourage/cgi-bin/blogs/familyplanning/2008/10/30/puerto-rico-revisited |archive-date=2016-12-08 |access-date=2017-07-25 |website=stanford.edu}}</ref> It was a [[birth control]] and eugenic sterilization law that allowed the dissemination of information regarding birth control methods and legalized the practice of birth control.<ref name="Mass" /><ref name="Nick" /> The government cited a growing population of the poor and unemployed as motivators for the law. Changers were made to the Penal Code in 1937 which made abortion effectively legal. It was allowed for health reasons, without specifying details in the law. This gave doctors discretion to interpret what constituted a health reason, effectively legalizing abortion.<ref>[https://www.tandfonline.com/doi/pdf/10.1016/S0968-8080%2897%2990006-9?needAccess=true Abortion in Puerto Rico: The limits of colonial legality], Yamila Azize-Vargas and Luis A. Avilés, ''Reproductive Health Matters 5''(9) 1 May 1997, page 56 (page 2 of the pdf)</ref> 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 8 June 1960.<ref name="Mass" />

=====1940s–1950s=====

Unemployment and widespread poverty would continue to grow in Puerto Rico in the 40s, both threatening U.S. private investment in Puerto Rico and acting as a deterrent for future investment.<ref name="Mass" /> 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]]."<ref name="Mass" /> 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.<ref name="Mass" /> 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.<ref name="Mass" />

The 50s also saw the production of social science research supporting sterilization procedures in Puerto Rico.<ref name="Mass" /> 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.<ref name="Mass" /> Their studies concluded that there was a significant need and desire for permanent birth control among Puerto Ricans.<ref name="Mass" /> In response, Puerto Rico's governor and Commissioner of health opened 160 private, temporary birth control clinics with the specific purpose of sterilization.<ref name="Mass" />

Also during this era, private birth control clinics were established in Puerto Rico with funds provided by wealthy Americans.<ref name="Mass" /><ref name="Nick" /> [[Joseph Sunnen]], a wealthy American Republican and industrialist, established the [[Sunnen Foundation]] in 1957.<ref name="Mass" /><ref name="Nick" /> 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.<ref name="Mass" />

=====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.<ref name="Lopez">{{Cite journal |last=Lopez |first=Iris |date=1993 |title=Agency And Constraint: Sterilization And Reproductive Freedom Among Puerto Rican Women In New York City |journal=Urban Anthropology and Studies of Cultural Systems and World Economic Development |volume=22 |issue=3}}</ref> 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.<ref name="Lopez" /><ref name="Briggs" /> 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.<ref name="Briggs">{{Cite book |last=Briggs |first=Laura |title=Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico |date=2002 |publisher=University of California Press |isbn=978-0-520-22255-7 |location=Berkeley and Los Angeles, California}}</ref>

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.<ref name="Briggs" /><ref name="B">{{Cite book |last1=Ramirez de Arellano |first1=Annette B. |title=Colonialism, Catholicism, and Contraception: A History of Birth Control in Puerto Rico |last2=Seipp |first2=Conrad |date=1983 |publisher=The University of North Carolina Press |isbn=978-0-8078-1544-1}}</ref> Though sterilization could be performed on men and women, women were most likely to undergo the procedure.<ref name="Mass" /><ref name="Nick" /><ref name="Briggs" /><ref name="B" /> 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.<ref name="Briggs" /><ref name="B" /> 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.<ref name="Briggs" /><ref name="B" /> 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.<ref name="Briggs" /><ref name="B" /> There is additional evidence that true [[informed consent]] was not obtained from patients before they underwent sterilization, if consent was solicited at all.<ref name="B" />

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.<ref name="Mass" /> 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.<ref name="Mass" /> 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.<ref name="Mass" /> 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.<ref name="Briggs" /> The effects of the sterilization and contraception campaigns of the 1900s in Puerto Rico are still felt in Puerto Rican cultural history today.<ref name="Lopez" />

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

Some scholars, such as Bonnie Mass<ref name="Mass" /> and Iris Lopez,<ref name="Lopez" /> have argued that the history and popularity of mass-sterilization in Puerto Rico represents a government-led eugenics initiative for [[population control]].<ref name="Mass" /><ref name="Lopez" /><ref name="B" /><ref name="Elena">{{Cite journal |last1=Gutierrez |first1=Elena R. |last2=Fuentes |first2=Liza |date=2009–2010 |title=Population Control by Sterilization: The Cases of Puerto Rican and Mexican-Origin Women in the United States |journal=Latino(a) Research Review |volume=7 |issue=3}}</ref> 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.<ref name="Lopez" /><ref name="B" /><ref name="Elena" />

On the other side of the debate, scholars like Laura Briggs<ref name="Briggs" /> have argued that evidence does not substantiate claims of a mass-sterilization program.<ref name="Briggs" /> 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 of birth control legalization, and the individual agency of Puerto Rican women in making decisions about family planning.<ref name="Briggs" />

A system was proposed by the California state senator [[Nancy Skinner (California politician)|Nancy Skinner]] to compensate victims of the well-documented examples of [[compulsory sterilization#United States|prison sterilizations that resulted from California's eugenics programs]], but this did not pass by the bill's 2018 deadline in the legislature.<ref>{{cite book |title=SB-1190 – Eugenics Sterilization Compensation Program |first1=Nancy |last1=Skinner |publisher=[[State of California]] |url= https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1190 |date=18 February 2019 |access-date=19 February 2019 |archive-date=19 February 2019 |archive-url= https://web.archive.org/web/20190219130233/https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB1190 |url-status=live}}</ref>

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

In 1969, sociologist [[Harriet Presser]] analyzed the 1965 Master Sample Survey of Health and Welfare in Puerto Rico.<ref name=Presser>{{Cite journal |last=Presser |first=Harriet B. |date=November 1969 |title=The Role of Sterilization in Controlling Puerto Rican Fertility |journal=Population Studies |volume=23 |issue=3 |pages=343–361 |doi=10.2307/2172875 |jstor=2172875 |pmid=22073953}}<!--|access-date=10 October 2014--></ref> 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.<ref name="Presser" /> She found that over 34% of women aged 20–49 had been sterilized in Puerto Rico in 1965.<ref name="Presser" />

Presser's analysis also found that 46.7% of women who reported they were sterilized were between the ages of 34 and 39.<ref name="Presser" /> 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.<ref name="Presser" /> Nearly 50% of women sterilized had three or four births.<ref name="Presser" /> Over 1/3 of women who reported being sterilized were sterilized in their twenties, with the average age of sterilization being 26.<ref name="Presser" />

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.<ref name="Mass" /> As of 1977, Puerto Rico had the highest proportion of childbearing-aged persons sterilized in the world.<ref name="Mass" /> In 1993, [[ethnographic]] work done in New York by [[anthropologist]] Iris Lopez<ref name="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.<ref name="Lopez" /> 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.<ref name="Lopez" />