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On Medical Atrocities: Eugenics, Forced ICE Sterilizations, and the Puerto Rican Birth Control Trials

Even doctors without tattoos have a permanently written statement inked on their skin: “first, do no harm.” A guiding principle in medical ethics, the aphorism alludes to the need of minimizing harm in the hopes of doing what’s best for the patient. 

That is, the medical principle is supported by the belief that the benefits will outweigh the harm. For instance, in surgical procedures, harm is initially inflicted on the patients; however, the benefits of the operations are expected to surpass the impact of the damage or suffering. 

Thus, making an informed decision about medical care, while recognizing that harm may occur, is vital in the medical profession. In other words, regardless of the gravity of the potential damages, informed consent toward the patient is a professional and moral obligation. 

Despite the widely known moral code in medicine, women, particularly those belonging to minority groups, have been historically subjected to forced sterilizations at the hands of individuals who have called themselves physicians. Disguised as demographic discourses claiming a need to control population growth, forms of discrimination have supported sterilization abuse throughout the 20th century.

History 101: Forced Sterilizations on Minority Populations
Black Girl Beauty Landing Hero Image
Adebusola Abujade / Her Campus Media

Not long ago, over 60,000 women were sterilized in the US. Federally-funded forced sterilization laws, which go back to 1907, were initially passed in Indiana, and later on, in 31 additional states. In 1927, the Supreme Court ruled, specifically, in Buck v. Bell, that “forced sterilization did not violate the constitution.” 

Around the 1940s, this brutal practice led to the ordered sterilizations of low-income Americans, particularly people of color and women with HIV/AIDS, and of approximately 7,600 mentally handicapped women. 

In a 1965 island-wide study, researchers found that Puerto Ricans had suffered similar experiences when compared to women living in the US mainland. The Puerto Rican Department of Health’s study concluded that 34% of women, whose ages ranged from 20 to 49, were sterilized in Puerto Rico in the 1960s. 

After the US raised its flag in 1898 Puerto Rico, efforts to control population growth intensified. Due to alleged concerns about overpopulation, a series of institutionalized public policies were implemented, including Law 116, a eugenics sterilization law. 

Public policy began to promote permanent sterilization across the Island, instead of safer forms of contraception. Institutionalized practices to promote sterilization included domiciliary visits of healthcare workers as well as financial subsidies for submission to the surgical procedure. 

“The economically disadvantaged women of Puerto Rico lacked access to information that would make contraceptive alternatives available to them. By denying access to reproductive health services for the women who were most in need of them, U.S. policy exerted its control over the growth of the Puerto Rican population, as well as over the lives of many Puerto Rican women,” reported pro-choice organization Our Bodies Ourselves in an article that examines the history of forced sterilization in the US. 

Likewise to Puerto Ricans, Native Americans also suffered the consequences of these reproductive laws. In the same year that the Puerto Rican sterilization study was conducted, in 1965, the Indian Health Service (IHS) began providing family planning services to Native Americans. Similarly, an estimate of 25% of Native Americans between the ages of 15 and 44 were sterilized by the 1970s. Stories of Native American women show the adverse effects of misinformed and forced sterilizations under the medical care of the IHS. 

In 1973, the Relf sisters, two African American teenagers from Alabama who were sterilized without informed consent, held a press conference. Afterwards, African American and Native American women across the US came forth to address similar experiences. 

Though the prolonged American history of forced sterilizations is both disgraceful and unfortunate, it is not an unheard of occurrence even today. 

Forced ICE Sterilizations: Is History Repeating Itself?

A recent complaint filed with the Department of Homeland Security by Dawn Wooten, a nurse and former employee of an Immigration and Customs Enforcement (ICE) facility in Georgia, Project South and other organizations claimed that the Irwin County Detention Center (ICDC) is not only failing to provide safe medical care in the context of the COVID-19 pandemic, but is also performing hysterectomies on immigrant women at an alarming rate. 

A common type of surgery for women, hysterectomies result in the removal of the uterus. However, depending on the type of hysterectomy performed on the patient, it could also involve the removal of the cervix, the ovaries, or other related structures of the female reproductive system. 

To clarify the matter, hysterectomies are valid surgical procedures that treat a number of gynecological problems; including but not limited to fibroids, endometriosis, cancer and abnormal uterine bleeding. Thus, the problem does not have anything to do with the validity of the surgical procedure. Instead, the issue surrounds claims that the patients, who are detained immigrant women, are receiving hysterectomies without fully informed consent. 

According to Wooten, many women spoke to the nurse about their lack of knowledge as to why this procedure was being performed on them. In light of this human rights scandal, detainees have also spoken out with regards to the lack of consent of the patients receiving hysterectomies. 

Just as worrisome as the procedure itself are the allegations that, because some of the patients do not speak English, some healthcare professionals communicate with them by “googling Spanish.” However, the fact that “federal law requires the provision of linguistic services for those with limited English proficiency” raises a greater concern with regards to the quality of medical care at the ICDC.

Eugenics: A Discriminatory Pseudoscience

It is no coincidence that forced sterilizations have historically targeted African Americans, Latina women in Puerto Rico and the US; as well as Native Americans, mentally handicapped, and low-income women. Indeed, such a historical denial of female reproductive freedom has mostly occurred at the hands of medical professionals. 

If we were to analyze the long history of forced sterilizations in America, what has been the root of the problem?

A pseudoscience characterized by sexist and racist practices, eugenics aimed to improve the genetic pool of the human population by excluding groups that were considered inferior and undesirable. While eugenic principles have encouraged those considered “fit” to reproduce with each other, it has prevented, if not prohibited, those considered “unfit” from their right to reproduce. 

In the United States, the Eugenics Records Office (ERO) was founded in 1910. According to this office, the goal of the pseudoscience was “to improve the natural, physical, mental, and temperamental qualities of the human family.” As the eugenics movement gained popularity, there was a simultaneous growth in the efforts that prevented individuals who were considered to be “undesirable” from having children. 

“Eugenics researchers believed that by studying large human families in which a certain undesirable trait appeared, they could demonstrate a genetic pattern of inheritance for the trait, and such findings would justify policies aimed at removing the related genes from the population,” mentioned a Nature-published report. These policies served as the basis for the implementation of involuntary sterilization programs and institutionalization. 

Puerto Rican Birth Control Trials: The Impact of Racialized Science
Plan B
Alexandra Redmond / Spoon

Unfortunately, eugenic philosophies transcended the damage caused by forced sterilizations and still managed to control human reproduction through other contraceptive methods. 

In the 1950s, there was a notable opposition to birth control in the US mainland, which was influenced by cultural, religious and legal matters. Gregory Pincus, a controversial, Harvard-based biologist, was aware that, to obtain approval of the pill, a large-scale clinical trial needed to take place. Since the US was not an option, considering the magnitude and ethical dilemmas of the trial, Pincus, alongside researcher Dr. John Rock and birth control activist Margaret Sanger, decided to look to Puerto Rico as a trial site. 

The Island seemed like the ideal place to conduct the trial, considering that there was a notable population growth, rampant poverty and a series of birth control clinics, which were managed by the American eugenicist Clarence Gamble. 

Pincus not only recruited research subjects from Gamble’s birth control clinics, but he also focused on enrolling women who were from the poorest areas of San Juan, as well as other impoverished communities. The participating women received little to no information with regards to the safety or potential side effects of the pill. 

Although the efficacy of the pill was close to 100%, roughly 20% of the women suffered side effects such as nausea, headaches, vomiting, among others. During the trials, three participating women died; however, whether or not the pill influenced their deaths is unknown.

Even though the birth control trials were characterized by their unethical and uninformed nature, the standards for research involving human subjects back then were not as regulated as they are today. 

Nevertheless, one cannot fail to recognize the truth as it is. Atrocious human rights violations have been committed by healthcare professionals and eugenicist scientists at the expense of the suffering of the most vulnerable minority groups, and these practices continue to affect marginalized communities in the US and other developed countries.

Nicole is a Chemistry major, who also happens to love Biology. She is an avid learner, and has a passion for science, literature and journalism. Eventually, the young dreamer aspires to merge her passions in the future as a neurosurgeon surgeon, researcher and writer. She enjoys eating chocolate ice cream, "mofongo," and her abuelita's fried "chuletas." Three essential words to describe her would be inquisitive, determined and honest.
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