The History of Female Surgical Sterilization: A Social and Ethics Perspective

Abstract

Introduction Female surgical sterilization is one of the most common methods of contraception used in the United States. Unfortunately, the development of sterilization procedures is rooted in racism, eugenics, and misogyny. It is this history that provides the impetus for this companion review, which accompanies our concurrent review on the history of female surgical sterilization. We first present the basis of coercive sterilization practices in the United States, the eugenics movement. The eugenics movement, which gained popularity in the United States in the early 20th century, promoted the idea that certain individuals should be discouraged or actively prevented from reproducing, especially through coercive sterilization practices. Second, we discuss the coercive sterilization practices of the early 20th century that became the foundation for coercive practices in our more recent history. During the early part of the 20th century, coerced sterilization became a state mandated procedure for those considered to be “unfit” to reproduce. A link between intelligence and race, and the disproportionate effect of eugenics policies on women provided the setup for the coerced sterilization of women from southern and eastern Europe, black women, Native American women, Hispanic, and Latinx women. We move on to discuss the coercive practices that took place in the mid-20th century, namely in the 1960s and 1970s. Our presentation includes the involuntary sterilization of women of Mexican origin in the 1960s at the Los Angeles County Medical Center, and the sterilization of thousands of Native American women in the 1970s. We then present examples of coercive sterilization in the 21st century, including the sterilization female inmates in California state prisons without appropriate consent, and reports of hysterectomies performed on women in a Georgia immigration detention center without their knowledge or consent. Finally, we include a discussion on the continued control over the reproductive choices of some individuals. We discuss the creation of a standard sterilization consent and policy for patients with Medicaid, which were intended to protect women from coercive sterilization practices; in reality, these policies have become barriers to obtaining a desired method of permanent contraception for low-income and minority women. We also examine the barriers to reproductive health care individuals face when seeking care at Catholic-based institutions, which now account for 4 of the 10 largest health care systems in the United States. Understanding the social history of surgical sterilization in the United States is of paramount importance to provide a more complete review of the history of the procedure. As surgeons who perform tubal sterilizations, obstetrician-gynecologists have an obligation to acknowledge the historical physical and social harm associated with the procedure, and advocate for better policies and practices that preserve patients' reproductive dignity. (J GYNECOL SURG 37:465)