Compulsory sterilization

Compulsory sterilization, practice of permanently removing an individual’s ability to reproduce without the person’s free, full, and informed consent. The practice is typically done to women through tubal ligation, hysterectomy, or endometrial ablation, but vasectomy has also been used as a method to sterilize men.

The purported justifications for compulsory sterilization vary but are often rooted in eugenics—that is, the selection of subjective, desired heritable characteristics in order to improve future generations. The practice was common—and legal—in several countries in the early to mid-20th century. Women are typically forcibly sterilized through hysterectomy, tubal ligation, or endometrial ablation, while men are typically subjected to vasectomy. Complications from forced sterilization may occur and result in death.

In Nazi Germany (1933–45), the Law for the Prevention of Offspring with Hereditary Diseases mandated compulsory sterilization of men and women with any of nine mental and physical health conditions—including manic-depressive disorder (now known as bipolar disorder), deafness, and epilepsy—specifying that “the operation must be carried out even against the will of the person to be sterilized….Where other measures are insufficient, direct force may be used.” The law also created a precedent for forcibly sterilizing racial and ethnic minorities and ultimately led to the forced sterilization of approximately 400,000 people in Germany. Thousands of concentration camp inmates were also subjected to the practice.

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In the United States, the right of institutions to practice compulsory sterilization was upheld through Buck v. Bell (1927). Carrie Buck, whose mother was institutionalized after being deemed “feebleminded” and “sexually promiscuous,” became pregnant at age 17. She alleged that her foster parents’ nephew had raped her. Her foster parents had her institutionalized, and after she gave birth, she was chosen as the first person to be sterilized under a Virginia law that legalized forced sterilization for those “afflicted with hereditary forms of insanity that are recurrent, idiocy, imbecility, feeble-mindedness, or epilepsy.” As a result of the ruling, about 65,000 Americans were sterilized throughout the course of the 20th century. For example, in the 1960s and ’70s many Native American women were forcibly sterilized, sometimes while they were getting unrelated surgeries. The Virginia law was repealed in 1974, but forced sterilization continued in other parts of the country.

California, in particular, has a long history of sterilization, beginning in the first decade of the 20th century and continuing into the 21st. In the 1960s and ’70s, Mexican women with limited English proficiency were forcibly sterilized at the Los Angeles County-USC Medical Center, leading to a civil rights lawsuit that was decided in favor of the center. In 2014 a state audit of the California Department of Corrections and Rehabilitation found that there were deficiencies with the informed consent process for more than one-quarter of the 144 female inmates who had undergone a bilateral tubal ligation sterilization procedure in the fiscal years 2005–06 through 2012–13. Although each inmate had signed a consent form, it was unclear from records whether each inmate had received adequate educational material and counseling regarding the procedure.

Though many countries reformed their laws around forced sterilization following World War II (1939–45), the practice still exists throughout the world. Women, in particular, are often a target of compulsory sterilization. Additionally, ethnic and Indigenous minorities, such as the Roma people in Europe and the Uyghur people in China, are targets of the practice, as are people with disabilities and transgender and intersex persons. Men are not excluded from forced sterilization. In India millions of men in poverty were sterilized during the Emergency (1975–77), when the government declared a state of emergency and curtailed civil liberties.

Methods of coercing people into sterilization vary. Women with HIV/AIDS are often coerced through misinformation or lack of information around the safety of birthing a child or breastfeeding while HIV-positive. Women are also asked to sign consent forms for sterilization as a requisite to gain access to medicine and care or in situations where they are under duress, such as during labor, and believe that they are consenting to a cesarean section rather than sterilization. “Menstrual management” is also used as a pretense for sterilization, especially for women and girls with intellectual disabilities.

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