Compulsory sterilization

Compulsory sterilization programs are government policies which attempt to force people to undergo surgical sterilization. In the first half of the twentieth century, many such programs were instituted in many countries around the world, usually as part of eugenics programs intended to prevent the reproduction and multiplication of members of the population considered to be carriers of defective genetic traits.

Overview
Usually such programs advocated sterilization by means of vasectomy in males and salpingectomy or tubal ligation in females, as they were not operations which significantly affected sexual drive or the personality of the individuals operated upon (unlike, for example, castration). It has been argued that this increased the seemingly innocuous nature of the operations, adding a veneer of scientific objectivity and detachment. Some of these operations were carried out not only against the will of the patient, but without their knowledge, at the same time as other operations.

Today, compulsory sterilization programs are usually seen as overly coercive and blunt attempts at genetic engineering which focused disproportionately on poor and disenfranchised groups. The most well-known compulsory sterilization programs were those of Nazi Germany, which sterilized over 400,000 individuals in the 1930s and 1940s, the United States, which sterilized over 64,000 individuals from 1900s through the 1970s, and many Scandinavian countries. Sweden sterilized the highest proportion of its own citizens - 62,000 individuals from the 1930s through the 1970s within the population of over 6,000,000 were sterilized; it was a condition required for receiving welfare, securing one's release from prisons/mental institutions or for keeping custody of children.

Plans for forced sterilization for the purposes of avoiding overpopulation are sometimes, but not usually, directly related to a eugenic intent. (See population control for more information on this type of sterilization.)

United States


The first country to concertedly undertake compulsory sterilization programs for the purpose of eugenics was the United States. The principal targets of the American program were the mentally retarded and the mentally ill, but also targeted under many state laws were the deaf, the blind, the epileptic, and the physically deformed. Native Americans were sterilized against their will in many states, often without their knowledge, while they were in a hospital for other reasons (e.g. childbirth). Some sterilizations also took place in prisons and other penal institutions, targeting criminality, but they were in the relative minority. In the end, over 65,000 individuals were sterilized in 33 states under state compulsory sterilization programs in the United States.

The first state to introduce compulsory sterilization legislation was Michigan, in 1897 but the law failed to garner enough votes by legislators to be adopted. Eight years later Pennsylvania's state legislators passed a sterilization that was vetoed by the governor. Indiana became the first state to enact sterilization legislation in 1907, followed closely by Washington and California in 1909. Sterilization rates across the country were relatively low (California being the sole exception) until the 1927 Supreme Court case Buck v. Bell which legitimized the forced sterilization of patients at a Virginia home for the mentally retarded. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma, 1942, complicated the legal situation by ruling against sterilization of criminals if the equal protection clause of the constitution was violated. That is, if sterilization was to be performed, then it could not exempt white collar criminals.

Most sterilization laws could be divided into three main categories of motivations: eugenic (concerned with heredity), therapeutic (part of an even-then obscure medical theory that sterilization would lead to vitality), or punitive (as a punishment for criminals), though of course these motivations could be combined in practice and theory (sterilization of criminals could be both punitive and eugenic, for example). Buck v. Bell asserted only that eugenic sterilization was constitutional, whereas Skinner v. Oklahoma ruled specifically against punitive sterilization. Most operations only worked to prevent reproduction (such as severing the vas deferens in males), though some states (Oregon and North Dakota in particular) had laws which called for the use of castration. In general, most sterilizations were performed under eugenic statutes, in state-run psychiatric hospitals and homes for the mentally disabled. There was never a federal sterilization statute, though eugenicist Harry H. Laughlin, whose state-level "Model Eugenical Sterilization Law" was the basis of the statute affirmed in Buck v. Bell, proposed the structure of one in 1922.

After World War II, public opinion towards eugenics and sterilization programs became more negative in the light of the connection with the genocidal policies of Nazi Germany, though a significant number of sterilizations continued in a few states until the early 1960s. The Oregon Board of Eugenics, later renamed the Board of Social Protection, existed until 1983, with the last forcible sterilization occurring in 1981. The U.S. commonwealth Puerto Rico had a sterilization program as well. Some states continued to have sterilization laws on the books for much longer after that, though they were rarely if ever used. California sterilized more than any other state by a wide margin, and was responsible for over a third of all sterilization operations. Information about the California sterilization program was produced into book form and widely disseminated by eugenicists E.S. Gosney and Paul B. Popenoe, which was said by the government of Adolf Hitler to be of key importance in proving that large-scale compulsory sterilization programs were feasible. In recent years, the governors of many states have made public apologies for their past programs beginning with Virginia and followed by Oregon and California. None have offered to compensate those sterilized, however, citing that few are likely still living (and would of course have no affected offspring) and that inadequate records remain by which to verify them. At least one compensation case, Poe v. Lynchburg Training School & Hospital (1981), was filed in the courts on the grounds that the sterilization law was unconstitutional. It was rejected because the law was no longer in effect at the time of the filing. However, the petitioners were granted some compensation as the stipulations of the law itself, which required informing the patients about their operations, had not been carried out in many cases.

States (27) that performed sterilization programs until 1956 :


 * Arizona
 * California
 * Connecticut
 * Delaware
 * Georgia
 * Idaho
 * Indiana
 * Iowa
 * Kansas
 * Maine
 * Michigan
 * Minnesota
 * Mississippi
 * Montana
 * Nebraska
 * New Hampshire
 * North Carolina
 * North Dakota
 * Oklahoma
 * Oregon
 * South Carolina
 * South Dakota
 * Utah
 * Vermont
 * Virginia
 * West Virginia
 * Wisconsin

Germany


The most infamous sterilization program of the 20th century took place under the most infamous regime of the 20th century: the Third Reich. One of the first acts by Adolf Hitler after achieving total control over the German state was to pass the Law for the Prevention of Hereditarily Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses) in July 1933. The law was signed in by Hitler himself, and over 200 eugenic courts were created specifically as a result of the law. Under the German law, any doctor in the Reich was required to report patients of theirs who were mentally retarded, mentally ill (including schizophrenia and manic depression), epileptic, blind, deaf, or physically deformed, and a steep monetary penalty was imposed for any patients who were not properly reported. Individuals suffering from alcoholism or Huntington's Chorea could also be sterilized. The individual's case was then presented in front of a court of Nazi officials and public health officers who would review their medical records, take testimony from friends and colleagues, and eventually decide whether or not to order a sterilization operation performed on the individual, using force if necessary. Though not explicitly covered by the law, 400 mixed-race "Rhineland Bastards" were also sterilized beginning in 1937.

By the end of World War II, over 400,000 individuals were sterilized under the German law and its revisions, most within its first four years of being enacted. When the issue of compulsory sterilization was brought up at the Nuremberg trials after the war, many Nazis defended their actions on the matter by indicating that it was the United States itself from whom they had taken inspiration. The Nazis had many other eugenics-inspired racial policies, including their "euthanasia" program in which around 70,000 people institutionalized or suffering from birth defects were put to death.

Japan
main article : Eugenics in Showa Japan

In the first part of the Showa era, Japanese governments promoted increasing the number of healthy Japanese, while simultaneously decreasing the number of people suffering mental retardation, disability, genetic disease and other conditions that led to them being viewed as "inferior" contributions to the Japanese gene pool.

The Race Eugenic Protection Law was submitted from 1934 to 1938 to the Diet. After four amendments, this draft was promulgated as a National Eugenic Law in 1940 by the Konoe government. According to Matsubara Yoko, from 1940 to 1945, sterilization was done to 454 Japanese persons.

Canada
Although far less well-known than the Nazi eugenics and American eugenic sterilization programs, two Canadian provinces performed compulsory sterilization programs with eugenic aims. Canadian compulsory sterilization operated via the same overall mechanisms of institutionalization, judgement, and surgery as the American system. One notable difference is in the treatment of non-insane criminals. Canadian legislation never allowed for punitive sterilization of inmates.

Alberta
The most notorious sterilization program in Canadian history was afforded via the passing of the Alberta Sexual Sterilization Act of 1928. From the years 1928 to 1972, sterilizations, both compulsory and optional, were performed on nearly 3000 "unfit" individuals of varying ages and ethnicities. In total, over 2800 procedures were performed. Initially, the act only provisioned sterilizations where consent was given by the subject or legal guardian of the subject, depending on the competency of the individual scheduled to undergo the operation. The 1937 amendment to the act allowed for sterilizations to be carried out without consent in the case of those deemed mentally defective. Sterilization of individuals deemed mentally ill still required consent. At the end of World War II, while other eugenic sterilization programs were being phased out, Alberta continued on, even increasing the scope of eligibility for sterilizations. They continued until 1972, when approximately 50 persons were operated upon.

Targeted sterilization
Not surprisingly, youths, minorities, and women were sterilized in disproportionately high numbers. Minors, because of their legal dependency on adults, were almost always assigned as "mental defectives", thus bypassing the parental consent requirement. Albertan aboriginals and métis, regardless of age, were also targeted. Aboriginal people represented only 2.5% of the general population in Alberta, but made up 6% of the institutionalized population. Towards the end of Alberta's sterilization program, aboriginals and métis made up 25% of the sterilizations performed. Furthermore, those of aboriginal ancestry were disproportionately assigned the "mentally deficient" rating, which denied them their legal rights and made them eligible for sterilization without consent. Women, particularly women who were young, poor, and unmarried, were also disproportionately represented; they were thought to be at high risk for prostitution or at the very least promiscuity, activities suspected of breeding further immorality. While it was conceded that sterilization would not change the behavior of these women, it would prevent them from bearing similarly 'defective' progeny.

Aftermath
Despite the inaccuracy of IQ testing and tremendous grey area in classifying the mentally defective, nearly 3000 people were rendered sterile by the Sexual Sterilization Act. The true nature of the act was revealed when Leilani Muir, a former inmate of the Michener Centre (also known as the Provincial Training School for Mental Defectives, PTS), discovered in 1971 that she had been sterilized. After being admitted to the PTS at age 10 as an unwanted and abused child, Leilani was given a substandard education. She was inaccurately designated a mentally defective moron (an individual with an IQ between 51 and 70), effectively nullifying her human rights. She was administered powerful antipsychotic agents without any due cause, as she had not manifested any symptoms of psychosis during her residency at the PTS. Eventually she was given an impromptu IQ test, on which she scored a 64. Shortly thereafter, she was taken before the Eugenics Board, and sterilization was authorized pending her mother's consent (which was readily given).

In 1995, Leilani was awarded $750,000CAD and $230,000CAD in damages for her wrongful and humiliating labeling as a moron and her subsequent sterilization. Since the victory, another 1300 cases have been opened, several of them concerning individuals who may have actual mental disabilities. It is unlikely they will be awarded any settlements based on stigmatization, but they may win suits based on involuntary sterilization, which is now considered battery under Canadian law.

British Columbia
As in other jurisdictions in the early 20th century, prejudice against physical and mental disability, and concern over societal costs of caring for the disabled, existed in British Columbia. The devaluing and eventual enmity to disabled life popularized rapidly, and spread from disabled children to disabled adults.

Additionally, the substantial immigration rate of the 1910s and 1920s spurred a feeling of xenophobia among the Protestant, educated elite of British Columbia. Slavic immigrants in particular were accused of having very high incidence of undesired characteristics, which are now generally attributed to culture shock and language barriers. The aversion to "abnormal" or "strange" people coupled with the perceived societal drain caused by immigrants, the deformed, mentally ill, and mentally disabled created an environment conducive to the enactment of a sexual sterilization act.

Thus, in July 1933, five years after Alberta, British Columbia passed its own sexual sterilization act. A three member Eugenics Board comprised of a psychiatrist, a social worker, and a judge was given the duty of authorizing the sterilization of any institutionalized person who was deemed capable of propagating undesirable social characteristics. Since such social problems as criminality, prostitution, and addiction/alcoholism were believed to have a biological (and thus heritable) cause, almost any institutionalized individual could be found eligible. Although the records concerning BC's Sexual Sterilization Act have since been lost or destroyed, it is thought that only a few hundred individuals were operated upon before the law was silently repealed in 1973.

Canadian sterilization laws were only enacted in Alberta and British Columbia, which could be attributed to their Protestant denominations. Pope Pius XI of the Roman Catholic Church denounced surgical intervention in reproductive matters, making the more Catholic regions (such as Ontario, Quebec, or the Maritime provinces) an inhospitable place to lobby for eugenic sterilization of the disabled. The introduction of progressive, left-leaning governments in Alberta and B.C. also had a hand in strengthening eugenic legislation. Left-leaning parties were eager to embrace new ideas, especially those that held a promise of economic turnaround.

Aftermath
After seeing a precedent set by Leilani Muir in her successful legal action against the government of Alberta, the British Columbia Public Guardian and Trustee filed similar lawsuits to protect the legal rights of the sterilized disabled. Thus far, 18 lawsuits have been filed against the government of British Columbia regarding the sterilization act. The suits allege that the sterilizations were involuntary, non-therapeutic, and that they were done for the convenience of the hospital. These lawsuits were filed in 2001, and since, several of the plaintiffs have died. In 2003, the cases were dismissed. Early in 2005, however, that judgement was overturned by the British Columbia Court of Appeal. In December 2005, nine sterilized women were awarded compensation in an out-of-court settlement, totalling $450,000CDN ($50,000CDN per plaintiff).

Beyond Alberta and British Columbia
Although eugenic sterilization was never instituted in Ontario, the issue saw considerable debate concurrent with the enactment of sterilization laws in Alberta and British Columbia. The formation of the Eugenics Society of Canada (ESC) in 1930 sought to organize supporters of eugenics into a coherent group in order to make their lobbying of the government more effective. Founded in Ontario, the ESC boasted a large number of physicians in its ranks, including Clarence Hincks, one of the most devoted proponents of the Alberta Sexual Sterilization Act. Other notable members included the Lieutenant-Governor of Ontario, Dr. H. A. Bruce, and eminent psychiatrist Clarence B. Farrar, who had been head of the Toronto Psychiatric Hospital since 1925. As social traits like criminality and promiscuity began to edge off the list of heritable traits, the ESC found itself adapting its strategy to that of birth control, while maintaining a focus on economic benefit. It garnered considerable support, but was never able to table eugenic sterilization effectively in the political arena. The ESC met its end shortly after a public relations blunder in 1938, when a representative implied the ESC and the Nazi party sought to achieve similar goals through similar means. It is not surprising then, that when World War II broke out in 1939, the ESC lost nearly all of its support.

Recent court discussions in Manitoba have investigated the legality and ethical permissibility of involuntary sterilization of the mentally disabled. Focusing on those individuals found legally incompetent, the 1990 and 1992 reports outlined the scenarios where an involuntary sterilization could be warranted. As stated by the 1990 discussion, three conditions are necessary for an individual to undergo any medical procedure.
 * The individual must be informed of both the nature, and risks/benefits of the procedure.
 * The consent must be voluntary, not the product of coercion, threat, or fraud.
 * The individual must be competent enough to give the above consent.

Individuals who are legally incompetent include minors and sufficiently-disabled adults.

The discussion reached a consensus that involuntary sterilization (or sterilization with substituted consent) is only permissible if it has an explicit positive effect on the physical or mental health of the individual: this is called therapeutic sterilization. One such case involved was a seriously disabled girl with an aversive phobia to blood, who was scheduled to undergo a hysterectomy. The rationale of the surgery was not eugenic, but rather to protect the girl from the direct mental trauma that would likely arise upon initiation of menses. This judgement was seen to be on the very threshold between therapeutic and nontherapeutic surgical intervention.

This discussion also cites a landmark case in substituted consent known as the Mrs. E. vs. Eve case. In it, a mother, "Mrs. E.", wished to have her moderately intellectually disabled daughter "Eve" sterilized to save her the emotional distress potentially caused by pregnancy and childbirth. Additionally, it was argued that Eve would neither be capable of using any other method of contraception, nor caring for a child should she become pregnant. Since the sterilization was not explicitly therapeutic and carried grave physical harm and an intrusion on Eve's rights, Mrs. E. could not be given the authority to have her daughter sterilized. It was then explored whether or not the government itself could make the decision, using parens patriae jurisdiction. Parens patriae allows the government to make authorizations in the "best interests" where no other source of consent can be attained; this includes children and mentally disabled persons. In the Eve case, the risks were deemed too high and the benefits too obscure to authorize a nontherapeutic sterilization via parens patriae jurisdiction, since a surgical sterilization is an irreversible procedure.

India & China
While India and China have not engaged in eugenic programs of sterilization, they have engaged in forcible or coercive family planning regimes in order to control their expanding populations.

India's state of emergency between 1975 and 1977 included an infamous family planning initiative beginning April 1976, which involved the vasectomy of thousands of men and tubal ligation of women, either for payment or under coercive conditions. The son of then-Prime Minister Indira Gandhi, Sanjay Gandhi, was largely blamed for what turned out to be a failed program. A strong backlash against any initiative associated with family planning followed the highly controversial program, which continues into the 21st century.

Sweden
In 1997 widespread attention was given to the fact that Sweden once operated a strong sterilization program, which was active primarily from the late 1930s until the mid 1950s. The legislation was enacted in 1934 and was formally abolished in 1976. A government inquiry published in 2000 estimated that 21,000 were forcibly sterilized, 6,000 were coerced into a 'voluntary' sterilization while the nature of a further 4,000 cases could not be determined. The Swedish state subsequently paid out damages to the victims.

The program was meant primarily to prevent mental illness and disease. However, as in Canada and the US, racial politics also became involved, as there was a strong belief in the connection between race and genetic integrity among leading scientists and those carrying out the sterilizations. In the later decades it was primarily the mentally ill who were forcibly sterilized.

Other countries
Eugenics programs including forced sterilization existed in most Northern European countries, as well as other more or less Protestant countries. Some programs, such as Canada's and Sweden's, lasted well into the 1970s. Other countries that had notably active sterilization programs include Australia, Norway, Finland, Estonia, Slovakia, Switzerland, Iceland, and some countries in Latin America (including Panama). In the United Kingdom, Home Secretary Winston Churchill introduced a bill that included forced sterilization. Writer G.K. Chesterton led a successful effort to defeat that clause of the 1913 Mental Deficiency Act. The Roman Catholic Church has been a notable opponent of eugenics and sterilization programs. In Peru, former president Alberto Fujimori (1990-2000) pressured 200,000 indigenous people in rural areas (mainly Quechuas and Aymaras) into being sterilized. In Japan, forced sterilization and sometimes forced abortion were routine in leper colonies, long after treatments for Hansen Disease had been established. There are also a number of testimonies stating that newborn babies were killed shortly after birth.

The Soviet Union imposed forced sterilization on female workers deported from Romania to Soviet labor camps. This occurred after World War II, when Romania was supposed to supply reconstruction workforce (according to the armistice convention). India and China have also at various times implemented sterilization campaigns as a population control policy, though only the latter has made any previous overtures towards any potential eugenic motivations.

According to an article on the BBC News web site Czechoslovakia carried out a policy of sterilization of Roma women, between 1973 and 1990. After 1990 the policy was no longer official, but certain doctors continued to practice sterilization operations.