P·O OR
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including
BIRTH CONTROL PILLS AND BLACK CHILDREN
a statement by the Black Unify Party (Peekskili, N.Y)
A RESPONSE
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by black sisters
POOR BLACK WOMEN
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by Patricia Robinson
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.Birth Control Pills and Black Children
The Brothers are calling on the.Sisters to not take the pill. It is this system's method of exterminating Bl ack
people here and abroad. To take the pill means that we are contributing to our own GENOCIDE.
However, in not taking the pill, we must have a new sense of. value. When we produce children, we are aiding
the REVOLUTION in the form of NATIO:N building. - Our children must have pride in their history, in their heri tage, in their_beauty : Our childrentnust not be brainwashed as we were.
PROCREATION is beautiful, especially if we are devoted to the Revolution which means that .our value system be
altered to include the Revolution as the responsibility. A good deal of the Supremacist ('White} efforts to s ter i lize the world's (Non-whites) out of existence 1s turning toward the black people of America. New trends in Race
Control have led the architects of GENOCIDE to believe that Sterilization projects aimed at the blac k man in the
Uruted States can cure American internal troubles .
Under the c over of an alleged campaign to 'alleviate poverty', white supremacist Americans and their dupes ar e
pushing an all -out drive to put rigid birth control measures into every black home. No s uch drive exists within
th.e Wllite American world. In s ome cities, Peeks kill, Harlem, Mississippi and Alabam a, welfare boards ar e
doing their bes t to forc e black women receiving aid to submit to Sterilization .. This disguised attack on black
future generations is rapidly picking up popularity among determined genocidal engineers . This country is ,-'-,--:pr epared to exter minate people by the pi ll or by the bornb; therefore, we mus t dr aw s trength from ourselves .
You see why there is a Family Planning Office in the Black Community of Peekskill.
11,
The Sist ers Rep ly
Here is the sister s' reply:
Septem ber 11, 1968
Dear Brothe rs:
Poor black sisters decide for themse lves whethe r to have a
baby or not to have a baby. If we take the pills or
practi se birth contro l in other ways, it's becaus e of poor black
men.
Now here's how it is. Poor black men won't suppor t their famili
es, won't stick by their wome n•- all they think
about is the street, dope and liquor, women , a piece of ass,
and their cars. That's all that counts . Poor black
women would be fools to sit up in the house with a whole lot
of childre n and eventu ally go crazy, sick, heartb roken,
no place to go, no sign of affecti on -- nothin g. Middle class
white men have always done this to their women -O'lly more sophis ticated like.
So when whitey put out the pill and poor black sisters spread
the word, we saw how simple it was not to be a fool
for men any more (politi cally ·we would say men could no longer
exploi t us sexual ly or for money and leave the .
babies with us to bring up). That was the first step in our waking
up!
Black women have always been told by black men that we were
black, ugly, evil, birche s and whore s -- in other
words , we were the real nigger s in this society -- oppres sed
by whites , male and female , and the black man, too.
Now a lot of the black brothe rs are into a new bag. Black women
are being asked by militan t black brothe rs not
to practis e birth contro l becaus e it is a form of whitey commi
tting genoci de on black people . Well, true enough ,
but it talces two to practi se genoci de and black women are able
to decide for themse lves, just like poor people
all over the world;- whethe r they will submi t to genoci de. For
us, birth contro l is freedo m to fight genoci de of
black women and childr en.
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Like the Vietna mese have decide d to fight genoci de, the South
Ameri can poor are beginn ing to fight back, and
the Africa n poor will fight back, too. Poor black women in the
U.S. have to fight back out of our o,vn experi ence
of oppres sion. Having too many babies stops us from suppor
ting our childre n, teachin g them the truth or stoppin g
the brainw ashing as you say, and fightin g black men who still
want to use and exploi t us.
But we don' t think you are going to unders tand us becaus e you
are a bunch of little middle class people and we
are poor black·w omen. The middle class never unders tands
the poor becaus e they always need to use them as
you w8:11t to use poor black women 's childre n to gain power for
yourse lf. You'll run the black commu nity with
your kind of black power -- you on top!
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Patric ia Haden - welfar e recipie nt
Sue Rudolp h - housew ife
Joyce Hoyt - domes tic
· Mt.Ve rnon. N. Y.
, Rita Van Lew - welfar e recipie nt
Cather ine Hoyt - grandm other
~atric ia Robins on - housew ife and psycho therap ist
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Poor Black Women
by Patricia Robinaon
It is time to speak to the whole ques tion of the position of poor black women in this society and in this his torical
period of revoluti on and counterrevoluti~n ._ We have the foregoing analys is of their own pers pective and it offers
all ot'us . some very concrete points.
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First, that the class hierarchy as seeil f:~om the poor black woman's position is one of white male in power, followed by the white female, then the black male and lastly the black female.
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Historic.ally, the myth in,the ,black. worla is.,.that there are only tw.o free 'people L11 the United States,..the Vfhite man
and the black woman. , The :myth ·was estaolished by_the black nian in the long period of his frustration-when he
longed to be free to have the material and social advantages of his oppressor, the white man . On examination of the
myth, this s o-called freedom was based on the sexual prerogatives taken by the white man on the black fe m ale.
It was fantasied by the bl ack man that she enjoyed it.
The bll:lck woman was needed and valued by the white female as a domestic. The black female diluted much of the .
actu~l oppression of the white fe~ale by the,white male. With the help of the black woman, the white woman had
free time from ·mother and housewife responsibilities and could-escape her do1I1estic prison oversee:r~d hy the
white male.
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The poor black woman still occupies the position of a domestic in.this society, 'rising no higher thartpubllc welfare,
when the frustrated male de-serts her and the children. (Public welfare ·was instituted primarily for poor whites
during the depression of the thirties to stave off their rising.revolutionary violence. It was considered ~s a tempo- _
:r-ary stop -gap oniy .)
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The poor black: male dese:rt¢d tl)e. poor,, black female al}q fled· to •t}le cities where }ie made his 1ivj:ng· by his,; wits
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hustling. ·The black male, did.not question the kind 'of society,he Uyed in:.other than on the basfaiof racism:.. 'The ·
white man won't let me up 'cause r:m black!'' •Other. rationalizations included.blaming the black woman, which has ',:
been a much described phenomenon .. The black roan-·wanted to-take the master's place and all that went with i t.
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Simultaneously. tlie poorbl_a ck wom~ did•not"question. the soctal ,a ncf'economic system. She ·s aw her ma:in prob lem as described in the accompanying article --·• sociai, economic'. and psychological oppression ,by the black man . '
But iwareness in this case llas move(toa setondphase and '~oses an important fact in.th~ whole process of op pression. It takes two to oppress, a proper dialectical pe1rspective to examine at this point in·our movement.
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,?.An examination of the ·process: of oppr~ssi~ in. any or an of its fo:r1'!s· shows si~ply that at least two parties are
involved. The ri.eed for th~ wftlte man;.;p-a,rticula:rtly, to oppres~fothers !eveals his ,own amtiety and inadequacy
about bis own ·maleness and humanity.• ¥any black male writers hav~ eloquently analyzed thls social andpsycho1-0gicai fact ·. Gene:raUy ~ fee),ing ofma~quac.y cant; traced to-~ th~se who desperately ne.ed power and authority
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enclangerihg oHhis power, wsitiori bri:ngsj )n a ,sta:te ofJDadne'Ss anct,cirrationality within the. individual which ex,....,, .
),ose~ the basic fe~ and insecurity bene~th .-- politically speaking, ~the imperialists ~e pa~r tiger~. .., -:~'.. •,'.,•.,;,
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But _the;oppressor rpust ha,;ye tpe coope-~a.~on of the c_>ppressed, of those, he most_feel better than. The oppressedand the da?l}ned are placedm'.an inieriorsuch force: But the long-time' maintenance of power over others is ·secured by psychological manipulation and secfuction. The oppressed must begin to believe in the divine right and position of kings, the inherent right of an
·elite to rule. the supremacy of a class oi:
ethnic group, the power of such condensed wealth as money and pri vate property to give to its owners high social status : So a gigantic and complex myth has been woven by thos e who
have power in this society of the inevitability of classes and the superiority and inferiority of certain groups. The
oppressed begin to believe in their own inferiority and are left in their lifetime with two gener al choices: to identify with the oppressor (imitate him} or to rebel against him . Rebellion does not take p lace as long as the oppres sed
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are certai n of their inferi ority and the innate super iority
of the power fulr in es sence a neuro tic illus ion. The oppres sed appea r to be in love with their chain s.
In a capita lis t s ociety , all power to rule is imagi ned in
male symbo ls and, in fact, all power in a capita lis t societ
y
1s in male hands . Capit alism is a male supre macis t
societ y . Weste rn religi ous gods are all ma le. The city,
basis of 'civili zation ' , is male as oppos ed to the count
ry which is femal e. The city is a revolt agains t e ar lier
femal e pr incipl es of nature and man's depen dence on them
. All domes tic and internationa l politic al and eco nom ic
dec isions are made by men and enforc ed by males and
their symbo lic extens ion - guns. Wome n have becom e
the
larges t oppre s sed group in a domin ant, male, aggre ssive,
capita listic cultur e. The next larges t oppr e s s ed group
i s the produ ct of their worrb s, the ch1ldr en, who are ever
press ed into s ervice and labor for the maint enanc e of
a
male -domi nated class societ y.
If it· is grante d that it takes two to oppre ss, those who
neuro tically need to oppre ss and those who neuro tically
need
to be oppre ssed, then what happe ns when the femal e in
a capita list society awake ns to the reality ? She can either
identi fy with the male and oppor tunist ically imitat e him,
appea ring to share his power and giving him the ~urplu
s
produ ct of her body, the child, to use and explo it. Or-sh
e can rebel and remov e the childr en from exploi tative
and oppre ssive male autho rity.
Rebe llion by poor black wome n, the bottom of a class
hierar chy her etofor e not dis cus s ed, places the ques tion
of
what kind of societ y will the poor black woma n deman d
and strugg le fo r . Already she deman ds the r ight to have
uir th contro l, .ike middl e class black and white wome
n. She i s aware that it takes two to oppre ss and that she
and other poor people no longe r are submi tting to oppre
ssion, in this case genoc ide. She allies herse lf with the
have- nots in the wider wo:dd and their revolu tionar y strugg
les. She has been forced by histor ical condit ions to
withd raw the childr en from male domin ance and to educa
te and suppo rt them herse lf. In this very proce ss, male
autho rity and exploi tation are seriou sly weake ned. Furth
er, she realiz es that the childr en will be used as all
poor childr en have been used through histor y -- as poorly
paid merce nar ies fightin g to keep or put an elite group
in power . Throu gh these steps in the accom panyin g analyt
ic articl e, she has begun to questi on aggre s s ive male
domin ation and the class societ y which enforc es it, capita
lism. This questi on, in time, will be posed to the en tire black movem ent in this count ry.
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This arti cle_ is one of a seri es on
fe~a le libe rati on chos en by Bost onarea wo~e n and publ ishe d by
En.g land Free Pres s
791 Trern ont St.
Bost on, Mass . 0211 8
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Gesell also said .there was
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·welfare .pp.,ments if · they a "nearly universalcomtoon 1
, A federal Ju~e baned the_ change .tli,tiJ:,minds.
• law and statutory rule that
•=~me: re::-::1tifrq~;_; The' ,:National Welfare ' minors and mental uico~pe••ii ::: •~{ t , . ..,, . .
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_a on _ Righta··'brganizationtbrought · ~ents canno_tconsentiomed- 1 ..:• . ,
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HEW, claiming' that the · . 1:her~ was no immediat
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sterilization rules were file- mdic,tion w h e t h e r -the
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In .a ,15-pa!i(f opinion, U.S. gal and unconst·tu.::
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gov·ernment would appeal \ ·.·- '. ,,,, , ' .•·
,,.•,~ 1~q;:: ':.-.~: '• .•, District Judge Gerhard A. ·
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.:;:-'_.. .;--- ~: ·~: -~· Gesell also orderedth~ -De·judge',· heta tikt the
Gesellsaidfuat"what.ever :::_·•:t-,_· •~ : •·· .>;, '::·. \·0 . :t :· partment of Health, Educa- rules were illegalsinceCon- might be ·themeritsoflimit-, · , ; ..,,· , .. ,·, ;
tion and Welfare to amend gress nevei: authorized the ing irresponsible reproduc-", ,..:. ; . , 1. ., •. .
its new st~rilization regula- use of federal family plan- tion, Which ·each year places •
tions· to assure that adults nin2 funds for involuntary increasing. numbers . . of
·· .· ·:·, .:,/ ..»: t· !·; ;ir n , seeking sterilization are not ,s terilizations.
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for Congress and not individual social workers and phy-:~icians to determine the : ••·; • :t ~~- ~ •
manner in which federal •: '. :·:· ••• : · •·•
. funds should be us.ed to sµp- , :: <)·:: . i /
port such. a program."
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The new HEW sterilization
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days while .the legal and
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challenges .
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h::ve gone into effec_t. at;mict-r .
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No. 62 January/Feltruary 1975
Health
Policy
Advisory
Center
I Sterilization:
WOMEN FIT TO BE TIED. Me dica l abuses
are consistent with US government policy.
7 Health Manpower:
BIGGER PIE SMALLER PIECES. The growth
of health workers has far outstripped most
industries.
14 Media Scan:
Psychoanalysis and Femin ism. Juliet Mitchell.
24 Vital Signs
Sterilization
WOMEN
FIT Sterilization abuse is not the exception but
TO BE the rule. It is systematic and widespread.
TIED Women are often misled about the dangers
of surgery, misinformed about its permanence and coerced while under the stress of
labor or abortion.
Newspapers abound with horror stories of
abuses in the health system- Medicaid Mills,
nursing home ripoffs, profiteering in the drug
industry, unnecessary surgery and clinical
research on unknowing public patients. Generally these instances are treated as illegitimate, illegal aberrations of an otherwise decent health care system.
Yet any careful examination of these socalled abuses would reveal that each can be
causally connected to particular aspeds at
the core of our health system. For example,
Medicaid Mills and nursing home scandals
are the literal extensions of Medicaid and
Medicare financing (see BULLETIN, September/October, 1974), while drug company
profiteering is the consequence of a health
system that allows and encourages profits to
be made from human misfortune. The fee-forservice system with its concomitant lavish
remuneration of surgeons is the only possible
explanation for all the unnecessary surgery
performed. The abuses of clinical research
are a function of the imperative of the medical system that often sets teaching and research before patient care.
Sterilization abuse stems from a combination of factors inherent in the health system
plus one critical additional factor. Besides
.. resulting from teaching and research imperatives, profitmaking and the fee-for-service
system, such abuse is the most widespread example of medicine as an instrument of social
control. Sterilization is the most extreme form
of birth control and birth control is official US
government policy. In 1973 there were about
500,000 sterilizations performed on American
women.' (!)
How It's Done
2
Female sterilization is accomplished by
either tying, obstructing or removing the Fallopian tubes (tubal ligation) or by the removal of the uterus (hysterectomy). (2) T·1bal
ligations are done by either traditional surgical techniques, reaching the tubes through
the vagina or the abdomen, or by the newer
endoscopic procedures, in which a tiny incision is made in the abdominal wall and the
tubes are cauterized or clipped. The traditional surgical procedure requires a two-or
three-day hospital stay, while the endoscopic
methods can be performed on an outpatient
basis.
None of the sterilization methods is innocuous. Each procedure is associated with some
physical and psychological side effects. Estimates of mortality and morbidity are widely
varied, but there is general agreement in the
medical literature that some risk is attendant
to each procedure.
. The method of postpartum sterilization most
commonly employed in the US is surgical abdominal tubal ligation performed within 48
hours of delivery. Because the peritoneal
cavity must be entered, this procedure is
, classified as major surgery. The mortality
. rate from this operation is 25 per 100,000
women. (3) It is associated with a postoperative morbidity of from 2 to 4 percent, primarily from infection or bleeding. (4) The
-----------------•..The mortality rate from
surgical tubal ligation is
25 per 100.000 women.
endoscopic method most commonly used is
laparoscopy, in which a needle is inserted
into the abdominal cavity, through which
carbon dioxide is pumped until the abdomen
becomes taut and the Fallopian tubes are
caught with forceps and cauterized. The
death rate following this operation is various} y estimated to be from 14 to 30 per 100,000
women. (5) There are fewer serious side effects than with the other common sterilization
methods, but from 1 to 2 percent of women
experience bleeding, uterine perforation, accidental burning or bowel trauma. (6) Less
serious physical side effects include abdominal pain or pain during menstruation (20 to
30 percent (7)) and increase of menstrual
bleeding (from 10-40 percent). (8)
Psychosexual complications from female
sterilization are widely reported. A 1973
study shows that the actual prevalence of regret among sterilization patients may be as
high as 25 percent. (9) Another recent study
reported that "about 40 percent of pelvic operations in women may be followed by a
c::mdition having certain features character~stic of agitated depression beginning about
one month after the operation and lasting
more than six months." (10) As long ago as
1965 a report appeared in Obstetrics and
Gynecology noting that "A year after the operation, successful emotional adjustment
seems to be correlated, in a majority of
women, with the presence of one striking unrealistic fantasy : the ability to b<?come prenancy [sic] again!" (11)
The complication rate resulting from
hysterectomy is 10 to 20 times higher than
that associated with tubal ligations. (12)
Death from this major surgical procedure occurs 300 to 500 times for every 100,000 operations. (13) Similarly, morbidity is much
higher from hysterectomy than from other
sterilization techniques. One study found a 22
percent morbidity rate, while other estimates
range from 10 to 34 percent. (14)
While a hysterectomy is by far the more
dangerous sterilization method, it has the advantage of being 100 percent effective, as opposed to a tubal ligation, which will fail one
out of every hundred times. (15) The risks of
tubal ligation become more significant in
light of comparable risks and benefits from
other types of birth control. The 1 percent failure rate of the pill is the same as that of tubal
ligations while IUD's fail in about 2 percent
of cases. (16) The other mechanical contraceptive techniques are considerably less successful in preventing pregnancies. However ,
the physical and psychological risks associated with birth control methods short of sterilization are minimal compared with those of
tubal ligations or hysterectomies . The pill is
held responsible for one death in 200,000
users. (17) Yet in 1970 the Food and Drug Administration became so concerned over the
potential dangers of the pill that it required
every prescription to be accompanied by
warning literature. (18)
Sterilization on the March
Sterilization is both the most dangerous
birth control method and the fastest growing.
The most comprehensive sterilization statistics are prepared by the Association for
Voluntary Sterilization (AVS). Though these
estimates must be read skeptically because of
the vested interest of A VS in promoting sterilization, the trends they reflect are comparable with those seen in other reports. Since
1970 the figures show an almost three-fold
increase in the incidence of female sterilization, from 192,000 in 1970 to 548,000 in 1974.
(19) Hospital and local surveys report sim-
ilarly spectacular increases. At the University of California-Los Angeles County Medical Center there was a 742 percent increase
in elective hysterectomies and a 470 percent
increase in tubal ligations in the two years
from 1971 to 1973. (20) Dr. Richard Hausknecht
reported that the number of sterilizations performed at Mount Sinai Hospital in New York
City has increased 200 percent since 1970. (21 )
The situation as it was in 1970 is shown in
the National Fertility Study, conducted by
the Office of Population Research of Princeton University under a grant from the US Department of Health, Education and Welfare
(HEW). (22) A total of about 1.43 million married American women under 45, who were
neither pregnant, postpartum, trying to get
pregnant or naturally infertile, were sterilized
in 1970, (8.5 percent of this group). That
average percentage increases from young to
older, white to Black and educated to uneducated. Only 5.6 percent of college-educat ed
white women were sterilized and 9.7 percent
of comparable Black women. Among women
with less than four years of high school, 14.5
percent of white women and 31.6 percent of
Black women had been surgically sterilized.
Relatively few women under 30 reported
they were sterilized in the 1970 survey specifically, 2.8 percent of white women and 5.0
percent of Black women under 30 had been
sterilized. As would be expected, a larger
proportion of older women had been sterilized, specifically 8.4 percent of white women
and 32.5 percent of Black women.
There is much evidence to suggest that the
increase in the number of sterilizations has
fueled a trend toward the sterilization of
younger women with fewer children. A recently published study of a large hospital in
St. Paul. Minnesota showed that the ratio of
tubal ligations to births increased from 1:9.2
in 1968-69 to 1:4.3 in 1971. (23) In the earlier
period 19.7 percent of the women were under
25, whereas three years later 29.7 percent
/
Publishe d by th e Hea lth Policy Advis or y Cente r , 17 Murray Street , Ne w York, N.Y. 10007 . Te le pho n e ( 212 ) 267-8890. The He alth
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3
were 25 or younger. The median age of women sterilized in federally financed family
planning programs in 1973 was 28; 4 percent
of such women were under 20 and only 38
percent were over 30. (24) Even among the
relatively poor women served at these clinics
racial disparities are apparent. More than
half of the patient population was white, but
only 40 percent of those sterilized were white.
At the same time, about one-third of patients
were Black, while 43 percent of the sterilized
women were Black.
Meclicine Joins the Bandwagon
4
The editors of Family Planning Digest, the
official publication of HEW's National Center
for Family Planning Services, wrote in 1974:
"As US professional attitudes change, it is
possible that we may see sterilization become as important in family planning in the
fifty states as it already is in Puerto Rico."
(25) (Of married Puerto Rican women, aged
15 to 44, 35 percent are sterilized; two-thirds
of the women are under 30. (26)) Surveying
the attitudes of mainland doctors, particularly
gynecologists, it is difficult to see how much
further in that direction they could change.
Official accommodation to liberalization of
sterilization practices in the US came in 1969,
when the American College of Obstetricians
and Gynecologists (ACOG) withdrew its ageparity formula. (27) by this rule of thumb
sterilization could only be performed on a
woman whose number of living children multiplied by her age equalled 120, as, for example, a woman age 30 with four children.
In 1970, the ACOG dropped its widely used
recommendation that the signatures of two
doctors plus a psychiatric consultation be obtained prior to performing a sterilization. Dr.
Don Sloan, Director of Psychosomatic Medicine at Metropolitan Hospital. a municipal
institution in New York City, used to receive
two or three referrals per day; since 1970 he
has gotten about one per month.
The liberalization of sterilization guidelines
opened the floodgates to abuse. Although
some of the increase in the number of operations performed is due no doubt to increased
demand, much of it is the result of misinformation and coercion. Women are often convinced to undergo sterilization with a soft-sell
pitch. Describing laparoscopies as "bandaid
surgery" and calling tubal ligations "a
stitch," doctors minimize the dangers involved. As one noted, women find the pro-
cedure more acceptable if the term "operation" is not used. (28)
Gynecologist/ obstetricians are surgeons,
and with the birth rate falling there are fewer
and fewer opportunities to learn and practice
their surgical skills. "The early 'rewards' for
doing more operations on the poor and disadvantaged in the form of residency certification and specialty board qualification are
translated, after training, into financial rewards wherein, the more you cut, the more
money you make," noted one report. (29)
Many young gynecologists in training
have united their professional needs and
their political ideas. Two recent surveys are
revealing. Doctors were polled about their attitudes towards contraception for public versus private patients. Of the doctors queried
in Detroit, Grand Rapids, West Virginia and
Memphis only 6 percent said they would recommend sterilization as the method of choice
to their private patients but 14 percent chose
sterilization as the first method they would
push with public patients. Additionally, 94
percent of the gynecologists favored compulsory sterilization of welfare mothers with
three illegitimate children. (30) Sterilization
is pushed for low-income and welfare women
because many doctors believe that the poorer
the woman, the less likely she is to use other
methods successfully. (31)
It can at least be argued that a tubal ligation is relatively simple, cheap surgery.
Hysterectomy is not. But there has been
a tremendous upsurge in the number of hysterectomies for the purpose of sterilization,
or hystersterilizations, as the procedure is
euphemistically called. The acting director of
OB/ GYN at a municipal hospital in New York
City reported, "In most major teaching hospitals, in New York City, it is the unwritten
policy to do elective hysterectomies on poor
Black and Puerto Rican women , with mini·
mal indications, to train residents. . . . At
leaat 10 percent of gynecological surgery in
New York City is done on this basis. And 99
percent of this is done on Blacks and Puerto
Rican women." (32) The same situation prevails at other public hospitals. An OB/GYN
resident at Boston City Hospital commented:
"We like to do a hysterectomy. it's more of a
challenge . . . . You know, a well-trained
chimpanzee can do a tubal ligation .. . and
it's good experience for a junior resident . . .
good training." (33) A staff doctor at Los Angeles County Hospital contributed to a dis-
cussion by saying: "Let's face it, we've all
talked women into hysterectomies who didn't
need them, during residency training." (34)
Training imperatives and political attitudes account for some of the increase in hysterectomies. A third, compelling reason, is
greed. At Albert Einstein Medical School's
College Hospital in New York , a hysterectomy will cost $800, while a tubal ligation
costs about $250. Some private doctors get
as much as $1,000 to perform a hystersterilization. (35) Dr. Rosenfeld points out that
"Once the doctor sells a woman on sterilization, it is easy to move it up to a hysterectomy." (36) Patients who ask about the effect
of a hysterectomy on their sex life are told
cavalierly at one major hospital in New York
City, "We'll take away the baby carriage,
but we'll leave you the playpen." (37)
r~\
Signing on the Dotted Line
Sterilization is unlike every other form of
birth control. It is for all intents and purposes
irreversible. A woman making a decision of
this magnitude should have access to all pertinent information concerning the risks and
benefits and the ability to make the decision
in an atmosphere free of coercion. This is
rarely, if ever, the case.
A sterilization consent form is frequently
thrust in front of a woman while she is in the
midst of labor. A resident at LA-USC Hospital
said, "I used to make my pitch while sewing up the episiotomy when the anesthesia
started wearing off." (38) According to another doctor at the same institution, "Some
house staff would routinely ask women if
they wanted their tubes tied during labor."
(39) Sterilizations are also performed concur-
, ! .-
.
41- ~
/--
~.-~
~
t
--------
-------- - - - - -
5
rently with abortions, with all the attendant
trauma that that procedure entails. (40)
One indication of sterilization's acceptability
to those who are truly informed is demonstrated by a 1972 study conducted by Albert
Einstein College of Medicine. Surveying birth
control practices of obstetricians and their
wives, the study revealed that 4 percent of
these women were sterilized, as compared to
12 percent of a comparable group of white
women in the general population. (41)
Others Join the Chorus
The most common source of information regarding sterilization is the booklet "Voluntary Sterilization for Men and Women " prepared by Planned Parenthood-World Population (PP-WP). (42) There is no mention at all
in the booklet of the potential risks or disadvantages of sterilization. In fact, the impression promoted is all wine and roses : "Women
can't detect any difference from before the
operation. Actually, they often find sex is more
"We '11 take away the baby
carriage. but we'll leave you
the playpen."
6
pleasant because there is no reason to worry
about becoming pregnant." Not only does the
pamphlet ignore any discussion of the potential for severe psychological problems, as
discussed previously, but it never even mentions the physical risks nor does it compare
the efficacy of tubal ligations with other
forms of birth control.
The sterilization booklet is inadequate even
by comparison with other Planned Parenthood literature. The booklets on the pill and
IUD's at least mention some of the risks involved and suggest that women ask their
doctors for additional information. The sterilization booklet is incomplete and misleading to a dangerous degree.
There is evidence that the necessary modifications of the Planned Parenthood booklet
would not discourage those who were actually seeking sterilization with a full understanding of its implications. The argument
that couples seeking sterilization will be
"scared off" or become "unnecessarily worried" by informed consent is questionable. Dr.
F. J. Hulka of the University of North Carolina
School of Medicine recently wrote concerning counseling of couples applying for sterilization: "If they have had two children and
are in their mid-20s, an increasingly common
pattern, I ask if they know that abortions are
available. These couples are often worried
both about pregnancies and surgery but are
willing to have surgery because they fear
pregnancy more. We tell them that if, despite
use of their contraception method, pregnancy
occurs, we will terminate this unwanted pregnancy and do a tubal ligation at the same
time, as an out-patient procedure. Very few
couples are dissuaded from elective sterilization by this offer, however, because most patients seeking sterilization will not contemplate even the possibility of pregnancy.
'Please stop our worry now,' they plead." (43)
Even if it were established, however, that
full information would "scare" potential sterilization patients, i' is clearly their decision to
make for their own reasons, whether their
fears be grounded in medical fact or not. The
professionals' argument evidences a paternalism that has been characteristic of the
physician-patient relationship almost since
its inception.
The efforts of Dr. Bernard Rosenfeld to alleviate the shortcomings of the Planned Parenthood booklet are documented in correspondence between him and Dr. A . J. Sobrero,
permanent member of the PP-WP National
Medical Advisory Committee. Concluding
the correspondence, Dr. Sobrero wrote: " ...
none of Planned Parenthood's materials is
supposed to assume the burden of informing
the prospective client of the benefits, risks,
effectiveness, and mode of use of any method of contraception . .. . Again let me stress
that none of the printed material has been
prepared nor is being advocated for use for
informed consent." (44) The Planned Parenthood booklet, however. is the only source of
information available to patients at many
public hospitals. (45) (In response to the
criticism mounted b y Dr. Rosenfeld and
others, the Planned Parenthood book has recently been revised, but the tone of the
pamphlet has not changed.)
Indicative of the pervasive misunderstanding concerning sterilization is the discussion
in Our Bodies, Ourselves, the otherwise carefull y w ritten book published by the Boston
Womens' Health Book Collective. (46) The disContinued on page 10
Sterilizat ion
Continued from page 6
cussion of sterilization begins with the clearly
erroneous statement that " ... sterilization is
... 100 percent effective .... " As indicated
above, ten women out of every thousand who
undergo tubal ligation for sterilization will
become pregnant. The book suggests, as
does the Planned Parenthood booklet, that
sterilizations and information regarding them
are available from the Association for Voluntary Sterilization, a group confessedly
more interested in population control than
reproductive freedom.
Most importantly, there is no mention in
the book of mortality or morbidity associated
with sterilization. Paying some deference to
the possible psychological implications of
vasectomies for men, the writer suggests that
men who are anxious about the effect of a
vasectomy upon their sexual performance
". . . should not have vasectomies, because
worrying about sexual performance is likely
to impair a man's ability to have an erection,
even though the production of sperm and
male hormones continues." Women, however, receive less consideration. First, the authors include the testimony of one woman
who experienced intense pre-operation fear of
regret, but who subsequently was relieved
"that she was free to proceed with her life."
There is no mention of the high rate of regret
IO associated with sterilization, especially if the
decision is made by a patient under 30, made
during a time of stress, based on possibly
temporary financial circumstances or initiated by the physician. In the last situation, a
regret rate of 32 percent has been documented. (47) The importance of alerting women to this possibility is evidenced by a finding reported in the American Journal of Obstetrics and Gynecology that most of the
women who regretted the sterilization became frigid (June, 1964).
Our Bodies, Ourselves compounds the error
by suggesting as does the Planned Parenthood booklet, that a woman's sexual response
is not lessened at all by sterilization but in
fact "usually improves as soon as she no
longer fears pregnancy." Finally, in stark
contrast to the suggestion that a man who
fears sterilization should not risk the possibility of altered sexual performance, women
are told merely that they will "have to deal
with their own deeply internalized feelings
that someone who is infertile is inferior."
This summary treatment of sterilization is especially regrettable in light of the 30 pages
of the book devoted to an extensive discussion of almost every aspect of other contraceptive methods.
Medicine as Handmaiden of
Public Policy
Doctors' attitudes toward sterilization and
the misinformation about its impact stem
from the same s0urce: a clear-cut change in
government attitude toward population con•
trol. Though budget belt-tighteni ng is today
the byword for most government -financed
health care, this is not the case for contraceptive services. On December 9, 1974, in implementatio n of amendment s to the federal
Medicaid law, HEW proposed to increase the
federal contribution for birth control services
provided to Medicaid recipients from 50 to 90
percent. And to further add to its expenditures, HEW intends to transfer family planning from optional to mandatory services,
thus obliging every state to provide these
services to every welfare woman. (49)
The government 's involvemen t with family
planning has a long and checkered history.
Fifty years ago, Margaret Sanger was jailed
for demanding contracepti ve services .
Through most of the years that women fought
for birth control and abortion, the government steadfastly opposed their efforts. (50)
Today, however, contraceptio n has been embraced as a major ingredient of public policy .
Open availability of birth control devices
and accessibility of services is the result of
two divergent persp2ctives . On the one hand ,
there are those who want birth control as a
right and a matter of health, an important
element in the demand by women for control
of their bodies. But birth control is also an
instrument of population control. For example, Dr. Curtis Wood, past President of
the Association for Voluntary Sterilization , is
an outspoken exponent of population control: "People r,ollute, and too many people
crowded too close together cause many of
our social and economic problems. These, in
turn , are aggravated by involuntary and irresponsible parenthood. As physicians we
have obligations to our individual patients,
but we also have obligation to the society of
which we are a part. The welfare mess, as it
has been called, cries out for solutions, one
of which is fertility control." (51 )
Even more bluntly, a doctor who routinely
performs sterilization s explained, "A resident who was up the entire night with some
woman, or a doctor who just got his income
tax back and realized it all went to welfare
and unemploym ent was more likely to push
harder." (52 )
One of the more spectacular applications
of the population-c ontrol ideology involved
an Aiken, South Carolina obstetrician / gynecologist who refused to deliver a third baby
for a welfare mother unless she first submit-
ted to sterilization. An investigatio n by the
South Carolina Department of Social Services
revealed that the doctor, Clovis Pierce, had
performed 28 sterilization s during a six-month
period. The investigatio n was initiated when
Pierce tried to coerce a white welfare mother
into accepting sterilization. Although Pierce
was decertified by the Department and bar·
red from providing obstetric services for
Medicaid money, he is still permitted to re•
ceive federal program grants for gynecological treatment provided to indigent patients.
(53) His nurse commented that although the
overwhelmi ng majority of the patients sterilized had been Black, "This is not a civil
rights thing, or a racial thing , it is just welfare ." (54)
"The welfare mess, as it has
been called, cries out for
solutions , one of which is
fertility control."
Dr. Curtis Wood, past President
Association for Voluntary Sterilization.
Asked about Pierce's policy, Dr. Wood, the
man from A VS, said: "I admire his courage.
I'm sympathetic to his point of view . However, I question his method. After 30 years of
delivering babies, I've found that if the doc·
tor does a proper job of offering sterilization
to these women [on welfare]. a high percentage of them would accept it. I have found that
after three or four minutes of talking with
them, they will accept it- they want the sex,
but not the babies." (55)
As befits his station, John D. Rockefeller
III, Chairman of the President's Commission
on Population and the American Future,
made the same point far more tactfully: "The
Commission believes that slowing the rate of
the population growth would ease the problems facing the American government in the
years ahead . Demand for government services will be less than they would be otherwise,
and resources available for the support of
education, health and other government ·
services would be greater." (56 )
Then President Nixon nominally rejected
the Commission 's report because it called for
the legalization of abortion. The facts, how- 11
ever, tell a very different story. Between 1967
and 1973 federal support for family planning
services increase d more than 1,300 percent,
from $11 million to $149 million. (57) Dr. Louis
Hellman , Assistan t Secretar y of HEW for
Populati on Services , estimate s total federal
expendit ures for family planning between
1970 and 1975 at $1 billion. (58)
Just as spectacu lar has been the growth
of US spending for its birth control program
abroad. The Agency for Internati onal Development (AID) increase d its birth control program budget from $2.1 million in 1965 to $ 100
million in 1971. (59) In 1974 AID distribut ed
100 million birth control pills a month , paid
for the insertion of innumer able IUD's and
provi-ded the money and manpow er for countless sterilizat ions. (60)
"It is better for all the world ... if
societ y can preven t those who
are manif estly unfit from
contin uing their kind."
US Supreme Court Justice
Oliver Wendell Holmes
for therapeu tic or non-ther apeutic purposes ."
(63) HEW is happy to pay 90 percent of the
costs of sterilizat ion, but not abortion.
Compuls ory sterilizat ion of "incomp etents"
has long been a matter of law. Upholdin g a
Virginia statute that allowed for the involuntary sterilizat ion of an institutio nalized person when the state determin ed that such a
procedur e was in the best interests of society, Supreme Court Justice Oliver Wendell
Holmes wrote: "Experie nce has shown that
heredity plays an importan t part in the transmission of insanity and imbecilit y . . . the
Public Welfare may call upon the best citize ns for their lives . It w ould be strange if it
could not call upon those who already sap
the strength of the state for those lesser sacrifices ... . It is better for all the world .. . if
society can prevent those who are manifest ly
unfit from continuin g their kind." (64 )
The line between voluntar y and involuntary sterilizat ion is becomin g thinner all the
time.
- Barbara Caress (Much of the i nitial research
for th i s article was carried out by Nikki
Heidepri em, a third-yea r student a t New
York Universit y Law School . The conclusions of course are those of the author. )
Refer ences
l. Association f or V o luntary Sterilization , Inc ., ' 'Esti m a t e of
Numbe r s o f V olu n tar y Steril i zations Pe r fo rm ed ," N ove m -
In the governm ent 's own words, providin g
birth control services is populatio n control.
Replying to a United Nations question naire
on populati on policy, it said the United States'
policy was to actively provide the widest distribution of birth control services. "This position," the paper noted, "implies a policy de
facto towards a further decrease in the rate
of populati on growth." (61 )
Lifting the parity formula and removing
all formal impedim ents to sterilizat ion, the
America n College of Obstetric s and G y n ecology was bowing to the prevailin g winds.
Whether he knows it or not , the OB / GYN
resident who said in defense of sterilization,
"I just don't think it's good for them [ welfare
recipient s] to drive around in a 1950 Chevy
full of kids," was an agent of governm ent
policy. (62)
HEW's proposed changes in birth control
services were capped off with a final twist,
containe d in the last paragrap h . " Not included under this definition [of family plan12 ning services] are abortion s performe d e ither
ber . I 974 ( m im eo l.
2. Cedric W . Porter . Jr. a n d Jar oslav F. Hu l ka , " Fem ale S te r ili zation in Current C li n ica l Pra c ti ce ," Famil y Planninq
Pe r spec ti ves , VI Winter 1974 ) , 30.
3. H . B. Presse r , " Vo luntary Sterilizat io n : A W orld Vie w ,"
Reports on Popu l a tion F a m il y Planning , No . 5 ( 1970 ).
p . I.
4. Po rter and H ulk □ , op . cit .. p . 37 .
5. Ibid.
6. I b id.
7. Lu and Chun . "'A Long Te rm Follow -u p Study o f 1. 055
Cases of Post•Partum Tubal Ligation ," Obstetrics Britis h
Common w ea lt h, Vol. 74. p. 875.
8. Ibid.
9. Whi t ehouse , "S terili zat ion o f Young Wi ves ," BrHish M ed ical Jou rn a l. Ju n e 19 , 1971. p. 707 .
10 . Bernard Rose n feld , M .D ., " Fe male Con traception," u n p ub•
lis h ed manuscript . 1974 .
11. Bar l ow , Gunther, John a nd M el t zer, " Hyst er ec t om y an d
Tubal Li gatio n : A Psychiatr ic Com parison ,'' Obs tetrics
and Gynecology , XXV ( April. 1965 ), 520.
12. Porter and Hu lka , op . cit., p . 35.
13. Ibid.
14. I b id.
15. Pr esser , op. c i t ., p . 9
16. Ibid .
17 . R osen f eld . Wolfe a nd M cGarrah . " H ealth Resea rch Group
Study o n Su r gical St e r iliza t ion .'· October 29, 197 3.
18 . J. B. Lippinc ott Company , " H a za rd s o f M edication A
M a nual on Drug I nteract i o n . Incom pa t a bi l i ties , Cont rain •
dicatlon s and Adverse Ett ec t s." 1972.
19. Associa tion for Volun tary St eriliza tion . op . cit .
20. " Sterilization : Despi te High er Ris ks . Some Doctor s Sti ll
Prefer Hy st er ec tomy t o Tuba l L iga tion , " fami l y Pl an n i n g
Digest . II ( January. 1973 ). 9.
21. Newsday , Ja n uary 2, 1974 , p. 4A .
22. Ch arles F . Westott . " The Moderniza tion o f U .S. Contra .
ce p t ive Pr acti ce ," F am ily Pla n n in g Perspect i ves , IV ( Ju l y ,
1972 1. 9.
23. L. E . Ed w ards and E. Y . Hakanso n . ""Cha n gi n g Stat u s of
Tubal Sterilizati on : An Eval uat ion of Fourteen Ye ar s' Ex-
p er ience ," A m erican Journal of Obste trics a n d G yn ecol -
og y , C XV (1973 ) . 347 .
24. De n to n Vaugha n a n d Gerald Spar er , " Ethnic Group a n d
Welfare Sta tus of Wome n Sterilized in Federa lly Funded
Family Planning Programs ," Family Planning Perspec tives, VI ( Fall . 1974 ) , 224 .
25 . Family P lanni n g Digest, I ( May , 1972 ) , 6.
26 . Ibid.
27 . Hulka and Porter , op. cit., p . 30.
28. McGarrah, " V oluntary Fe male St er ili zat ion : Abuse s ,
Risks and Guidelin es ,"
Hastings
Ce nte r Report, Jun e,
1974 . p. 5.
29 . Jbid., p . 6 .
30. " Physician Attitudes: MDs Assume Poor Can ' t Re m e mber
to Take Pill, " Family Planning Digest, I (January , 1972 ) ,
3.
31. " Physician Attitudes ," op . cit .
32 . Newsday , op. cit .
33. Rosenfeld , Wolf e a nd McG a rrah , op. ci t .. p . 6.
34 . Ibid .. p . 8.
35. I nterview w i th Dr . Erw i n K aise r.
36. Ros e nf e ld . o p . c it .
37 . Intervi ew with Dr . D o n Sl oan .
38. Los An g eles Times , op. ci t.
39 . Ibid.
40. Sl o a n , op . cit.
41. Newsday , op . cit.
42. Pl a nn ed Pa renth ood -W or l d Popu l a t io n , " V o l u n tary St er il ization fo r M en a n d W o m e n ."
43. H ul k a, " Vo l u ntary St er ilization: T he Ro le o f Physi ci a n ,"
Hos pital P racti c e , V II ( Novem b e r , 1972 l, 119.
44. Le tt er fr om A . J. Sob re r o, M .D. t o Bern o r d Rosenf eld.
M .D ., M a y 17 , 1974
45. L e tt e r fr o m Be r nar d Rosenf eld, M .D. t o M s. Gin a Jo hnson .
Edi t or o f Publ icat io n s. Plan n ed Parent h ood- W orld Popu -
la ti o n , Ap ri l 5, 1974 .
46. Bos to n W o m e n 's H ea lth Book Coll ec t ive , O u r Bodies. Oursel ve s ( N ew Y o r k: Si m on a n d Sc hu ster , 197 3 ) .
47 . B a rn es a nd Zu span , " Pa t ie nt R eac tion to Pue r per al Sur -
gical Sterilization," American Journal of Obstetrics and
Gynecolog y , LXXV (Ja nu ary , 1968 ), 65.
48 . Adams , " Female Steriliza tion ," American Jo urna l of Ob-
s te trics a nd Gynecolog y , LXXXIX (J un e 1964 ) , 395.
49 . Federal Register, Vol. 39 , No . 237 ( Dece mb e r 9, 1974 ) .
50. Jea n Sha r pe , " The Birth Co nt roll e rs ," Health / PAC Bulle ti n , No. 40 ( April , l972 ), pp. 3-12.
5 1. Contemporary Obstetrics and Gynecology , I (1973 ) , 31.
52. Los Angeles Times , op. cit.
53. Ne wsday, op. cit.
54. Rosenfeld , Wolfe and McGarrah , op. cit .. p. 3.
55. Newsday , op. cit.
56. John D. Rockef e ll e r Ill. " A Call fo r Stabiliza tio n ," New
Yor k T i m e s. Apr i l 30 , 1972 ( special supplement sponsor ed
by th e Popul a ti o n Crisis Committ ee in as socia t ion with
th e Planned Parentho od Federation of Am erica ) .
57. " DHEW 5-Yea r Plan Re port: Program Serv ed 3.2 Mill ion
i n FY 1973 ; Pr o vid er C ountri es , Agencies Increase ," Family Plann ing Dige s t, Ill ( Ma y , 1974 ).
58. " Birth Curb Leaders Cite Future N e eds , " American Med ica l Ne w s, Ma y 6, 1974 , p . 16.
59. S har p e, op . cit.
60. R. T. Ra v e n h o ld a nd Jo hn C h ao, " Availability of Family
Planning Servic es th e K ey t o Ra pid Fert i lity Redu c ti o n ."
Pa m i l y Pl a nnin g Perspec t ives, VI ( Fa ll 1974 ), 2 17 .
61. W . Pork f> r M o ul din . N a zl i Ch o u cri . Frank N o tes tei n a n d
M ich ael T ei te l ba um . " A Report o n Buchar es t : Th e W orld
Popu l ation Co nf e r e n ce a nd the Popul a t io n T rib u n e , Au gust. 1!:!74 ," Stu dies i n Pa m il y Pl a nn i n g , V ( D ece mbe r.
197 4 ), 393 .
62 . Los An ge l es Tim es, op . c i t.
63. Pe d er a l Re g is t er , o p . c it.
64. M orri s E . D a vis , " In vo lunt a ry St eril i za ti o n : A History of
Social C o nt rol, " Jo urn a l o f Blac k H ealt h Pe r s p ec riv es , I
( Augus t-Septe mb e r , 1974 ) , 46 .
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~ \;yti'Q,j
I
Steril.i zin g the Poor
CLAUDIA DREIFUS
Los Angeles they made the women suffer. I had a private doctor. When
They sit quietly on her lap as she weeps: the two living I was nine months pregnant , he told
me that the baby' s
children of Guadalupe Acosta, two little girls with coffee- head was too big and I would have
to go to the County
tone skin and classic Indian faces. Clean and pretty in Hospital because they had better
equipmen t.''
their starched dresses , the girls are with their mother as
The child' s head was more than just too big; it was
we meet in the East Los Angeles offices of her attorney, severely malforme d-anencep halic,
it had no brain.
Antonia Hernande z of the Model Cities Law Center. Because of the abnormality, the pregnancy
lasted eleven
Mrs . Acosta, a large, somber-looking woman of months. For that last month of term,
Mrs. Acosta
thirty-five, has taken the morning off to talk with me. The attended weekly pre-natal clinic sessions
at Countychildren have been brought because, well .. . baby sitters where, not once, was she counseled
about sterilization.
are expensive . And also because Lupe Acosta finds it hard
However, on August 20, 1973, eleven months and
to be away from them for any sustained period of time. eleven days pregnant, Lupe Acosta entered
L.A. County
Though Mrs. Acosta has given birth to four infants, it is in the final stages oflabor. ' ' When I was being
examined ,
only these two children- the middle ones-tha t she has they pushed very hard on the stomach
," she recalls.
been able to nurture and raise. There was a first baby, " Very, very hard. With their hands.
One doctor would
born in Mexico, who was taken from her and given to a have one leg open. The other doctor would
have the other
relative for adoption. The fourth child died shortly after leg open. And then , there were two doctors
just pushing
birth at L.A. County General Hospital on August 21 , 1973. down on my stomach and Icouldn 't. . .
Icouldn 't stand it. I
And it was after that delivery that doctors at L.A. County pushed one doctor because I couldn't
stand the pain.
sterilized her. Without her knowledge . Without her When he came back, he hit me in the
stomach and said,
informed consent. And it is because of this sterilization 'Now lady, letusdowh atwehave to.' I
felt very sick. I was
that Lupe Acosta's common law husband abandoned her. sweat all over, sweat. I kept telling them
to do something
The operation is the reason she cries throughou t our to bring the baby . .. . They kept me in
that condition from
interview, the reason she holds her two daughters to her six o'clock in the evening till three
o'clock in the morning.
body so tightly.
That was the last time I saw the clock-the last time I
"I didn't want to go to L.A. County Hospital," she remember anything. "
begins. '' I heard they didn't treat you right there and that
A question to Mrs. Acosta from her lawyer: "Do you
remember signing a consent form?"
ClaudiaDr eifus is afree-lance writer whose articles have
"No, " she answers. " I don 't remember signing
appeared in The Progressiv e, The Nation, Rolling Stone, anything. Only when I left the hospital-p erhaps
an exit
andNewsd ay. Sheisthea uthoroftw obooks, "Woman' s
paper?"
Fate·· and' 'RadicalLi festyles. ·'Research for this article
The day after Mrs . Acosta's caesarean delivery , her
was assisted by a grant from the Fund for Investigat ive common-law husband came to her bedside.
''He told me
Journalism , and the author also acknowled ges the the baby was alive and in an incubator ,"
she says,
assistance of Joyce Rosenfeld, Elissa Krauss, and weeping at the mere recollection. "Seven
days later the
Miriam Cutler.
doctor came round to take out the stitches and I asked him
Reprinted from
~PROGRESSIVE Madison, WI.
1975
how my baby was. 'What baby?' he asked. 'Your baby
died when it was born.' "That's how Acosta learned the
fate of her fourth child.
But more was to come. A month after delivery, she
arrived at County for the standard post-natal check-up.
"My common-law husband, he told me to get the Pill at
the hospital,'' she recounts. ''When I asked the woman
doctor, she asked me ifl knew what had happened to me. I
said, 'No.' And then the doctor told me, 'Well, you won't
need the Pill because they tied your tubes.' I said that I
didn't sign anything. She said, 'Your husband did.' And
then I told them he wasn't my husband.''
When Lupe Acosta got home that night, she was
alternating between fury and hysteria. "I became very
angry," she says, "and I asked him why he had done
that-he had no right. He told me that he didn't sign
anything except for a paper for a caesarean. He said, 'If I
had signed the paper, would I have sent you for the Pill?' ''
The relationship between Guadalupe Acosta and her
common-law husband of eight years quickly deteriorated. Built into Mexican culture is the idea of
machismo, a value that says a man's masculinity is
measured by the number of children his wife produces.
Given the reality of machismo, a sterile woman is
considered worthless-useless. On a smoggy day last
autumn, Lupe Acosta's man abandoned her and the two
children. She was, as a result, forced on welfare. Then the_
tubal ligation hemorrhaged and she was hospitalized.
Nothing has gone right in her life since August 1973.
Sometimes she gets pains from the tubal ligation. "And
my nerves and my head are in great pain,'' she complains.
"Ever since the operation, I am very inattentive. Not
forgetful, inattentive. People sometimes have to tell me
things twice. It's not that I don't understand them, it's
that I'm not there.''
It was a different story for Maria Diaz (not her real
name). In 1972, Mrs. Diaz, pregnant with a third child,
was living with her family in Hermosillo, Mexico.
Because Mrs. Diaz, then thirty-two years old, was a
legally immigrated resident of the United States and
because her husband had not yet attained that status, it
was decided she should journey to Los Angeles alone for
the infant's birth. ''Mybrother-in-lawtold me it would be
better for the baby to be born in the United States," she
recalls.
Mrs. Diaz explains all this as she pours coffee for me
and her lawyer, Antonia Hernandez. It is a warm July
afternoon. The three ofus are sitting in the living room of
her spotlessly clean cottage in Glendale, California. On
the walls hang dimestore prints of John F. Kennedy and
Emiliano Zapata-and also, lovingly mounted crayon
scribblings by the children. ''Yes, I went there because I
thought it would be better," explains Mrs. Diaz who, like
her husband, works as a baker. ''I could cross the border
freely and my husband could not-so I went alone.''
On April 6, 1972, Maria Diaz and her brother-in-law
arrived at L.A. County Women's Hospital; she was in
labor. For three-and-a-half hours, they sat in the waiting
room until the hospital would admit her. Then, after
several more hours of labor, she was informed that the
child would be born by caesarean section. "I told them I
could not accept the caesarian operation because my
-husband was not there and Icould not do as I pleased ....
When they were talking about the caesarian, I heard the
doctors use the word 'tubes.' The doctors said they were
going to tie my tubes because it would be dangerous for
me to have more children. I told them I could not accept
that. I kept saying no and the doctors kept telling me that
this was for my own good.''
Maria Diaz was approached repeatedly during the
final stages of her labor. A tube was pushed into her
vagina. She was crying with pain. Nevertheless, the
attending staff continued pressing her for sterilization.
She was drugged and ''they had already given me
anesthesia when I signed the consent form for the
caesarian and they were still insisting that I would accept
the tubal operation and I was still saying, 'No, no, no.' "
Finally, Mrs. Diaz broke down. '' I was in great pain,''
she tells us. ''I thought I was going to die. The two other
children, the pain was nothing like this. I got angry and I
cried, 'If you're going to do anything, do it, but let me
have my baby now because I feel I am going to die.' I
remember very little after that because it was like a dream
and I was in great pain."
"Did you sign a paper for the caesarian?" I ask.
"For the caesarian, yes," Maria Diaz answers, "but
for the tubal-no.''
"Is it possible that you told them verbally to go
ahead?" I inquire.
"I know that I didn't because there was a nurse or a
receptionist at the hospital who showed me the chart and
there was no indication that I approved. The chart said I
rejected all their efforts for sterilization, but I don't
remember everything. It's possible in the pain ... but I
don't remember doing that."
Mrs. Diaz discovered she was sterile some weeks later
during her post-natal clinic visit. "When I heard that, I
started to cry," she recalls. "The doctor said, 'Don't cry.
It's best for you that you not have any more children. In
Mexico, the people are very, very poor and it's best that
you not have more children. At that moment, I thoughtbut I didn't say it, 'What is it to you? You're not my
husband.' ''
When Mrs. Diaz wrote her spouse of the operation, he
sent back a letter saying he didn't understand what she
was talking about.' 'To this day,'' she says-speaking in a
low voice, so that her husband, who sits outside, will not
hear, "he is very angry. There are constant problems.
Fighting. He says, 'Surely we will part. You neverlacked
home. You never lacked food. Why did you let them do
this to you?' "
Since the operation, Maria Diaz says, she has become
nervous, rare. That's the word she uses: rare. "Now the
child is three years old and I think I should be pregnant
now, according to the pattern I'd established, but I can't. I
go to the doctor every month for the nerves. For a year, I
was sick with the wound-the scar that did not close .... I
-2-
...
feel very bad and I want more people to know this so it
won't happen to someone else."
"She's a brave woman," Antonia Herandez tells me
later. "It's dangerous for her to speak up with her
husband not yet fully immigrated. We could have had
many, many more plaintiffs on the lawsuit, but the
women were afraid of the Immigration and Naturalization
Service . . . . "
About the lawsuit: Mrs. Diaz, Mrs. Acosta, and nine
other Los Angeles area Chicanos are suing USC-L.A.
County Medical Center, certain John Doe doctors (the
women do not know the names of their sterilizers), the
State of California, and the U.S. Department of Health,
Education and Welfare. These women, with one exception, were all sterilized at County; they claim the practice
of pushing these operations on the poor is a part of
national sterilization epidemic they want stopped.
The plaintiffs demand a new set of self-enforcing Federal
guidelines that will make coercion more difficult; consent
forms in English and Spanish; consent forms written on a
reading-level comprehensible to all women; conformity
by California with the 1974 Federal ban on sterilization of
women under the age of twenty-one-the California limit
is eighteen. What's more, the women are suing for
financial damages. ''We are asking for money,'' explains tion: Present Abuses and Proper Regulation," the death
Antonia Hernandez, ''because money is the only thing rate on hysterectomy (often improperly used for sterilizathat doctors understand."
tion) is 1,000 deaths per million; for tubal ligation, 1,000
To prove her point, Hernandez hands me the legal per million; for laparoscopic tubals, the mortality rate
documents of Dolores Madrigal et. al. v. E. J. Quilligan, goes down to 300 per million. According to that same
Director of Obstetrics at USC·L.A. County et. al. These study, the death rate for IUD is nine per million women;
documents are so filled with pain that even the cold, for pills, it is thirty-one per million. It should be said,
objective tone oflegalese cannot blunt the suffering that however, that we still do not know all the long-term effects
has obviously occurred:
of use of the birth control pill. There has yet to be a full
Maria H ustado: '' I do not remember the doctor telling generation of women who have used oral contraception
me anything about tubalization. All that I remember is for their full fertility-life. It is possible that ten or twenty
after the doctor injected my dorsal, spinal cord, he told years from now we may see a cancer epidemic among pill
me, 'Mama sign here. No more babies. Sign here.' " users; the evidence still isn't in. But the point is this:
Maria E. Figueroa: '' ... A doctor asked me if I wanted basedonwhatwenowknow, as dangerous as the Pill is, it
to have a tubal ligation .... I told the doctor that I did not seems to be safer than sterilization.
want to be sterilized since my husband and I planned to .
Once a woman has had a tubal, she must consider
have another child .... I was groggy from the drugs, herself pe~manently, irrevocably sterile. Legal remedies
exhausted from the labor, as well as from the doctor's for coercion are rare, expensive, and generally unavailconstant pressuring. Finally, I told the doctor, 'Okay, if able to the poor. Besides-no judicial award can ever
it's a boy, go ahead and do it .... My daughter Elizabeth compensate a woman for her stolen fertility; a woman
was born by caesarian operation. While my husband was involuntarily sterilized suffers many of the permanent
visiting me in the medical center, the doctor came to my psychological impairments of a rape victim. Between 10
bed and informed me that he had performed a tubal and 30 per cent of all women who agree to it later regret
ligation on me."
the operation. Though a costly operation for reversal
Reading through the papers, one begins to perceive a . exists, it is successful in only 10 to 20 per cent of all cases.
pattern. Few of the plaintiffs spoke more than minimal
But the doctors told the women little of this. Consent
English; they were Mexican and poor. The women were forms were pushed at women in the throes of laborpressured into the procedure during the stress and agony women who were drugged, women who were under
of childbirth-a time when they could not possibly make anesthesia. Sometimes, the physicians even disposed of
an informed decision about an irreversible operation. the minimum legal nicety of a signed consent form; they
Even if they had spoken the language. Even if they had simply cut without permission. And, if one is to believe
been given all the facts.
the sworn affidavits of eleven women, the L.A. County
A few unadvertised, unpleasant bits of information obstetrics staff, in its zeal to sterilize, was dispensing
abouttubal ligation: the death rate is significantly higher medical misinformation as it it were aspirin. Though
than for long term use of the IUD or the Pill. According to tubal ligation is one of the few operations that is 99 per
the Health Research Group study on "Surgical Steriliza- cent elective, an unusual number of Chicanas were told
-3-
'Ultimately , we are all, as Guadelupe Acosta understood ,
helpless in the face of a medical system that has little accountabi lity.'
that would die if they did not submit. Some patients were
misled into thinking their tubes could be "untied" at
some time in the future. Others were told that there were
legal or medical limits on the number of caesareans that
patients were permitted-an untruth to say the least. As
Dr. Alan F. Guttmacher, the leading American authority
on contraception, explains: "By tradition the American
obstetrician is prepared to sterilize any patient who
desires it at the time of the third caesarean section. How
magic number three was derived is unknown to me.''
"It would be a mistake to think of the situation at L.A.
County as an isolated fluke. This is happening all over the
country," asserts Dr. Bernard "Buddy" Rosenfeld, the
thirty-three-yea r-old co-author of the Ralph Nadersponsored Health Research Group study on forced sterilization. To prove his point, the two of us sneak our way past
security at USC-LA. County's dormitory for house
staff. Rosenfeld wears his medical wbites-he is an MD; I
wear a most unjournalistic pair of dungarees. We knock
on doors, introduce ourselves as researchers doing a
"rough study" on informed consent practices, and ask
interns and residents to tell us what they have witnessed
at other institutions where they have trained. None of the
physicians we speak with know that I am a reporter, that I
am making careful notes after each interview, that their
comments will see print.
Rosenfeld and I are looking for two things: we want to
know whether the L.A. County house staff, recent arrivals
from some of the ranking medical schools around the
country, have seen abuses similar to those that have
occurred here. We also want to know whether the 1974
Federal guidelines against coercive sterilization are
being enforced. Those regulations specifically ban sterilizations on women under twenty-one; prohibit operations on women less than seventy-two hours after they
have signed consent forms; require a careful counseling
procedure so that patients truly learn that the operation is
permanent and that there are other birth control choices.
For Buddy Rosenfeld, our visit to County is an odd kind
of homecoming. In 1973, he was an obstetrics resident
here. Then, when he began to raise the issue of forced
sterilization with the house staff; when he began speaking with newspaper reporters; when he signed his name
to the Health Research Group study; when he made all the
noise that led to The Big Scandal-well, then, Rosenfeld
was "not renewed" for his second year of training. Dr.
Rosenfeld's training remains incomplete. He supports
his family by working the midnight shift at half a dozen
private hospital emergency rooms around Los Angeles.
E. J. Quilligan, Chairman of the L.A. County department
of obstetrics and gynecology, says, "Rosenfeld was
evaluated and found to be an unsatisfactory doctor."
"Nonsense," says Dr. Rosenfeld in reply. "My
evaluations were above average. Besides, I think what I
did was in the best tradition of medicine. I mean, I helped
curb some terrible suffering. Yeah, maybe I did ruin a
promising career, but L.A. County is now one of the
cleanest institutions in the country.''
Apparently, but that is hardly saying much. Judging
from our' 'rough study'' interviews, forced sterilization is
a part of academic training at more than a few major
teaching hospitals around the nation. The doctors we
interview seem to accept coercion as an everyday fact of
medical life-few of them are even aware of the moral
significance of what they have witnessed. For instance,
a friendly intern who has just completed studies at Wayne
State Medical School in Detroit, recounts the most
remarkable things in perfect innocence:
'' Most of our patient population was black, inner city,''
he explains. "We had a lot of young girls come in ...
thirteen and sixteen and they'd have two or three
children . In those cases, we'd ask 'em, often when they
were in labor, if they wanted tubal ligations. There were
so many young girls and most of them had a real low
mentality. We'd tell them about birth control and they
wouldn't take it. It would get some of the residents really
mad.
"With sixteen year olds, you needed the parents'
permission. That usually wasn't hard to get. The parents
weren't in labor. Some of the parents said, 'No.' They
liked having the babies around. Sterilization was offered
to women in labor no matter what their age. Those over
eighteen you didn't need the parents' permission .... "
''You mean you sterilized sixteen year olds?·· asks an
incredulous intern from Milwaukee, who has been sitting
on the side, taking the discussion in.
"Well, yeah ... if they had two kids. But we didn't do
many abortions, though. The residents didn't like to do
them. You know, you look at a fetus and you see it is a
formed human being, so we didn't do many. There was
beginning to be a whole lot of trouble. Detroit's blacks,
they're really very anti-white. They were having all these
meetings about 'genocide.' ''
A similarly pleasant doctor up the hallway claimed his
training institution, Jefferson Davis Hospital-Bayl or
Medical School in Houston, Texas, was a good deal less
discriminating:
"Our patient population was 80 per cent black, 15 per
cent Chicano and 5 per cent what you'd call poor white
trash,'' he twangs in a voice of pure honey. ''There wasn't
any racism there. No more than here. If a resident wanted
to practice doing a laparoscopic [tubal ligation], he'd
push it, sure. There was a basic social pressure that
-4-
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1
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three children were enough. If a woman came in with two
children and wanted a tubal, we would try to talk her out of
it. But if a woman came in with five children, we'd sell the
operation-sure. Women were approached in clinic and
sometimes during labor, sure. We'd ask a woman in
labor, if her chart wasn't available . . . . "
An intern who had done his medical school rounds at
UCLA-Cedars of Lebanon Hospital in Los Angeles: "I
did see instances of women in labor being asked. I didn't
see any prejudice against Mexicans or blacks per se, but
the ward patients weren't given as much information on
sterilization as the private patients. Often an intern would
say, 'I want to do a tubal.' That was a big influence in
prompting them to do it-they wanted to get another
tubal under their belt."
"Why are women approached about sterilization
during labor?" I inquire. "It seems so unfair."
"It's expedient," the intern explains. "Although it's
like asking a drowning person, do they want to get out of
the water."
A female intern in a nearby room had recently
completed obstetrics rounds at Riverside General Hospital in nearby Orange County. The patients there were
also Mexican. "I didn't see any real pushing but it was
often suggested after labor," she commented dryly.
''The doctors would say, 'Do you want to go through this
again?' Mostly, the doctor's individual philosophy
towards sterilization had a lot to do with whether or not a
patient was approached."
"You don't consider asking a woman about the
procedure after labor, pushing?" Rosenfeld asks.
"Not really," she replies. "Now when I was down in
Nicaragua, there we pushed. People would come in with
nine children and they didn't have food and we pushed
them."
A pediatric intern, formerly at New York's Bellevue
Hospital: ''There was a large Puerto Rican population
and I think a lot of women didn't know the full
consequences of what was happening to them. There was
a language problem. Many of the women thought their
tubes could be untied."
A former medical student from the University of
Chicago, where the patient population is primarily black:
"No one ever said to a woman, 'We don't trust you with
taking the pill,' it would be presented very positively.
'This is the best thing for you. This will be the easiest
thing for us.' Mostly, we'd approach women with large
families and we'd tell them this was the best solution.
We would explain the world population problem."
An intern previously at Barnes Hospital, St. Louis:
"Whether or not a patient was approached positively
about sterilization depended on the doctor's own approach. A woman on welfare with a large family was more
likely to be approached earlier than a woman not on
welfare. No one was pushed, though."
Another intern, formerly at UCSF-San Francisco
General Hospital : "It was always explained-if the
patient asked, yes, she'd be told it was permanent. If
there was a big rush, the staff wouldn't bother. There was
concern by some of the students that minority groups
were getting pushed, so the hospital became very careful.
They're slick now. Although official policy has changed,
the attitudes of the doctors didn't. They became slicker at
talking patients into tubals. Tubals are way up and the
birthrate is way down." ·
For three nights, Rosenfeld and I wandered through
the bleak hallways of the house staff dorm-a building
which one intern jocularly described as "decorated in a
style of early hysterectomy." We spoke with twentythree doctors. Nine of them had either witnessed coercion
or worked under conditions that could easily lead to it:
hard-selling, dispensing of misinformation, approaching
women during labor, offering sterilization at a time of
stress, on-the-job racism. At L.A. County, we found four
doctors who had worked at institutions where the
operation was softly, slickly sold. Only four physicians
could honestly and unequivocably state that they had
trained at hospitals that were clean. Six doctors gave us
answers that amounted to "no opinion." Of those six,
three had trained at Catholic institutions where sterilization is strictly prohibited; the other three were USC-LA.
County trained. "I didn't see anything," said one L.A.
County doctor defensively. Another L.A. County man
provided us with the most bone-chilling statement of all:
"I guess the problem we have here is a problem of
philosophies. Most of the patients are Mexican and they
have a different philosophy from us."
"At one major teaching hospital, the Women's Hospital Los Angeles County Medical Center, the following
increase in the number of sterilization procedures
occurred in the two year interval between July 1968 and
July 1970: Electivehysterectomy-742 per cent increase;
elective tubal ligatlon-470 per cent; tubal ligation
after delivery-151 per cent."
-HealthResearchGroupReporton
Surgical Sterilization, October 1973
''In 1968, my own mother went into County to give birth
to my baby sister. The doctors told her that ~he would
have to get her tubes tied because if she had another baby,
she would die. For the longest time, we were very
worried. But then, we went to our own family doctor and
he told us there was nothing wrong with her.''
-Antonia Hernandez, Attorney,
Model Cities Law Center
There is a wounded innocence to Dr. Edward James
Quilligan' s manner as he shifts about restlessly during an
interview in his textbook-lined office at L.A. County
Women's Hospital. Before this sterlization expose
broke, his was one of the great medical success stories: a
distinquished career; more than sixty professional publications; membership on nearly every important policysetting council within his speciality; the chairmanship of
the Obstetrics and Gynocology Department at USCL.A . County Medical Center, one of the three top
obstetrics residencies in the country. And now he must
-5-
face lawsuits and accusations and suspicious journalists.
"We have tried in every instance to comply with what
we thought was good medical practice," Dr. Quilligan
says. He is a fiftyish man; bald and heavy. "In my
opinion, there is no physician on staff here who wants to
sterilize people for welfare reason or other reasons. I
know these doctors and I've worked with them and I feel
they're solely interested in the patient's interest."
As for the Health Research Group's study on sterilization he grimaces at the mere mention of it.· "Yes,
certainly, their statistics are correct," he says. "I don't
have the figures in front of me, but I don't think the total
e".er got above 5 or 6 per cent of all who came in. This was
not a high sterilization rate compared to the rest of the
country. You would get the feeling from the article that we
sterilized everyone who walked in, when that just isn't the
case. We turn down a lot of patients for sterilization!"
"How do you manage that?" I inquire.
"Well, let'sjustsaywe counsel them so that they don't
want it," he replies.
That's a candid admission; It means that Dr. Quilligan
understands that the type of counseling a patient receives
will determine her ultimate decision. And at L.A. County,
until most recently, counseling was a haphazard busi-
ness, dependent on circumstance and the whim of the
attending doctor.
Dr. Quilligan is asked about Bernard Rosenfeld, who
has been conducting "informal studies" of physicians'
attitudes for some year now; Rosenfeld' s interviews have
shown thatthe L.A. house staff has witnessed a good deal
of coercion during training. '' Most of the patients that are
sterilized are seen by these residents here," asserts
Quilligan, "and they don't tell me that there's a lot of
coercive sterilization going on. And they object strongly
to Dr. Rosenfeld going around saying that they have."
'' So if there is very little forcible sterilization going
on," I interject, "then why are so many women suinghere and elsewhere? What's their motive?"
Quilligan looks at me coldly. "It's very difficult to
understand a patient's motives when she's changed her
mind," he explains. "Personally, I'mju·s t anxious to see
the patient get what she wants. Now, that can get you into
trouble because some patients will say, 'I don't ever want
to have another baby!" And the sympathetic doctor,
feeling he's done his best, sterilizes her. She may go
home and change her mind. Or she may find her husband
is angry. Suddenly, the doctor is the bad guy."
Bad guy or good guy? Something unfortunate was
'There Must Be More'
It is likely that a good many more stories similar to
the Aiken one will be coming forth soon. One night,
while in Los Angeles, Bernard Rosenfeld and I went to
the Martin Luther King Medical Center in Watts,
where we encountered a group of newly arrived
interns from Howard University Medical School,
Washington, D.C. One young physician told me:
"When I was at Howard, a woman came in through
emergency and when I noticed she didn't have any
children, I asked her why. She said she came from a
town in North Carolina and that in this town they
sterilized the daughters of every woman who was on
welfare when the girl turned fifteen. That's what
happened to her."
"I saw a few cases like that, too," said another
former Howard medical student. ''They were mostly
from that area-North Carolina, South Carolina.
They were routinely sterilizing the girls whose
mothers were on welfare."
A third intern, a young woman, joined in: ''I was at
Mount Bayou, Mississippi, Tufts Health Center and
two young women came in for a check-up. One was
sixteen. One was eighteen. The sixteen-year-old, I did
a routine pelvic on her. She didn't have a uterus and
shedidn'tevenknowit . .. . The eighteen-year-old had
a tubal ligation. I was only there three weeks and I
found two cases. There must be more." -C.D.
What is the dollar value of a black woman's fertility?
Low-if the woman happens to be a welfare mother in
South Carolina.
For some years now, an Aiken, South Carolina,
obstetrician named Clovis Pierce has been refusing to
deliver welfare mothers with two or more children
unless they agree to-sterilization. Two Aiken womenboth black-Virgil Walker, twenty-five, and Shirley
Brown, twenty-six, went to Federal Court this past
summer claiming that Dr. Pierce had, among other
things, violated their civil rights. The obstetrician is
white.
Mrs. Walker was actually sterilized, while Mrs.
Brown was kicked out of Aiken County Hospital with
her day-old infant when she refused to undergo the
procedure. Yes, the Federal jury agreed, Virgil
Walker's civil rights had indeed been violated; she
was awarded $5 in damages. Shirley Brown was given
nothing for her suffering.
Dr. Pierce considers the whole business terribly
unjust and is appealing the decision. He has a good
deal of support within the medical community. Dr. H.
Curtis Wood, an obstetrician who heads the Association for Voluntary Sterilization, told Les Payne of
Newsday some months ago: "I admire his [Pierce's]
courage. I'm sympathetic to his point of view.
However, I question his method."
-6-
happening at L.A. County because on February 22, 1974,
Dr. Quilligan was compelled to issue a memo to his
impeccable staff: '' Effective immediately, patients will
not be approached for the first time concerning steriliza- .
tion when they are in labor."
Nevertheless, Dr. Quilligan wants me to know about all
the fine improvements that have been made on his
service: "In early 1974, the HEW guidelines came out
- - ~ °'-.
stating that certain criteria had . to be followed if
Federally funded hospitals were to maintain their
grants. There should be a waiting period and the
minimum age should be twenty-one. We abstracted those
guidelines and put them out as law, here."
Not quite. In December 1974, Robert Kistler, an
investigative reporter for the Los AnReles Times, telephoned Quilligan to ask him ifhe was complying with the
then seven month-old HEW orders. The doctor answered
that he could not recall seeing them. So Kistler read the
rules to Dr. Quilligan, who according to the December 3,
1974, Los Angeles Times commented: "Well, I would
have to agree with that, in some areas, we're probably not
following them at the present time.''
Eventually, County did move into full compliance with
Federal regulations. There is now a special sterilization
counseling clinic, one offew in the country. ''What we're Health, Education, and Welfare has yet to move against a
doing,'' Dr. Quilligan explains, ''is that every patient has single institution named by the ACLU.
to go through the counseling clinic and they have to take a
It can't happen to me. That is the response of educated
test atthe end ofitto make sure they know what's happen- middle-class womeri when they hear about forced steriliing.'' A group of specially trained female counselors has zation. Not true. Doctors who learn to push sterilization
been hired. ''They can have little rap sessions with the on indigent patients during training will do the same in
girls and ask questions," he says.
private practice. There is profit in it. A gynecologist earns
Finally, Dr. Quilligan wants us to know what a trial this nothing for dispensing condoms or the birth-control pill.
has been for the hospital. "The thing that's bothered me The bill for an IUD insertion is rarely more than $100.
most,'' he complains, ''is how the adverse publicity has However, average fees for a tubal ligation begin at $300.
affected our patients .. .'. They come here in great fear, Elective hysterectomy is $600-plus. I remember that
feeling that we're going to grab them and sterilize honey-voiced gynecologist-to-be from Houston whom we
them-which is the furthest thing from our mind.''
spoke with one summer evening in the L.A. County dorm.
His eyes gleamed when he spoke of hysterectomy: "In
It can't happen here. That is the defensive response Houston, a lot of well-to-do women would come in and
most people have when I tell them the L.A. county story. they'd want hysterectomies because their friends had
Interestingly, USC-L.A. County Medical Center seems them. Maybe the indications weren't so strong, but why
now to be one of the few institutions in the United States shouldn't we take her womb if it makes her feel better?''
actually conforming to law. According to a study made by Several of my friends have recently submitted to tubal
ElissaKraussfortheAmerican Civil Liberties Union, few ligations; the doctors call it "Band-Aid surgery." Yet,
major teaching hospitals are following the 1974 HEW one study showed 1,594 serious complications and
orders. ln November 1974, when the guidelines were nineteen deaths of out 63,845 operations surveyed. My
nearly half a year old, Krauss sent questionnaires to the friends are middle-class and well educated. Nevertheheads of OB-GYN departments of 154 ranking teaching less, the same medical practice that sell tubals to the poor
hospitals. Less than a third of the queried chairmen under the stress of labor, sells my affluent friends the lie
granted the ACLU the courtesy of a reply. And of the of Band-Aid simplicity for a dangerous operation.
Ultimately, we are all, as Guadalupe Acosta underfifty-one respondents who did answer the poll, one in
three gave replies that showed conformity with the letter stood, helpless in the face of a medical system that has
and spirit of the Federal guidelines. ''Thirty-six major little accountability. It was Mrs. Acosta, of all the
teaching hospitals are in non-compliance with Federal protagonists, who had the sharpest focus on what had
regulations on sterilization," said the ACLU report. happened. I once asked her if she thought the physicians
''These institutions-plus another twelve hospitals re- at L.A. County were racist. "I don't know about things
sponding to this questionnaire-should be subject to like that,'' she replied, clutching at her two babies. ''You
immediate withdrawal of funding because they are in go to the hospital so sick, so dependent, one doesn't ask
complete non-compliance .... " But will those hospitals questions."
D
Few of us do.
lose their Federal monies? Not likely. The Department of
-7-
Tu rn Am eri ca Aro un d...
one pers on af a time .
Reprints from The Progressive are especially valuable to students,
consumer groups, environmentalists, and others working
for change and new priorities.
26. There Isn't Much Time
18. Who Will Plan the Planned
Economy?
Repr ints
George Wald
"We live in a highly lethal society. We now
have it in our hands to wipe out all humanity
and much of the rest of life on earth . I am
one of those scientists who still find it difficult to see how the human race will get itself
much past the year 2000. So there isn 't
James Crotty and Raford Boddy
1. Nuclear Power: Uninsurable
Herbert S. Denenberg
" Is the present state of nuclear power techExa mine the willingness of
nology safe? .
the nuclear establishme nt itse lf to assu me fi nancial respons ibility for accidents and their
co nse quences .··
2. The Food Monopolies
" The developmen t of detailed economic plan ning wIth1n the present array of political
forces in the United States undoubtedl y
means corporate co ntro l. .. We need a democ rati c. socialist . national political organiza tion to break the power of the co rporations
and the super -rich who own and co ntrol
much time. "
27. Sterilizing the Poor
them ."
Claudia Dreifus
23. Nuclear Fuel: the Hot Shuffle
Dan iel Zwerd ling
• Did Great Wes tern Suga r. with its 2.000 per
ce nt profit increase . soak its consumers to
help pull ,ts sagg ing real estate ve nture out of
despe rate f1n anc1a l straits?"
(Also inc luded Exporting Fo od Monopo li es
by Danie l J Baiz )
3. Dead End: America on Wheels
Robert Erwin
·· Th e point ,s that th e automobile tends
toward whatever leve l of inefficiency is necessary to ex haus t whatever resources are avai lToday ·s standard American car gets
abl e
fewer miles to the ga ll on th an did ,ts predecesso r fifty year s ago •
"The women, few of whom spoke more than
minimal English , were pressured into the
procedure during the stress and agony of
childbirth . . . . ' I do not remember the
doctor telling me anything about tubalization . All that I remember is after the doctor
injected my dorsal , spinal cord , he told me,
" Mama, sign here. No more babies. Sign
McKi n ley C . Olson
" If we are to believe the claims of the nuclear proponents. then we have to assume
that accidents never happen. emergency
systems always work . storage facilities never
leak . trucks and rail transportatio n are accident and sabotage free . and that a society
will exist stable enough to contain radi oactive wastes for thousands of years."
here."'"
l~nd More Reprin ts
24. Socialism for the Rich
Sidney Lens
4. Chile: The Dream Bides Time
it is where corporate soc ialism is going
- permanent economic crisis, perverted
social priori ti es, internal dictatorship , and
war - th at is decisive. The choice for the
7. Running Out of Everything
United States in the 1970s is not between
Sidney Lens
socialism and a free enterpr ise capitalism
that ex ists only in the dark recesses of
·· our prosperity was built on th e quicksand of
Rona ld Reagan's imagin ation , but between
m1iltarIsm and monopoly We mortgaged our
!thusJ we have arrived ai . corporate socialism and true , participator y
future to both
socialism ."
the sho rtage economy . intractable inflation .
and a loom ing depression •
Pat Gar rett and Adam Schesch
5. The Great Drug Education Hoax
Seymou r Halleck . M.D
6. The Saturday Morning Massacre
Joseph J. Seldin
13. Vietnam: The Aftermath
25. Mishap: July 5, 1976
16. On Justice for the Palestinians
I. F. Stone
" I want to see Israel live [but] we are in dan ger of bowing down to the idols of militarism
and force and realp olitik . If we do not pursue
the path of reconciliatio n . the Jewish people
will be transformed in the span of a generation . we cannot harden our hearts against
our Arab broth ers and remain th e kind of
people we have been proud of being for 2.000
years ··
Fred Branfman
Richard Lipez
15. Indians, Coal, and the Big Sky
" Dear Customer :
You have no doubt read about the big
exp losio n at our southeaster n New York
nuclear generating plant last Th ursday
afternoon;• W e ll. as the wise man said ,
accide nts WILL happen. A s your electric
compa ny has pointed out, the odds against
a boo-boo of this magnitude taking place
were so mething like eighty-seve n trillion !o
Fred and LaDonna Harris
17. Partners: Labor and the CIA
Sidney Lens
22. Appalach ia: The View from the
Hills
John Egerton
one. WELL! "
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~PR(K;RESSIV
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Back issues of The Progressive are
available in limited quantities.
Queries invited.
Sch mid t said that the FDA had ar•
ranged with A.H . Robins Com pan
y
(ma nufa ctur er of the Dalk on Shie
ld)
to limit dist ribu tion of the IUD to
doc tors who agree to register each
pati ent at the time of inse rtion of
the
device and maintain follow-up reco
rds.
In this way, Sch mid t said, the need
ed
safe ty data will be coll ecte d.
According to the FDA, the tota l
num ber of reco rded sept ic abo rtio
ns
associated with use of all IUD 's is
287 ; of these 219 occur.red in wom
en
using the Dalkon Shield. Say ing that
"on the basis of all the evidence
we
can get, the IUD is a safe, reliable
and
perf ectl y acce ptab le alte rnat ive to
oral cont race ptiv es," Sch mid t claim
ed
that the figures do not yet prove
that
the Dalkon Shield is less safe than
othe r I UD's.
- The Spokeswoman
PEACE NEWS WINS AWARD
The British pacifist magazine, Peac
News, recently won an award frome
Gra nada TV for the "Sc oop of the
Year." The pub lica tion had prin ted
an
article last year abo ut how a cert
ain
British colonel had made_plans for
a
civilian "vol unte er forc e." At the
award dinn er, the thre e Peace New
s
staffpeople refused to stan d for the
trad ition al toas t to the Que en. Inst
ead
of a meek and grateful acce ptan ce
speech, the spok_esperson for the
~ollective spoke of Brit ain's sup_press1on
of
a mut iny in the United Kingdom
. And ,
instead of being shoc ked and angr
y,
the audience appl aude d war mly .
You can con tact Peace News abo
thei r award-winning stor y at 6 Elm ut
Stre et, Not ting ham , England.
/
I
•
\
WORLD WAR I PACIFIST DIE
S ings and
dist ribu te leaflets. Elsewhere
Louis P. Loc hner , a leader of the
Amer- the peace ship had to be con
tent with
ican peac
e mov eme nt befo re and durbom bard ing the coas t with radio
ing World War I, died on Janu ary
message
s.
eigh th at the age of 87 in Wiesbad
en,
The
voyage of the peace ship was
W.est Ger man y. In the years befo
re
the first dram atic anti war dem onst
World War I, Loc hne r beca me one
raof
tion of mod ern times. Unf ortu nate
the best kno wn peace advo cate s
ly,
in the
both in Ame rica and Eur ope , the
cou ntry because of his num erou s
peace
lecship
was
ridiculed by the press in
ture s on pacifism to college audience
s
num erou s artic les and cart oon s.
und er the spon sors hip of the Ame
As
rican Walter Millis, the military
hist oria n, rePeace Soc iety .
flected in 193 5, "the Peace Ship ..
Loc hne r with drew from the Ame
.one
riof the few really gene rous impulse
can Peace Soc iety when that orga
s of
nizathos e insane years, had been snuf
tion , the first peace orga niza tion
fed
in
out with a crue lty and a levity whi
Ame rica, foun ded in 182 8, decided
ch
were appa lling ."
that it was all right for pacifists to
Like man y pacifists, Loc hne r was
fight in the War to End War. He help
ed inte rest ed in war . Mor
eover, he was
star t several new groups which conlucky enou gh to be bure au chie f
tinu ed to opp ose the war, includin
of
g
the Associated Press in Berlin from
the People's Council for Peace and
192 4 to 194 1, duri ng the rise of
Dem ocra cy, the first maj or coal ition
Hitler.
of He was the first foreign corr
espo nde nt
pacifists and socialists.
to follow Hitl er's arm y in its inva
Loc hne r's mos t dram atic acti on
sion
of
Poland in 193 9 and received a
against war was helping to organize
Pulitzer Prize for his repo rting that
the voyage of an ocean liner whic
h
year
. His war repo rting was so objectravelled across the subm arin e-in
fest ed
tive and disp assi onat e that his Ger
Nor th Atla ntic in Dec emb er 191
man
5 to
con tact s wer e genu inel y surprised
urge the cou ntri es at war to stop
fightwhen he den oun ced fascism after
ing. With the help of the Hungari
he
anwas
released from a brie f inte rnm ent
born pacifist Rosika Sch wim mer
,
following Pearl Har bor and allowed
Loc hne r pers uade d Hen ry Ford to
to
retu rn to the Uni ted Stat es. Loc hne
und erw rite the cost of char terin g
r
the
wro te several boo ks and was an edit
Scandinavian-American liner Osca
or
r II
of the Goebbels Diaries. During the
for the voyage. Several neutral coun
early 196 0's he was a radio com men
tries allowed the activists to hold
tameet- tor.
-He nry Bass
ster iliza tion of Pue rto Rican wom
en as
the principle solu tion .
JOHN MA RK S-C O-A UT HO R
Num erou s stud ies place the num
ber OF CIA EX PO SE -EX PE
-Ne ws Desk of Pue rto Rican wom
LLE D
en of child-bearing FROM SOUTH
VIE TN AM
ag~1whAocchoarvde_ naglret adtyhebep~~rst:r~/
SECRET GO VE RN ME NT
~:~ at John D. Marks, co-a utho r of The CIA
35 10
1 0
•
REPORT REVEALS PLANS
and the Cult of Intelligence, was ardem ogra phe r Dr. Jose Vas quez CalTO "RE DU CE TH E WO RK ING
rested in Saigon Dec emb er 26 and
zada
,
35.3
%
exof Pue rto Rican wom en
pelle
d from the cou ntry the following
SECTOR" OF PUERTO RICO
betw een the ages of2 0 to 49 year
s
day. Marks, a form er foreign serv
have been sterilized.
BY STE RI LIZ ATIO N
ice
officer atta ched to the US emb assy
And a stud y don e at the Universit
in
y
Saigon, had arrived five days earl
of Pue rto Rico, based on the Mas
ier to
A hith erto secret repo rt from the
ter
do research for a magazine artic le
Sam ple Surv ey of the Dep artm ent
Gov erno r of Pue rto Rico 's econ omi
he
of
planned to write.
c
Health (con duc ted qua rter ly to inve
policy grou p which tal~s open_ly
sti:i.nd
gate medical aspe cts of the island
According to Saigon imm igra tion
dire ctly a_bout alternatives available
's
officials, Marks' nam e is on an inte
pop
ulat
ion)
show
s
that
it
is
rior ,
indeed the
for reducm~ the num bers of the
Pue rto wor king class which is
dep artm ent blacklist of persons conbeing reduced.
~ica n W?~k,~g class by mean_s of th
sidered "un desi rabl e" by the Thie
e masThe highest rate of ster iliza tion ocu
S1Ve sten hzat 1on of Pue rt? Rican
~om gov
ernment. The officials exp lain ed
cure
d
amo
ng
the $4,0 00-$ 5,00 0 per
that
en has rece ntly surfaced m the Uni
Marks mus t have ente red the cou
ted
year inco me brac ket. Fort y-th ree
ntry
perStat es.
. .
thro ugh "a slip at the airp ort. "
cen t of wom en in this grou p had
Enti tled "<?pportunit1e_s ~or,~mp
been
Before he was expelled by the Thie
loy- sterilized .
•
u
men t, Edu cati on, and Tram mg
gov
ernm ent, Marks had managed to
and
The
stud
y also distinguished with in
indate d November, 197 3, the repo
terview several mem bers of the anti
rt
the whit~ collar brac ket betw een
·
cites the prob le": of u~e mpl oym
"pro - Thie u Thir d Forc
ent,
e and journalists, and
fess
iona
l"
and "non -pro fess iona l
and discusses as its mam solu tion
had requ este d interviews with US
the
wor kers " show ing the rate of steri
emneed to "red uc~ the grow th of ~he
liza- bassy officials. late r
Marks said he
tion
to
be
muc h higher amo ng "no n- .
wor king sect or' of the populat10
was 98% sure that
professional wor kers ."
line of atta ck focuses on the mas ~. Its
-LN S involved in his exputhe US emb assy was
sive
lsio n.
-LN S
• 18W IN
)
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I
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F./e ~ ,.. J · t.:.
POLICE KILL OVER 50 VILLAGERS PROTESTING MASS / /
FORCED STERILIZATION IN INDIA
11 ~ 7J,,:,
NEW:YORK (LNS) -- At least 50 people and perhaps
as many as 150 were killed October 18 when police
opened fire on villagers protestin g mass forced
steriliza tion in India.
The vill agers said that when police rounded up
fourteen men who had more than two children, a crowd o
of 4,000 to 5,000 people came to their defense. Villagers told an Associate d Press reporter in Muzaffarn agar,
about 100 miles northeast of New Delhi, that hundreds
of people were hit ..when policenop ened ~fire : into the
crowd. Others were roundeau p and shot in the marketplace later in the evening.
Ther e has been no way to determine exactly how
many were killed, the villagers said, as some bodies
were found in the river and others were buried secretly.
Over sixty people were killed in a similar demonstra tion in Delhi in April.
Prime Minister Indira Ghandi referred to the
go;;·c:rnme nt's steriliza tion campaign -in an October 27
speech to parliamen t and admitted that, "some deaths
have taken place, due to firing." While Mrs. Ghandi
insists that "there is no coercion in the national
family planning program," the governmen t has used its
Dec.l aracion of Emergency of 1975 to turn the campaign
into a massive assault on poor Indians.
The federal governmen t has set steriliza tion
targets for each state, giving the state governmen ts
wide latitude in their methods for reaching the targets . At least three of the 22 states have drafted
bills prescribin g jail terms for one member of a
couple who does not voluntari ly limit their family
to three children.
Leaders in the town where the recent demonstra tion
was held said that regional authoriti es told ricksha
pullers, shop keepers, poop people with governmen t
ration cards, and most others who need governmen t licenses that th~y would lose their credentia ls if they
did not volunteer for steriliza tion.
"The governmen t policy," wrote New Asia News
reporter Ashok Mukherji recently, "involves the
propagati on of the official ideology of family planning . The idea that 'populatio n causes poverty' in
many ways fits the prejudice s of the bureaucra tic
elite . It is doubtful that India's rulers really
believe the ideology. There are too many Indian
agricultu ~al experts saying that India could relatively easily double its food productio n.
"Bue real agricultu ral developme nt would involve
both investmen t and large-sca le mobilizat ion of human
labor power . This, however, is not the developme nt
policy that the governmen t of India has been following .
Increasin gly since the State of Emergency , the emphasis
has been on export and reliance on Western multinationals .. . like the 'Brazilian model' which requires
a relativel y small, but 'disciplin ed' labor force .
l-zM
the S ilva appointment. The A rchdiocese of
'.f;1:~··" ·::~ ~-"-_,New - York
recently purchased New York
• .. • -Medical College. an affiliate.of. Lincoln. Met• •
"nierous ront~~versies'over the years; In the. i ropolitan and Miseracordia Hospitals. These"
•
• '
early 1970s,act1v1sts took over the hos 1talandJ ':. sources felt that the church may be using it!\ inNe~ York_ City· appointment ::_ -· demanded community control~•~ti"'.·"7,.
.~~- fluence at Lincoln to push for"an increased
.
, "' ,· ., . _. • .. :1, ,-,..J,·~--:.::.t;'•.
The sterilization of Puerto Ric~'n'wome_n i~ , . sterilization program in order to reduce the
~: • ... Feminists and advocates of Pllerto Rican ~·-· New Yor~ . City and on the island · is part o(•
necessity for abortion services/- .·:.j{. ~ 1--· •. - fJl:·r::.:
independence a're objecting to the recent ap-:;Z_ ,. farger program of population control imple: .-~-~~- A spokeswoman from the health andhospj':a:·
pointmcnt of a pro-sterilization .official as •_.,,. mented almost three g_enerations ago'. In New ·
tals division of the Archdiocese claimed that
' director ·or obstetrics and gynecology _at New_,,,._ York City: l.ati[io .women are si~ times more .
the church had no ihnuence on appointmen~
.•
. York City·s Lincoln ~ospitaL .' .... - - '-:.;-:-..:·, '~likely than white_s and_ t_hree ti~es ~~: likely
at Li~coln. ev.en though a monsignor sits i:>~J,h~-.. •• f The doctor. Antonio Silva. was formerly as-'~_,. than Blacks to be stenhzed. MariY,,imes conhospital board . . -·
. ' • • *,,;-i.l••••d• :
' - sistant secretary Qf,the Family Planning As:.
-sent 1s ootained in a lan,.guage unknown to the '. '.
In the past, the church has'sanctioned steri'
sociation (FPA) in ·P uerto Rico. The federal
patient, during childbirth or abortion . Prior to • lization and has turned a deaf ear to foes. of
-:.
govern~ent funds 80% of the FPA•s budg~t. the 1977 establishment of inonitoring laws;- .... steriliz.ation abuse whil!! vehemently opposing
• ..;.,
The association is the key sterilization agency , ; one-third of the women w_ho agreed to be steri~
abortion rights . Officially. however. the Na.on the island . .. :° · --'::,, ~, ·..,: ••;__ • ·: :
•.' • ·: li1.ed did not know it was irreversible.
.•
tional Council of Catholic Bishops extended
• -~7 ;'..( . Progressives ha~e long protested the excep: -..,r;:.. Some re productive rights _movemeni
its intervention in a woman's righttochoose by
.::t,"i. tionally high rate of sterilization in Puerto':', ·_activists and members of the city . hospital
denouncing all sterili1.ations. In a July I0state-~';;'. ( Rieo. which is widely viewed as a third world::~·· · system cite an economic reason for Silva's ap. ment. the council .said that "even if done f~r
>''..•
• testing ground for population c_ontrol ideas:·,
pointment. The state legislature may cut Medi- ..
medical reasons." sterilization through the
, . Some one-third of all Puerto Rican women o( . -~ caid funding for ahortions from the financially '
widely used procedure of tubal ligation is im~• childbearing-age have been sterilized: .• .... ·.:-, strapped ~ity hospitals: St~rilization. however,
moral except for~gr~ve reasonsextrinsictot~e
~- . .:.. . Most of the patients at Lincoln Hospital are .
w·111 remam 90% Med1ca1d funded . Increased .
case." According to a U.S. Catholic Conferthird world people. Many of them are Latino, ..
rates of sterilization can provide ah important : ence· spokeswoman, an example of a ~grave
specifically. Puerto Rican . The hospital is lo- ·: ·, source of income for public health facilities /~
reason" would be a threatened hospital closing
cated in the heart of the South Bronx, a poor, "_·:..
In addition. some sources have expressed
if a sterilization was not performed . .:
•~
•· Latino -area,' and has been the center of .'. concern over the role of the Catholic Church in
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The Wom en's Center
Reid Lectureship
Novem ber 10 and 11, 1976
Two Lectures by Helen Rodriguez-Trias, M.D.
·r
Barnard College
New York
I
I
•~••
The Women's Center
Reid Lectureship
November 10 and 11, 1976
Two Lectures by Helen Rodriguez-Trias, M.D.
Barnard College
New York
TABLE OF CONTENTS
A Woman Doctor's Perspective on Women
and the Health-Care System ....... . . .. . .. .. . 1
Sterilization Abuse ........ . .... .. . .. . .... . .... 12
Cop)ITight © l978TheWomen 'sCenter, Barnard College, New York , N .Y. 10027
All Rights Reserved
Permission to reproduce and/ or translate
will be granted by the Women's Center
~ ~ 159
ii
INTRODUCTION
The Women '.s Center annual Reid Lectureship is designed
to bring to the Barnard campus distinguished women who
have shown commitment to the problems of our sex and to
the betterment of the human condition. In the two days the
lecturer spends on campus, she has the opportunity to
immerse herself in our program in a continuous dialogue
with students, alumnae, and other members of the Barnard
community.
The first Reid lecturers were two outstanding writers,
June Jordan and Alice Walker, whose talks were reprinted in
the first booklet in this sen·es. We are proud that this year's
Reid lecturer shares with Jordan and Walker sensitivity, a
commitment to social change, and a feminist perspective.
Dr. Helen Rodnguez- Tnas lived in Puerto Rico until she
was ten; she spent the remainder of her formative years in
New York City. She returned to her homeland for college,
marn·age, the beginning of her family, and then, after an
interruption of several years, premedical and medical study.
She graduated from the University of Puerto Rico Medical
School with the highest honors, first in her class. She started
her postgraduate training as a conventional academic with
speciality training in pediatn'cs and research credentials in
neonatology.
As her career developed, Dr. Rodnguez- Tnas was struck
by the sen·ous contradictions between a physician's
dedication to quality health care for everyone and the reality
of a dual-track health-care system - one system for the n"ch
and one for the poor - that existed and continues to exist .
This disturbing situation led her to seek a new career in
community medicine, which in 1970 brought her to Lincoln
Hospital in the South Bronx as director of the Department
of Pediatn·cs in an embattled hospital in an embattled
neighborhood.
V
From Lincoln Hospital, Dr. Rodriguez- Tnas went to the
faculty of the Biomedical Program at City College in 1975.
There her course in social medicine bn·ngs students in direct
contact with the living contradictions of their patients-to-be.
Under her supervision, students walk through the
neighborhood, conduct a census, observe the services that
exist, and listen to the people of the community descn·be
their situations. When these students ultimately complete
their basic science and clinical rotations, they will have had
an extra dimension of exposure and understanding, unique
in medical education in the United States.
Most recently, Dr. Rodnguez- Tnas has been forced to
confront still another contradiction in her life, that of being
a woman and dealing with women patients and women
health-care workers in a setting where the ground rules have
been defined by upper- and middle-class white men. She is
now a strong advocate in the movement to combat
sten"lization abuse, a condition that affects poor and thirdworld women who have little or no political power.
This publication, made possible by a generous gift from
Lynn and Harold Strudler, contains the two lectures
delivered by Dr. Rodnguez- Tnas at Barnard, on November
10 and 11, 1976. In the first, "A Woman Doctor's
Perspective on Women and the Health -Care System," Dr.
Rodnguez- Tn·as shares some of her personal and
professional recollections with us. In the second, she focuses
on the important issue of sten'lization abuse.
The Women's Center expresses its gratitude to Carole
Lopate, Natalie Meadow and Jane Wholey for editorial
help.
Esther Rowland
Executive Committee of the
Women's Center and
Pre-Professional Adviser
Barnard College
November 1977
VI
A Woman Doctor's Perspective
on Women and the Health-Care System
It is an honor to be invited here by those who have created
a living Women's Center at Barnard . I am also happy to be
here because my first contact with the women's movement
occurred five and a half years ago at Barnard, at a large
conference on abortion .
At that conference, women, mainly but not exclusively
young, converged from all parts of the country eager to
share experiences and to free themselves and their sisters
from the dangers of illegal abortions. I heard women from
the Southwest relate the experiences of Chicano women; I
heard both black and white women from many states speak
of their own experiences, and above all I heard the anger
and determination to fight social inequities reflected in their
treatment. And I was deeply moved . These and many other
women's voices have been raised in struggle to change a society which downgrades our womanhood. They are defending the best human values. And I am proud to add my own
as I attempt to share with you episodes of my own growth as
a woman, as a mother, and as a physician .
I shall try to show how my personal experiences have led
me to the belief that before we can change health-care struc tures for women, we must first identify and confront the for-
ces that oppress women and others who are without power. I
believe that the identification and confrontatio n of the oppressive forces must first occur within each of us . My own
consciousness of these issues arose partly because , after a
brief schooling in the United States , I was educated and
trained as a physician in Puerto Rico. So I came to under stand the relation between elitism in medicine and questions
of hierarchy and status in the American colony. The
medical profession reproduces the hierarchical structure of
the surrounding society; in the colonial setting, where the
power lies outside the colonized nation , medicine reinforces
the dependence and oppression of the people.
The birth of my first child, a daughter, marked my first
conscious contact with the health-care system in the United
States . I still draw upon those experiences to maintain my
sensitivity to others' feelings in the health-care setting.
I was conveyed in a wheelchair (women in labor were not
supposed to walk) to the dingy , bare labor room of the ward
service at one of our still -standing voluntary hospitals in East
Harlem . On the way I was asked by a resident in obstetrics
whether I knew anything about natural childbirth . I answered that I had read the then -popular book , Chi'ldbirth
Wz'thout Fear, by Grandy Dick-Read, whereupon he wondered whether I was willing to try it. I replied that I did not
feel ready , a truthful statement because "prepared childbirth" does by definition require preparation. I thought that
since I had not been so prepared . I should receive sufficient
sedation to induce something like a twilight sleep . My misconception, deliberately fostered during that time , was that
labor was made painless by all the wonderful doctors and
their miraculous painkillers.
The young doctor expressed disappointm ent at my deci sion, and then spent the remaining hours of the night shift
discussing with a colleague, within my hearing. the clinical
details of the tearing of tissues in childbirth . All the while I
2
writhed in pain, fear , and loneliness, with an unsympathet ic
nurse admonishing me to keep quiet. I later found out that I
was an unwitting control subject in an experiment involving
"primiparas with and without emotional support. " I was the
"without ," as I continued my nightmare in that lonely room a nightmare in which scopolamine , a hallucinatory drug ,
played a role . I have since wondered whether there wasn't
just a touch of sadism in the doctor's pursuit of clinical ex perimentatio n. I may never know .
My second set of formative experiences occurred in Puerto
Rico, where I spent the '50s and '60s studying, raising a fam ily, working in the medical school , and otherwise adapting
to the constricted life of the island. Education in the colonial
setting is curious in that it fosters excessive delusions of om nipotence within the reality of extreme powerlessness. In a
nation where for three generations children were forced to
learn - or , rather , mislearn - their subjects in a foreign lan guage , where the daily violence perpetrated against a people
and a culture has battered human dignity for 78 years, in
this nation the university was dedicated to the exploration of
"Western culture" and "universal values ." Of course, no student organization s were allowed on campus, save the most
frivolous fraternities and sororities.
My medical school was simply an extension of my earlier
education. Patterned after the most conservative schools in
the United States, the University of Puerto Rico Medical
School pursued its schizoid way into the technocratic
labyrinth of medicine as we know it today. Its graduates, like
those of most medical schools, would in the main go on to
lucrative private practices in the large metropolitan areas or
to a very esoteric kind of academic life. Ironically, the local
health centers, which were presumably the reason for the
existence of the medical school , were being increasingly staffed by graduates of foreign schools.
3
These contrad ictions , however, still escaped me, and I set
out to conform . I studied hard; I got good grades; and I suppressed my anger at the open hostility toward women which
our professors often express ed in the gallant languag e of our
Spanish heritag e. Still I could not stop my emergi ng
consciousness from develop ing. I was aware of the unfairn ess
of the contrad ictory decisions often forced upon women . For
exampl e, a , woman with eleven childre n was denied
steriliz ation by Catholi c obstetri cians. In anothe r case, a
mother of five died_because of inadeq uate anesthe sia at a
poorly staffed , poorly equipp ed health center in a small
town because the doctors there underto ok to do a tubal
ligation so that they could practic e their skills. In both cases,
it seemed to me that the women were the losers .
I could not unders tand the sanctim onious talk of my
colleag ues about abortio n . I could not unders tand the offer
from the Puerto Rican Medica l Association of a reward for
inform ation leading to the arrest of an abortio nist - of
whom there were many operati ng openly and lucrativ ely for
fees ranging from $700 to $1000 . As an intern on the
obstetr ical service , just after I had my own fourth baby, I
saw woman after woman come in with bleedin g or infectio n
from incomp lete abortio ns . Some met their death among
the soiled bedcur tains under the ministr ations of the
trainees of our wards.
My awaren ess grew out of a reality . I knew all along that,
despite my diplom a and the status it partly conferr ed , I was
of the same flesh as the women who scream ed during a midforceps delivery withou t anesthe sia . I believe that this sense
of deep commu nality with women as patient s someho w kept
alive in me the humann ess I now try to nurture , and which
perhap s I then attemp ted to suppres s as too painful .
An exampl e of the need for this kind of suppres sion, this
kind of disassociation which many of us as professionals
4
underg o during our formati ve years, may be provide d by a
conside ration of the so-calle d "Puerto Rican Syndro me. "
This deroga tory term was coined about 20 years ago by a
psychologist seeking to describ e hysterical attacks to which
our people are presum ably prone. I had first heard the term
when training in the University Hospita l in San Juan from
someon e who had recently returne d from a United States
interns hip . The term quickly became popula r and was often
applied to our distressed patient s with the alienat ed scorn
that oppress ed peoples frequen tly heap upon themselves.
I disasso ciated easily . I did not want to be part of that
young woman who was scream ing in the emerge ncy room . I
preferr ed to remain the cool , collecte d woman in white ,
forever in control of herself and others. It took me nearly ten
years and the probing of racism in this country to
unders tand the concep t of the Puerto Rican Syndro me for
what it is - the intellec tualizat ion of racism and sexism (it is
sometim es also applied to men, albeit "femin ine" men who
shout and carry on "like a woman ") in an attemp t to
legitimize these attitude s .
It is this unders tanding that enabled me to comba t the use
of the term when I found it in the fifteent h edition of a text book on pediatr ics, edited by two professors from the Albert
Einstein School of Medici ne , where it was used to categor ize
Puerto Rican adolesc ents who attemp ted suicide . I recently
learned that in response to my letter of protest , the new edition of this textboo k will no longer include the term. A small
victory , perhap s , but one which strengt hens my own
consciousness of the need to struggl e and grow.
I believe that the acknow ledgme nt of the fact that we all
share our woman hood is perhap s the first stage of that
growth . We must begin by recogni zing that the scream ing in
the emerge ncy room is also us . We must stop the shame
engend ered by our failure to conform to the distorte d
s
images of ourselves which are constantly projected to controi
and socialize us into desired behavior patterns. When we
break through that shame, we begin to identify and empa thize ; we are free to begin saying all of us , rather than we
and they. I think that is extremely important for us as
professionals , because time and again we find ourselves
unable to deal with the reality of the person in front of us
because we think "us" and "them " - we disassociate .
My understanding of these issues was greatly accelerated
on my return to New York in 1967 , just as the women's
movement in the United States was emerging. My appointment as head of Pediatrics at Lincoln Hospital , at a time
when the community was seeking some measure of control
over the health-care institutions , spurred me to learn more
about the United States health -care system . Some of the
characteristics of this enormous industry are summarized by
Boston Women's Health Collective in Our Bodies Ourselves
as follows:
Over the last two decades, and especially since government funding of Medicare and Medicaid, the health
business has become a huge growth industry involving
drugs, hospital supplies, and construction and insurance companies. In the sixties the total dollars spent for
all health care in the United States doubled, reaching
162 billion in 1969. The figure was expected to climb to
over 194 billion by 1975, but instead it reached 1104.2
billion in fiscal 1974, making the health industry the
nation 's largest in dollar volume and number of people
employed.
It is not simply that there are proji"ts of millions each
year made out of our illnesses, but that the impact of
the marketing, advertising, and product development
of large corporations on our health-care system as it is
presently organized tends to get in the way of effective
general and preventive health care for those of us who
depend on the system for our survival. 1
6
I also had the opportunity to observe how this enormous
h-.:alth -care system operated as a pyramidal structure, where
the positions women workers hold are similar to those held
in the society as a whole, and where large pay differentials
are maintained , from slightly. over $4000 a year at the base
to over $40,000 at the top. Fewer tha·n one out of every ten
doctors is a woman , while~ of the two million hospital
employees in the United States , nearly 80 percent are
women. If we exclude managerial positions, the percentage
of women goes up to 85 percent. In 1970 , the breakdown for
the lowest paid strata of hospital workers was: laboratory
technicians , 75 percent women , 40 percent nonwhite ;
licensed practical nurses , 85 percent women , 90 percent
nonwhite ; hospital aides and manual service workers, 80
percent women , 80 percent nonwhite . 2
Even at Lincoln Hospital, where in 1970 a movement was
taking place to overthrow the old hierarchies , I found that
the system of rank was well entrenched by rules , regulations ,
and established privilege. The table of organization of all
hospitals determines a clear top -down flow of directives
discouraging any real input into patient care or
administrative policy by people at the base.
My awareness of these and other facts that contribute to
maintaining the present structure grew out of the efforts to
make some necessary changes at Lincoln Hospital in the
Department of Pediatrics . As we worked toward some sem blance of participatory democracy in our own policy
making, we included all strata of workers in patient care
and administrative discussions . Worker teams were also
involved in the selection of doctors . But the difficulties of instituting new processes became obvious as we worked . For
one, the doctors were used to commanding and did not
gracefully give up the directive role . The differences in sta tus became glaring when actions were taken which could
lead to firing workers . Everyone knew that the doc.tors were
7
1i
less vulnerable. Even if they were fired , they would have another job within the week . We discussed these difficulties,
but the harsh socioeconomic realities remained , strengthening my conviction that the organization of health -care
workers must be changed.
Another important element in my understanding of the
role of women in health care has been the great contribu tions of feminists to the demystification of the health care
needs of women . The self-help movement has had an impact
much beyond its size. It has raised the issues of control of our
own bodies, of control of knowledge , and of alternative service models . Ahead for us, however, are the tasks of reshap ing the health-care institutions themselves and of demand ing patient advocacy systems, adequate child care, the upgrading of human resources , and the entry of proportionate
numbers of women and minorities at all levels of decision
making.
Ultimately, we are speaking of changing power relations .
But to start , we must rally around those women who are
making efforts to provide alternative health-care facilities .
We must demand legitimacy for such projects.
The Maternity Center Association is one such project ,
where women have organized to create a workable model for
out -of-hospital deliveries. Located in New York City on the
fringe of the wealthy upper East Side and bordering the lower part of East Harlem , the Center proved that babies can be
delivered in a warm homelike environment , with all the
safety factors of hospital care but without the stressful and
impersonal atsmosphere too often associated with hospital
deliveries. The Center was organized and is run by a group
of well-trained, competent midwives under the leadership of
Ruth Watson Lubic , a humane and wise person with broad
experience in this field .
Although approved by the State Department of Health ,
8
which would permit low-income women to pay for its facilities with Medicaid , the Center has been bitterly attacked by
many sectors of the medical establishment. The New York
City Department of Health has recently withheld approval
for Medicaid reimbursements to Maternity Center patients.
This means that the services of this carefully planned facili ty, designed for use by women of all socioeconomic levels ,
are limited to those women who can afford to pay or have
medical insurance.
At the annual meeting of the American Public Health
Association in 1975 , the Women's Caucus drafted and approved a resolution in support of the Maternity Center and
in censure of the New York City Health Department for its
stand . It is important for us to recognize that the very energy
of the attacks against such alternative health -care structures
attests to the potential vitality of these alternatives.
We must begin to capitalize on our collective experience
of the past ten years and bring insights and unity to our organizing efforts. I see this beginning to happen in the abortion movement , where more and more women , realizing the
limitations of focusing on one isolated issue , are viewing
abortions in the broader setting of total health care.
Perhaps the way my own daughters approached some of
problems they encountered can illustrate the impact of
changing feminist attitudes . In contrast to my own early de velopment , all three women are active in organizations. All
believe in the need for women to organize independently as
well as to work in organizations with men . Their consciousness has been raised through this collective process.
The oldest is now a medical student. Her route was a circuitous as mine but it was vastly different in substance. Her
legacy is shared by all those who participated in the struggles
for community control , civil rights , and peace that shook
the country a few years ago, to which she adds another cause
we share, that of the struggles of the Puerto Rican people for
9
1!11
liberty. She brings to medical school work experience in
clinics with people from the communities in which constant
sharing of skills was programmed into the functions of providing health care. This was not part of my background; it
simply didn't exist then .
She told me recently of her first anatomy lesson. In the
routine of dissecting a cadaver, she encountered a pacemaker under the skin of the chest. This aroused much curiosity in her and her classmates. Then, opening the chest
wall, she found the heart enlarged to three times the normal
size. At this point she was stunned with the realization that
she was dealing, not with a cadaver, but with the body of a
human being, a man who had died in his fifties, and that
she knew nothing about this man who was now serving her
needs. Greatly troubled, she discussed it with her classmates.
They agreed that there could be a far more humane way of
learning anatomy . A cadaver should be presented, they felt ,
as a person who had died in a certain way , so that the person
and the illness could be studied together . Whether she and
her classmates will succeed in changing their anatomy
teaching remains to be seen, but I think it is a good example
of the kind of thinking and feeling women can bring to
medicine .
My second daughter has developed mostly in Puerto Rico,
and her framework of activity has been our struggle for national liberation . As a student of nutrition, she is involved in
the larger questions of the reasons for hunger on this planet.
She carries this over into her political work, and I believe she
illustrates the way in which people are finding it possible to
blend their professional experience and their body of exper tise , into the struggle to bring about social change . Whereas
I was a doctor with a set of skills which I used in a laboratory
setting but nowhere else in my life, my second daughter integrates her understanding of nutrition into everything - her
personal life, her politics .
10
When the third, who is actually my daughter-in -law, went
to the University Hospital in Puerto Rico - the same hospital where I had trained - to have her second child, she was
told that they would have to record the baby's heartbeat by
attaching electrodes to its scalp . Secure in her knowledge
that this was an unnecessary process, and in her belief that
she had a right to speak up, she questioned the need for the
procedure. The doctor became incensed, insulting, and
even obliquely threatening as he suggested that something
could happen to her child if she refused. The only person in
the room, in fact , who seemed to support her was a nurse's
aide, a woman. At that point she felt she was approaching
an end to delivery , and while saying to herself that it was her
baby and her labor, she took a few deep breaths and bore
down steadily with each contraction. The baby was born
within minutes on the stretcher, moving vigorously , crying
loudly, and, I like to fantasize , with his clenched fist held as
high as that of his mother.
The deepest and biggest changes that have taken place
have been those within-us , which means that we have begun
gaining the strength we need to have if we wish to change
the world.
NOTES
1. The Boston Women's Health Book Collective . Our
Bodies Ourselves (New York: Simon & Schuster, 1976),
p. 341.
2 . Vincente Navarro , "Women in Health Care," New
England Journal of Medicine, 290, no. 8 (1975):
398-402.
11
Sterilization Abuse
Recent events have shown that sterilization is a procedure
freely chosen by some people in family planning but de manded of others against their will . Consider , for example,
what has recently happened in India. Mrs . Indira Ghandi's
government was defeated - an event many attribute to the
mass forced sterilization program it sponsored - but before
the final ousting, at least 300 Indians died in riots protesting
the assault of forced sterilizations on both men and women.
The Indian sterilization experience showed the world that
some population control programs mean ugly coercion.
A second item is right here at home: large numbers of
native American women have been sterilized by the Indian
Health Services, a United States government agency. A recent report from the General Accounting Office, produced
at the request of Senator James Abourezk from South
Dakota, reveals 3,406 sterilizations of American Indian
women between the ages of 15 and 44 . These were
performed in Aberdeen, Albuquerque , Oklahoma City, and
Phoenix between 1973 and 1976. 1 Evidence that the basic
elements of informed consent were not communicated to the
patients lends credence to Dr. Connie Redbird Uri's many
public statements charging the United States government
with having a deliberate genocide policy against her people,
who number under a million. z Although there has been a
moratorium since April 1974 on government financing of
sterilization of women under 21 years of age, there were 13
violations by the Indian Health Service in two years. 5 To
date, there has been no action against the violators .
Sterilization is a time-honored procedure in the United
States. The first of the laws empowering the state to sterilize
unwilling and unwitting people was passed in 1907 by the
12
l
I
Indiana Legislature . The Act was intended to prevent
procreation of "confirmed criminals, idiots, rapists, and
imbeciles" who were confined to state institutions. The law
was clear in its tenet that heredity plays an important part in
the transmission of crime, idiocy, and imbecility.• After
World War I, a model federal law was proposed by Dr.
Harry Hamilton Laughlin , Superintendent of the Eugenics
Record Office, and copies were widely distributed in large
quantities to governors, legislators, newspaper and
magazine editors, clergymen, and teachers . According to
the model law, the following ten groups were labeled
"socially inadequate" and were therefore subject to
sterilization : (l) feeble-minded; (2) insane (including the
psychopathic); (3) criminalistic (including the delinquent
and wayward); (4) epileptic ; (5) inebriate (including drug
habitues); (6) diseased (including the tuberculous , the
syphilitic, the leprous, and others with chronic, infectious ,
and legally segregable diseases); (7) blind (including those
with seriously impaired vision); (8) deaf (including those
with seriously impaired hearing); (9) deformed (including
the crippled); and (10) dependent (including orphans ,
"ne'er-do-wells, " the homeless , tramps , and paupers. 5 Laws
such as this , known as the eugenics laws, were passed in 30
states and as of 1972 were still on the books in 16. 6
It is shocking to learn that between 1907 and 1964, more
than 63,000 people were sterilized under these eugenics laws
in the United States and one of its colonies, Puerto Rico. 7
Practices sanctioned inside institutions often become
commonly accepted practices in the larger community. It is
therefore important to keep in mind this long history of
legally sanctioned forced sterilization as a framework for
understanding current hospital practices.
Labeling of people mentally retarded, insane , criminal ,
or indigent is an act we must examine closely. This sort of
13
labeling is a peril in itself, but when it is used as grounds for
sterilization, it is doubly dangerous. The groups considered
undesirable may change, but they always include people
who work for wages or are unemployed ; they are inevitably
the most exploited , and, therefore, poor. In the United
States, the labeling process has additional racial overtones,
because . most third-world people are in the least
remunerated strata of the working class and are definitely
poor. It is a cruel irony that people with preventable diseases
due almost solely to poverty are included in groups seen fit
for sterilization .
Under the eugenics laws , many black women had been
sterilized without challenge. The challenge came only when
in 1924 Carrie Buck, a poor , white 18-year-old woman
institutionalized for mental retardation, was threatened . Al though judged retarded , Buck had completed six grades of
school in five years . She had defied the norms by bearing an
illegitimate child and was about to be sterilized, when mem bers of a religious group in Virginia challenged the law all
the way to the Supreme Court. Justice Oliver Wendell
Holmes handed down his well-known Buck vs. Bell opinion
in favor of her sterilization in which he stated : "the principle
that sustains compulsory vaccination is broad enough to
cover cutting the fallopian tubes ." He concluded that "three
generations of imbeciles are enough . " 1
Implicit in Justice Holmes's opinion was the belief that
Carrie Buck's alleged mental retardation was hereditary .
Today mental retardation is often determined on such
questionable evidence as inability to cope with the school
system , the discredited I. Q . tests , or even evidence of
cultural differences .
Perhaps an even greater impact of these infamous laws
was the social legislation they inspired . At least 10 states
have proposed compulsory sterilization of people on
welfare . 9 No state has passed such legislation, but the very
14
existence of such proposals should make us question the
prevailing social climate. In a country plagued by chronic
unemployment , such proposals reveal virulent feelings
toward women who cannot earn a living because they must
care for children , the elderly , or others.
Physicians play an important role in implementing the
view that poor people have no right to decide on the number
of their children. A survey of obstetricians showed that
although only 6 percent favored sterilization for their
private patients, 14 percent favored it for their welfare
patients. For welfare mothers who had borne illegitimate
children , 97 percent of the physicians favored sterilization. 10
Similarly, a number of polls of the public at large show that
the idea of sterilization of welfare recipients is very much accepted. In a 1965 Gallup poll , about 20 percent of the
people surveyed favored compulsory sterilization for women
on welfare . 11
We are witnessing a resurgence of the Malthusian ideas
which proclaimed the poor unfit to receive the knowledge
and hygienic measures which might decrease their
mortality . 12 The more sophisticated modern version calls for
a decrease in the social , medical , educational, and other
resources allotted to poor people and for an offer of
sterilization instead. In lieu of social changes to provide a
decent living for every American , the population planners
choose to curtail population . In the words of Dr. Curtis
Wood , past president of the Association for Voluntary
Sterilization ,
People pollute, and too many people crowded too close
together may cause many of our social and economic
problems. As physicians, we have obligations to the
society of which we are a part . The welfare mess, as it
has been called, cries out for solutions; one of these is
fertility control. 15
15
The use of the phrase "fertility control" is itself deceptive . In
reality , it means only one thing , permanent control - that
is, sterilization. Therefore it does not surprise us that a 1973
survey revealed that 43 percent of women sterilized in
federally financed family programs were black. 14
Hysterectomy, now the most frequent major operation,
done four times as frequently in the United States as in Sweden, is an indication of still another way of sterilizing women
without their consent. 1 s Black women on welfare suffer the
most abuse . According to the New York Times:
In New York and other major cities, a hysterectomy
which renders a patient sterile costs up to 1800, while a
tutal ligation (the tying off of the fallopian tubes),
which does the same thing, pays only 1250 to the surgeon, increasing the motivation to do the more expen sive operation. Medicare , Medicaid, and other health
plans for both the poor and the affluent will reimburse
a surgeon up to 90 percent for the costs of any sterilization procedure, and sometimes will allow nothing for
abortion. As a consequence, "hysterilizations"so common among some groups of indigent blacks
that they are referred to as "Mississippi appendectomies"-are increasingly popular among surgeons despite the risks. 16
Several lawsuits since 197 3 around the country provide
evidence of both the widespread nature of abuse as well as of
the rising redress on the part of people .
Most notorious is the case of the two sisters , Mary Alice,
then 14 , and Minnie Lee Relf, who was 12 at the time of
their sterilizations in Montgomery , Alabama in June 1973 .
As described in court by their mother, two representatives of
the federally financed Montgomery Community Action
Agency called on her requesting consent to give the children
some birth control shots. Believing that the agency had the
16
best interests of her daughters' health in mind , she consented by putting an X on paper. 17
Judge Gerhard Gesell , who heard the case, declared :
Although Congress has been insistent that all family
planning programs function purely on a voluntary basis
there is uncontroverted evidence in the record that
minors and other incompetents have been sterilized
with federal funds and that an indefinite number of
poor people have been improperly coerced into accept ing a sterilization operation under the threat that various federally supported welfare benefits would be with drawn unless they submitted to irreversible sten'lization. 18
In another case, a number of women from Aiken, South
Carolina , sued Dr. Clovis Pierce, a white former Army physician , for his coercive tactics in obtaining consent including
threats to refuse to deliver their babies. In 1973 , black
women were subjects of 16 of the 18 sterilizations paid for by
Medicaid and performed by that physician. 19
Norma Jean Serena , a native American mother of three
children , will be the first to raise sterilization abuse as a civil
rights issue . She charges that in 1970 health and welfare officials in Armstrong County, Pennsylvania , conspired to
have her sterilized when her youngest child was delivered .zo
Ten Mexican-American women are currently suing the
Los Angeles County Hospital for obtaining consent in
English when they spoke only Spanish . Some were in labor at
the time, others even under anesthesia . A few reported being told such things as "Sign here if you don't want to feel
these pains anymore" while a piece of paper was waved
before their eyes . 21
Largely as a result of the pressure mounted when the Relf
case came to light , the Department of Health Education and
Welfare (HEW) decided to write guidelines on sterilization
17
procedures during 1974. In effect, these established a moratorium on sterilizations of people under 21 years of age, and
on those who for other reasons could not legally consent. In
addition, the guidelines stipulated that there must be a 72hour waiting period between the granting of consent and the
carrying out of the sterilization. They also required an informed consent process including a written statement to the
effect that people would not lose welfare benefits if they refused to be sterilized, and they included the right to refuse
sterilization later, even after granting initial consent.
Although HEW promulgated the guidelines early in 1974,
a study conducted in 1975 by the Health Research Groups, a
renowned Washington-based organization, n and later corroborated by Elissa Krauss of the American Civil Liberties
Union, showed that only about 6 percent of the teaching
hospitals were in compliance with these guidelines. Many of
the hospitals provided only the broadest of consent forms
without proper explanations. 25 A still more recent study by
the Center for Disease Control, an HEW agency, revealed
that widespread noncompliance continued to be the rule .
The study attributed the fact to ignorance of the
guidelines. 24
Early in 1975 those of us who were concerned about the issue of abuse formed a committee which we called The Committee to End Sterilization Abuse (CESA). We were faced
with some hard realities: First, HEW can only regulate for
federally funded procedures, and although it is true that the
primary targets of sterilization abuse have been women on
welfare, there are still many other vulnerable groups who
are not welfare recipients, including the recently unemployed, undocumented workers, and workers whose earnings are just barely above the poverty line. Second, it
seemed obvious that without a national monitoring system,
it is impossible to determine what is happening to whom or
18
whether guidelines are being followed . Third, those who
control information often manipulate people's behavior. For
example, the inclusion of hysterectomy as one form of sterilization in an HEW informative pamphlet 25 tends to grant
legitimacy to that mutilating operation in the eyes of the
reader. Finally, the need for strong enforcement
mechanisms became clear . There is no way that wellestablished actions and practices can be uprooted without
the use of some measure of enforcement, particularly when
the practices are profitable and socially sanctioned.
These facts, coupled with the rise in number of sterilizations observed in the New York City hospital system, particularly in those hospitals serving black and Puerto Rican
communities, prompted a number of concerned people
from the Health and Hospitals Corporation, the New York
agency responsible for the municipal hospitals, and from
citizens' groups to form an ad hoc Advisory Committee on
Sterilization Guidelines early in 1975. The Committee to
End Sterilization Abuse, Healthright, Health Policy
Advisory Center, the Center for Constitutional Rights, the
community boards of the hospitals, and many other organizations and individuals were represented on this new committee. Most of the members were women involved in patient advocacy and who at the same time represented New
York's various ethnic communities.
Our goal was to write new guidelines for the municipal
hospitals. We met initially to ascertain the facts and to analyze the processes by which abuse takes place. Then we compiled the information in a report . 26 We identified existing
weaknesses in the HEW regulations by using women's experiences as the touchstone for the drafting of stronger
guidelines.
Many consents are obtained around the time of abortion
or childbirth . The philosophy behind this practice is exemplified in the words of one doctor who said, "Unless we get
19
those tubes tied before they go home , some of them will
change their minds by the time they come back to the
clinic . "t 7 The waiting period of only 72 hours after consent
had been obtained at a time of great stress , allowed no op portunity for the woman to discuss the matter with friends ,
famil y, or neighbors to assure herself that she really wanted
a sterilization . The time of abortion was particularly
hazardous, because many teaching hospitals offer abortions
as a "package deal" together with sterilization . 28 What kind
of information was given to women was also key since both
the vocabulary and the amount of information can clarify or
confound . This reflects another weakness inherent in both
the structure of the health system and the doctor -patient relationship: the ·coercive nature of medical advice given as it
is in a patriarchal setting.
Our coalition of concerned groups drafted guidelines to
remedy these weaknesses . They called for a 30-day waiting
period ; an interdiction of consent at time of delivery, abortion , or of hospitalization for any major illness or procedure ; the requirement that full counseling on birth con trol be available so that alternatives are offered ; the stipula tion that the idea for sterilization should not originate with
the doctor; and the provision that informational materials
must be in the language best understood by the woman .
The guidelines also stated that if she wished , the woman
could bring a patient advocate of her choosing to participate
at any stage of the process . She could also have a witness of
her choice sign the consent form. Perhaps the most important point we made was that a woman should express in her
own words , in writing on the consent form, her understand ing of what the sterilization entailed , particularly its
permanence .
We were unprepared for the ferocity of the opposition to
our guidelines. Our files , replete with angry letters from ob 20
stetrioans , organizations involved in family planning and
population control , and other groups , attest to the length
and difficulty of our struggle. The chiefs of the obstetrical
services in the municipal hospitals marshaled many objections , especially to the extended waiting period and the pro.hibition of consent around the time of abortion or childbirth . Some based their arguments on dramatic stories
about the "habitual aborter" and the "grand multipara. "
The "habitual aborter" was described as a young woman
who is using repeated abortions rather than contraceptive
methods ; the "grand multipara" as a woman who could only
consent to sterilization while in hospital for childbirth , this
being the only time she sought services. Our response was to
continue to bring testimony of how abuse takes place and to
negotiate on the provisions of the guidelines until they were
acceptable to our committee , its constituency, and to the
obstetricians and other staff. It was a massive outreach effort that gained the support of community groups , boards of
hospitals , health organizations , and legal groups . And it was
this broad-based support, backed by several thousand letters
and petitions, three or four demonstrations , hundreds of
speeches and dozens of meetings that finally overcame the
still strong opposition in medical circles.
New York City's Health and Hospital Corporation had
once more been responsive to public wishes , illustrating that
even imperfect institutions can respond , provided
consumers find the channels through which they can fight
for change .
The guidelines became effective November 1, 1975. Barely three months later , six professors of obstetrics and gyne cology representing six major medical schools filed suit op posing the guidelines issued by HEW , New York State , and
the New York City Municipal Hospital System . They
claimed the guidelines interfered with the rights of two wo21
men specifically: one a mentally retarded nineteen -year old,
the other a woman about to have a third cesarean section ,
both of whom requeste d steriliza tion. In their own behalf,
the doctors claimed infringe ment of their right to free
speech , since they were mandat ed to discuss steriliza tion
only in the context of other methods of birth controJ.Z 9 The
obstetric ians had carried their protest to the court , since
their objectio ns had been overrule d by a vigilant public .
During the same period , a 19-year old black woman, detained on a crimina l charge at Rikers Island Prison , arrived
for an abortion at King's County Hospita l, largest of the municipals, and the one that had publicly refused to follow the
regulati ons . She stated that she had been asked whether she
desired pregnan cies in the immedi ate future . When she said
no, she was offered an operatio n for contrace ptive purposes ,
which, she was told, could be reversed "when she became a
normal citizen." She consente d. Her uterus was removed
during the operativ e procedu re. This young woman is
currentl y suing for gross malprac tice . It was painful to see
the need for enforcem ent of the guidelin es through her suffering. The observa nce of just one single stipulati on would
have prevente d that tragedy - consent cannot be obtained
during admissio n for abortion .
We began to see that there were some critical problem s to
be solved. First, how could we implem ent and enforce the
new regulatio ns? Second, how could we establish a monitor ing system to know about steriliza tions on an ongoing basis?
Third , how could we apply the guidelin es to private hospitals, not just the municip al hospitals? At present, the med ical schools contract with the municip al system to deliver
medical services. Doctors work at both public and private
hospital s and can carry out their program s at either place.
Often doctors prefer the private setting as long as the fees for
the services are forthcom ing. We realized that guidelin es
could be circumv ented simply by admittin g Medicai d recip-
22
ients or other insured patients to their private hospital s .
A fourth concern was the definitio n of "elective " in any
surgical procedu re. By specifyi ng that the guidelin es applied
only to "elective " procedu res , large loophole s were left for
the "medica lly indicate d ." Doctors define "medica l indications" on the basis of their experien ce or preferen ce. Entrenched in their position s of power , doctors often resent any
question ing . Attempt s by patients to enter the sacrosan ct
areas of "medica l indicatio ns" are invariab ly vigorously
repelled .
A fifth and extreme ly importa nt problem , mention ed
previously, was the control of informa tion . It is possible to
sell a procedu re by giving distorted account s of its benefits
and downpla ying the risks . We strongly maintai ned that the
mental, physical , and social hazards of steriliza tion should
be discussed in informa tional material s . We felt these
should be differen t from those of HEW, whose off-hand
informa tion can easily mislead .
Finally , the concern over the abuse of hysterec tomy was
still paramo unt . Since excessive hysterec tomies are performed not only for reasons of money, custom, poor medical
practice , and hostility to women , but also as an occult
manner of sterilizin g women without their informe d consent , we recogniz ed the need for guidelin es on hysterec tomies also .
These problem s are as yet unresolv ed. Our approac hes
have been to continue to organize coalition s of people from
within and without the hospital s in order to monitor what is
happeni ng and to continue to press in whateve r ways are
possib1e to have some impact upon these practice s. For
although one group of people manage d to write and pass the
guidelin es, many more people are needed to see that they
are honored .
23
The lessons from these battles have been invaluable. We
have learned that we can organize coalitions of community
groups and health workers, and that these coalitions can be
effective in sharing information as well as applying pressure.
More important to me has been the experiences shared
with women and community groups . We managed to iden tify some of the ways in which racist ideology keeps us from
acknowledging our common oppression as women . Within
the women's movement we sometimes found a denial of the
experiences of others in statements such as "I had a hard
time getting a sterilization five years ago. I can't see the need
for a waiting period ." And certainly it is true that in the not
too distant past many middle-class women were denied
sterilization by physicians. The issue became clear only
when women understood that the same people who would
deny a white middle -class woman her request were the ones
who were sterilizing working-class whites, blacks, Puerto
Ricans , native Americans , and Mexicans without ever
bothering to obtain consent.
We examined social class attitudes of superiority which
can lead to an acceptance of coercion of "others" such as
welfare recipients, and we dealt with them in open discussion . We learned to identify our friends from the ranks of
women , third-world people, health workers, and church
groups. We likewise identified our opponents from the ranks
of gynecologists , board members of the organizations dedicated to population control-which promulgate the "peoplepollute" ideology - and of those who favor a coercive society
which oppresses people .
We also learned that there are many organizations which
mask their ideology of population control by providing
needed services in the areas of health, education , and family
planning. These organizations are often linked to the large
24
corporations and to a small number of private foundations
in the United States.
In the process of study we analyzed the case of Puerto
Rico . There during the last 30 years the government with
United States funding has sterilized over one-third of the
women of childbearing age . so This was achieved by providing sterilizations free at a time when women were joining the
workforce in large numbers. The lack of family support services, of legal and safe abortions, of alternative methods of
contraception, and of full information about the permanency of sterilization have all combined to produce those
startling numbers.
An analysis of the complex situation of Puerto Rican
women showed us that there are many coercive factors in
society which easily lead to sterilization abuse . Freedom of
choice requires that there be real alternatives. We have
deepened our understanding of the connections between the
current denial of abortion rights to poor women , the dearth
of child-care facilities, and the cuts in welfare and sterilization abuse .
We are now confident that we will halt sterilization ·abuse
in New York City and that our example will serve as a model
to groups of like-minded people who are springing up across
the country to combat the same problem in their
communities.
25
EPILOGUE
Since November IO , 1976 , the date of this lecture, many
important developments have taken place. My note of opti mism on the effectiveness of coalitions to win protective
legislation was justified. As consciousness developed , a
movement grew to support further legislation in New York
City . Public Law Number 37 was passed by the City Council
with a vote of 38 -0 in April 1977. The Law embodies the
principles of the Guidelines on Sterilization of the New York
City Health and Hospital Corporation and applies them to
all New York City health facilities, both public and private.
The law regulates sterilization of both women and men.
Provisions in summary are :
1. Informed consent in the language spoken or read by the
person .
2. Extensive counseling to include information as to alternatives.
3. A prohibition of consent at time of delivery or any other
time of stress, and of overt or veiled pressures on welfare
patients .
4 . The right to choose a patient advocate throughout the
counseling or any other aspect of the process .
5. A 30-day waiting period between consent and procedure.
Support was broad and varied and included such groups
as the Committee for Human Rights ; Community Boards of
Methodist and St. Luke's Hospitals; Committee of the
United Neighborhood Houses of New York; New York City
Coalition for Community Health ; Committee to End Sterilization Abuse; New York Civil Liberties Union; Physicians
Forum ; Women United for Action ; National Black Feminists Organization ; New York National Organization for
Women. Several other groups endorsed it in principle.
The opposition was primarily from the ranks of organized
medicine and from the organizations with population con trol programs. The reasons often had to do with their speci26
fie interests . These are best described by Carter Burden, the
City Councilman who introduced the legislation , when he
commented on the role of one of these organizations in the
following words :
The principal, and certainly most effective, lobbyist
against this bill has been Planned Parenthood, a distin guished and dedicated organization which we all have
reason to respect . Many of its principals are old and admired personal friends, people I know too well to have
any doubt about the sincerity of their concern or the
honor of their motives. I do have some concern, however, and I feel it should be said publicly, that Planned
Parenthood's exaggerated fear about this bill has some
relationship to the fact that they too will be directly
affected by it . Some months ago, Planned Parenthood
applied to the Health Systems Agency for authorization
to perform female sterilizati'ons in their outpatient
clinics. That application was rejected by a special review committee because Planned Parenthood refused
to adhere to certain criteria set down by the committee
- including a 30-day waiting period. 31
On the negative side are some currently unsolved problems. The Hyde Amendment , which withdraws federal
funding of abortions, was upheld by the Supreme Court in
June 1977. Besides the incalculable hardship this measure
presents for women on welfare, who are condemned to bear
unwanted children or to risk illegal abortion, which may
lead to death , it opens the door to the sale of the "package
deal" of abortion -sterilization. The federal government is
willing to pay as much as 90 percent of a sterilization procedure, so for those institutions eager to get this fee , it becomes an additional incentive to coerce women who are desperate for an abortion by pressuring them to consent to sterilization. There is no doubt that the struggle for abortion
rights is completely linked to the struggle against sterilization abuse.
November 1977
27
NOTES
1. U.S . General Accounting Office Report to Hon . James
G . Abourezk , 8 164031 (5) November 1976 , p. 3.
2. "Uri Charges I.H .S. with Genocide Policy," Hospital
Tn"bune 11 , no . 13 (August 1977).
3. U .S. General Accounting Office Report 8 164031, p . 4 .
4. Allan Chase , The Legacy of Malthus: The Social Costs
of the New Scientifi·c Racism (New York: Alfred A .
Knopf, 1977) , pp . 15 -16.
5. H .H . Laughlin , Eugenics Sten"lizati"on, 1922 , pp. 446 447 , quoted in Ibid ., p. 134.
6. Gena Corea , The Hidden Malpractice, How Amen·can
Medicine Treats Women as Patients and Professionals
(New York: William Morrow , 1977) , p . 128.
7. Chase , p. 16.
8 . Ibid . , p . 315 .
9. James E. Allen , "An Appearance of Genocide: A Review
of Government al Family Planning Program Policies ,"
Perspecti"ves in Bi"ology and Medidne, Winter 1977.
10. "Physicians' Attitudes: MDs Assume Poor Women Can't
Remember to Take the Pill ," Family Planm·n g Digest,
January 1972, p . 3.
11. Chase, p . 2.
12. Ibid ., p . 6.
13. H . Curtis Wood, J r., "The Changing Trends in Voluntary Sterilization ," Contempora ry Obstetn·cs and Gynecology 1, no . 4 , (1973) : 31 -39 .
14. Denton Vaugham and Gerald Sparer, "Ethnic Group
and Welfare Status of Women Sterilized in Federally
Funded Family Planning Programs," Family Planm·n g
Perspecti"ves 6, (Fall 1974): 224 .
15. Joann Rodgers , " Rush to Surgery, " The New York
Ti"mes Magazine , September 21 , 1975, p. 34 .
16. Ibid ., p . 40.
17 . Jack Slater, "Sterilization : Newest Threat to the Poor ,"
Ebony, October 1973 , p . 150.
28
18. Relf vs . Weinberger, 372 Federal Supplement 1196 ,
ll99(D .D.C . 1974).
19 . Slater, p. 152.
20. Joan Kelly , "Sterilization and Civil Rights ," Rights
(publication of the National Emergency Civil Liberties
Committee) , Sept. / Oct. 1977 .
21. Claudia Dreifus, "Sterilizing the Poor, " The Progressive, December 1975 , p . 13.
22 . Robert E. McGarraugh , Jr. , "Sterilization Without
Consent : Teaching Hospital Violations of HEW Regulations : A Report by Public Citizens' Health Research
Group, " January 1975 (available from Public Citizens'
Health Research Group , 2000 P Street , Washington ,
D .C .).
23 . Elissa Krauss , "Hospital Survey on Sterilization Policies:
Reproductiv e Freedom Project ," ACLU Reports, March
1975 .
24 . Carl W . Tyler, Jr., "An Assessment of Policy Compli ance with the Federal Control of Sterilization ," June
1975 (available from the Center for Disease Control,
Atlanta , Ga .).
25 . U .S. Department of Health , Education and Welfare ,
"Your Sterilization Operation, Hysterectom y, " Wash ington , D .C .: U.S. Government Printing Office , 1976.
26. New York City Health and Hospitals Corporation, "Why
Sterilization Guidelines Are Needed ," 1975 (available
from Office of Quality Assurance, 125 Worth Street ,
New York City 10013).
27 . Bernard Rosenfeld , Sidney Wolfe , and Robert McGar ren , "A Health Research Group Study on Surgical Sterilization : Present Abuses and Proposed Regulations, "
(Washington , D.C. : Health Research Group , October
1973) , p . 22 .
28 . Ibid .
29 . Gordon W . Douglas , M.D. , et al. , and John L.S . Hollo man, Jr., et al., Civil Action File no . 76 , CW 6 , U.S .
District Court , January 5, 1976.
29
30 . Jose Vazquez-Calzada, "La Esterilizacion Fernenina en
Puerto Rico," Revista de Ciencias Socia/es, (San Juan,
Puerto Rico) 17, no . 3 (September 1973): 281 -308 .
31. Carter Burden, Testimony upon Introduction of Bill
#1105, April 18, 1977, now Public Law #37 (available
from New York City Council) .
GENERAL
REFERENCE S
1. Clara Eugenia Aranda , et al., La Mujer: Explotacion,
Lucha, Liberacion . (Mexico 20 D. F: Editorial Nuestro
Tiernpo S.A . , 1976) (available from Avenida Copilco
300, Locales 6 y 7, Mexico 20 D. F).
2. Barbara Caress. "Sterilization," Health Pac Bulletin 62
Qanuary/ February, 1975).
3. _ _ _ _ _ _ . "Sterilization Guidelines," Health Pac
Bulletin 65 Quly/ August 1975).
4 . Linda Gordon , Woman's Body: Woman 's Right (New
York : Grossman/ Viking , 1976).
5. Terry L. McCoy, et al. , The Dynamics of Population
Policy in Latin America (Carn bridge, Mass .: Ballinger,
1974).
6. Bonnie Mass, Population Target (Brampton , Ontario,
Canada : Charters 1976).
7. Barbara Seaman and Gideon Seaman, Women and the
Crisis in Sex Hormones (New York: Rawson Associates ,
1977).
30
Single copies ........... .. $1.00
10 or more ........... ...... 75
Order from:
The Women's Center
Barnard College
New York, N.Y., 10027
FIGHT ING
STERI LIZAT ION
ABUSE
Judith Herman
In 197 3, two black sisters in Alabama, aged 12 and
14, were sterilized in a federall y funded family planning
program. Their mother had been persuaded to give her
consent by making an X on a form which she could not
read . She did not know that the operation was permanent.
In the same year, a white mother in South Carolina
revealed that the area's only practicing obstetrician routinel y refused to deliver a third child to women on welfare unless they consented to sterilization . As his nurse
explained it, "This is not a civil rights thing or a rac ial
thing, it's just welfare." In a six month period, this doctor had performed 28 sterilizations, mostly on black
women.
In Armstrong County Penn sy lvania, Norma Jean
Serena, a Native American woman, is suing hospital
and welfa re officials for involuntary sterilization . Her
tubes were tied immediately after the birth of her third
child , while she was medicated and exhausted from the
delivery. She was not aware th at she had been sterilized
until the following day, when she was persuaded to sign
a consent form . Her medical chart states that the operation was performed for "socio-economic" reasons .
In Los Angeles, ten Chicana women have filed a
class-action suit against hospital and state health officials charging that they were either coerced or deceived
into being sterilized. Some were presented with consent
forms while in labor. Others never signed forms at all
and only le._uned later that they had been sterilized .
Sterilization: U.S. Policy
Sterilization as a means of controlling population
World countries has been a part of our governThird
in
This article first appeared in Sister Co11rage , a B ostonarea feminist newspaper. whose address is: P.O. Box
296, Allston . MA 02134.
Jan .-Feb.- 1977
ment's policy for years . In Puerto Rico , the laboratory
for U.S . population experiments, and testing ground for
the pill, over one-third of all women of child-bearing age
have already been sterilized .
In the last five years , this policy has come home to
the mainl a nd . Since 1970, female sterilization s in the
U.S. have increased almost threefold. Between 600,000
and one million procedures are now performed on
women each year. Poor women and women of colo r are
heavily overrepresented: Twenty percent of married
black women have been sterilized, compared to about 7
percent of married white women. Fourteen percent of
Native American women have been sterilized.
The in crease in female sterilization has come about
not in response to women's dem a nd s (a s in the case of
abortion) , but as the result of governmental policy _and
pressure from hospitals and doctors. In 1971 , Nixon appointed John D. Rockefeller III to be chairman of a
commission on "Population and the American Future."
Rockefeller has been eminent among the promoters of
the idea that the "population explosion" is responsible
for poverty in the world . A natural enough idea for a
Rockefeller . The Commission advised that :
... slowing the rate of population growth would
ease the problems facing the American government in the years ahead. Demand for government
services (read welfare) will be less than it would be
otherwise, and resources avai lable for the support
of education , health, and other services would be
greater.
17
Funds for Sterilization, not Social Services
Though Nixon rejected the Com mission's report
because it reco mmended legalized abortion as one
method of limiting births, man y of the Commission 's
recommendatio n s have been put into effect. Between
1969 and 1974, federal allocations for family planning
increased from 11 million to 250 million dollars, while
funds for Head Start, child care, and co mmunity health
were repeatedly cut. By 1974, HEW had modified its
guidelines to require states to provide family planning
services to welfare recipients. And mo st recentl y, HEW
has announced that states will be paid 90 percent of the
cost of sterilizations for poor women, but only 50 percent of the cost of abortion. This gives ho spitals and
clinics an incentive to promote an irreversible birth control method and to discourage the method which gives
the individual woman the greatest amount of nexibilit y
and personal control.
At the same time that government policy has sw ung
around to prom ot ing population control within this
country, medical policy has a lso shifted in favor of
liberali zed guide lines for sterili za tion . In part , thi s may
be beca use the medica l professio n has accepted the
Rockefeller lin e o n overpopulation . In a recent survey,
94 percent of gynecol ogists polled in four majo r cities
said that they fav o red compulsorr sterilization for welfan.: mothers with three or more "illegitimate" children.
t\s Dr. Cu rti s Wood, president o f th e Asso ciation for
Voluntary Sterili za ti on put s it:
The name of the game is su rgery - bring the patien t in , cut her open and practice, and move her
out. While she is there she is an object, treated
coldl y, patro nizingly. Backs are turned on
patien ts, question s are un answered, operation permit for ms are not explained. It is jokingly said that
the only needed prerequisite for a hysterectomy is
not to speak Engli sh . It isn't much of a joke.
Federal Guidelines Minimal
As a resu lt of the case of the Relf sisters in Alaba ma, H EW was ordered to set up guidelines for sterilizati o ns suppo rted by federal funds. The guideli nes were
minimal , but they did include a requirement that the patient be tol d that sterilization is permanent, and that she
be assured that she would not lose any benefits such as
welfare, if she refused .
A 72-hou r waiting period was also required between th e time the woman signed the form and the perfo rm ance of the operation. This was in cluded to a llow
th e woman to change her mind if she had signed un der
duress. Almo st a year after the court order, the ACLU
repo rted that mo st of the· ho spita ls they surveyed did
not bo th er to comply with even these minima l gui delines.
People pollute, and too man y people crowded too
close together cause many of our social and economic problems ... As physicians, we have obligations to our individual patients, but we also have
obligations to the society .. . The welfare mess , as
it has been called, cries out for solutions, one of
which is fertility control.
Practice for Surgeons
Even more than ideology, the doctor's interest in
surgical training has led to the promotion of sterilization, especially in major teaching hospitals. Women
who want birth control are talked into sterilization,
without any discussion of the risk s involved (sterilization is at least as dangerous as the pill or the IUD) or the
available alternatives.
Women who definitely want sterilization are often
persuaded to have a hysterectomy , rather than the far
less complicated tubal ligation , simply because a hysterectomy is a more interesting and challenging operation
for the surgeon-in-train ing. As a medical student at Boston City Hospital reported:
18
Science for the People
'.
·-
Women Organize to Fight
In the last year, women have begun to fight forced
sterilization in an organized way . In New York , The
Committee to End Sterilization Abuse (CESA) has developed model guidelines for sterilization that include a
30-day waiting period and a rigorous definition of informed consent.
After a long struggle within the bureaucracy of
New Yo rk's Health and Hospitals Corporation , a citizens' group has· succeeded in getting its guidelines
adopted as hospital policy. For the process, they provoked opposition fro m a large segment of organized
medicine and the population control esta blishment, including Planned Parenthood, the Association for Voluntary Sterilization , the American College of Obstetricians and Gynecologis ts, and HEW. Enforcemen t of
the new guidelines will depend on constant vigilance
and pressure from consumer groups.
In California, the ten women who are suing the
state have succeeded in getting a court order which halts
the use of federal funds for sterilizing women under 21.
The judge also ordered the state to rewrite its Spanish
langu age consent form so that ordinary people can
understand it. These may seem like token victories, bul
at least they are a beginning .
Local Action You Can Join
Feminists Slow to Respond
Feminist reaction and organizing around this issue
has, until recently, been slow . In part, this may be because white, middle-class women have not felt the pressure. If anything, breedin g is still encouraged among
more privi leged women . A young white married woman who li ves in an affluent suburb of Boston tells her
obstetrician that she plans to have only one child. "But
my dear," he exclaims, "you are just the sort of a person
who should have four or five' " This happen ed recently
to a friend of mine . It probably happens all the time to
women who get their care from private obstetricians
rather than from public clinics .
Another reason that femini sts have been slow to
understand the threat of sterilization abuse is that the
population control establishmen t, which is promoting
sterilization, has been our ally in the abortion fight. As a
result , it has been hard for us to be clear about the fact
that their purposes are very different from ours.
When the feds increased funding for family planning twentyfold, they are interested in limiting births,
especially among poor women. They have decided for
the time being that there are too many of us . They are
not interested in our right to control over our bodies. It
is important for us to be aware of this especially when
we cooperate with them around specific issues.
Jan.-Feb. 1977
Recently, women's unions in Minneapolis , C hicago, and Boston have begun to organize action against
steri lization abuse. In Boston , a coa liti on of women
(from the Women's Union , Women's Law Collective,
Women 's Community Health and several other health
organization s) is collecting information on the guidelines and practices in local hospitals.
The gro up would like to hea r from any woman who
works in a clinic or hospital where sterilizations are being performed, and from any woman who has been sterilized, is co nsidering sterilizati o n or has had sterilization suggested to her by a doctor. People both within
and outside the Boston area should contact Madge
Kaplan, Co mmittee to End Sterilization Abuse (CESA),
PO Box 2068, Boston , MA 02106. Another useful
nation al co ntact address is CESA, PO Box 839, Cooper
Station , New York , NY 10003.
En ough information has a lready come to light to
make it clear that forced sterilization is not just something th at happens to other people far away. It is happening here, and now . Only women can stop it. □
Judith Herman writes regularly on wo men's health
issues. She is a psychiatrist and works with the Women's
Mental Health Collective. a feminist therapy group in
Somer ville, Mass.
19
Rep ort on the Nati onal Conference on Ste
r! llza tlon Abu se
Sponsored by the tn terr el lgio u s Fou nda
tion for Community Org aniz atio n
as Pres ente d to the Gover ning Boa
Nat iona l Counci I of Churches of Chr ist rd of the
in the U.S.A.
Novembe r 10, 1977
Pres ente d by Adisa Dou
Con fere nce Coo rdin ator and Sta ff Asso glas
ciat e for Human Rig hts
The par tici pan ts of the Nati ona l
spo nso red by the lnte rrel lgio us FoundaCon fe renc e on Ste ril lzat ion Abuse
tion for Col'llf!lunlty Org aniz atio n cal led
for a moratorium on fed eral ly funded ste
Hea lth, Edu cati on and Wel fare (H EW) has rll izat lon s unt ll the Department of
developed more effe ctiv e fede ral
reg ulat ion s and system for mon itor ing
them
Con fere nce held In the Old Sen ate Off ice . The eigh ty par tici pan ts at the
September 22-23 took such ·an acti on afte Bui ldin g In Washington, D.C. on
and afte r disc uss ing spe cifi c forms of r hea ring many alar min g sta tist ics
fol lowed a rep ort by rep rese ntat ives of ste r i llza tlon abu se. The acti on also
Con fere nce who met with high otfl cla ls va riou s org aniz atio ns atte ndi ng the
The rep ort des crib ed the meeting as beinIn HEW on beh alf of the par tici pan ts.
the need for more effe ctiv e fede ral reg g fru itfu l but clea rly dem ons trat ing
ulat ion s and mon itor ing syst em.
Mr. Al Ian Chase, the auth or ot the
06 Ma lt~ : The Soc-iai. C04.U 06 the New rece ntly pub lish ed book, The Lega.c.y
enc e tha t the United S·t ates has exp erie Sc., lent i6Ic Racl.6m, told the Con fernce d a "ste ri I lzat lon epid emi c" sinc e
1965, which now app roac hes 2 mi I lion
pers
ons a yea r. Along with the incr ease
in the actu al number of surg ical ster i
I
izat
a repo rted Incr ease in ster l I lzat ion abu ion s performed each yea r has come
se.
The 1976 General Accounting Off
(GAO) repo rt on four Indian Hea lth
Ser vice area s reve aled tha t In a threice
e-y ear per iod , 3,40 6 Nat ive Americans
were ster iliz ed. (Na tive American s are
lati on of the United Sta tes. ) In Pue rto abo ut half of one perc ent of the poputhe women of chil dbe arin g age ~ad a lrea Rico by 1968, thir ty-f ive perc ent of
grap her Jose L. Vazquez Calzada In La dy been ste rll !zed acco rdin g to demoEst eri l izac lon Femlna en Pue rto Rico
(Aprl I 197 3). A nati ona l fert ! ! tty stud
perc ent of the Bl ack and 21.7 perc ent y done In 1973 ind icat es tha t 20.I
or have been mar ried are ster l I I zed . of Chicana under the age of 45 who are
The Con fere nce par tici pan ts repr esen ted
some of the member communions of
the Nat iona l Council of Chu rche s, comm
unit
y
org
aniz atio ns working on the Issu e,
members of c Iv i I r Ights grou ps, c Ity and
nat
Iona
I ·1eg is Iato rs, and concerned
lnd lvld uals . They heard keyn ote spea ker
Dor
othy
Hei ght, Fir st Vic e-P resi den t
of the Nat iona l Councl I of Ch urch es and
Pre
side
nt
of the Nat iona l Counci I of
Negro Women make a very Informa tive and
moving add ress .
Dr. Hei ght cal led the ste r ili zat ion prob
lem "one of the con trad icti ons
of our soc iety aris ing from r acis m, sex
ism
and
c lass ism ." She asse rted tha t
"the pass age of pro tect ive law s ls not
enou
gh,
but must be fol lowed by edu cati on
and clos e mon itor ing. "
Report on the Nationa l Conference on Sterll lzatlon Abuse
-2-
Ster! I lzatlon abuse takes differe nt forms. Involun tary sterl I lzatlon
sterl lizatlo n performed withou t the patien t' s knowledge or consen t, is one ,
of the worst forms of this example of human rights violati ons . Increas ingly,
women are discov ering after a period of not being able to bear childre n that
they have been lnvolun tarl ly sterll I zed. Such women have begun to overcome
their feel l~gs of shame and fear of be i ng identif ied publi c ly and are
speakin g out agains t such abuse. Some have brough t the ir cases to court and
have sued various hospita l s , medical profes sionals , and social worker s. Among
the curren t court cases discuss ed at the Conference were the cases of Norma
Jean Serena of Pittsbu rgh and Rosalin d Johnson and Sandra Eaddy of New York.
Ms. Kathy Ml lier of Women Agains t Sterl I lzatlon Abuse, a corrrnunlty
zation based In Phi ladelph la, spoke on the case of Norma Jean Serena , a organi
Native.
American who was lnvolun tarl ly sterl I ized after the birth of her third chi Id
In 1970. Ms. Serena contend s that the consen t form that the casewo rker pressur
ed
her to sign while she was exhaus ted from labor listed "socloe con0mk reasons
"
tor the operat ion. Further more, testimo ny wl I I show that the consen t form
was
signed after the operati on had alreody been performed.
'•· • .
New York CI ty Counc i Iman Carter Burden, the author of the bi I I wh kl1
establi shed the New York City guldel Ines, referre d to two cases. They were
the cases of Rosal ind Johnson and Sandra Eaddy, two black women, both coerced
by white male doctors Into accepti ng sterl I ization under false pretens es.
Sandra Eaddy was able to avoid the actual steril lzatlon proced ure but only
after first signing the forms and being prepare d for surgery . Rosalin d Johnson
,
age 19, was not as fortuna te. She is now Involved in a multi-m i II ion dot tar
lawsuit agains t the city hospita l that steri Ii zed her.
Another form of sterll lzatlon abuse ls the threat of government reprisa
such as the removal of welfare benefi ts, lf the patient does not consen t to l,
sterll izatlon . This abuse was recogni zed In the histori cal court case, Re~6
v. WunbeJLgeJt et. al. brough t on behalf of low-Income victims of Involun tary
sterl llzatio ns performed In hospita l s and clinics partici pating in tederfunded fami ly-plan nlng programs .
•
In a landmark decisio n, Distric t Judge Gerhard A. Gescl I declare d: " ... that
an Indefin ite number of poor people have been Improperly coerced into accepti
a steri lizatlo n operati on under the threat that variou s feder.JI ly s upporte d ng
welfare benefi ts would be withdrawn unless they submit to irrevor sible steri
Iizatlon ." One of the court orders which resulte d in the case was that all consen
t
forms must display promin ently a stateme nt assurin g the welfare mother that
such
benef Its cannot be wI thdrawn. However , desp Ite 1-h Is measure, accord I rig Iu
ference speake r Beulah Sanders of the New York Welfare Rights Organi z~tlon, Conwelfare mothers contin ually report inciden ts of this kind of coercio n.
- 2 -
had requested this information from the NYCDH several months before the begining of the Local Monitoring Project with no success. PL37 does not specificall y
require that this information be published and we found ourselves in the awkward
position of having to effect its release from the NYCDH. Qi this, we were able
t.o obtain the collaboratio n of elected officials. Finally, after an exchange
on this point between a CESA member and Dr. Jean Palcter, Director of the Bureau
of Maternity and Family Planning of the NYCDH at a public meeting in September
of 78, the compiled and partially analysed data reached us a month later, sixteen
months after the enactment of the law and five months after the Project's original request.
The NYCDH, in a letter that accompanied the figures, claimed that it
was understaffe d and underfunded , a fact that we do not doubt, but the political
sensitivity of the issue of sterilizatio n abuse leads us to conclude that there
are other reasons inherent in the delay.
The NYCDH has been and remains staunchly opposed to PL37, claiming that
abuse does not axist, that it is, in any case, statistical ly insignifica nt, that
PL37 interferes with MP flexibility , and that it restricts access to service. While
the first three reasons are either untrue or not valid objections, the last point,
if proven by the data, could be grounds for a suit or for a legislative repeal.
The data, ·however, gives no indication that access to sterilizatio n services has
been restricted as a result of PL37. The only years in which figures were collected were 1973 and 1974 with totals of 7551 .and 7823 respectivel y. 1Ihe total number
of female procedures reported to the NYCDH from 7/1/77 to 6/30/78, after the law
went into effect, was 8022. While it is true. that reporting was not mandatory in
1973 and 1974, the 77-78 totals also reflect considerabl e underreport ing. 'lhe
number of procedures reported in the first three months under the law was one fifth
of the number reported in the fourth three-month period (650 compared to 3040). 'lhe
figures for the first three reporting quarters reflect the refusal of some providers to. report, a fact that we brought to the attention of the NYCDH. 1Ihe NYCDH,
in turn, tried to effect voluntary compliance by writing to non-reporte rs, but has
not taken the next step which would be to turn this information to .the Corporation
Counsel for prosecution .
We suspect, from our experience, that the NYCDH sees itself as a spokesperson for the interests of the physicians. This, we think, accounts for its
further reluctance to publish the data, since the data indicates that some provi-,
ders may still be engaged in illegal sterilizatio n practices punishable under PL37.
Another example of institution al reluctance to implement the law came to
at a meeting called to share information on a questionair e discussed
attention
our
representat ives from our Project, the Ccmnittee for Abortion Rights
between
below,
n Abuse (CARASA), the Greater New York Hospital Association ,
Sterilizatio
and against
of Greater New York, and City Council member Ruth MeShi~ld
Blue
and
Cross
Blue.
best expressed in the following paragraph from the
is
reluctance
This
ssinger.
by the Greater New York Hospital Association to
distributed
Manual
1978 Consent
insinuates that PL37 may not be valid and
paragraph
The
hospitals.
its member
to consumer dissatisfac tion (as of this writdue
short-lived
be
that the law would
It goes on to ignore the official interpred).
materialize
has
ing no such lawsuit
facilities should refer in the event
all
which
to
NYCDH
the
by
tation distributed
I(
- 3of conflict and instead refers the hospitals to their own counsels. If this course
were followed, uneven .and confusing patchwork of• disparate standards in each facility would be the result.
The cily of Nl'W York h:1s adc1pted legislation purporting 10 apply fl, all
palicnfi; prnhihiling lhe performance of slcriliLatiuns of a n111H:mcrgc11cy na1u1e
s
lc511 lhan 30 ,bys after the ~ig11i11~ of the cnns1.nt.28 Unlfrr cerlain .:irc:1n1sl,rncr
where other surgery or met.li.:al treatmcnl takes place within lhe .10 day period on
an emer!!cncy hasis, the law permits the sle,ilization to take place more rhan 72
hours after the consent is given. The New York Cily law als,, sets out spet:ific
requiremenls as to lhe manner in which lhe consenl is secured, the type of doCll•
men talion which h required and (1ther requirements which appear to be in conflit:t
hoth with the gent'ral state statute on consent and the specific provisi,im applicahlc
to Medicaid patients. While some counsel believe that lhe New York City law is
void by virtue of lhat conflict, this issue has not been resolved by the courts. Since
compliance with the statute in its present state may give rise lo legal ohjcctions by
prospective patients, and disohedience of the statute would give: rise to the imRosition of civil penalties, hospitals faced with this dilemma should consult their own
counsel as to the current state of tJ1is law before establishing any policy relating
thereto.
To aid both the Project and the corrmunity advisory boards in obtaining the data., we also visited a meeting of the Consumer Council to the N)'CDH. The
Consumer Council in turn decided to cooperate by demanding that the next contract
for Ghetto Medicine funds be written to empower the community advisory boards to
obtain the kind of statistic al data on steriliza tion with which we have been dealing in this report. 'Ihat attempt failed. It is noteworthy that the data was 'already in existence and in any case was being sent to the NYCDH on a regular basis.
KNOWLEroE OF THE ISSUE AND THE REGULATIONS
In general, we found the level of awareness of PL37 and the issue of abusive steriliza tions to be higher among providers and health workers, whose attitudes on the need for the regulatio ns were largely positive with some reservati ons.
Most of the corrnnunity groups visited, on the other hand, while sympathetic
to the Project's aims, had not been previousl y involved with the issue or aware of
the passing of the law.
'Ihe higher st~te of awareness among providers is possibly due to two factors: the publicity given the issue in the Spring of 1977, when it was being debated in the City Council, and the efforts of the NYCDH, entrusted by PL37 with
the oversight and enforcement of the law, to notify all providers of the law's enactment in ·June 1977,
'Ihe NYCDH, we found out during the course of the Project, provided all
hospitals with guideline s, reporting instructio ns and informati onal material with the
consent doct.nnents, and followed up non-repo rters and questiona ble reports by mail.
'Ihe issue was given additiona l publicity in the early part of 1978,
during the Department of Health, Education and Welfare, Region II hearing, when a
large number of medical personnel testified largely in oppositio n to DHEW regulations (modelled after PL37) concerning federally funded steriliza tions.
Our observati ons of provider awareness were also based on an informal
study done by means of a ·question aire written by several women's health groups,
including CESA, and distribut ed to approximately l~O providers of women's health
- 4services through several members of the NY City Council (tabulate d results from
this questiona ire can be obtained through CARASA at P.O. Box 124, Cathedral Station,
New York, N.Y. 10025).
Of the 33 facilitie s reporting that they do steriliza tions, sane 88%
claimed they were in compliance with the 30-day waiting period,~ % in cornpliance
with the 21-yearmininrun age requirement and 64% with t~ prohibiti on on eliciting
consent from wanen during abortion, childbirt h or labor. While far from perfect,
this record of professed compliance is nruch better than reported in previous studies by the American Civil Liberties Union and Ralph Nader's Health Research Group
in 1975. These reports concluded that 2/3 of the institutio ns studied were in
gross non-compliance with an earlier and far weaker set of federal regulatio ns.
At that time, many of these facilitie s claimed t6 be unaware of the existence or
provision s of the DHEW regulatio ns. .
THE EFFECT O,E THE RE.GUIATIONS IN CURBING STERILIZATION ABUSE
How effective has PL37 been in ending steriliza tion abuse? While we
do not have definite answers., we do have anecdotal indicatio ns of the uses to
which very strict definitio ns of voluntari ness and consent may be put.
A labor and delivery nurse in one of the nrunicipal hospitals told us
she intervene d numerous times to prevent physician s and administr ators from violations of PL37 in connection to the waiting period and anission of the necessary
signature s. When the abuses could not be stopped, the incidents were docl.Bllented
and sent to the proper office at the Health and Hospitals Corporati on for investigation, etc. Had there not been strict standards by which to judge the actions
of the physician s and administr ators, she could not have sucessful ly challenge d her
superiors .
During a visit to another hospital, in a rreeting with staff members from
the departren ts of Psychiatr y, Pediatr~c s, OB/GYN, Social Service and others., we
learned that about one half of those wanen who canplete counselin g and sign consent forms do not return to have the steriliza tions done after the 30-day waiting
period. We were told that the reason was that during the delay, the wanen involved
weight the decision to be sterilize d against the future possibili ty of having a
satisfyin g relations hip with a new partner. Apparently., the lack of danestic permanence and stability frequentl y pranpts medical personel to recomrend steriliza tions, while this saroo factor leads the wanen to select a non-permanent method of
fertility control. Even those members of the staff who were not convinced of the
necessity for legislati on in this area were approving of the positive education al
functions of the waiting period.
In still another hospital, an Admitting Office Clerk spoke of patients
showing up for admission to be sterilize d, who did not even know they were supposed
to be admitted to the hospital. "The doctor told me to cane to this office for an
steriliza tion," was a constant occurrenc e.
REFERRALS AND ADVOCACY
Still another activity the Project becaroo involved with entailed referring victims or potential victims of abuse to legal or medical assistanc e or
providing the necessary infonnati on ourselves when possible. Most of the calls received at the office were for infonnati on about steriliza tion. '!he callers were
usually attemptin g to make a well-informed decision and researchi ng this either
during the wa1 ting period or before signing the consent fonns. Sane of the requests
"""'\
\
- 5-
APPENDIX A
were of a more difficult nature: a woman, 21 years of age, came to the office
requesting a plastic uterus with which to replace her own which she had lost in
a hysterectomy two years earlier. This kind of gross mis-information points to
the drastic need for patient education and referral service.
This referral function, or advocacy, rrust be institutionalized if it is
ever to serve a significant number of people. Small, underfunded and understaffed
cormnmity and consumer groups cannot provide this service except in a very fr~ntary manner.
SavIE SUGGESTIONS AND DEMANDS
1. The establishment of a centrally located, well advertis¢ referral and advocacy system funded in an ongoing way.
,
2. Legislation _at State level or remedial legislation in NYC ordering the
NYCDH to publish the monthly reports.
1r
LOCAL LAWS
OF
THE CITY OF NEW YORK
I
FOR THE YEAR 1977
I
No.37
I
Introduced by Mr. Burden; also Ms. Friedlander, Rev. Gigante, Ms. Pinkett, Mr, Stcingut,
Ms. Stringer, Meur1. Samuel, Rappaport, Berger and Muratori-
I
A LOCAL LAW
I
To amend the administrative code of the city of New York, in relation
to the establishment of guidelines to insure informed consent for
1terilizati()n1 performed in New York city.
3. Legislation to increase penalties, revoke licenses of violators,
publish their names, enable community advisory boards to obtain information from
the hospitals.
B, it moct,d by thr CoMJtCil os follows:
4. Legislation to remove enforcement reponsibilities from the Department
of Health and place it with an agency that will not have such a conflict of interest in monitoring physicians.
I
5. Better multilingual educational material written jointly between the
government, consumers, physicians, nurses, etc.
6. Place direct responsibility for reporting violations on advocates,
cormnmity advisory boards, and consumers, in addition to the oversight body.
7. Begin a ·controlled study to ascertain the safety and efficiency of
new sterilization techniques. Maintain a public registry listing providers with
the exact types of services provided.
*The 21 institutioQs which reflected lack of knowledge of or non-compliance with
PL37 were notified by mail. As of this writing, 12 have replied that they are now
in compliance.
I
I
I
\
Section 1. Chapter 22 of the administrative code of tl\e city of New York ii hereby
amended by a-eating a new title C to follow title B to read as follows :
TITLE C
I C22-1.0. Finding■ and declaration.-The council declaree that due 11D the iffeversible nature of the sterilization procedure, it is essential that the patient fully c:,omprehends the effects and possible oomplications of the operation. The patient should have
a reasonable time to consider his or her decision and possible alternative methods of contraception before the operation is performed. Since it is within the purview of the public
policy of the city to preserve, protect and improve the public health, safety and welfare,
it is imperative that the c:ouncil establish stanI C22-2.0. Definltiau.-When used in thi1 title:
1. "Sterilization" shall mean any procedure or operation, tbe purpose of which
ia to render an individual permanently incapable of reproducing.
2. "Patient" shall mean a -person, twenty-one years of age or older, who is legally
capable of giving his or her consent.
3. "Department" shall mean the department of health of the city of New York.
§ C22-3.0. Application of title.-This title shall apply to every sterilization performed within the city of New York.
I C22-4.0. Wallins period.-A 1terilization may not be performed ,ooner llhan
thirty days following the initial informed consent given by the patient unless the patient
waives the thirty-day waiting period under the following circumstances :
1. A patient who has completed the appropriate forms and infonnational session,
and who has signed the required informed consent form at lea.sit thirty days prior to
her anticipated delivery date, may be sterilized in less than thirty days, but in no
case less than seventy-two hours following the initial informed consent given by such
patient if she delivers prior to the anticipated date and the sterilization is performed
at the time of delivery,
2. A patient who hu completed the appropriate forms and informational session
'\,.,
2
I.
3
and v:ho signs the required consent form at least thirty days prior to the anticipated
sterilization may be sterilized in less than thirty days if that patient is, within the
thirty-day period, admitted to a facility for emergency abdvminal surgery and the
sterilization is concurrent with the abdominal surgery, but in no case shall the sterilization ~cur less than seventy-two hours after the initial consent.
3. If a patient apl)ears for del ivery or emergency abdominal surgery at a facility
other than that at which she has completed the appro;>riated forms and informational
session, the receiving facility shall contact, by telephone, the facility at which the
forms and procedures were completed for verification of same. This must be noted
in the record, with the name and title oi the person providing the information, the
date that the consent form was signed and the anticipated delivery date if under suhdivision one of this section or sterilization date if under subdivision two of this section.
If it is verified that the consent form was signed at least thirty days prior to the
anticipated delivery or sterilization date, the receiving facility may perform the sterilization operation. Telephone ver:f;cation may not be waived unless the patient presents
a duplicate copy of the initial consent, duly signed, witnessed and dated at least thirty
days prior to the anticipated delivery or sterilization date.
I C22-S.0. Requirement• for informed conaent.-No aterilization ahall be performed which does not meet the following conditions :
1. Initial consent may not be elicited from a female patient during admission or
hospitalization for childbirth or abortion.
2. An info=tional ses.,ion conducted by a counselor, who is not the operating
physician, must precede the patient's consent. During the session, information abcout
the irreversibility of sterilization, alternative methods of contraception, and the corresponding risks must be discussed in ttie preferred language of the patient .
3. Written infom-.ed consent for sterilization must be obtained from each patient .
A standardized consent form must be used to satisfy this requirement. The form, supplied by the department must be explained orally by the counselor in the presence
of a witness. A c:-opy of the signed consent form shall be provided the patient.
4. On admission to the facility where the sterilization will be performed each
patient must give written affirmation of his or her informed consent to the sterilization.
S. The patient must be given oral and written assurance that medical services
or benefits will not be lost as a result of refusing sterilization.
6. Contraceptive devices will be prescribd for the patient's use during the JO.day
waiting period.
7. Consent for the sterilization may be revoked any time prior to the operation.
§ C22-6.0. ConNnt form.-The standardized consent form provided -b y the de•
partment must include information about the irreversibility of sterilization, alternative
methods of contraception and the corresponding risks.
§ C22-7.0. Repmu.-Tbe ob1tetric1 or gynecology department of each hospital
where sterilizations are performed, the administrator in charge of each clinic where sterilizations are performed, and phy.sicians in private practice who perform sterilizations must
submit monthly reports of the number of sterilizations performed to the department of
health. Forms will be provided by the department.
I CZZ-8.0. Enforcement proceecUnp.-.. Notwithstanding the provision• of
any other law, any person violating any of the provisions of this title shall be liable and
res!)!"r.s ible for a penalty of not more than $1,000 to be recovered in a civil action but
in the name of the city in any court of record in the city.
b. The commissioner of health may in his discretion request the corporation counsel
10 in stitute legal proceedings to restrain, correct or enjoin any violation of th is title; and
the corporation counsel shall thereup<>n institute such action or proceeding as may be
necessary and appropriate for such purpose.
c. ~uch actions and proceedings may be entered into by the corporation counsel
in anr court of civil jurisdicti~ within the city. In such actions and proceedings the
city may apply for restraini!ig orders, preliminary injunctions or oth~ provisional remedies wi th or without notice.
cl. In no case shall the department or any officer or employee thereof be liable for
cost• in any such action or proceeding and offi.cers and employees of the department, actin,
in good fa ith, shall be free from liability for ac.ts done in any action or proceeding.
§ C22-9.0. Separability.-lf any provision of thi1 chapter is held inv,.lid, oc ineffective in whole or in part, or inapplicable to any given situation, it is the intent and purpose of this chapter that all other provisions of this chapter shall nevertheless be separat-ely
and fully valid, effective, and applicable.
§ 2. This local law shall take effect 30 days after enactment.
THE CITY OF NEw YoRK, OFna OF THE CITY CLERK, s .s. :
I-hereby certify that the foregoing is a true copy of a local law of The City of New
York, passed by the Council on April 19, 1977, and approved by the Mayor on May 20,
1977.
DAVID N. DINKINS, City Clerk, Oerk of the Council.
CERTIFICATION PURSUANT TO MUNICIPAL HOME RULE LAW SECTION Zl
Pursuant to the provisions of Municipal Home Rule Law Section 27, I hereby certify
that the enclosed local law (Local Law No. 37 of 1977, Council Int. No. 1105-A), contains the correct text and r·eceived the following vote at the meeting of the New York
City Council on April 28, 1977 : 38 for, none against, and 3 not voting.
Was approved by the Mayor on May 20, 1977.
Was returned to the City Clerk on May 23, 1977.
W . BERNARD RICHLAND, Corporation Counsel.
I
\
Birth control as an individual right must not be confused ~ith population control as social manipulation.
dad como un derecho individual no debe ser confundido con el control manipul!!_do de la poblacion.
El control de la natali .,
APPENDIX B
VOLUNTARY HOSPITALS
STERILIZATIONS REPORTED IN NEW YORK CITY
(MANHATTAN)
BEEKMAN OOWNTavN
BEI'H ISRAEL
II
DOC'IOR' s
JEWISH MEMORIAL
JULY 1, 1977 THRU JUNE 30, 1978
(FIRST YEAR)
II
II
ARTHUR C. LOGAN
LENNOX HILL .
II
II
MOUNT SINAI
II
NEW YORK
II
NEW YORK INFIRMARY
II
PRESBYTERIAN
II
ROOSEVELT
II
ST. LUKE'S
II
TRAFALGAR
II
UNIVERSITY
(BRONX)
BRONX LEBANON
II
UNION
(BROOKLYN)
BROOKDALE
II
BROOKLYN
II
A total of 8500 steril izatio ns were report ed to the New York City
Department of Health between July 1, 1977 and June 30, 1978.period was as fo'lhe number performed in each borough during this
llows:
MANHATTAN
2472
BRONX
1232
BROOKLYN
2656
QUEENS
1634
RICHMOND
556
I
I
I, .
I
-
I
8550
'IDTAL
I
A breakdown of these 8550 steril izatio ns by indivi dual provid er is
as
I
follow s:
TABLE I
NUMBER REPORTED
FROM JULY 1, 1977
THRU JUNE 30, 1978
NAME OF PROVIDER
MUNICIPAL HOSPITALS
BELLEVUE
HARLEM
METROPOLITAN·
SYDENHAM
BRONX MUNICIPAL
NORlli CENTRAL
CONEY IS:LANp
CUMBERLAND
GREENPOINT
KINGS COUNTY
EIMHURST
QUEENS GENERAL
(MANHATTAN)
II
II
II
(BRONX)
II
(BROOKLYN)
II
II
II
(QUEENS)
II
252
119
140
31
258
83
76
103
101
152
119
122
I
I
I
CALEIX)NIAN
II
Ca.1MUNITY
JEWISH
IDNG ISLAND COLLEGE
II
II
11
II
LUTHERAN
LUTHERAN MEDICAL C'IB II
II
MAIMONIDES
11
MEI'HODIST-PECK M.
11
ST JOHN EPISCOPALIAN
II
STATE UNIVERSITY
II
UNITY
"
WYCKOFF HEIGI-rrS
II
BAPI'IST
II
VIC'IORY MEMORIAL
(QUEENS)
BOOI'H MEMORIAL
II
FilJSHING
II
JAMAICA
II
L.I. JEWISH
II
PENINSULA
II
LA GUARDIA
II
SOUTH SHORE
RICHMOND MEMORIAL (RICHMOND)
II
STATEN ISLAND
'IDTAL VOLUNTARY
27
189
54
5
4
118
86
400
179
192
50
332
1
89
377
48
511
77
147
26
69 ·
313
36
81
237
18
157
14
21
80
11
100
97
101
188
159
43
176
102
90
3_38
5403
PROPIErARY HOSPITALS
MEDICAL ARI'S
PARKCHESTER
PROSPECT
FLATBUSH
INTERBORO
(MANHATTAN)
22
(BRONX)
172
II
(BROOKLYN)
II
294
99
88
1556
'IDrAL MUNICIPAL
- 2 -
- 1 -
-~- --- --- --- --- ~~ -~~
'- -~- --- --- --- --- -~~ ~-~ ~-- --- --- -~- --- --- --- --- --- --'- ---
-~- --- --- --- --- --- -~- --- ---
KINGS HIGHWAY
LEFFERTS
DEEPDALE
HILLCREST
PARKWAY
PARSONS GENERAL
TERRACE HEIGHTS
WHITESTONE
PHYSICIANS
BOULEVARD
OOCTOR' S
(BROOKLYN )
II
(QUEENS)
II
II
II
II
II
II
II
(RICHMOND )
60
16
68
297
7
7
32
6
'57
37
100
l:l-1?.
. . . .
:>:t co
1362
rl
I:'--
0\
\0
rl
(\J
rl
l
(\J
0
I:'--
~~ I (Y)
0\
TOTAL PROPRIETARY
0\
rl
(\J
l:l-1?.
I:'-I:'--
0\
..
..:::r
I:'--
I
l:l-1?.
0
0
I
r:--i
I
0
r-i
I:'--
r-f
I:'--
I
I.["\
rl
CLINICS
~ ffi
I
PLANNED PARENTHOOD (MANHA'ITAN )
HAMILTON MEDICAL ASSOCIATES (BROOKLYN)
UROI.ffiIC SURGICAL ASSOCIATES (BROOKLYN)
FLUSHING WCT-1EN' S MEDICAL CENTER (QUEENS)
TOTAL -CLINICS
;
170
2
1
CJ)
lg
181
~
f
H
H
PRIVATE PHYSICIANS
'
I
(MANHA'ITAN )
BERNARD FRUCHMAN
AIEXANDER sarIROPOULOS (MANHA'ITAN )
GERAW ZELIKOVSKY (MANHA'ITAN )
GASPAR M. ADAMO (QUEENS)
STANLEY GINSBERG (QUEENS)
IRA A. WASSERBERG (QUEENS)
KAI M. CHEN (RICHMOND )
TOTAL PRIVATE PHYSICIANS
TOTAL ALL PROVIDERS
E-i
2
1
9
2
3
3
28
48
8550
;
~
~::,..
~
~
el
~
N
I
l:l-1?.
I
~
i
-~
co
~
. b\
NO'rl
(\J
r-i
• 0\
(\J
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rl
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0
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..:::r
(\J
..:::r
..:::r
(Y)
I.["\
;1 I
,-;
I
I:'-•O\
~ O'rl
\0
rl
I:'--
co
\0
rl
(Y)
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..:::r
..:::r
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I.["\
rl
(Y)
~
I
I:'--
. b\
..:::r G r-1
.....,
I
I
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I:'--
I:'-f@ •' 0\
(Y)Q'rl
~
I
I
~
~
I
\0
(\J
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I.["\'
rl
r-f
. . . . .
l:l-1?.
~
I
co
I.["\
\0
I.["\
I.["\
I:'-r-f
I:'--
(\J
r-f
\0
(\J
I.["\
(\J
..:::r
I.["\
rl
I.["\
co
(\J
I.["\
(Y)
. . ..:::r. . .
rl
(Y)
(\J
0\
\0
(Y)
0
(Y)
(\J
(\J
I:'-(Y)
rl
(\J
~ =
H
p..;
rl
(\J
I:'-rl
..:::r
0
(Y)
l:l-1?.
0
0
rl
0\
0\
I.["\
(\J
l:l-1?.
0
0
rl
0\
I
I
I.["\
(\J
(\J
l:l-1?.
0
0
r-f
(\J
I.["\
\0
~
::
H
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I
I
rl
(\J
rl
(\J
l:l-1?.
0
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•
r-f
(\J
l:l-1?.
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(Y)
(\J
r-f
co
8
p..;
I
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I:'-rl
. . . . .
I
l:l-1?.
~
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- 3-
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l:l-1?.
I~ ~i
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CJ)
~
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11
..:::r
TABIB III
ALL STERILIZATIONS REPORrED IN NEW YORK
CITY SINCE JULY 1, 1977
NUMBERS AND PERCEm' BY INDICATION AND SEX
INDICATION AND SEX
3RD
Q.
%
1977
4TH
Q.
%
1977
Q.
%
1978
MALES-'IUI'AL
41
121
187
BIRIB CONI'ROL ONLY.
26 66.7
BIRIH CONIBOL AND
MEDICAL
MEDICAL INDICATION
ONLY
INDICATION Nar STATED
6.3%
5.4%
89 84.8
1ST
7.2%
163 89.1
2ND
Q.
%
1978
179
5.9%
147 88.6
JULY
1978 %
45
4.3%
28 71.8
2
5.1
5
11
28.2
11 10.5
19 10.4
17 10.2
-
9 23.1
16
4
13
6
2
4.8
- 1
0.5
2
1.2
2
5.1
FEMALES-'IDrAL
611 93.7%
2138 94.6% •
24).2 92.8%
BIRIH CON'IROL ONLY
2861 94.1%
463 77.0
1012 95.7%
1575 75.8
1777 76.2
1891 67.8
709 71.0
41
168
174
211
7.6
102 10.2
BIRIH CON'IROL AND
MEDICAL
6.8
8.1
7.5
MED ICAL INDICATION
ONLY
97 16.1
335 16.1
381 16.3
INDICATION NOI' STATED
_684 • 24.6
187 18.7
10
60
Sci
75
14
10TALS
652 100%
3040 100%
1057 100%
2259 100%
2599 100%
- 5-
TABIB N
BIRTH CONTROL INDICATED STERILIZATIONS
REPORTED
IN NEW YORK CITY SINCE JULY 1, 197 7
NUMBERS AND PERCENT BY PARITY
(PREVIOUS BIRTHS)
4TH
Q.
%
1977
1ST
Q.
%
1978
2ND
Q.
%
1978
JULY
1978 %
PARITY
3RD
Q.
%
1977
12
2.6%
31
2.2%
48
2. 8%
55
3.0 %
14
2.0%
1
42
9. 3
121
8.5
168
9-Ei
161
8.7
78
11.2
2
171
37 .7
509
35. 6
582
33 .4
621
33 .7
242
34. 8.
3
127
28 .0
426
29 .8
508
29. 1
545
29.5
200
28.8
4
60
13 .2
180
12.6
258
14. 8
257
13. 9
91 ' 13.1
. 5+ •
41
9.1
162
11.3
181
10.4
206
11. l
70
10 .1
NS·
10
146
14
--
TOTALS
463 100%
1575 100 %
SOURCE:
32
Individual ste rili zat ion Reports
- 6-
1777 100%
46
1891 100%
709 100 %
TABIE V
Ff1.1ALE BIRTH CONTROL INDICATED STERILIZATIONS REPORTED
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS AND PERCENT BY PROCEDURE
PROCEDURE
3RD
Q.
%
1977 ·
TH
Q.
%
1977
LAPARA'IOMY
262
56.6%
794
COLPCJ.I'O!VIY
2
0.4
LAPARASCOPY
139
OI'HER TUBAL
60
1ST
Q.
%
1978
2ND
Q.
%
1978
JULY %
1978
50.4%
1051
59.1%
1017
53.8%
398
56.1%
25
• 1.6
21
. 1.2
35
1.9
17
2.4
30.0
520
33.0
530
29.8
648
34,3
220
31.0
13.0
236
15.0
172
9,7
188
9, 9
73
10.3
3
0. 2
3
0.2
1
0.1
HYS'IEREC'IOMY
CYI'HER
TOI'AL
SOURCE:
463 100%
,,.
1575 100%
1777 . 100%
1891 100%
709 100%
Individual Sterilization Reports
- 7 -
TABIE VI
F'EMALE BIRTH CONTROL INDICATED STERILIZATIONS REPORTED
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS AND PERCENTS BY El'HNIC GROUP
\
4TH
Q.
%
1977
1ST
Q.
%
1978
2ND
Q. . JULY
1978 1978
%
El'HNIC GROUP
3RD
Q.
%
1977
WHITE
189
40.8
687
43 . 6
680
38,3
777
41.1
316
44.6
NON-WHITE
153 • 33,0
532
33 , 8
556
31.3
585
30.9
232
3·2. 7
HISPANIC
121
26.1
356
22.6
541
30.4
529
28.8
161
22.7
TOI'AL
463 100%
SOURCE:
1575 100%
Individual Sterilization Reports
- 8 -
1777 100%
1891 100%
709 100%
TABIE VII
FEMALE BIRTH CONI'ROL INDICATED STERILIZATIONS REPORrED
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS· AND PERCENr BY AGE
3RD
AGE
4'lli
Q.
%
1977
Q.
%
1977
1ST
Q.
%
1978
2ND
Q.
%
1978
2
1
0-19
0.1%
JULY %
1978
0.1%
20
3
0.4%
21-24
45
10.9%
114
7.8%
194
11.6
147
8.1
63
9.2
25-29
82
19.9
384
26.3
433
25.8
459
25.2
154
22.4
30-34
158
38.3
471
32.3
527
31.4
646
35.4
254
37.0
35-39
93
22.6
380
26.0
383
22.9
425
23.3
163
23.7
40-44
32
1.8
105
1.2
125
7.5
137
7.5
47
6.8
3
o.4
2
45-49
0.5
50+
5
0.3
1
0.1
12
10
0.7
NS
51
115
101
TCYrAL
463 100%
1575 100%
1777 100%
...
tL5
66
22
1891 100%
709 100%
SOORCE: Individual Sterilization Report
- q -
I
TABIE VIII
FEMALE BIRTH CONI'ROL INDICATED STERILIZATIONS REPORTFD
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS AND PERCENTS BY TJJ,1E STERILIZATIONS WERE PERFOOOD
3RD
4TH
1ST
%Q.
1978
JULY %
1978
677
37.0%
286
41.6%
6.7
72
3.9
31
4.5
59.3
1081
59.1
370
53.9
Q.
%
1977
Q.
%
1977
AT TIME OF DELIVERY
156
39.0%
557
39.8%
590
34.0%
AT T1ME OF .ABrnTION
19
4.8
66
4.7
117
PREnNANCY
225
56.2
776
55.5
1028
NO!' STATED
63
176
TCYrAL
463 100%
1575 100%
NO!' ASSOCIATED WI'lli
SOURCE:
42
Individual Sterilization ·Reports
- 10 -
2ND
%
TIME PERFORMED
1777 100%
Q.
1978
61
1891 100%
22
-- 109 100%
TABLE IX
FEMAIB BIRTH CONTROL INDICATED STERILIZATIONS REPORTED
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS AND PERCENT BY METHOD OF BIRTH CONTROL USED PREVIOUSLY
1ST
Q.
%
1978
2ND
Q.
%
1978
3RD
METHOD OF BIRTH CONTROL Q.
%
1977
4TH
Q.
%
1977
BIRTH CONTROL PILLS
134
33.3%
385
32.8%
387
28.7%
390
26.9%
172
30.9%
U.D.
23
5.7
95
8.1
155
11.5
153
10.6
46
8.3
RHYTHM
8
2.0
10
0.9
13
1.0
19
1.3
11
2.0
DIAGPHRAM
12
3. 0
60
5.1
62
4.6
78
5.4
28
5.0
FOAM &· JELLY
3
0.7
27
2.3
22
1.6
32
2.2
10
1.8
NONE
132
32 . 8
365
31.1
394
29 . 2
457
31.5
168
30 . 2
OI'HER
3
0.7
4
0.3
11
0.8
12
o. 8
4
0.7
MULTIPIE METHOD
71
17 ,6
166
14.2
247
18.3
230
15.9
81
14.5
NO!' S'I'ATED
60
CONDQVI
17
TOI'AL
463
SOURCE:
Individual Sterilization Reports
428
403
4. 2
60
5.1
58
441
4.3
1777
1575
JULY
1978
79
152
5,4
1891
37
6.6
709
- 11 -
TABIE X
FEMALE BIRTH CONTROL INDICATED STERILIZATIONS REPORTED
IN NEW YORK CITY SINCE JULY 1, 1977
NUMBERS AND PERCENTS BY TYPE OF PAYMENT
3RD
Q.
%
1977
4TH
Q.
%
1977
1ST
Q.
%
1978
2ND
Q.
%
1978
JULY %
1978
SELF
120
7. 0
36
MEDEAID
661
38.7
218 36-.5
OTHER THIRD PARTY
925
54.2
344 57.5
NOT- STATED
185
111
1891 100%
709 100%
'I'YPE OF PAYMENT
TOTAL
463
SOURCE:
Individual Sterilization Reports
1575
1777
- 12 - 1
6.0
INDIVIDUAL STE3ILilA'IIO~; ?--EPORT
NAME OF .:.c.. CILITY _ _ _ _ _ _ _ _ _ _ __
(APPENDIX C)
REPORTING ?ERIOD
------------
Date Consent Signed
Date Surgery Performed
Date Reaffirmation Signed
Chart Nur-~er of Patient
PROCEDURE
Laparotomy
Colpotomy
!.aparosCOP¥
Other Tubal
HysterectomyVasectomy
Other (Specify)
SEX OF p_::._TIENT
~ale·
Female
--------
-------------- BASIS OF :?.~.YMENT
-----------
INDICATION FOR PROCEDURE
Birth Control O,nly···
Medical Indication Only - - - - - - Birth Control and
Medical Indication
---------
---------
MEDICAL INDICATION
Cardiovascular Disease
------Infectious Disease
Metabolic Disease
Renal and Renal-V_a_s_c_u~l_a_r_ _ _ _ __
Malignancies
Conditions D_u_e_t_o_ _ _ _ _ _ _ _ __
Obstetrical Injuries
------Other (Specify)
AGE OF PATIEN=T=-----------
"' ·
Self___
Medicaid
Other Thi=d Party
---------
HOSPITAL STAY
RACE OF F.~TIENT
White
Black
Hispanic
Oriental .
Arner. Inc.ian
Other
COMPLICA':"IONS
None
Hemorrhai;e
Infectior.
Incomplete Sterilization
----Death
Other (Sr:ecify)
PREVIOUS BIRTHS
,...----~W~e_r_e-=B-o_r_n-=A~l-i~v-e_ _ _ _ ___;
Are Now
Living _ _ _ _ _ _ _ Now Dead _ _ _ _ _ __
If None
·check Here
Spontaneous
Fetal Deaths
Before 13 weeks
----~
.13-19 weeks
2o · and more weeks
-----
- - - -- - - - - - - -- -_, ----=a•
Month uncl Year o f :
Induced
Last Live Birth
Fetal Deaths
·- - - L~st Spontaneous
B~fore 13 \-:eeks
Fetal Death
13-19 weeks
Lust Induced ,
20 and more weeks
fetal Death
•
METHOQ .OF BIRTH CONTROL USEC PREVIOUSLY ,
Diaph r =-.ro--=--=--------Birth Control Pills_________
Foam & Jelly _ _ _ _ _ _ __
_________
IUD
None
Con1om
Other {Specify) - - - - - - Rhythm
, TIME PERFORMED
At Time of Abortion _ _ _ _ _ _ _ __
At Time of Delive t y Not Associated with Pregnancy _ _ _ _ _ _ _ _ _ _ __
. I
FIGHTING
STERILIZATION
ABUSE
Judith Herman
In 1973 . two black sisters in Alabama . aged 12 and
14, were sterilized in a federally funded family planning
program . Their mother had been persuaded to give her
consent by making an X on a form which she could not
read. She did not know th a t the operation was permanent.
In the same yea r, a white mother in South Carolina
revealed that the area's only practicing obstetrician routinel y refused to deliver a third child to women on welfare unless they co nsented to sterilization . As hi s nurse
explained it. "This is not a civil rights thing or a racial
thing. it's just welfare." In a six month period. this doctor had performed 28 sterilizations. mostly on black
women.
In Armstrong County Pennsylvania, Norma Jean
Serena. a Native American woman, is suing hospital
and welfare officials for involuntary sterilization. Her
tubes were tied immediately after the birth of her third
child. while she was medicated and exhausted from the
delivery. She was not aware that she had been sterilized
until the following day, when she was persuaded to sign
a consent form. Her medical chart states that the operation was performed for"socio-economic" reasons.
In Los Angeles, ten Chicana women have filed a
class-action suit against hospital and state health offi cials charging that they were either coerced or deceived
into being sterilized. Some were presented with consent
forms while in labor. Others never signed forms at all
and only le1rned later that they had been sterilized.
Sterilization: U.S. Policy
Sterilization as a means of controlling population
in Third World countries has been a part of our governThis article first appeared in Sister Courage, a Bostonarea feminist newspaper. whose address is: P.O. Box
296. Allston , MA 02134 .
Jan .-Feb.- 1977
ment·s policy for yea rs . In Puerto Rico. the laboratory
for U.S. population experi1m:nts. and testing ground for
the pill. over one-third of all \\Omcn \lf child-hcaring age
have already been sterili1ed.
In the last five years. this policy has come h\lmt: to
the mainland. Since 1970. female sterili1ati(1ns in thc
U.S. have increased almost thrcefuld. Bet\,ccn 600.000
and one million procedures arc now performed on
women each year. Poor women and women of C\llor are
heavily overrepresented: Twenty percent of married
black women have been sterilized. compared to about 7
percent of married white women. Fourteen percent of
Native American women have been sterilized.
The in crease in female sterilization ha s come about
not in response to wnmen·s demands (as in the case of
abortion) . hut as the result of governmental polic~ and
pressure from hospitals and doctors. In 19 7 1. N 1.xon appointed John D . Rockefeller Ill to he chairman nf a
commission on "Population and the American Future."
Rockefeller has been eminent among the promoters of
the idea that the "population explosion" is responsible
for povert y in the world. A natural enough idea for a
Rockefeller . The Commission advised that :
.. .slowing the rate of population growth would
ease the problems facing the American government in the years ahead. Demand for government
services (read welfare) will be less than it would be
otherwise. and resources available for the support
of education. health. and other services would be
greater.
17
Funds for Sterilization, not Social Senices
Though Nixon rejected the Commission·s report
because it recommended legalized abortion as one
method of limiting births, many of the Commission's
recommendatio ns have been put into effect. Bet,\een
1969 and 1974, federal allocations for family planning
increased from 11 million to 250 million dollars. while
funds for Head Start. child care. and community health
were repeatedly cut. By 1974, HEW had modified its
guidelines to require states to provide family planning
services to welfare recipients. And most recently . HEW
has announced that states will be paid 90 percent of the
cost of sterilizations for poor women . but only 50 percent of the cost of abortion. This gives hospitals and
clinics an incentive to promote an irrever sible birth control method and to discourage the method which give,
the individual woman the greatest amount of flexibilit:
and perso nal control.
At the same time that government polic: has S\\ ung
around to promoting population control '"'ithin this
country. medical policy has also shifted in favor or
liberali,ed guideli nes for sterili1ation. In part. this may
be because the medical profession ha, accepted the
Rockefeller line on O\erpopulation . In a recent surve:.
94 percent of g: nernlogists polled in four major citie,
said that they favored co 111pul.rnrr qerili1atinn for \\Clfare mothers with thn:e or more ••itlcgi timate ·· childrt:n.
As Dr. Curtis Wood. president of the Association for
Voluntary SteriliLation puts it :
The name of the game is surgery - bring the patient in. cut her open and practice. and move her
out. While she is there she is an object. treated
coldly, patronizingly. Backs are turned on
patients. questions a re unanswered. operation permit forms a re not explained. It is jokingly said th a t
the on ly needed prerequisite for a hysterectomy is
not to speak English . It isn·t much of a joke.
Federal Guidelines Minimal
As a result of the case of the Relf sisters in Alabama. HEW "as ordered to set up guidelines for sterili1ation, ,upported b: federal funds. The guidelines were
minimal. but they did include a requirement that the patient be told that sterilization is permanent. and that she
be assured that she would not lose any benefits such as
" ·c lfarc. if she refused.
A 72 -hour ,,ailing period "a~ abo required bet\\cen the: time: the \\Oman -.i gncd the form and the performance or the nperation. Thi, "a~ included to al low
the \\Oman tu ch:1nl!e her mind if ,he had ~igned under
dure-., . J\lmo,t :1 :c::1r aft er the c11urt order. the ACLU
reported that 1110,t or the h11,pitah the: ~ur veyed did
not bother to com pl'., "ith even the,c minimal guideIinc, .
People pollute, and too many people crowded too
close together cause many of our social and economic problems ... As physicians. we have obligations to our individual patients, but we also have
obligations to the society ... The welfare mess. as
it has been called, cries out for solutions, one of
which is fertility control.
Practice for Surgeons
Even more than ideology, the doctor 's interest in
surgical training has led to the promotion of sterilization, especially in major teaching hospitals . Women
who want birth control are talked into sterilization.
without any discussion of the risks involved (sterilization is a t least as dangerous as the pill or the IUD) or the
available alternatives.
Women who definitely want sterilization are often
persuaded to have a hysterectomy , rather than the far
less complicated tubal ligation. simply because a hysterectomy is a more interesting and challenging operation
for the surgeon-in-train ing. As a medical student at Boston City Hospital reported :
18
Science for the People
Women Organize to Fight
In the la st yea r . women have begun to fig ht fo rced
sterili zation in an o rga nized way. In Nev. York . The
Com m ittee to End St e rili za ti o n Abuse (CESA) h as developed m o d el guide lin es fo r sterilization that include a
JO-day waiting period a nd a ri gorous definiti on of informed consent.
After a lo n g stru gg le w ithin the bureau cracy o f
Ne\\ Yo rk' s H ea lth a nd H os pital s Co rp o ra tion . a c itizens' group h as su cceeded in getti n g its guidelines
adopted as hospital policy. For the process, th ey provoked o pposi ti o n from a la rge segment o f o rga ni 1ed
medi c ine a nd the po pul ation co nt ro l establishment . inc lu ding Pl a nned Pare nth oo d. the Association fo r Vo luntar y Sterili zation. the American Co ll ege o f Obstetricia ns a nd Gyneco log ists . and HEW . E nforce ment of
the new g uidelines ,,,.ill depend on cnnstant vigilance
and press ure fr om co n sum e r groups.
In California . thc ten wo men ,,ho a re suing th e
state have succeed ed in gctting a court or der whi c h h a lts
the use nf fede ra l funds for ste rili ting v. omen under 2 1.
The _j ud ge a b n orde red the sta te to rev.rite it s Sp anish
language consent form so that ordinar~ peo ple ca n
understand it . These may seem li kc token vic tories. hut
a t ka st th ey a re a be gi nnin g.
Local Action You Can Join
Feminists Slow to Respond
Feminist reaction and organizing a round this issue
h as . until recently, been s lo'A. In part. th is may be because white. middle-class \\Omen have not felt the pressure. If anything. breeding is st ill encouraged a m ong
m ore privileged wo m en. A young white married woman who li ves in an afnuent suburb of Boston tells her
o bst e tri cian that she plans to have only one child. "But
my dear ... he exclaims. "rou are just the sort of a person
v.ho shou ld have four or fivcl" This happened recently
to a friend ,)f mine . It prnhably happen~ al l the time to
\\ Omen v.ho get their care from private obstetricians
rather than from public clinic~.
Another reason that feminists have been slov. to
und e rstand the threat of steri li zation abuse is that the
po pulati on con trol establishment. which is promoting
sterili za ti on. has been our a ll ) in the abortion fight. As a
result. it has been hard for us to he clear about the fac t
that their purposes a re ve ry different from ours.
When the feds increased funding for family planning twent y fold. they are interested in limiting births.
especial ly among poor women. They have decided for
the time being that there are too many of us. Ther are
not interested in our riiht to co ntrol o l'er our hodies. It
is important for us to be aware of this especially when
we cooperate with them arou nd specific iss ues.
Jan .-Feb. 1977
Recen tl y. \Hlmen\ union~ in Minneapnli, . Chicago. and Boston ha,·c begun to o rgani;c ac ti nn again,t
sterili 1a ti on abuse. In Bost1in. ;1 coalition of ,, omen
(from the W o m e n's Union . W o men's La w Coll ec ti ve .
W o men 's Co mmunity Health and several o the r hea lth
o rgani za tio ns) is collect in g inform atio n o n the guidelin es a nd practices in loca l hosp it a ls .
The group \\ Ould like tn he ar from an~ \\Oman ,, ho
'AOrks in a clinic nr hospital" here ,tcrili1ations a rc being pe r fo rmed . and from an~ ,,on, ;111 \\h o h as been ~tc rilited. is considcring ,tcrili1atinn nr has had ,tcrili1ati on su ggested to he r by a doctor. People both within
and ou tside the Bo~ton area ,hnuld contact Madge
Kaplan . Committee to End Steri li1,1t ion Abuse (CES/\ ).
PO Box 2068 . Boston, M/\ 02 106 . Another use ful
nationa l co ntact a ddress is CESA. PO Box 839. Coo per
Station, New Yor k . NY 1000 3.
Enoug h information has a lready come to light to
make it c lear that fnrccd \ teri li;ati o n is no t jus t something that h ap pen s to o ther peo ple far av.ay . It is h a ppening here . a nd now. On ly v.omen ca n stop it.D
Judith Her man writes rei ularl_1· on tt·n m en ·s health
issues. She is a ps_l'chiatrist and works with th e Women's
Mental Health Co llecti ve, a femin ist th erapr gro up in
Somerville. Mass.
19
THE LEGACY OF MALTHUS;
The Soci a l Cost s of the New Scie nt if ic Racis
m
(A Sect ion from Chap ter I)
by Al Ian Chase
[Rep roduced wi-th perm issio n from Alfr ed A.
NOT TO BE SO LD
Kno pf , Inc. , 1977 ]
NOT TO BE SOLD
(reproduced with permission from Alfred A. Knopf, Inc. 1977)
THE CURRENT EPIDE'.\IIC OF FORCED STERILIZATIO~S
The co mpuiso ry steril izations den o unced by Judge Gesell do not begin to
include all of the involuntary go nadal surgery presently being committed
against equally poor people by nonfederal state and voluntary agencies. In
1974, the Assoc.: iation for Voluntary Sterilization, Inc., estimated that 936,000
Am erican people-538 ,000 (57 percent) males, and 398,000 females-had
be en surgi cally ste ri li zed during 1973. This represented a drop of I 66,000
from the to tal of I, I 02,000 ste riliza tions in 1972-but a jump of 13 percent
in th e esrimated nu mber of female s sterilized. If what a high government
o ffi .:ia l involved in the se matters told me off the record proves correct,
possib ly ano ther 250,000 sterilizations are di sgui sed in the hospital records as
hysterectomies in wh ic h female sterilization is an unavo idable sid e effect. 20
[n eth ica l medical practice, a hysterecto my- the remo va l of the uterns
- is perfo rmed o nly when its tissues becom <:: d amaged, di seased, or malignant ,
and no t to achieve sexual sterilization . Med ically, th erefore , to perform a hysterectomy in o rde r to sterilize a female is, obse rved the president of the American College of Surgeons, Dr. Charles McL aughlin , "like killing a mouse with
a ca nnon. ":? 1 It is al so much mo re lethal th an simple steriliz ati o n operations
to women , si nce at p resent some 12,000 deaths a year occ ur among women
rece iving hysterec to rnies.2 ~ Ne vertheless, since the current re vival of Galton's
ni nc:tee nt h-century crusade for surgical steril iz ation was launched, the hysteria
unleas hed by the new M althusian populatio n extremi sts ha s caused the annual
nu mber of hyste rectom ies to rise , so that this operation is seco nd only to the
append:?ctomy as th e most fre q uently performed surgical proce dure in
A merica .
The ch ief victims of med ically needless hy sterectomies a re, pred ict ably,
G a!ton 's original ta rge ts : the lower- mid.d ie-cl ass a nd wo rking -class familie s
wh 0 cannot affo rd the costs of prope r med ical ca re, and th e unemplo yed. By
l
18
THE F U:-.:CTlO.SS .~N D SOCIAL COSTS OF SCJESTIFJC RACJSM
1975, according to The New York Tim es: " In New York and other major
cities, a hysterectomy which rend ers a patient sterile costs up to $800, \\J,ile
a tuba l ligation [the tying off of the Fall o pi an tubes] , which does the sr.m e
th ing, pays only 5250 to the su rgeon, incre as ing the mot ivation to do th e more
expensive operat ion. Medicare, M edicaid and othe r h ealth pl ans for t(le· poor
and the affluent b oth will reimburse a su rgeo n up to 90 percent for the costs
of any sterilization procedure, and sometimes will allow nothi ng for ab ortion.
As a consequence, 'hyster- steri liza tions'- so common among some groups
of in dige nt bl acks tha t th ey are referre d to as •Mi ssissippi append ectomic s' are increasingly p opular am o ng surgeo ns, de spite the risks. " 23
The officially repo rte d hospita l sterilizati o n operations represent about
half of the actual sterilizati o ns pe rfo rmed each year in America. Most , ·asecto mies- -male sterilization s- are p erform ed under local anesth esia in d oct o rs'
offices, rather tha n in hospitc1l opera ting roo ms.
The actual numb er of A merica ns \\'ho are each yea r sterilize d n :i]u ntc1 ri ly ,
o r under threats of go,·ernrnent reprisJ.ls, is not known . Jn his 1973 ;rnn ual
report, Dr. H . Curt is Wood, Jr. , the medica l consultant fo r the A ~~ocia ti on
fo r Volun1 ary Ste rili za tion, In c., est im at ed tha t, betwe en 19 60 and 1972., "the
incrc :=tse in steri liz atio ns in the l.J11i1 1: d St at1: s [was) from aro und 100,000 per
ye a r to I or po ~sibly e \'en 2 rni lli o n a yea r. " In 1974, R obe rt E. i\-kG a mi h,
J r., the Jt torn cy fo r the P ubli c C i1i1c n· s H ea lth Rc ~ea rch C ounci l o f \\ '.cishin gto n, D .C. , ,, ro te that " at presen t rate s, a to ta l of two milli o n people un de rgo su rgical stc rilizati on e:ich :ea r and the fe d eral go , ernme nt al o ne is
eG i\'cn th e hard dat a tha t are a, :iihible, it is quite p o ssible that the estim a te of two m illi o n surgical ste ril iza ti(,ns per ) ear is on the "ery conse n ·ati \'e
side . H owe \·er, in the absence of easily 0bt ain able factua l documentat ion, it
must remain only an estimate.
Not all steri lizations p erformed in the C'nited States are imoluntal)' . In .
1974, fed eral agencies estim ated, according to Th e New Y o rk T imes, that
"at least o ne A me rican couple in si.x in the m a in child-bearing years-age 20
to 39-has h ad a sterilizat ion operation '· fo r purposes of contraception.~~ On
the ot her h an d, a ~uney of ~u rgica l steri li zat ions in Am erica n an d C anad ian
teaching hospitals p ubli shed in 19 70 by Joha n W . Eliot a nd his associate s~6
sh owed th at " ·hat is kno,\n in ob stetrical circles as the " P ackage Deal'·--a
variati o n of the form of compulsory steri li zatio n denounced by Jud ge G esell
in the cases of "plai ntiffs Wa ters and Walker"-is now endemic in Xorth
A merican h osp itals. As El iot et al. de<-cribed it: " Some women desiring an
ab ortion were required to ha,·e si11wl1anco 11s s1crili:::.ation as a con dition of
approval of the abortion in fro m o ne-third to two-thirds of these teaching
hospitals in diffe ren t regions of the cou ntry. This practice was most common
in the Mountain St ates, the Far Wes t, and C a n ada, an d lowest in New England
and the Pl ains St ates. In all, 53.6 p ercent of teach ing hospitals made this
requirement for some of their pat ients." ( Jt a lies added. )
B e tty Sa rvis an d Hyman R odma n, comm enting on the above st ate ment
m their book The Abortion Co111roi·ersy (1973), write : "Consi dering the
TH E GESESIS AND FL':-SCTIO:--. S OF SCJESTI F IC RA CIS~l
19
illegality of the requ irement, it is lik ely that an even hi gher percentage
of hospit als sometimes in sist upon sterilization as a condition of abortion.
. . . The large number of ~ospitals acknowledging th at they sometimes
practice this fo rm of comp ulsory steriliz atio n indicates that it is not unco mmon and th a t it has been thoro ughly ra tionalized within the medical
proie;sion . ·•
A feder al me asure aimed at forcing more poor pe ople to ha\'e "volunta ry"' ste rilization we nt into effec t on Janu a ry 10, 1975 . As of that d ate , under
the revised C ode of Federal R egu lation s governing Se ctio n XIX (Med icaid)
of the Social Security Act, the nat iona l gove rnm ent would no w provid e a
fl at 90 percent of the m edic al costs of surgical steri lizati ons suffered b y poor
o r medically indigent p wple u nder Medicaid in all fift y states-b ut wo uld ,
hencefonh , pro\'ide only matching fu nd.;; of the costs of abortions (which
do not ste rili ze women) performed on people el igible for ~1edicaid . This
me :.1n t rhat, depend ing on their current rates of assis ta nce to the ir citizcns,
th-= indi\ id ua l sta tes \\ OUld be reimbursed fo r fro m 50 to 81 perce nt of the
co~ts o f hospit al abo rt ions. En acted in a time of rising infl at io n and swelling
unen1 p!oyment, thi~ n ew federal regul a tio n ga ve loc al h ea lth age ncies and
hos pitals co mpto choose "vol untary"' steril izatio n as th ei r me th od o f fam ily pl a nning. ~7
F ro m all pre~ent in fo rma tion , it is no t unreaso nable to fea r th a t up1ra rd
of half of the mo re th an one mi lli o n steri lization op erat ions pe rfo rmed upon
A merican men an d wo me n ye a rly are q ui te p oss ibly in vo lu nt ary . In the
absence of a full- scale co ri_~re-ssion al in,·est iga tio n, with an ad eq u ate rese a rch
staff properly fu nded and a rmed with full subpoena powe r, and wh ose he aring~ a re open to the mass me dia a nd the publ ic, the actual numb e rs of compul sory steri lizatio ns commi tted agai ns t helpl ess peo ple in the Un ited St ate s
w ill remain a grim and tra gi c secret from th e rest of us- whose taxes happen
to pay fo r a majo rity of the se forced mutilations.
THI:: HISTORICAL ROOTS OF TODAY'S
FORCED STt::RILIZA TIO~S
W ha tc1·er the actu al number of the victims of involunt ary and im!\·asible
st eri liz ations (prob a bly at le ast 2 00 ,000 Ame rica ns per yea r), the re can be
no doubt th at th ey owe thei r surgical muti lations to Sir Franc is G alton·s
par:.i.noiac o b session with the gonads o f the p oo r.
The First Intern atio na l Con gress of Euge nics, held at the Uni\'ersi ty of
London in 1912-whose vice-presidents included the R ight H onorable Winston Churchill, First Lord of the Admiralty; Dr. Charles B . Da ve nport, director of the Euge nics Record Office and secretary of the American Breeders'
Association; Dr_. Charles W . Eliot, presiden t-emeritu s of Harvard University;
Dr. David St ar r-Jordan, president of Stanford University; and Gifford P inc hot,
a future govern o r of P ennsy lva nia-anno unced as one of its goals the " Prevention of the propagation of the unfit by segregati o n and sterilization ."
The Second Interna tio nal Congress of Eugen ics, held in New York in
1921, whose spon so ring comm ittee included Herbert H oover, then Secreta ry
:zo
THE F USCTIOS S .~SD SOCLU. COSTS OF SCIE1'T!F JC R.~CJSM
of C o mmerce , as well 2s the presi dents of Clark Uni ,·ersity, Sm ith
College,
and the C arnegie Insti tut ion of W ashingto n, ad\·ance d the cause o f
the compul so ry gelding of the poor in many ways .
The program of that Second Internat ional Congres s of Euge nics not o
nly
included a pape r, ''The Presen t St at us of Eu genical Steriliza tion in th
e United
States," by H arry H . L aughlin. It also b oasted a h ighly in fluent ial
paper by
E. J . Lidb ette r, entitle d ··Pl."digrees of P a uper Stocks," in which he p rese nted
th e results of his eugenic study of the poor-wh ite subpopul ation in
the East
End of L ondon wh ose st a tus was de,cribe d by the term "pauper ism.''
\\ 'hat L iJbctter di~coYer ed among the white }'-:ord ic poor of L Mdon
was, he and hi s eugt'n ics peers ag reed, "~ciemific·• proof of G alton's
postulat e
that "pa uperis m'· was !he product of '·bad blood ." H is conclusi ons,
as p re~cnted to th e Intern a ti o nal C ..,ngress of E ugen ics, included the " findings
":
"l. ·niat there is in e xi~tcnce a definite race of chronic pauper stock s
( ita lies adde d) . . . .
" 2. That modern meth ods of publi c ~nd pri\·ate charity ten d to encourage the in c rea se of this cl ass. . . .
.
"5. Th at the reductio n of thi s cl :.i ss may b e brought ab o ut by a du e
obse n ·ance of the laws of heredity . . . and that reduct io n ma y
bec o me
progre ssi\·e in proporti o n ;is ou r J..nowkd ge grows ." 10
In ~h o rt, the poo r of al l n ati on s co nstitut e ~eparate and distinc t races
o f ch ronic p auper st ocks, who are by heredity mental and physiolo
gica l degenerate s, an d who ha\·e to be wiped ou t by steadily expan ding program
s of
forced go nada l surgery.
At the T hird l ntern ationa l Congres s of E ui;t·ni cs, also hel d in :'sew York,
in 1932, the Yisiting pre5ident of 1he Brit ish E ugenics Socie ty, Sir
Bernard
:\fallen, in his o ration to the fait hful , " Th e R eduction o f the F ecun dity
of 1he
Socially Inadequ ate ,· ' call ed fo r the enfo rc ed ext erminat ion of wha
t he desc rib ed as this " defin ite race of chronic p aupe rs, a race para sitic
upo n the
co mmuni ty, breedin g in an d through successi ve generati o ns.'' The
po or, Sir
Berna rd claimed , as a group a re th ose whose "anti-so cial ch arac1eri
qics a re
th e result, main ly, of inferior heredity , an d its fert ility is higher than
that of
any other social element ."
Therefo re, conclud ed the head of the Brit ish Eugen ics Society, "it
is
only to ste rilizati o n that \\e can look to lim it the fe rtili ty of me ntal defecti\·
es
a nd of th ose classes compo~i ng the Soc ial Proble m Group [i .e., the
' definite
race of chronic paupers ']. "~ 9
Thi s call for the forced steriliza tion o f the poor and the rapidly escalating number s of the world's unempl oyed- the Th ird Int ern ational C ongress
of
Eugenic s was held in Year Three of the G reat D epre ssi on-wa s taken
up by
th e solvent physicia ns , professo rs, and bu si nessmen in attendan ce . Dr.
Theodore R ussell R ob ie, of the E ssex C ounty !vfental Hygiene Clinic
in Kew
J ersey, in his present ation , " SelectiYe Steriliza tion for R ace Culture , •· 3
o ca11ed,
for exampl e, for the steriliza tion of, a t the ve ry minimu m , the 14,000,
000
Am ericans \\ ho h ad rac ked up low in telligenc e test scores si nce Wo rld
War I.
In a bl azing perorati on co mpound ed of equal el eme nts of Malthu
sia n dem ography , G allon's gonad al nightm ares, th e n ew IQ test score mystiqu
e, and
THE GE:S: ES!S A:--1 D Fl' :--I CTIO :--S OF SCJESTIF !C RA CIS'.1-!
21
Soen ce r·s Soc ia! D arwinism , D r. R obie to ld the ass~m bled tru e b elieve
rs and
u;em p!oyed college grad ua tes with noth ing el se to do in 1932 :
. . . there a re tho se who believe th a t o ur po pulation h as al re ad y
att ained a gre ate r nu mber th an is necessar y for the efficien t function
ing
of the race as a whole . Ce rtainly our present p icture of m illions of
une mployed would p oin t to th e bel ief that this suggesti on is a reason
abl e
onr.. It would u ndoubte dly be found, if such research was possi b le,
that
a major portion of th is vast army of unemplo yed are social inadequ at
es,
and in many cases m en tal defective.s, who might have been spa red
the
misery they a re now fa cing if they h ad neve r been b o rn. It would
certain ly be underst andable ho w m a ny of them would prefer not to have
been bo rn, if thev could have k nown what wa s in store for them on
this
earth whe re the ; tn:ggle for existenc e and the urge toward the survi
\·al
of the fit test makes it necess;i rv for all those who would survive to
posse~s a na ti,·e [grnetic ] endowm e nt o f at le ast a vera ge intellige nce.
Spea ker afte r spe a ker , incl udi ng Len a Sadler, an irascible Chicago
surgeo n, and th<' C aliforni a milliona ire Eugene S. G o sn ey, presiden
t of the
H umQ n Betterm ent F o und at io n of Pa sadena , ech oed Dr. R obi e's cal
l for the
cnmpuls ciry ste ril izat io n of th e millio ns of A meric a ns \\ hom th e raging
Depres,io n had thrtl\'. n out o f work since tht' Wall Stre et c rash of l 92 9. 31
N or were th ese merely the ravings of some lunatic fringe o f the gre
akr
soc iety. D r;. R o b ie and M all ett and SaJ!e r spo ke for the majority
of the
edu cateJ pe o ple o f this country in 1932 . Two ge nera tio ns of th e
teach ing
of Socia l D ar,\i ni:-.111 and eugenic s as legitima te sciences in most
le ading
A merica n uniYersit ies had , by 1932 , tu rned G alton's gonad;il o bsession
in to
th e poliric:i l solu tio n o f ch oice for thousan ds of educate d A merican
s, m a ny
of th em in high polit ical, ed itorial, and ac ade mic offi ce . M a ny of the
college
g raduate s o f that era \\ho had b een thoroug h ly b rainwas hed by such
"science ·•
du ring the crit ic al years in \\hich th eir lifelong val ue syskms had bee
n formeJ
were, e vidently , also the te achers of the succeed ing generati o n;; of legislato
rs ,
opin io n molders - and voting ci tizens .
Of all the noble profe ss ion s, th at of med icine seemed to be p a rt icu
lar ly
su scepti ble to the pun iti,·e dogmas of eugen ical steriliz a ti o n of the
poo r. A
1972 study m ade by th e Pl anned P a renth ood- \\'o rld Popul atio n
societi~
sho wed th at, in differen t urb:.in and rural regions of the coun try, fro
m 30 to
5 2 p ercent o f all doc to rs po ll ed advocat ed th a t mothers on we lfare
w ho b ecame pregn ant sho uld be forced to accept ster iliz at ion as a conditio n
o f being
all o wed to rem ain on the publ ic assis tanc e roll s. In this belie f the doctors
as
a group we re in accord with the th in ki ng of the general public.
In 1965, for example , some th irty-three ye ars afte r D rs. Malle rt and
R o bie and Sadler had called for the steriliza ti o n o f the poor, the u ne
m pl o yed,
and th e unfo rtunate, the national G allup Poll put the followin g question
to
Americ ans from coa st to coast: " Somet imes unwed mothers on relief
continu e
to have illegitim ate c h ild re n and get rel ief money for each nev.· child
bo rn.
What do you th ink sh ou ld b e don e in the case of these wome n? How
about the
ch ildren?" O ne in every five A merican s rep lied that the solution
was to
"steril ize the wo men." 33
22
THE FIJSCTJ OSS A:--.-D SOCIAL COS TS OF SC IESTIFJC RACI SM
By 1971, the editors of 1he Philadelphia foquirer, in 1he wake 01 the
pub lic impact of the IQ test score and genet ic ensl avem ent claims of P rofessor
Arthu r R. J ense n, con ducted a phone poll on the question: -- s hould the U.S.
Encourage Steriliza tion among Lo w i. Q . G roups?'' A \, hopping 69.2 perc ent
of the P hiladelphians polled favo red the forced steriliz ation of fellow Am ericans wi th low JQ test scores. 34
:\'OT \VffH A SCRE.-U I BUf A SHRUG
If th ese Gallup and Philadelp hia In quirer polls of modern times are e,·en
close to be in g statistical approximations of nationa l a ttitudes, they also explai n
why Judge G e5ell's historic de nunci ation, o n :--rarch 15, 1974, of the fac t
that, in fe d erally funded birth c·ontrol programs, "a n indefinite number of
poor p eople Jzm·e been im p roperly _coerced into accep1i11g a sterilization operation unda the threa t rha1 rarious federally supported 1,·elfare benefi1s 1,·011/d
b e 1·,·irhdra,rn un less they s1;bmir,~d to irre•,ersihle sterili::.mion " (italics
add ed), was immedi3tel y follu\\c·d not by nati ona l cries o f shame and outrage
but, inste ad, by a national shrug and yawn. By prcci~e ly the same k ind of
shrugs and ya,,ns with \,·hich the good, decent, educated, and solven t G erma ns g reeted the daily newsraper accounts of the decisions of the Erbgcs1111 dheitsgerichtc-the no10rious Nazi Eu gen ics C ourts- -which sen tenced an average of J 65, 000 G erma ns a yea r 10 be stcril i,:ed ::tpinst their will for the
crime of being,, hat th eir ~azi judges termed socinlly inadequa te .
Cl ea rly, three generations of the ~okrnn te achin g of the essential ly religious dogmas of G altonian eugenics as a legitimate scien ce are reflected in
the fact tha t polls taken in this na tion in J 965 ;;nd 1971 sho" cd that b ern een
20 and 70 percent of the fL' ~ponde n1s are conYinccd that force d Sur2;'.i cal
ste ril ization is th e onl y fc2 sible soluti o n to som e of o ur mo st pressing problems. T he~e proble ms includ e the physi ological and mtntai difficultie s of that
on e third or more of our natio nal po pulation who lJck the in come pr6ently
re quired to meet the ew r soaring c-osts of the min im um amo unts of food,
me dica l ca re , and cultural amenities scientifica lly p ro \·e n to be the b asic prerequisites for the proper de\'e]opme nt of thei r inhe ri ted or gen etic p oten ti als
for physic al an d menta l h ealth.
W ith this growing p ublic acceptance of th e my th s of eugenic steril izatio n,
the scien tific racists have al ready helped dim the viab le h opes for the human
condit ion abundant in the vast reservoir of bi omedical and other scientific
discoveries about human poten tia ls and devel opment that are now part of our
national heritage . F o r the greater social dangers of the forced sterilization
movement extend far beyond th e human prices paid by its immediaie , inims.
After all, poor people are sti ll the o nly sources of cheap help and e,·en
cheaper child labor---two commodities still in great demand. H isto rically,
starting with M althus and Spencer, the prophets of scientific racis m have
always been among th e fiercest defenders of low wages and the employment
of Yery young children in agriculture, mi ning, and manufacturing.
Much more de \·astating than th e actual st eriiiz ,ni on of a few hundred
thousand sacrificial welfare moth ers is the more '>\ idespead political objective
THE GE:SESJS A~,D F L':--.-CTJO:SS OF SCIE :-. Trf! C RACI S \1
23
of the co mpulso ry sterilization m ovemen t. This is, o f cou rse, to brainwash
the nation's teache i S, doctors, government oft1cia1s, and t.'..lxpayers into be lie ving that th e only practicai way to cope \\'ith the m,Junt ing \\'tlfare costs
of the infectious, deficienc y. and mental disorders of poverty is a nd rem :1ins
the fo rced surgical sterilization of the poor.
\Vhen, in the mind s of our ed ucated cl ass es, the steriliz:1t ion o f the poo r
becomes the only acceptable alternati\·e to the n11: ani ngfu! envi ronmen t::ll anJ
family hea lth measures propo5ed since early in th e nincke n th cen tury by the
Engli sh Sa nitary Refo rmers (our fi rst emironmenrnlists), and the living wages
sought by 1he trade uni ons , and the uni\·er.,al free educ a tio n for all c hi ld ren
sou ch
t b v social and ed ucational reformers for o, er two ce n turies. it will
~
be at prc>cisdy this point that the scientific racists 1,·i!I ha ,e won total victo ry
in thei r Jong b attle for the minds of th e men an d \\ omen who dete rmine
Am erican prio riiie5 anJ pvl icie s. The acceptance o f the gct-'em-in-th.:--gonads
F in al Sol uti on to th e em inently en ·, irnnmenta! and soci:.il ca uses of the biologic al and intel lectual p,,.thol ogies of po1·eny also acts to make soh ·en t and
lit erate ta .xp ayer~ fe e t that e,e ry penny of th eir tax dollars spent on su(·h
' 'fa tuities· · as food for the stan·ing, shelter for the h L,rne le~s. and nLltio,rn id e
fre10 vaccina tions ag.iinst the common causc:5 of infant lll l)rta lity and eye, ear,
heart, and b rain defects, is all part of the con tinuing trib ute \1e pa,', for the
inabil ity of vote -hu ngry po litici a ns to say no to the '·bkeding-hc:,in liberals."
• Th e roll of the victi ms of compu lso ry euge n ic stuilirntit)n the rs:fore £)11~
begins with the 200,000 -plus p oor people subjecred to irre\ersib le surge ry
on their gon ads e\ery ye ar in A. merica. l n 1977, as during e\c ry International
Congress of Fug eni:::s since 191 2, the comp ulsory sterili1 ut ion of 1he vict im ,
of th e preve ntable and non;enctic disea~e5 and d i~ord,:r~ of pO\\:rty-from
tuberculosis and nutriti on ::il anemia to low IQ te st scars: ~ am.l oth<?r s<?qu c:: lae
of b iocu ltur:il depri\·ations- - -remai ns the f ina i Solu tio n of scie ntifk racism
fo r the emironm::n tal affiictiorh of socie ty . \Ve forget, at m0rt al pc'ril, that
the kni,·es that e ach year inflict involuntary and irre -,·ersibk stcrilir.::t io n on
our p oor also infl ict equ al!y lasting and even nwre pai n ful injury upo n the
rest of us.
J
•
Th e surgeons' knives th at act out our educated fa ntasic::s of aggre5sion on
th e sexu ality of th e p oo r are tempered in the same forge s \\hich turneJ out
the knivc ., th at ha\·e kill ed every pol itica l effort in our time,, to ach ic\'e pa ssage of a medic all y adequ at e urfr.-e rsal vaccination law. Th e cont inued abse nce of precisely such a law in our na tional and st ate publ ic health codes
gu arantees th at , every ye a r, thous;:mds of ch ildren \,ith mi nds da maged by
med ically preventable infections ( such as ru be lla, measles, \vhooping co ugh,
and dip htheria ) will get the low IQ test scores th at make them the vic tims o f
compulsory steriliz ation.
The gelders' knives, with their p seudo- solutions to the real and solubl e
bi o med ica l probl ems of our society, also guarantee that for the res t of this
century hundreds of millions of A me rica ns will continue to d ie, long before
th eir generically allotted time, for want o f th e medical and socia l modali ties
that the legi timate sciences con tinue to develop as scientific and moral alt ernatives to the ste rilization of the " soc tally inad equ ?..te classes .''
bNATIONAL NEWS :.:;.:.:.·.·
: ,'-"(.:.:.rn.,.:.:.rn;.;:.:.:;,.:,.:;.:...~,.:.:.:.:.:-'.:.·;.:.:.:·:;.:,.:.:,:.:.:.:.:;.:·
New Regulations ior Sterilization
also stipulate that no woman under the
age of 18 is to be sterilized 11nd that these
rules apply only to "elective " steriliOn Dec. 20, 1976, Norma Ero, a
(operations not ordered by doczations
25-year-old mother o,f three, went to
medical reasons) .
for
tors
Lincoln Hospital in the Bronx for a Pap
these "interim guidelin es" have
Because
test and was told by a doctor that, since
ly criticized, the H . E.W.
extensive
so
been
n
Fallopia
the
she had had a pregnancy in
guidelines for pronew
proposed
has
tubes the year before, she should have her
stipulate that there
These
women.
tecting
wanted
who
tubes cut. When Ms. Ero,
period between
waiting
30-day
a
be
must
another child, objected, he told her that
consent and the operatio n,
women's
the
sewn
be
when she wanted, the tubes could
and that no woman under the age of 21
back together.
can be sterilized. They erase the tradishe
n,
operatio
On Jan. 14, 1977, after the
tional distinction between "elective " and
began to have abdomin al pains. Lincoln
"clinica lly necessa ry" steriliza tions,
a
need
would
doctors told her she
thereby regulating (for the first time)
hysterectomy. "I became very worried and
operatio ns which doctors order for medihad
I
if
me
told the doctor to please tell
cal reasons .
cancer. The doctor told me that if I wanted
The new rules have been hailed as a
have
to see my children grow up, I should
first step. "(They) are a trepositive
this operatio n . .. . They said it was the
victory," Dr. Helen Rodriguez,
mendous
I
what
'doctor's privilege' not to tell me
a long-time leader of the movement
had."
against sterilization abuse, told Seven
On May 25, 1977, doctors removed one
Days. "Four years ago they used to say
abuse
ion
sterilizat
of her ovaries and her appendix. When of studies documenting
ing
the Relf sisters were an isolated case. Now
Account
ent
Governm
a
g
(includin
bleeding began, -she was told that she
the testimony is 80 percent in favor of
steriliad
widespre
would need still another operatio n . The Office report about
regulatio ns."
Indian
the
by
women
Indian
of
zation
problem, it seems, was that the doctors
a
But there were profoun d questions
from
pressure
and
Service);
Health
the
left
and
ovary
had removed the wrong
as to the scope and the enforce,
raised
feminists
involving
nt
moveme
one with a very large cyst still in her body. protest
of the guidelines as. well as to the
and
ability
church
Norma Ero is a victim of " sterilization health activists, lawyers,
ent's purpose in developing
governm
of
and,
.
..
s
legislator
leaders,
ity
abuse," and, as she stood testifying in commun
.
them
victims .
Washing ton at the Jan. 17 H.E.W. course, sterilization abuse
Critics have pointed out that the current
The issue revolves around the question
hearings (called to discuss new regula"consen t" to guidelines do not forbid the soliciting of
tions), she spoke for thousand s of women of just how women come to
they are sel- consent for the operatio n during an aborally,
Tradition
sterilizations.
with similar experiences.
hardly ever tion or childbirt h, when much sterilizaare
ves,
alternati
of
told
dom
denied
or
These women are misinformed
tions tion abuse occurs. Nor do they provide a
ramifica
the
about
ion
informat ion and overtly or covertly given informat
are often sterilized description of sterilization procedures
forced to consent to an operatio n which of the operatio n, and
consenting to the and alternatives in language the patient
after
will render them incapable of bearing within minutes
frequently been can understa nd, or plug all tile loopholes
has
Consent
n.
operatio
children. Once an almost invisible issue,
h or abortion that can allow hysterectomies for sterilichildbirt
sterilization abuse has recently been solicited during
difficult for zation under the guise of medical indimost
lly
emotiona
is
it
when
recognized as one of the most brutal facts
cation. The present guidelines also do not
.
decisions
of life, victimizing poor, and especially women to make such
guarante e the patient access to informaby
funded
been
often
have
tions
Steriliza
minority, women .
tion other than that offered by the
planning
family
In Puerto Rico, 35 percent of the women federal grants to special
physician.
since
Medicaid
through
or
s
program
of childbearing age are sterilized. Almost
The absence of such provisions provictims of
frequent
most
the
women,
poor
even
an
and
women
black
all
20 percent of
Karen Stamm, of the Committ ee to
voked
operaafford
cannot
abuse,
ion
sterilizat
higher percentage of Indian women in the
tion Abuse (CESA), to call
Steriliza
End
in
ns,
regulatio
tions. This is why the new
U.S. have had similar operatio ns.
regulations "somew hat symboli c,"
the
Joseph
Secretary
.
H.E.W
of
words
the
To get the federal government to estab, are "designe d to eliminate particularly if they are not well enforced .
lish sterilization guidelines has taken four Califano
support for coerced or unin- Dr. Rodriguez told Seven Days, "To
federal
years of litigation in the case of the Relf
really insure compliance, we have to go
sisters (two black women who were formed sterilizat ions."
furtherth an H .E.W . propose s."
es,"
guidelin
"interim
current,
The
sterilized after a doctor threatened that he
The biggest doubts do fall within the
put into effect, provide
would not deliver their babies); a number which the H. E.W.
of enforcem ent. Recent studies by
area
between
period
waiting
Maritza Arrastia is a journalist, poet for a 72-hour
for Constitu tional Right s, the
Center
consent and the actual operatio n. They the
and a feminist activist.
BY MARITZA ARRASTl A
Seven Days
13
, ,',
!,
I,
With the popu latio n bomb proving to be
are,
p employment and for education, dayc
dud, and in the face of growing
ACLU and the Health Research Grou
a
care,
cal
nt housing, adeq uate medi
dece
ns
latio
regu
im
inter
nt
curre
the
show that
oppo sitio n to steri lizat ion, Plan ned
safe and effective cont racep tion, and
are not being met in over 80 percent of
Pare ntho od and the Association for
ac<:ess to abor tion .
U.S.
the
in
itals
hosp
ntary Sterilization were "con ciliteaching
There is powerful opposition to sterili- Volu in Washington. They defended
"H .E.W . is simply attem pting to cover
"
atory
the
des
zation regulation which inclu
to sterilization and questioned
ess"
"acc
up a lot by exposing a little ," Stamm says,
and
ians
etric
Obst
of
r American College
of abuse but, on the whole, did
e
degre
the
and her doub ts are echoed by othe
as
ogis ts and grou ps such
ecol
Gyn
has
ano
Calif
etary
Secr
.
.E.W
not oppose regulation. "Giv en the undis
·activists. H
Planned Pare ntho od Federation and the
e ancl lax
abus
past
of
nce
evide
puted
given preferential funding to sterilization
ons.
Association for Voluntary Sterilizati
over abor tion even though he has gone on
rcem ent," accordin~ to Pam ela
The last two, connected by interlocking enfo
e.
abus
n
izatio
record in opposition to steril
to
Horowitz of the ACL U, "acc ess to steritorates and comm on funding
direc
all
of
nt
perce
0
for9
pays
W.
"Sin ce H.E.
n lization must yield to the need to prevent
organi zations such as the Popu latio
sterilizations but does not pay for one
of
abuse ."
, Council, are in fact service agencies
Although they have scored a victory,
abor tion, " Stam m told Seven Days
on
ulati
"pop
the
what is known as
cates of regulations realize that the
"wom en can continue to be pushed into
advo
ent .••
lishm
estab
."
ns
latio
regu
out
with
or
problem is far from solved. The powerful
sterilization with
That " popu latio n establishm ent" is an
y sees any form of cont rol as
Nancy Stearns, of the Center for
funded lobby that pushes the, medical lobb
welle,
activ
of
cases
rted
repo
ts,
Cons tituti onal Righ
a threat to its continued dom inan ce of the
myth of the "pop ulati on explosion ." It
exin
tions
abor
ed
Activists like Dr. Rodrioffer
being
en
wom
ded sterilization as a way of health industry.
defen
long
has
also
cs
Criti
ns.
guez feel that a broa d grass rpots
change for sterilizatio
def using the "pop ulati on bom b." But
will
on"
ositi
"opp
ano's
Calif
that
movement is the only way to insure that
claim
ming obsolete rhetoric.
beco
kly
quic
is
this
re
sphe
atmo
the
government will enfo rce sterilization
not alter what CESA called
As Dr. Allan Chase said, during the the
to
en
wom
ing
push
"
cion
coer
n regulations with the same conviction that
of "sub tle
hearings, the United States popu latio
established the new guidelines .
become steri lized -an atmosphere created has been declining since 1957 .
paid
for
ties
rtuni
oppo
of
by the lack
,t
n
ta
at
h
an
M
e
as
h
C
om
ir
d
en
ri
F
A
craft giant owes Chase over $460 million
complete portions of their projects.
in loans, made to keep Lockheed out of
Companies subject to Hewitt's v1g1debt in 1971. Chase would like to see
lance will include McDonnell Douglas,
heed pay that loan and anything that
Washington, D.C. Before his inauguraElectric, United Technologies, Lock
ral
Gene
this
of
le
peop
the
told
er
can be done to assure the firm 's solvency
tion, Jimm y Cart
Boeing, General Dynamics and Rockwell
would be appreciated.
coun try that his nominees for government
International. The six companies were
As blata nt as these conflicts might
service would be screened to avoid even
accontr
se
defen
among the natio n' s top
est.
inter
of
lict
conf
of
ce
, they are, in fact, not really conaran
seem
appe
the
, and Chase owns large blocks.
1976
in
tors
the
in
holes
sidered conflicts by Congress. According
But there seem to be some
of shares in all six.
of
on
inati
nom
t's
iden
onal sources, a conflict ocPres
The
n.
scree
rding to the bank •s· equity to Congressi
acco
fact,
In
ved in a
tary
Secre
stant
Assi
John J. Hewitt, Jr. as
, curs when a nominee was invol
holding report of December 31, 1976
t conagedirec
s
Man
hold
h
ncial
whic
Fina
any
for
e
comp
Forc
fic
Air
speci
of the
in 57 of the 100 largest
stock
held
e
inChas
were
are
h
ings
whic
hold
e's
licts
tracts. Because Chas
ment is replete with conf
se firms . Eight of its ten largest
r
defen
.
racto
ce
cont
aran
in
appe
of
stock
er
the
matt
a
ugh
than
(thro
t
much more
ach valued at more direc
es-e
shar
of
s
y
block
worr
to
to
cted
ing
expe
noth
is
h
companies), Hewitt has
His nom inati on, whic
than $125 mill ion- are with such defense
abou t.
breeze throu gh the Senate early this ses$823
an
est,
inter
est
great
cont racto rs . Its
Even when conflict occurs, the nominee
sion, will get a warm welcome from the
, ranked
IBM
with
is
t,
tmen
inves
on
milli
To
rs.
racto
present a plan by which
cont
se
defen
st
natio n's large
receiving defense would be asked to
anies
comp
g
amon
30th
he or she would leave the companies inthem, Hewitt is an old chum.
ds. In Exxon, ranked 33rd, the bank
awar
dent
Presi
Vice
as
job
t
recen
volved. Nominees with conflicts are
In his most
had $619 million worth of stocks.
seldom, if ever, denied appo intm ent.
at
of the Trus t and Fiduciary Investment Deitt managed all these accounts
Hew
,
Bank
n
hatta
Man
e
Chas
"An executive from a defense corp orapartm ent of
Chase.
would have a conflict with a single
tion
Hewitt had daily business transactions
will
her of Hew itt's specific duties
Anot
of
many
ons,
orati
corp
of
cont racto r," said a source within the Air
with hundreds
be monitoring the paying back of $50
Force. "A bank .official like Hewitt has
which have Air Force contracts .
oh Lockheed Aircraft Corp
whic
on
milli
lish
estab
will
itt
Hew
conflicts with hundreds ."
In his new job,
ration owes the government since it overthe
for
es
edur
proc
ing
audit
"If Hewitt were to disqualify himself
and
et
budg
of three defense projects it
costs
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Washing ton , D. C. resea
BY FIELD ING Mc GEHEE
r
W OR KB OO K
ON
ST ER ILI ZA TIO N
·• '
•
Ad Hoc Wome n's Studies Comm
ittee
,·
.
Against Sterilization Abuse
NATION WID E W O MEN'S PROGRAM
AF SC i::':01 CH!::F'~Y S T.
PHILA., P A. 19 10 2
(215 ) 241 -7160
WORKBOOK ON STERILIZATION
researched and written by the
Ad Hoc Women's Studies Committee
Against Sterilization Abuse
Copies available at cost from: Women's Studies, Sarah Lawrence College
Bronxville, New York, 10708. Telephone (914) 337-0700, ext. 405
TABLE OF CONTENTS
Introduction
I.
II.
Who to Contact
5
What is Sterilization?
6
How do other forms of contraception work, in
contrast to sterilization?
6
What are the procedures for female sterilization?
7
Can female sterilization be successfully reversed?
9
What is male sterilization?
9
Who uses Sterilization to prevent Conception?
Has the sterilization of women in proportion to
men increased?
12
How do race and ethnic differences affect sterilization rates?
12
Are there regional differences in rates of
sterilization?
13
How do socio-economic differences affect sterilization rates?
14
III. What is Sterilization Abuse?
IV.
Copyright io 1978-Sa r a h L aw rence College
11
16
In what way does withholding sterilization constitute an abuse of reproductive freedom?
16
What are some indications of involuntary
sterilization?
17
How do health professionals contribute to sterilization abuse?
21
What is the relationship between sterilization
abuse and access to other forms of birth control?
22
How does the social and economic context lead
to sterilization abuse?
25
Sterilization in Puerto Rico: a case study
27
What is the relationship between the socioeconomic background of Puerto Rico and its
sterilization program?
27
What is the relationship between abortion and
sterilization?
30
Do Puerto Rican women choose sterilization?
30
v.
What do we propose?
Appendix
34
36
INTRODUCTION
New York City Health and Hospitals Corporation
Guidelines for Female Elective Sterilization,
November 1975
37
Proposed HEW regulations, December 1977
40
freedom.
Footnotes
45
nor government officials.
General Bibliography
51
writers and students -- all active participants in the women's
This workbook is dedicated to women's fight for reproductive
movement.
We, the women who have worked on it, are neither doctors
We are teachers, scholars, psychologists,
We believe that reproductive freedom for women includes
adequate general health care, complete birth control information,
abortion on demand, and sterilization by choice.
We believe that
a prerequisite to control over our own bodies is knowledge of what
the medical profession and the government are doing to women's
reproductive freedom in the United States and all over the world.
In the past two years we have become increasingly alarmed by
the growing threat to the reproductive rights of all poor and
minority women in this country.
On the one hand, there has been
the onslaught on the right to abortion.
This culminated in the
Supreme Court decision to uphold the Hyde Amendment which curtails
federal funds for abortions and so makes legal abortions inaccessible to those who cannot pay.
On the other hand, is the evidence
that thousands of poor women -- mainly black, hispanic and Native
American -- are being subjected to sterilization without adequate
knowledge of the alternatives or consequences of the procedure:
that is, without real voluntary consent.
Many of us were outraged in 1973 when the Relf sisters, two
black teenagers, aged 12 and 14, were sterilized in a federally
funded family planning program.
Their mother, who did not know
that the operation was irreversible, had been persuaded to give
-1-
to extend the municipal hospital guidelines to private hospitals.
her consent by marking an "x" on a form she could not read.
A
couple of years later, there was more alarming news : In Armstrong
County, Pennsylvani a, Norma Jean Serena, a Native American woman
was suing hospital and welfare officials because her
tubes were
tied while she was medicated and exhausted from the delivery of
her third child.
Her medical chart stated that the operation was
performed due to "socio-econo mic factors."
Around the same time,
ten poor Chicano women in Los Angeles, most of whom speak minimum
English, filed a class-actio n suit against hospital and state
health officials, charging that they were either coerced or deceived into being sterilized.
Some of the women were presented
with consent forms in English while in labor or under anesthesia;
others were told they would die if they did not submit to tubal
ligations.
lic arena.
At this time, many feminists who had championed the right to
abortion and sterilizatio n on demand, and who were worried about
any curtailment of what they had learned to consider reproductiv e
freedom, began to ask themselves important questions.
Is it dangerous?
sterilizatio n?
Health, Education and Welfare adopted a set of guidelines to be
used by public hospitals and in sterilizatio ns paid for under
Medicaid or other federal programs,
concerned that the HEW sterilizatio n guidelines were not being
enforced in most federally funded procedures and were not even
applicable in sterilizatio ns performed in municipal
or private
The Committee to End Sterilizatio n Abuse and other
groups began a campaign to institute guidelines in New York City
municipal hospitals.
These guidelines were more comprehensi ve
than the earlier HEW rules.
Then in early 1977, the same coalition
of health workers, human rights advocates, women's groups and community organizatio ns
supported a bill in the New York City Council
-2-
Who is abused by
this freedom?
Do we want the government regulating any aspect of
birth control?
Should some women sacrifice the privilege of imme-
diate sterilizatio n on demand to protect other women from unwanted
procedures?
We, the authors of this workbook, set out to find the answers
We wanted the answers for ourselves,
but we also wanted them for the women we work with in our schools,
on our jobs, and in the women's movement.
In answering our questions, we have learned that sterilizatio n
abuse does exist -- on a large scale.
Early in 1975, a group in the New York metropolita n area became
What is
Who benefits from the freedom to
receive the sterilizatio n procedure on demand?
to these and other questions.
In 1974, in response to the Relf Case, the Department of
hospitals.
This brought the campaign against sterilizatio n abuse into the pub-
We have become aware that
sterilizatio n abuse occurs mainly among poor and minority women,
and that it is the result of an overt and covert campaign to solve
economic and political problems by programs of population control.
Population control attempts to regulate the growth rate of groups.
Unlike birth control, it denies women control over their own reproductive systems,
In the course of gathering this information and understandi ng,
we have formed ourselves into the Ad Hoc Women's Studies Committee
Against Sterilizatio n Abuse.
As such, we supported the New York
City bill which extended sterilizatio n guidelines to include a
-3-
was passed by the New York City Council and is now law.
WHO TO CONTACT
The Bill
30-day waiting period in voluntary and private hospitals.
Further-
The following groups will provide advice, counseling, inform-
more, through the efforts of groups such as ours in several cities
ation and activities concerning sterilizatio n and sterilizatio n
across the country, HEW has been forced to propose more stringent
abuse.
guidelines for all federally funded procedures (see appendix).
whom you may want to work with,
Most recently, our group testified on these new guidelines.
tact your local civil liberties organizatio n,
Yet our study of sterilizatio n abuse has led us to understand
that guidelines are only a necessary beginning.
forced.
They nrust be en-
Unless they are monitored by women in the community, they
will be ignored by doctors and hospital administrat ors.
Women nrust
become aware of how poverty, sex and race are connected to sterilization abuse.
Understandi ng, vigilance, and solidarity across
race and class lines are the only way to take back control of our
bodies and our reproductiv e lives.
Ad Hoc Women's Studies Committee against Sterilizatio n Abuse
They will put you in touch with other people and groups
In addition, you may want to con-
CARASA
(Conmittee for Abortion Rights and Against Sterilizatio n
Abuse)
231 Center Street, #6
New York, N.Y. 10013
Center for Constitutio nal Rights
853 Broadway
New York, N,Y, 10003
CESA
(Committee to End Sterilizatio n Abuse)
P.O. Box A244, Cooper Station
New York, N.Y. 10003
Coalition for Medical
4079 A 24 Street
San Francisco, Calif.
Rights for Women
IFCO
(Inter-Relig ious Foundation for Conmunity Organizatio n)
475 Riverside Drive
New York, N.Y. 10027
Electa Arenal
Susan Bram
Nancy Breen
Bell Gale Chevigny
Judith Friedlander
Jane Gould
Atina Grossman
Joan Kelly
Carol l.opate
Ruth S, Meyers
Natalie Sokoloff
hny Swerdlow
Phyllis Vine
Los Angeles Center for Law and Justice
2111 East Brooklyn Avenue
Los Angeles, Calif. 90033
Southern Poverty Law Center
1001 South Hull Street
Montgomery, Alabama 36101
New York
Spring, 1978
-4-
-5-
I. WHAT IS STERILIZATJO~?
Sterilization is a form of contraception, radically different
The choice to use either the IUD or the pill may be controlled
by women, though the IUD is inserted by a doctor or medical practi-
from all other forms in that it is a "procedure or operation, the
tioner and the pill is dispensed by a doctor's prescription.
purpose of which is to render an individual incapable of reproduc-
tility is regainable when the coil is removed, or when ingestion
ing, 111
of the pill is stopped.
For all practical purposes, sterilization is irreversible.
Fer-
The IUD is successful in preventing con-
ception for about 93 percent of all users,
2
and the pill for 98-99
HOW DO OTHER FORMS OF CONTRACEPTION WORK, IN CONTRAST TO STERILIZATION?
percent.
The IUD, however, can slip and cause pain and bleeding;
For any contraception to be effective, the sperm and the ova
and some IUD users report infections, increased menstrual bleeding,
must be prevented from meeting and developing. This can be accomand discomfort.
plished by a variety of means,
Some prevalent forms traditionally
Users of the pill have reported tender breasts,
weight gain, and nausea.
Increased risk of heart disease and
used in America include:
stroke is associated with its use.
More significantly, there is
interrupted coitus - ending the sex act before the
sperm is ejaculated,
evidence that both the pill and the IUD can cause cancer.
rhythm - refraining from intercourse during so-called
fertile periods.
WHAT ARE THE PROCEDURES FOR FEMALE STERILIZATION?
pessary, sponge, foam, or diaphragm - inserting an
object into the back of the vaginal opening to cover
the cervix in order to close off the entry to the
fallopian tubes,
Hysterectomy - The most radical form of sterilization is the
hysterectomy, or the removal of all or part of a woman's reproductive organs.
shield or condom - covering the penis with a rubber
to contain the semen, the fluid containing the sperm,
All of these methods are used at the time of the sex act,
If the organs are healthy and the operation is
performed for sterilization only, it is referred to as
"hysterilization."
A ten or fifteen day hospital confinement,
There is minimal risk of physical damage; but because they are
followed
difficult procedures to monitor, their success rate is difficult
ectomy patients indicate serious complications in 10-34 percent of
to measure,
all cases,
by a six week convalescence, is usual.
3
Studies of hyster-
The incidence of death is as high as 3 to 5 per 1,000.
4
Two relatively new contraceptive measures make it possible
If the operation impairs the functioning of the ovaries, or includes
for the first time to separate contraception from the sex act,
their removal, estrogen levels may be decreased, causing early meno-
These are the birth control pill, which is taken regularly once
pause and higher susceptibility to coronary disease.
a day, and the intrauterine device (IUD), a ring or coil-like device
is a major operation and should not be considered an option for
inserted through the vaginal opening, which can then be left in for
sterilization.
several years or until pregnancy is desired.
Hysterectomy
A second type of sterilization is accomplished by interfering
with the travel of egg cells through the fallopian tubes.
-6-
-7-
Ligation procedures are constantly being refined.
The method is to ligate or cauterize the tubes.
Vaginal tubal ligation - The physician inserts an instrument
called a culdoscope through an inch-long incision in the vagina.
The culdoscope has a tiny forceps attachment and cauterizing device which cuts and cauterizes (burns to close) the tubes.
The
incision is then closed with stitches which dissolve in about ten
days.
This rarely used procedure lasts about half an hour, but
women are generally advised to remain in the hospital overnight.
Abdominal tubal ligation - The physician makes a 4-5 inch
incision above the pubic hair line.
The fallopian tubes are ex-
posed, a small piece is cut off both ends, and they are tied and
cut or clipped, or cauterized.
This operation is performed under
general anesthesia and frequently postpartum or in conjunction
with other abdominal surgery.
Women usually remain in the hospital
procedure called the minilaparoto my, which will soon be performed
in clinics, only takes ten minutes.
jected into the cervix.
A local anesthetic is in-
A ''uterine elevator" is inserted into the
uterus to allow the surgeon to manipulate the uterus.
A second
local anesthesia is administere d above the pubic area; the fal5
lopian tubes are exposed, cut and tied or clipped.
permanent freedom
Although ligations are undertaken to assure
from pregnancy, 1-2 percent of women so treated have become pregnant.
7
Infection, bleeding,
This matches the failure rate of the pill.
uterine perforation , and accidental bowel trauma are side effects
8
increased pain during
experienced in 1-2 percent of all cases,
menstruatio n in 20-30 percent, and an increase in menstrual bleeding
9
There are also reports of psychoin 10-40 percent of all cases.
logical side effects, including depression, regretting or denying
for two or three days.
Laparoscopy
A new
This is a refinement of the abdominal ligation.
The physician makes two half-inch long incisions in the abdomen.
A laproscope, an instrument that combines a high intensity light
and magnifying lens, is then inserted in one hole, and carbon dioxide
gas is pumped in to distend the abdomen for viewing.
A second in-
strument is then inserted, containing a forceps and cauterizing
device with which the tubes are sealed eltctrically .
Laparoscopy
is generally performed under general anesthesia, and the patient
usually spends the night in the hospital.
The operation is said to
be "simple," and is r eferred to by such euphemisms as
the ''bandaid operation" or the "stitch."
In reality, there are
psychologic al disturbance s decrease with age, number of children,
and informed consent.IO
CAN FEMALE STERILIZATION BE SUCCESSFULLY REVERSED?
Ligations have been reversed surgically (that is, pregnancy
has resulted) in 10-40 percent of all cases when incisions were made
11
In cauterizatio n procedures,
without further damaging the tissues.
the incidence of successful reversal is lower because of extensive
scarring.
WHAT IS MALE STERILIZATION?
Male sterilizatio n operations interrupt the delivery of sperm
through the vas deferens - sperm carrying tube.
dangers associated with it.
called a vasectomz.
-8-
However, the
the operation, and decreased sexual functioning .
The procedure is
Here, the physician cuts and ties off the vas
-9-
6
tube so that the sperm, produced by the testicle , cannot
the semen.
Vasectom ies do not affect ejaculat ion.
Reversi bility is possible , and surgical success in reconnec ting the
vas deferens has been reported in 60-70 percent of all cases, but
resultan t pregnanc ies are reported in less than 30 percent of all
13
However, spenn banks exist which are said to hold sperm
cases.
for up to ten years, giving some elastici ty to the man's decision
Still, the HEW guidelin es warn: "A doctor will
not usually perform a vasectom y unless he is sure that the man wants
There have been uruch more systemat ic studies on the psychological response s to vasectom ies than those to female steriliza tion.
Reduced sexual function , anxiety, reduced personal function , and
impotenc y have been reported among the adverse effects.
Though
there is less risk, surgical trauma, physical discomfo rt and function al
imbalanc e from male steriliza tion than female steriliza tion, greater
lengths are taken to discoura ge men from surgical contrace ption
II
1975.
1
It is now estimate d that one million women in the United
States are sterilize d each year.
Accordin g to the most recent
National Fertilit y Study of the
Office of Populati on Research
at Princeto n Universi ty, "steriliz ation now rivals the birth control pill as the leading contrace ptive method used by married
couples" in the United States.
2
Th.e 1970 National Fertilit y Study-A- describe d the "typical "
white sterilize d married couple as composed of a wife with a median
age of 31.8 years and a husband with a median age of 35.1 years,
married 11.5 years, and with an average of 2.8 children .
it and understa nds that it is permanen t."14
than are taken to discoura ge women.
Female steriliza tion increase d 350 percent between 1970 and
Vasectom ies
are routinel y performe d in doctors' offices, and there is a short
12
recupera tion period. 1he failure rate is 1-4 percent.
to be sterilize d.
II. WHO USES STERILIZATION TO PREVENT CQ:tffi~PTION?
mix with
rates of steriliza tion vary accordin g to sex, race, religion ,
region, and socio-eco nomic class, and these patterns of steriliza tion
have been changing in the last few years.
In order to understa nd
* Comprehensive national data on rates of steriliza tion that rep-
resent all groups of the populati on in the U.S.A. (e.g., whites,
blacks, hispanic s, oriental s, and others), and that distingu ish
between those who are married, single, separate d, and divorced ,
are not currentl y availabl e. Unless otherwis e noted, the data in
this paper are from work by Presser, H. and Bumpass, L. (1972) and
are based on the two National Fertilit y Studies of 1965 and 1970.
1he data were collecte d from women under age 45, married, with
husband present in the 1965 study (sample sizes 4810) and a similar
group in the 1970 study (sample size= 5884). Blacks and whites
are separate d in most analyses of the data; in some cases blacks and
other minority groups are combined to form the category "nonwhit e".
In the report of the data, the "populat ion at risk" includes women
of childbea ring age, that is under age 45, who are not infertil e,
and who do not intend to have more children . "Prevale nce" refers
to the proporti on of people in a given populati on who are currentl y
sterilize d, i.e., have been sterilize d in the current year or in
previous years.
:1
-10-
However,
-11-
some of the factors that determine who gets sterilized in the
United States, we must analyze data on the rates of sterilization
population" were sterilized as of 1970.
6
This is more than twice
as high a percentage of black as white women being sterilized.
according to sex , race, region, and socio-economic status.
Furthermore, these figures probably underestimate the racial difHAS THE STERILIZATION OF WOMEN IN PROPORTION TO MEN INCREASED?
ference for two reasons: first, they do not include hysterectomies,
In as little as five years, the proportion of sterilizations
performed on women vs. men has increased more than 2~ times.**
which are more prevalent among black women; and second, since the
In
1970, 20 percent of all sterilization operations in the U.S.A. were
performed on women, the rest on men. 3
In contrast, by 1975, 51 per-
cent of all sterilizations performed in the U.S.A. were on women.
4
sample is drawn from married individuals with the husband present,
fewer black than white women are included;
The conmonly given explanation for the higher percentage of
black vs. white women is the different cultural attitudes of these
Women are being sterilized at a growing rate, and it appears that
two groups towards the sterilization process.
female sterilization is growing at a much faster rate than is male
interviewed have been found to be strongly opposed to male steril-
sterilization,
ization, whereas white men and women have not.
Black men and women
Thus among blacks,
according to this reasoning, the woman is more likely to be sterilHOW DO RACE AND ETHNIC DIFFERENCES AFFECT STERILIZATION RATES?
ized than the man.
If one examines the data on the percentages of sterilizations
performed on whites and blacks in the United States, regardless of
sex , there seems to be no significant racial differences in steril-
However, another reason could be that, given
the high numbers of female-headed households among the black population in the U.S.A., more black women than black men are accessible
to federal health and welfare services that perform sterilizations.
ization rates,
In a 1970 study comparing sterilization rates among
There is no comparable national data for Puerto Ricans in the
whites and blacks, married, and in the "risk population," approxUnited States.
imately 21 percent of all blacks and 18 percent of all whites were
sterilized. 5
However, a study of New York City voluntary and
municipal hospitals in 1973 found that the proportion of SpanishHowever, if one looks at the data on black vs. white
women, a very important difference becomes evident,
speaking women sterilized was almost three times as great as the
Approximately
16 percent of all black married women in the "risk population"
proportion of blacks, and six times as great as the proportion of
.
7
wh 1.tes.
On the island of Puerto Rico, an estimated 35.3 percent
compared to only 7 percent of all white married women in the "risk
of all women of childbearing age have been sterilized.
** Since most of the data refer here to tubal ligations, rather
than to hysterectomies and other forms of female sterilization,
the numbers are likely to be a conservative estimate of female
sterilization rates.
(See pp26-32.)
ARE THERE REGIONAL DIFFERENCES IN RATES OF STERILIZATION?
In 1965 and again in 1970, contraceptive sterilization was most
prevalent in the western part of the United States.
-12-13-
One factor
contribu ting to this may have been the high rate of steriliza tion
among Native American or chicano women.
However, increase s during
that five-yea r period were greater in other regions.
This was es-
Another federally -finance d study to determin e the efficacy
of family planning programs around the nation
found that black
and hispanic women were more likely to be sterilize d than white
pecially true in the Northeas tern U.S., where steriliza tion increase d
women in the same program.
most among blacks -- rising from 6 to 20 percent of the populati on
8
studied.
hispanic women made up 17 percent of the steriliza tion patients ,
HOW DO SOCIO-ECONOMIC DIFFERENCES AFFECT STERILIZATION RATES?
Income.
Tubal ligation s are more prevalen t among the poor,
especial ly among those with "family" incomes below $5,000.
Vasec-
tomies are more prevalen t at higher levels of income, with the
Specific ally, the study found that:
but only 11 percent of the entire program populati on; black women
made up 43 percent of the steriliza tion patients , but only 37 percent of the program populati on; but white women made up 40 percent
of the steriliza tion patients , and as much as 53 percent of the
11
program populati on.
highest percenta ge performe d among those with incomes of $10,000
and above.
Thus it appears that, at income levels where there is
relative ly more freedom of choice, men are more likely than women
to be sterilize d.
Converse ly, at levels of income where there is
the least freedom of choice, women are more likely than men to be
sterilize d.
Between 1965 and 1970, the greatest increase in preva-
lence of tubal ligation s was found among black and white families
9
with incomes under $5,000.
Educatio n of women.
In general, women who have received less
schoolin g are more likely to be sterilize d than those who have had
more educatio n.
In 1970, the highest prevalen ce of tubal ligation s
was among those women with 0-11 years of educatio n.
Public assistan ce recipien ts.
A recent study of women on non-
private and private medical services indicate s that non-whit e women
in nonpriva te facilitie s are sterilize d more frequent ly followin g
abortion s, at younger ages and after fewer children than are white
10
.
. l
women on pr i vate me d ica services .
-14-
-15-
Until 1969, a "120 formula" was applied to most, but not all
III. WHAT IS STERILIZATION ABUSE?
Every responsib le adult has the right to choose sterilizat ion
as her or his form of contracep tion.
to choose NOT to be sterilized .
And every adult has the right
If a person's right to be steril-
ized is interfered with, that constitute s an abuse of reproduct ive
freedom.
And if a person is sterilized without having made that
choice, in full knowledge and freedom, that constitute s an abuse of
reproduct ive freedom.
All questions of sterilizat ion abuse must be
understoo d in the context of reproduct ive freedom.
It is an abuse of reproduct ive freedom when:
1) a person chooses to be sterilized , but is discourag ed
or even prevented from undergoin g the operation ;
women who wanted to end their fertility,
This was a rule of the
American College of Obstetric ians and Gynecolog ists (ACOG).
It
enabled a doctor to refuse requests for sterilizat ion unless the number of children a woman already had multiplie d by her age came to 120
or higher (as, for example, a 30-year-o ld mother of four children) .
As late as 1970, the ACOG also required the permissio n of two doctors
and a psychiatr ist for married women who wanted to be sterilized .
These rules, however, were largely enforced with upper- and middleclass women in private facilities .
As governmen t and social policy
began to support mass sterilizat ion of low-incom e women, the ACOG
dropped both the 120 formula and the requireme nt of medical and
2) a person is sterilized without informed and voluntary
consent;
psychiatr ic certificat ion.
3) a person "chooses" sterilizat ion because lack of
access to contracep tion and abortion makes it the
only alternativ e to more children;
WHAT ARE SOME INDICATIONS OF INVOLUNTARY STERILIZATION?
4) a person "chooses" sterilizat ion because poverty and
lack of social services make it an alternativ e to
increased misery.
tion, yet the growth of sterilizat ion in the last decades gives a
IN WHAT WAY OOES WITHHOLDING STERILIZATION CONSTITUTE AN ABUSE OF
REPRODUCTIVE FREEDOM?
Steriliza tion can be, and has been, withheld to promote reproduction of certain classes.
Although sterilizat ion has been with-
held from working-c lass women until recently, it was especially
upper- and middle-cl ass women who had to conform to strict regulations before they could be sterilized .
These women, just like
women who are sterilized without consent, were treated as objects
of populatio n policy.
The governmen t and medical professio n were
exercising control over their bodies and their reproduct ive lives
in order to keep what they view as a ''healthy" population balance.
Numbers alone are not enough to indicate involuntar y steriliza -
backdrop to the picture.
Between 1960 and 1972,ster ilizations rose
from 100,000 a year to about one million a year, and the growth
rate has continued since then,
Part of this growth was related to
restrictio ns on other forms of birth control, particula rly abortions .
Until the legalizati on of abortion in 1973, teaching hospitals
especially in the :t-buntain States, the Far West, and Canada -required that women who wanted abortions agree to the "package deal"
1 Even after abortion
of sterilizat ion as a condition of approval.
was legalized , legal abortions continued to be unavailab le in 80
With abortions legal, only 18 percent
2
of the nation's public hospitals performed them in 1975,
percent of all U.S. counties,
Meanwhile , as of January 1975 the federal governmen t assumed 90
-17-
-16-
Informed consent required that the person to be sterilized be given:
percent of the cost of sterilization under Medicaid for all poor
1) a fair explanation of the operation;
or medically indigent people.
2) a description of the discomforts and risks;
The scandal of involuntary sterilization in federally funded
family planning programs became public with the Relf case.
3) a description of expected benefits;
In
4) an explanation of alternative family planning methods and
their effects, and an explanation of the impact of sterilization, including the fact that it is expected to be irreversible;
1973, Mary Alice and Minnie Lee Relf, two Alabama sisters aged
12 and 14, were sterilized without their real knowledge or consent.
In the investigation that followed their parents' protests
5) an offer to answer questions concerning the operation;
it was disclosed that the Alabama clinic had sterilized a total
of eleven young girls, ten of them black.
6) an explanation that, if the person didn't want to be
sterilized, no government benefits could be withheld as
a result of this decision.
At least thirty other
minors were found to have been sterilized in the preceding year
in govermnent sponsored birth control clinics around the country.
The Federal District Judge, finding on behalf of poor victims of
involuntary sterilization, wrote:
Although Congress has been insistent that all family
planning programs function on a purely voluntary basis,
there is uncontroverted evidence in the record that
minors and other incompetents have been sterilized
with federal funds and that an indefinite rrumber of
poor people have been improperly coerced into accepting a sterilization operation under the threat that
various federally supported welfare benefits would
be withdrawn unless they submitted to irreversible
sterilization. Patients receiving Medicaid assistance
at childbirth are evidently the most frequent targets
of this pressure, as the experience of plaintiffs
Waters and Walker illustrate. Mrs. Waters was actually
refused medical assistance by her attending physician
unless she submitted to 4 a tubal ligation after the
birth. (Italics added)
To regulate federally funded sterilizations , in 1974 the
Department of Health, Education and Welfare (HEW) issued a set
of guidelines.
These guidelines included the stipulation that
all sterilization procedures take place only after the potential
patient had given her "informed consent."
-18-
3
In addition, a 72 hour waiting period was imposed to allow the patient
time to reconsider her decision, and the minimum age for sterilization
was set at 21.
However, even though HEW offered guidelines, many continued to
ignore them.
5
lhe required 72 hour waiting-period , even when ob-
served, did not offer sufficient protection against coercion.
More-
over, as a New York Times news story pointed out in 1975, federal
funding itself worked to make the poor choose sterilization rather
than abortion (for which states were reimbursed only 50-80 percent
of the cost).
Worse, it worked to promote sterilization by unnecessary
hysterectomy, which pays $800 to the surgeon, rather than by tubal
ligation, which pays only $250:
'Hyster-steril izations' -- so connnon among some groups of
indigent blacks that they are referred to as 'Mississippi
appendectomie s' -- are increasingly popular among surgeons,
despite the risks ....
The scandal of "Mississippi appendectomies " as these sterilizations
were called, was widespread.
The reporter also found them "in New
York and other major cities. 11 6
-19-
Subseque nt complain ts, investig ations, and legal cases have
uncovere d not just single instance s of involunt ary steriliza tion,
but a policy and practice of coercive steriliza tion of the poor -a dispropo rtionate number of whom are black, hispanic and Native
American girls and women,
7
In these cases of gross steriliza tion
abuse, the key point at issue is the absence of voluntar y and informed consent to this irrevers ible procedur e,
The followin g three
cases provide some examples :
One of the ten chicano women who were sterilize d in 1971
without consent, and who brought suit against the Universi ty
of Southern Californ ia, Los Angeles Medical Center, discover ed
she was sterilize d when she returned to the hospital after a
stillbir th for contrace ption, The consent form in her file
had been signed by her common-law husband, who thought he was
signing only for the Caesaria n she had had, The other women
in the case were persuade d to sign consent forms while under
anesthes ia during labor, They were not informed of theirreversib le nature of the operatio n, and their consents were
obtained in English, although only one spoke English, g
Rosalind Johnson, who brought suit against New York City
for involunt ary steriliza tion in 1976, is a black woman who
was taken from Rikers Island, where she was a prisoner , to
Kings County Hospital for an abortion , Asked whether she
wanted any more babies "now," she was told her tubes could be
tied, then untied once she was a "good girl." She wa& deliberately misinform ed about the irrevers ibility of the procedure. The 30-day waiting period required by Nzw York City
guidelin es was violated . Ms, Johnson was 19 years old at the
time, despite the prohibit ion against sterilizi ng persons
under 21. 9
Norma Jean Serena is a Shawnee Indian who is s~ing
health and welfare official s of Armstron g County, Pa. for
sterilizi ng her without her knowledg e or consent after
delivery of her youngest child, Her cas e is related to charges
of genocide by steriliza tion made by Native American groups,
With fewer than a million Native American s in the United States,
accordin g to Dr. Connie Uri, a Choctaw- Cherokee physicia n in Los
Angeles, up to 25 percent of all Indian ~omen of childbea ring
age have been involun tarily steriliz ed. 10
The governm ent's General Accounti ng Office found, in a
survey publishe d in November 1976, that 3,000 female sterilizations had been performe d in a four year period in the
federall y funded facilitie s of the Indian Health Service, Moreover, the consent forms on file were "general ly not in complian ce
with • .,.regula tions." ·£ hat is, the governm ent's own review of
-20-
the official records of the IRS found that the most widely
used consent form "did not indicate that the basic elements
of informed consent had been presente d orally to the patient, "
It did not contain written swmnatio ns of the oral presenta tion nor a statemen t notifyin g subjects of their right to withdraw consent, Finally, there were 13 steriliza tions of minors,
as well as 13 violatio ns of the 72 hour waiting- period, 11
HOW DO HEALTH PROFESSIONALS CONTRIBUTE TO STERILIZATION ABUSE?
Steriliz ations are often performe d without any knowledg e on
the women's part, with consent gained by misinfor mation, under
threats to terminat e public assistan ce, and as a result of other
pressure s applied to women in vulnerab le circumst ances,
"Sure,"
a physicia n from Texas said about tubal ligation s:
they pushed them all the time there, from the third year
medical students to the resident s, If an intern got them
to sign he'd get to do it, so they'd do anything , even beg
them,.,f or the practice . Yes, they would ask them during
labor. 12
The acting director of OB/GYN at one New York municipa l hospital
reported the same kind of informal policy,
Accordin g to him:
In most major teaching hospital s in New York City, it is
the unwritte n policy to do elective hysterec tomies on
poor black and Puerto Rican women, with minimal indicatio ns,
to train resident s,13
In addition to receivin g training and money for unnecess ary
hysterec tomies and other steriliza tion procedur es, doctors consciously and unconsci ously carry out "social policies " when they
steriliz e.
A case worker, writing to the New York Times after the
Relf scandal, reported that tubal ligation s were corranonly done
without patients ' knowledg e at Washingt on Hospital Center in Washington, D,C. and at Long Island College Hospital in Brooklyn ,
The
tubal ligation s were performe d "at the discretio n of the hospital
staff and were usually based on their consensu s that the woman in
1114
question , usually black and poor, had too many children ,
-21-
believing that they themselve s might become pregnant again.
Dr. Clovis Pierce and two other obstetrici ans in Aiken County,
South Carolina were found to require sterilizat ion before agreeing
to deliver babies for welfare patients with two or three children.
The hospital records showed that nearly half of the mothers who
18
In other words, the very physician s who had so influenced these
women had not made clear to them the most significa nt part of
the operation ; that is, it is irreversi ble.
Hospitals do not list for us how many women signed consent
had Medicaid- paid deliverie s in Aiken County in 1973 were steril-
forms unknowing ly, or because they were told welfare payments would
ized, and the doctors themselve s admitted that their policy was
15
based upon their social views.
be suspended , or because they believed their tied tubes could be
Several surveys of doctors' attitudes show an alarming percentage of physician s favoring compulsor y sterilizat ion of mothers
on public assistanc e.
In one survey, 97 percent of the doctors
"untied" some day.
Women rarely come forward to accuse doctors of
deceiving them -- particula rly women on Medicaid or who otherwise
feel they are in no position to assert themselve s and bring charges.
Vigilance on the part of women and women's groups, and stringent
responding favored sterilizin g women on public assistance who had
16 One of many physician s who wrote
borne illegitima te children.
doctors' assumptio n that they have the right to decide which women
in support of Dr. Clovis Pierce expressed the widely shared attitude
should be sterilized , when, and for what reasons.
regulation of sterilizat ion procedure s are essential to combat the
that, "One way to decrease future welfare roles (sic) is the deliberate prevention of future welfare recipient s.
Steriliza tion is
the answer, and just exactly as the obstetric ian in South Carolina
17
recommend s."
The problem of doctors' attitudes is particula rly crucial since
WHAT IS THE RELATIONSHIP BETWEEN STERILIZATION ABUSE AND ACCESS TO
OTHER FORMS OF BIRTH CONTROL?
Steriliza tion abuse occurs when a person is sterilized because
abortion is unavailab le, or because other methods of birth control
are too costly.
New national regulatio ns, such as the HEW guide-
physician s exercise a great deal of influence on their women patients.
lines -- if they cover all sterilizat ions, whether they are federally
A survey now being conducted in New York City by the United Methodist
funded or not, and if they are monitored -- can protect women from
Church indicates that in thirteen out of twenty-six cases of tubal
involunta ry sterilizat ion urged or forced by health professio nals.
ligation, doctors suggested sterilizat ion to the women and exercised
But such regulation s cannot protect women from sterilizat ion abuse
the greatest influence on their choice.
Ten of the twenty-six
women were not sure they would "choose" the operation again, given
the same circumsta nces,
and fifteen felt they would decide dif-
ferently if their life circumstan ces were different .
Most sig-
nificantly , eighteen of the 26 women believed that women who had
fostered by the governmen t's restrictio ns on other forms of birth
control.
They cannot give women real choice.
be said to be chosen freely until other safe and effective forms of
contracep tion
and their backup, abortion -- are made fully
available to all women.
their tubes "tied" rather than cut could become pregnant, thirteen
-22-
Steriliza tion cannot
-23-
Race and class biases are implicit in a federal policy which
At a miniurum, genuine contraceptive choice requires that
sinrultaneously restricts abortion and fosters sterilization.
legal abortion, and public funding for abortion, be as available
as sterilization and its funding.
l
do know, however, that over 38 percent of all black and other
·1
minority women have relied upon Medicaid for their abortions, as
As it now stands, sterilizations
are paid for by Medicaid, family planning programs funded by HEW,
We
and by the Public Health Service and the Indian Health Service.
compared with only 7 percent of all white women. 20
No distinction is made in the new, proposed HEW guidelines between
intent, the effects of the policy are clear.
therapeutic and nontherapeutic (i.e. for contraception only)
means of birth control, poor and minority women are pressured into
sterilizations.
"choosing" sterilization.
Yet no federal funds are available for abortion,
except for very narrowly defined "therapeutic" cases.
Throughout
The question of poverty is inseparable from reproductive free-
But legal abortions are
dom for women.
still unavailable in most hospitals, even when federal funding
evils through population control, or whether one is on the side that
One of the rationales offered for the end to federal aid for
seeks to create reproductive freedom in the context of a more equit-
Yet the cost to the government of
able distribution of the world's resources.
funding abortions is far less than the cost of not funding them.
Funded abortions in 1976 cost the government $61 million.
We may gain an idea of the former line of thinking from a
If only
quotation by the past president of the Association for Voluntary
a third of the women eligible for Medicaid abortions give birth,
Sterilization, an organization which has fought hard not to have
it will cost the government $200 l!lillion just for the first year
any guidelines attached to sterilization.
of medical care and social welfare services -- not including
medical costs for botched, illegal abortions. 19
More important, sterilization of the
poor may reduce the number of potentially unemployed, along with
their claims for decent housing, food, jobs, and education.
This
is an economic consideration of a different and massive kind. In-
~
I
and too many people crowded too close together may cause many
of our social and economic problems. As physicians we have
obligations to the society of which we are part. The welfare
mess, as it has been called, cries out for solutions; one of
these is fertility control.21
Such statements promote sterilizations as a cure for social ills.
They make the victims of the unequal distribution of jobs, goods,
and services the causes of their own poverty.
s t ead of making the economy fit people's needs, sterilization can
be used to make people fit the economy's needs.
-24-
"People pollute," wrote
Dr. Curtis Wood in a professional medical journal,
Of course, steril-
ization of the poor is economically less costly to the government
than two or more abortions.
This connection between poverty and reproductive
freedom holds whether one is on the side that seeks to cure social
is there for them.
abortions has been economic.
Deprived of other
HOW DOES THE SO,CIAL AND ECONOMIC CONTEXT LEAD TO STERILIZATION ABUSE?
the country, sterilizations are performed in private and public
facilities, in hospitals and clinics.
Whatever the
-25-
Women in our society are torn by deep social contradictions .
Society demands, on the one hand, that the private family, and
A study of sterilization in Puerto Rico is strikingly relevant
women within the family, produce and rear the next generation.
At
the same time, society denies to millions of women the fundamental
means to this end: economic security, fair employment, adequate
nutrition and health care, day care, education, and housing,
If
we are to guard against sterilization abuse, this situation tm1st
be changed,
IV. STERILIZATION IN PUERTO RICO: A CASE STUDY
For women and families to participate in genuine
for three reasons:
1) It illustrates dramatically the relation between sterilization programs and socio-economic and political factors;
2) It shows what might happen in the United States if legal
and free access to abortion is denied as it is in Puerto Rico;
3) It shows how difficult it is within any socio-economic ,
cultural and ideological setting to determine whether the
choice of sterilization is really voluntary.
"family" planning, they need to do so in a context of guaranteed
employment, and with adequate health care, housing and childcare.
They need to choose to bear children, or not bear children -- the
only context that makes choice possible,
Former New York City
WHAT IS THE RELATIONSHIP BETWEEN THE SOCIO-ECONOMIC BACKGROUND OF
PUERTO RICO AND ITS STERILIZATION PROGRAM?
After its victory in the Spanish-Americ an War, the United States
began to control the rich resources of Puerto Rico and to use it as
Representative , Bella Abzug expressed the relationship between
a base for further domination of the Caribbean.
poverty and reproductive choice in the following words:
and dependence has deepened with the growth of United States'
Can we really say that a poor woman has elected sterilization
if abortion is unavailable to her, if she still suffers discrimination in the job market, if the courts cannot decide in
favor of universal maternity benefits, and day care centers
are closed?
interests.
The island's poverty
Agencies working for these same interests have taken the
initiative in identifying Puerto Rico's problem as "overpopulatio n,"
instead of responding to the real facts of unemployment and nationalist opposition.
As a result, Puerto Rico now has the highest
rate of sterilization in the world.
United States domination of Puerto Rico has worn many faces.
First, a single-crop economy replaced diversified agriculture as a
result of the U.S. sugar cartel, aided by a mercantile tariff policy
that fostered dependent trade relations,
In the 194Os, the
industrial emphasis shifted from sugar-cane economy to light industry,
with economic incentives for mainland investment provided by Governor
Munoz Marin's Operation Bootstrap.
Later, Puerto Rico became a
United Stares military base for training troops to be used against
revolutionary movements in Latin America and as a storage depot for
-26-
-27-
armaments.
In recent years U.S. investment in heavy industry,
mining and petro-chemicals, as well as in insurance and banking
sectors, has expanded,
1
Between 1948 and 1973, U,S, control of
manufacturing assets increased from 22 to 81 percent,
2
United
States investment in Puerto Rico now almost equals the level of
3
The first massive resistance by Puerto Ricans occurred in
the 1930s,
Feeling the double impact of economic dependency and
the Great Depression, Puerto Ricans began to strike back,
Dis-
possessed farmers formed militant unions and the nationalist movement swelled,
In response to this explosive situation, the Puerto
Rican government backed by the United States adopted three major
strategies: the killing and imprisonment of nationalists, the
encouragement of migration to the United States, and the passage
in 1937 of a bill in the Puerto Rican legislature legalizing sterilization,
In subsequent periods of economic or political stress,
Although Operation Bootstrap
precipitated a brief boom, few jobs were actually created for the
island's inhabitants, and emigration continued,
4
The successive
shifts from labor-intensive to capital-intensive industry, with
its need for a smaller labor force, have increased unemployment,
By early 1976, the official unemployment rate in Puerto Rico ranged
from 20 percent (according to Puerto Rican government figures) to
35 percent (according to U.S. government statistics),
5
As for women,
by 1973 their participation in the labor force had grown to 35 percent.
They constituted 49 percent of the workers, and their
-28-
It is
ing work force, since their labor can be bought more cheaply,
High unemployment and women as a source of cheap labor have
been two incentives to decrease family size, and sterilization has
For many decades
sterilization programs aroused religious opposition, but by the
1960s the government began to offer active support.
was decisive in this shift,
U.S. financial backing
While initially the International
Planned Parenthood Association supported the island's Associacion
Puertoriquena Pro Bienestar de la Familia, in the 1960s HEW's
Office of Economic Opportunity took over the funding,
At present
HEW pays 90 percent of all in-hospital costs for sterilizations,
In 1965, a Conunonwealth study found that 34 percent of women
between 20 and 49 years of age had received la operacion, the
neutral term by which sterilization is popularly known.
7
In 1968
the figure for sterilized women in the same age bracket had risen
one, two or all of these "solutions" have been employed,
Economic stress has only increased,
6
likely that women will occupy an expanding portion of the shrink-
been on the Puerto Rican scene since 1937.
its total investment in all Latin America and has produced a
Puerto Rican debt of nearly $13 billion to the United States,
salaries were lower than those of men for the same work.
to 35,3 percent,
8
The link between fear of a surplus labor force and sterilization remains ruthlessly direct.
In November, 1973, a Conunonwealth
report entitled "Opportunities for Employment, Education, and
Training" states frankly the need "to reduce the growth of the
working sector of the population,"
A crucial strategy toward this
end requires integrating population control with the health and
social service agencies and reaching "those who suffer most from
a condition of excess population," that is, "the groups with the
least income and smallest amount of education, 119
-29-
Noting that, of
the 485,948 women of reproductiv e age living in Puerto Rico,
106,363 were already sterilized, the report unabashedly directs
its attention to "a potential clientele of 325,585 women.
1110
6) Many women aspiring to enter the middle class have been
taught by the media to believe that upward mobility is
dependent upon having small families.
Although it is rarely stressed, the overwhelmin g majority of
the women sterilized in Puerto Rico come from that segment of the
WHAT IS THE RELATIONSHIP BETWEEN ABORTION AND STERILIZATION?
It is critical to understand that in 1968, when 35.3 percent
of Puerto Rican women between the ages of 24 and 49 had been
sterilized, abortion was illegal.
Women with low incomes seeking
abortions were subjected to the most stringent eligibility
restriction s.
Violators of the anti-abortio n laws were "punish-
able by imprisomnen t in the penitentiar y for not less than two
nor more than five years.
1111
Only wealthy Puerto Rican women
could afford the black market prices demanded by abortionist s.
peasant and working classes who have been persuaded to seek personal solutions to societal problems,
that if they manage to imitate the
They have come to believe
middle class family at home,
they will achieve middle class status in the outside world.
While
the median age of women sterilized is 28, according to Vazquez
Calzada, women who have been married a long time, not those coming
from ''unstable" homes, are being sterilized the most.
17 Also,
more women with small families -- mostly two or three children
Sterilizatio n became the contracepti ve form used by a third of
are "choosing" to have la operacio"n than those with large families
18
In other words, while Vazquez Calzada's
or no children at all.
the women on the island.
data do not discredit the growing evidence of overt sterilizatio n
DO PUERTO RICAN WOMEN f!!QQg STERILIZATION?
Before beginning to answer this question,co nsider these facts:
1) Government funds have not been used adequately to set
up clinics for counseling women in the use of less
final methods of birth control.12
2) Since women have been poorly informed, many have found
alternative s unreliable;1 3 La operacion, on the other
hand, is free, readily available and relatively sure.14
3) Women who have joined the work force in increasing
numbers (see Section I) have not received child care
and other forms of government support to relieve them
of their traditional ly unpaid domestic labor.15
4) Sterilizatio n, since it can be rationalize d as therapeutic, has met with less opposition from the Church
than have other methods of birth control.16
5) Cultural norms have minimized male responsibil ity for
contracepti on.
abuse of Puerto Rican women, they go on to alert us to an increasing submission to la operacion, especially by people who believe it
will provide them with an escape from abject poverty.
Intimate pressures within the male dominated family coincide
with the impersonal pressures of the patriarchal state.
The
traditional reluctance of men to assume equal responsibil ity for
contracepti on, particularl y when it interferes with their own
pleasures, has contributed to the success of the sterilizatio n
program.
1
According to Vazquez Calzada s study, for example, of
the women sterilized who had previously used some form of contraception (41.2 percent of his sample) women who had been "inconveniencing" their mates were more numerous than those who took res19
Thus 34.8 percent
ponsibility for contraceptio n themselves.
of this sterilized population listed condoms as the former means
-30-
-31-
of birth control, while only 13.5 percent said pills.
20
What is
Given all these socio-economic, cultural and ideological
more, whereas 36.1 percent of the entire group of women sterilized
pressures, we are then left with the question: under present
were post-operatively dissatisfied with la operaci6n, only 12 per-
conditions, can sterilization ever be really voluntary?
cent of their husbands were. 21
The state and the male-dominated family have also had the
subtle support of the Roman Catholic Church on the question, an
important ally in Puerto Rico where 80 percent of the population
is Catholic.
Although the Church has never sanctioned steriliza-
tion, la operaci6n, unlike contraception, can be rationalized as
therapeutic.
Furthermore, unlike abortion, sterilization was legal
for general health reasons and could therefore appear less offensive.
Since it was also performed prior to conception, it did not raise
•
•
•
d wit
• h i nterrupting
•
t h e mora 1 ob Jections
associate
a pregnancy. 21
Finally, the success of the sterilization program has depended
on the medical profession.
Both financial incentives for the
operation and certain prejudices about the poor, led doctors to
promote li!....2,peracion.
In a 1952 study, physicians were asked why
they supported sterilization:
80 percent cited reasons of health
22
and 66 percent added reasons of poverty.
Furthermore, according
to a 1954 report, ''Many physicians thought and still think that
contraception methods are too difficult for lower class Puerto
Ricans and regarded postpartum sterilization as the most feasible
solution to the (population) problem.
1123
No wonder,
given this
position, doctors have kept relatively quiet about the psychological
and possible physiological side-effects of li!....2,peration.
24
Known
in medical circles as the "post-sterilization syndrome 112 5, women
rarely learn until after the fact that there is a high incidence
of post-operative depression and frequent menstrual irregularities.
-32-
-33-
V. WHAT DO WE PROPOSE?
4) The provision to all women of other, safe forms of
With sterilization as the most rapidly growing means of birth
contraception and their back up -- abortion.
Genuine con-
control, we must all be vigilant to ensure that it is not used as
traceptive choice requires that concern for the women and
a substitute for social solutions to social problems.
children of this nation be translated into:
Social problems of poverty and unemployment need to be addressed directly.
And sterilization procedures need to be regu-
lated and monitored to ensure informed and voluntary consent.
We believe the minimum requirements for informed and voluntary
consent are:
1) A set of national guidelines that ensure full knowledge
of the operation and its alternatives, and require a 30 day
waiting-period for reflection and discussion with family and
(a) a federally sponsored program of research into
safe, effective means of contraception. At present,
except for the diaphragm, women "choose" between
effective contraceptives hazardous to the health
(the Pill, the IUD); less sure methods (foam, rhythm,
condom); and an irrevocable, surgical sterilization.
(b) sex education and birth control clinics -- and an
end to scandalous reports of family planning clinics
that push sterilization upon poor women and women of
color.
(c) abortion, and public funding for abortion, made
as available as sterilization and its funding.
friends outside the hospital envirornnent and removed from
conditions of stress, such as delivery and abortion.
This
allows, of course, for a woman who wants to be sterilized at
the ti.me of abortion or delivery to sign a consent after
proper counseling and up to 30 days before delivery or abortion
so as to be sterilized at that time.
It makes illegal the
pressuring of women, particularly at the ti.me of delivery or
abortion to sign consent forms.
2) The application of such guidelines to all sterilizations
and not just to Medicaid patients, the only ones covered by the
proposed HEW regulations.
The rights of others who are not
welfare recipients are also threatened.
3) A community based monitoring system to ensure enforcement of the guidelines.
Most of the cases of sterilization
abuse from 1974 to the present have been in violation of existing guidelines.
-34-
-35-
APPENDIX
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
GUIDELINES FOR FEMALE ELECTIVE STERILIZATION
Effective November 1, 1975
KNOW YOUR RIGHTS!
We are appending to this workbook two sets of guidelines
regulating sterilization.
The first set are the New
York City guidelines regulating all sterilization procedures.
We regard them as a minimal model legislation.
The second set of guidelines are those of HEW.
If you want to work for full legislative protection,
and/or if you believe your rights are not being respected,
The Health and Hospitals Corporation has adopted the following
set of guidelines for the performance of a female elective sterilization operation. The guidelines attempt to insure that a consent
form will be signed only after the woman has indicated a complete
understanding of the procedure to be performed, its complications,
and its after-effects. To help her attain this understanding, she
will receive an informational session which will include discussion
of all methods of birth control, and the advantages and disadvantages of each; she will also receive information about the permanence of sterilization, and the incidence of regret which may accompany the operation under certain circumstances. She will be
informed, as required by Federal regulations, that her consent may
be withdrawn at any time prior to the operation without threat of
loss of health services or other benefits. She will also reaffirm
her understanding of the sterilization operation and its implications by signing a second written consent given just prior to the
performance of the procedure.
contact one of the groups listed in our Introduction.
No woman will be subjected to any kind of pressure by any
employee of the Health and Hospitals Corporation or by any member
of a municipal hospital staff, medical or otherwise.
If, after careful consideration of all other methods of contraception, a patient elects to be sterilized, compliance with the
following guidelines is required in order to discharge the hospital's legal and social obligation to a competent adult woman
requesting the procedure.
(1) Patients eligible for sterilization in Corporation
facilities nrust be at least 21 years of age, and legally competent.
(2) Patients requesting sterilization will not be denied
sterilization because of their marital status, number of children,
or age, as long as they are 21 years old and legally competent,
unless the procedure is medically contra-indicated.
(3) Sterilization is to be discussed by hospital staff only
in conjunction with alternative birth control methods and in the
context of a general discussion on this subject.
(4) Initial consent may not be elicited from a patient during
admission or hospitalization for childbirth or abortion or other
medical treatment; consent obtained during these times will be
presumed involuntary.
(5) Informed consent for sterilization requires that the
patient understand the risks and benefits of sterilization, as well
as the risks and benefits of all alternative, reversible methods
of controlling conception. In order to meet the requirements of
informed consent, every patient nrust receive an informational
-36-
-37-
session by a non-physician counselor in addition to any information she may have received from a doctor or a medical student.
(12) All sterilizations, whether elective or based upon
medical indication, must be reported to the Office of Quality
Assurance on a monthly basis.
(6) At the time that a patient requests information about
sterilization, she should be given an informational packet and
an appointment for an informational session. She will be encouraged to bring to the session a friend, family member or
spouse who can serve as her witness.
(13) As required by New York State regulations, all women
nrust sign a statement reaffirming their request and consent to
sterilization upon admission for the procedure.
(7) Written informed consent for sterilization !11lSt be obtained from each patient. The Health and Hospitals Corporation
requires that the attached consent form be used. This form must
be presented orally in the presence of a witness. If the
patient has not brought a witness of her own choosing, the hospital
will provide a witness who is neither the counselor nor a
physician.
(8) All consent forms and informational materials nrust be
available in at least Spanish, French, Chinese, Yiddish and English.
If the counselor does not speak the primary language of the patient
and the witness cannot serve as an interpreter, the hospital nrust
provide an interpreter. Where an interpreter is not available, as
a last resort the patient should be referred to another nrunicipal
hospital where such an interpreter or counselor is available.
(14) There is no legal basis in New York which requires
that a married individual must be joined by the spouse in giving
consent as a prerequisite to the performance of a sterilization
procedure.
(15) Assurance must be given to every patient, orally and
in writing, in the form of the following legend, boldly printed
at the top of all consent forms and all informational materials.
The legend should read: "IF YOU DECIDE YOU DO NOT WANT TO BE
STERILIZED, YOU WILL NOT LOSE ANY BENEFITS OR MEDICAL SERVICES.
YOU CAN CHANGE YOUR MIND AT ANY TIME PRIOR TO THE OPERATION. 11
Medical services cannot be delayed or withheld while a woman is
considering sterilization.
(9) Sterilization may not be performed sooner than thirty (30)
days following the giving of initial informed consent by the patient,
except as described in (10) below. The hospital treating the
patient must offer and encourage the use of other methods of birth
control during the waiting period.
(lO)A woman who has completed the appropriate forms and
informational session and who signs the required consent form
thirty (30) days prior to her anticipated delivery date may be
sterilized in less than thirty (30) days if she delivers prior to
her anticipated date, as long as her delivery does not occur in
less than 72 hours after giving consent.
11
(11) If a woman appears for delivery (full-term or pre-term)
at a municipal hospital other than that at which she has completed
the appropriate forms and informational session, the receiving
hospital shall contact, by telephone, the hospital at which the
forms and procedures were completed for verification of same.
This nrust be noted in the record, with the name and title of the
person providing the information, the date that the consent form
was signed, and the anticipated delivery date. If the consent
form was signed thirty (30) days prior to the anticipated delivery
date, this will be sufficient to enable the receiving hospital to
perform the sterilization. If the patient presents a duplicate
copy of the initial consent duly signed, witnessed and dated at
least thirty (30) days prior to the anticipated delivery date,
telephone verification may be waived.
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-39-
PROPOSED HEW REGULATIONS
exerpted from a statement by Joseph A. Califano, Jr., December 1, 1977.
The new sterilization regulations would apply to all
operations, such as tubal ligations and vasectomies, performed
for the purpose of making an individual permanently incapable
of reproducing. The rules do not distinguish between sterilizations desired for personal reasons (so-called "nontherapeutic" sterilizations) or sterilizations needed in order
to avoid pregnancies for medical reasons ("therapeutic"). Current
regulations provide less protection to individuals who seek
sterilization to avoid pregnancy for medical reasons, and there
appears little justification to continue this distinction.
The consent requirements do not apply to operations undertaken for medical reasons other than sterilization even though
they result in sterility. For example, certain types of
radiation treatment, removal of a cancerous uterus, and a prostate operation that ends a man's capacity to have children, are
not covered by the sterilization consent procedures in the
proposed regulations.
Consent Procedures
Under the proposed regulations, federal funds would only
be available to pay for sterilizations conducted under newly
strengthened procedures designed to ensure that no person is
sterilized without giving knowing and voluntary consent to the
operation. These procedures require the following:
*
*
*
The person securing a patient's consent !ID.1st
inform the patient of his/her right not to be
sterilized -- that no Federal funds or benefits,
such as Medicaid or welfare benefits, may be
withdrawn because an individual chooses not to
undergo a sterilization.
The person obtaining a patient's consent nrust
state orally all the information on the consent
form, including advice that sterilization is
permanent and irreversible, and information
about other forms of birth control.
The patient's consent nrust be obtained by using
a consent form approved by HEW. This form nrust
be in the patient's primary lanbuage, unless an
interpreter is provided for the patient. Suitable
arrangements nrust be made for blind, deaf, and
other handicapped patients to ensure that information is effectively comnrunicated.
-40-
*
Doctors performing sterilizations, as well as
nurses, social workers or other persons obtaining
patient consent for sterilizations, must sign
the patient's consent form, certifying that they
have provided the patient with the necessary
information, that the patient has knowingly and
voluntarily requested to be sterilized, and that
the required waiting period has passed before the
sterilization was performed. This requirement to
sign the consent form would be imposed on doctors
for the first time under the proposed regulation.
The consent requirements have been designed to guarantee that
all patients will be provided with the information they need to
make an informed and voluntary decision on sterilization,
Waitin~ Period
The proposed rules would increase, from at most 72 hours to
30 days, the waiting period between the signing of the consent
form and a sterilization paid for with Federal funds, A 30-day
waiting period will assure that any decision to undergo sterilization is made carefully and voluntarily by providing the time
for reflection and discussion with family and friends. It will
also ensure that decisions to undergo irreversible sterilization
are not made and carried out during periods of stress which can
be associated with pregnancy, labor or childbirth.
This waiting period requirement will not impede prompt provision of emergency medical procedures, even those that result in
sterility, since such procedures are not covered by the proposed
regulations because they are not undertaken for the purpose of
sterilization.
Many states already have waiting periods to protect consumers in door to door sales in situations which have far less
consequence for the individual.
Minimum !!I!,_e
The proposed rules retain current HEW policy that sets 21 as
the minimum age at which individuals can obtain sterilization
paid for with Federal funds, Persons under 21 are more susceptible to coercion, and may not be well enough informed to provide
a knowing consent to a sterilization operation. Current policy
was established in 1973 following disclosures of grave cases of
coerced and uninformed sterilizations of young women, paid for by
Federal funds.
Incom£etent Persons
The proposed regulations seek comment from the public on two
alternative proposals on the issue of Federal funding of sterilization of mentally incompetent persons.
-41-
The first alternative would preclude Federal funding for
the sterilization of any person who is mentally incompetent
under state law, even in states where the law permits the
sterilization of mental incompetents. Current HEW policy follows
this practice.
The second alternative would authorize Federal funding of
some sterilizations of mental incompetents in those states in
which the law permits such sterilizations.
If the comments demonstrate that there exist persons who
are capable of giving informed consent even though they are
classified as mentally incompetent, Federal funds would be
available to finance sterilizations of these persons in states
which permit such operations. For sterilizations involving these
individuals, the proposed Federal regulations would require
stringent protective procedures, if Federal funds pay for a
sterilization.
A sterilization review committee, composed of a lawyer,
a doctor, a social worker and a patient-advocate would first
have to approve the sterilization. After a hearing -- with
counsel provided -- this conmittee would have to be satisfied
that the patient was capable of understanding the nature and consequences of the proposed sterilization and had voluntarily and
knowingly consented to be sterilized.
Second, before the sterilization could actually be performed,
the individual case would have to be presented anew to a court
with counsel provided -- and the court would be required to
determine for itself whether the patient was capable of understanding the nature and consequence of the sterilization and had
voluntarily and knowingly consented to be sterilized,
Under the proposed rules, no Federal funds can be used to
support sterilization of mental incompetents who the committee
or the court find cannot understand the nature and consequences
of a sterilization. The possibilities for abuse are simply too
great in this area for Federal funds to be used for sterilizations,
Institutionalized Persons
Institutionalized individuals would be accorded procedural
protections under the proposed rules because of the inherent
potential for coercion in mental hospitals, prisons and other
institutions. No federally funded sterilization of an institutionalized person could take place until both a sterilization review
committee (with the same composition as the coumittees proposed
for mentally incompetent persons) and a court, after full hearings,
with counsel, found that the patient understood the nature and consequences of sterilization and had knowingly and voluntarily consented to be sterilized.
-42-
Requirements for Hysterectomies
The proposed regulations prohibit the payment of Federal
funds for hysterectomies performed solely to sterilize, Other
methods of sterilization that are significantly less dangerous
are available to women. The use of hysterectomies as a family
planning technique is generally regarded as inappropriate by
the medical colllll1lnity. Nevertheless, the Department is seeking
comment from the medical profession whether it is ever appropriate to use hysterectomy for sterilization, If the comments
establish that such a procedure is warranted under exceptional
circumstances, the proposed regulations will be modified
accordingly with appropriate safeguards,
The proposed regulations also require that women about to
have hysterectoc:ies be informed that the surgery will permanently
end their capacity to have children,
State and local Laws
The proposed rules set out minimum requirements that must
be met for Federally funded sterilizations. More stringent
procedures, if required by State or local law, would have to be
followed to obtain Federal funding for all sterilizations. However, the proposed regulation specifically states that Federal
funding does not require that a spouse consent to sterilization,
even if required by State law. Such a requirement appears almost
certainly to be unconstitutional in light of the recent Supreme
Court decision in Planned Parerit:hood v. Danforth, 428, U.S. 52 (1976).
Enforcement
The new sterilization regulations must be readily enforceable. The proposed regulations, therefore, require that the
consent form - - signed by the patient, the doctor and any other
person obtaining consent -- must be filed with the State agency
or private family planning agency which is paying for the sterilization before that agency makes payment,
The system will also permit HEW's Inspector General, through
periodic audits of the consent documents and payment records, to
monitor compliance with the regulation,
Public Co11UI1ent
This is an extremely delicate and complex area, In these
proposed rules we have tried to strike the appropriate balance
for Federal funding, I hope there will be wide response, during
the next 90 days, to our invitation to comment on the proposed
regulations.
Comments should be submitted to Marilyn Martin, Public Health
Service, Room 722-H, Humphrey Building, 200 Independence Avenue,
s.w., Washington, D,C. 20201 or Emily Nichols, Health Care Financing Administration, Room 4513 Switzer Building, 330 C Street, s.w.,
Washington, D.C. 20201.
-43-
FOOTNOTES
In addition, the General Counsel of the Department with the
Public Health Service and the Health Care Financing Administration,
will hold a public hearing on the proposed rules in Washington on
January 17, 1978, in the auditorium of the HEW North Building. To
provide an opportunity to testify to individuals and organizations
concerned with sterilization but who are not able to attend a
hearing in Washington, the Department will also hold hearings in
its 10 regional headquarters cities (Boston, New York, Philadelphia,
Atlanta, Chicago, Dallas, Kansas City, Denver, San Francisco and
Seattle).
Those interested in testifying or submitting written testimony
for the Washington hearing should send their request to the addresses
listed above. Requests for participation in the regional hearings
should be sent to the Principal Regional Official in each region.
Following the issuance of the final rules, the Department
will undertake a major educational campaign to inform hospitals,
clinics, and doctors performing sterilizations, as well as
prospective patients and the general public of the requirements
of the new regulations.
I. WHAT IS STERILIZATION?
1. HEW Guidelines, Washington D.C., 1974.
2. Westoff, Charles F. and Jones, Elise F. Contraception and
s terilization in the United States : 1965-1975. Family Planning
Perspectives. 9 (4), July/August, 1977, pp. 153-157.
3. Porter, C.W. and Hulka, Jaroslav F. Female sterilization in
current clinical practice. Family Planning Perspectives. 6,
Winter, 1974, p.30.
4. Study on Surgical Sterilization.
ington, D.C., 1973.
Health Research Group, Wash-
5. Guardian, July 1977.
6. Presser, H.B. Voluntary sterilization: a world view.
on Population/Family Planning. 5, 1970, p.l.
~orts
7. Westoff, C.A . and Westoff, C.F. From now to zero. Fertility,
Contraception, and Abortion in America. Boston: Little Brown, 1971.
8. Porter and Hulka,...££_ cit.
9. Lu and Chun. A long term follow-up study of 1,055 cases of postpartum tubal ligation. Obstetrics British Commonwealth, 74, p.875.
10. Raisle r , Joan. The Politics of Contraceptive Sterilization.
Unpublished Dissertation, The New School, 1976.
11. Lader, L. Full Proof Birth Control.
Boston: Beacon Press, 1972.
12. Population Reports, 1976.
13. Fawcett, Donald W.
October 1977, p.8.
Progress in male contraception.
14. HEW Guidelines, WashingtDn, D.C., 1974.
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-45-
Comment 10,
II.
WHO USES STERILIZATION TO PREVENT CONCEPTION?
III. WHAT IS STERILIZATION ABUSE?
1. Westoff, Charles F. and Jones, Elise F. Contraception and
sterilization in the United States: 1965-1975. Family Planning
Perspectives, 9 (4), July/August, 1977, pp.153-157.
1. Eliot, J.W., et al., The obstetrician's view. In Abortion in a
Changing World. Edited by Robert Hall. New York: Columbia University Press, 1970, 2 vols.
2. The New York Times, July 22, 1977.
2. Family Planning Perspectives, 9 (3), May 1977.
3. Presser, Harriet B. and Bumpass, Larry L. Demographic and
social aspects of contraceptive sterilization in the United States:
1964-1970. In The Commission on Population Growth and the Future;
Demographic and Social Aspects of Population Growth. Edited by
Charles F. Westoff and Robert Parke, Jr. Volume One of Commission
Reports, Washington, D.C., Government Printing Office, 1972,
pp.505-568.
3. Ayres, B. Drummond Jr., Sterilizing the poor.
July 8, 1973.
4. The New York Times, May 5, 1976.
5. Presser and Bumpass, op cit.
6. Presser and Bumpass, Q£ cit.
7. Law, Sylvia. Sterilization comes easier for the disadvantaged.
NYU Law Journal, 1976.
8. Presser and Bumpass, Q£ cit.
9. Presser and Bumpass, Q£ cit.
10. Lewit, Sarah. Sterilization associated with induced abortion:
JPSA Findings. Family Planning Perspectives, 5 (3), Summer, 1973,
pp. 177-182.
11. Vaughan, Denton, and Sparer, Gerald. Ethnic group and welfare
status of women sterilized in federally funded family planning
programs, 1972. Family Planning Perspectives, 6 (4), Fall 1974,
pp. 224-229.
The Nation,
4. Relf vs. Weinberger et al: Civil Actions nos. 73-1557, 74-243,
U.S. District Court for the District of Columbia, March 15, 1974.
5. There have been many newspaper and magazine articles on this,
including most of the references cited here. Joseph Califano, Jr.,
the Secretary of HEW, alludes to these revelations in his statement
of December 1, 1977 on the new proposals for HEW guidelines. He
requested the revision "shortly after I received a General Accounting
Office r eport in June of this year on sterilizations performed by
the Indian Heal th Service." And he says further, "my interest in
revising our regulations has been reinforced by the deep concerns
expressed by several members of Congress and by many public interest
organizations about the adequacy of the Department's current regulation." HEW Ne·:- rs, December 1, 1977, pp2-3. Most of the articles since
the last round of investigations and Senate hearings prompted by the
Relf case in 1973 have been stimulated by the action of several community, health and women's groups. On some of these, and on the
issue in general, see Helen Rodriguez-Trias, M.D., The Reid Lectureship, 1977. New York: Barnard College, 1978.
6. Rogers, Joann. Rush to surgery.
September 21, 1975, p.40.
The New York Times Magazine,
7. Caress, Barbara. Sterilization. Health Pac Bulletin, Jan/Feb,
1975; Law, Sylvia . Sterilization comes easier for the disadvantaged .
NYU Law Journal, 1976; Harrington, Stephanie. Women as lab rats.
The Village Voice, April 18, 1977; Kelly, Joan. Sterilization and
civil rights. Rights, Sept/Oct 1977; Lopate, Carol. AbortionSterilization; the new package deal. Against the Grain, November,
1977. See also references cited below, and for an extensive treatment of race and class issues in connection with sterilization abuse,
see Chase, Allen. The Legacy of Malthus. New York: Alfred Knopf,
1977.
8. The New York Times,
December 9, 1977.
9. Ibid for Rosalind Johnson and other pending cases.
10. Medical Tribune,
September 14, 1977.
11. General Accounting Office Report
-46-
-47-
#B-164031 (5).
12. Harrington, The Village Voice, op cit.
IV. STERILIZATION IN PUERTO RICO: A CASE STUDY
13. Caress, Health - Pac,££ cit .
14. The New York Times, July 21, 1973.
1. Mass, Bonnie. Population Target: The Political Economy of
Population Control in Latin America. Brampton, Ontario, 1976, p. 104.
15. The New York Times, July 21, 1973. This article reveals, incidentally, that Dr. Pierce "earned" $60,000 in 1972 and the first six
months of 1973 just for treating Medicaid patients--to whom he refused
deliveries except on his own terms, requiring sterilization if the
women had two or more children.
2. North America Congress on Latin America. Latin America and
Empire Report. IX (1), New York, February 1975, p.8; cited by
EPICA Task Force, Puerto Rico: A People Challenging Colonialism.
Washington, D.C., 1976, p. 46.
16. Physician's attitudes: MD's assume poor women can't remember to
take the pill. Family Planning Digest, January 1972, p.3.
17. Med_ical Tribune, October 10, 1973 and November 21, 1973.
18. Testimony of Dr. Jody Carlson, HEW Hearings, Washington, D.C.,
January 17, 1978.
19. Spokeswoman, October 15, 1977.
20. Family Planning Perspectives, 9 (5), Sept/Oct, 1977.
21. Contemporary Obstetrics and Gynecology, 1, 1973, p.31.
3. Mass, Bonnie, QE_Cit, p. 105.
4. Mass, Bonnie, .Q.P cit, p. 92.
5. The New York Times, April 28, 1976 and Time, February 16, 1976;
cited by EPICA Task Force, p. 47.
6. Congreso Extraordinario del Partido Socialista Puertoriqueno,
La Alternativa Socialista. San Juan, Puerto Rico, 1974, pp.55;200.
7. University of Puerto Rico and Puerto Rico Department of Health.
Acute and Chronic Condition and Medical Care: Puerto Rico, October
1963-November 1964; cited by EPICA Task Force, p.63.
8. Jose L. Vasquez Calzad~.• et al. La Situacion Poblacionel en
Puerto Rico, Puerto Rico, 1968; cited by EPICA Task Force, p. 63.
9. Gov't Network Sterilizes Workers.
January 1975, p.4.
Puerto Rico Libre, 3 (1),
10. cited by EPICA Task Force, p.62.
11. Quay, Eugene. Justifiable abortion: medical and legal foundations. Georgetown Law Journal. Vol 29, Spring 1961, Appendix 1,
p.509; cited by Presser, Harriet B. Sterility and Fertility Decline
in Puerto Rico, Berkeley, 1973, p.80.
12. EPICA Task Force, p. 64.
13. Jose L. Vasquez Calzada. La sterilizacion feminina en Puerto
Rico. Revista de Ciencia Sociales, Vol. XVII (3), pp. 281-308.
14. Rodriguez-Trias, Helen, M.D.
1977.
Personal communication, November
15. Rodriguez-Trias, Helen, M.D.
ibid.
16. Back, K.W. et al. Population control in Puerto Rico. In
Law and Contemporary Problems, 25, 1960, p.572; cited by Presser,
p. 51.
17. Jose L. Vasquez Calzada, .£1? cit, p.292.
18. Jose L. Vasquez Calzada, .£1? cit, p. 294.
-48-
-49-
19. Jose L. Vasquez Calzada,~ cit, p. 302.
GENERAL BIBLIOGRAPHY
20. Jose L. Vasquez Calzada,~ cit, p. 305.
21. Presser, Harriet,~ cit, pp.50-51.
22. Presser, Harriet, 2.E. cit, p.49.
23. Stycos, J.M. Female sterilization in Puerto Rico.
Quarterly, I, June 1954, p.3.
fu:!.genics
24. San Juan Star, January 21, 1975; cited by EPICA Task Force,
p.64.
25 . Rodriguez-Trias, Helen, M.D. Personal communication, November
1977.
The following books and articles are readily available and provide a
set of basic readings on contraception, abortion, sterilization,
women and health, and population control. For more detailed articles
in medical journals, etc., see the footnotes for each of the sections
in the Workbook, Also, the following books contain further notes
and bibliographies.
Sterilization.
Caress, Barbara.
January/February, 1975.
Health Pac Bulletin, 62,
Sterilization Guidelines.
Caress, Barbara,
65, July/August, 1975.
Health Pac Bulletin,
Chase, Allen. The Legacy of Malthus; the Social Costs of the New
Scientific Racism. New York: Alfred A. Knopf, 1977.
Corea, Gena, The hidden malpractice. How American Medicine Treats
Women as Patients and Professionals. New York: William Morrow and
Company, 1977.
Gordon, Linda. Woman's Body, Woman's Right; A Social History of
Birth Control in America. New York: Grossman Publishers, 1976.
Littlewood, Thomas. The Politics of Population Control. Notre
Dame, Ind.: University of Notre Dame Press, 1977.
Mass, Bonnie. Population Target; The Political Economy of PopulA_tion Control in Lattn Amertca. Toronto: The Women's Press, 1977.
The Boston Women's Health Book Collective. Our Bodies, Ourselves.
New York: Simon and Schuster, 1976. Also available in French and
Spanish.
Rodriguez-Trias, M.D., Helen. Sterilization abuse. The Women's
Center Reid Lectureship. New York : Barnard College Women's Center,
1978, $1.00.
Seaman, Barbara, and Seaman, Gideon, M.D, Women and the Crisis
in Sex Hormones. New York: Rawson Associates, 1977.
-50-
-51-
NOTES
I
.
,t.
..
..
I
Some
.Questions
And
Answers
f
What Is Sterilization?
Surgical steiilization is a method of fertility control that
makes a woman or a man permanentl y unable to produce
children. In a woman, this operation involves cutting or
blocking the Fallopian tubes so that an egg cannot pass
through the tubes to become fertilized; this is called tubal
ligation. In a man, the procedure involves blocking off the
vas deferens (a duct where sperm are transported and
stored) to prevent sperm from being released; this is called
vasectomy.
While these techniques have been known for many
decades, it is only since 1970 that doctors in the U.S. have
decided to make the m widely available. The availability of
th ese procedures may increase people's birth control
options. It may give them the choice of ending their childbearing or not having any children-w ithout ever worrying
about the health risks or hassles of birth control again. But,
sterilization can also be a means of abusing some people's
reproductiv e rights. We do not oppose sterilization. As
feminists who support women's light to determine their
own sexual and reproductiv e lives, we believe that any
woman or man has the right to choose sterilization. But we
do oppose sterilization which is involuntary, coerced,
chosen under conditions of stress, or subject to manipulation by doctors, family planners, public authorities or
employers.
CAR.ASA
Who Gets Sterilized And By Whom?
1982
Committee for Abortion Rights and Against Sterllizatton Abuse
17 Murray St., 5th Floor, New York, NY 10007, (212) 964-1350
CA RASA is ,111 activist wom e n ·s or!-(anization fightin g for re product ive freed om.
\ Ve be li eve that wornen , regardless of age, race or class , must control for th e mselves whe th e ,; and und e r what conditions, to have childre n. Thi s requ ires
legal, safe & accessible abortion , sex inforrnatio11 , birth control , and a rtificial
insemi nation; an e nd to ste rili zation alrnse; th <:> freedom to live ope nl v as a
lesbian ; access to qua lity child care and health care; safe jobs; and adequate
i11 come.
x-1 0 1g
Thi s printing parti ally supported by Reproductive Rights National Network
Des ign : RaAAcd Ed!-(e Press
Cove r illu stration : LNS \ Vornen·s G raphics
, I
Whether sterilization broadens or restiicts reproductiv e
choice depends on who is doing the sterilizing, on whom
and for what purpose. In the U.S., we have a long and
shameful history of the forced steiilization of poor immigrants, Blacks and persons in institutions. These programs
were carried out in the name of "eugenics," a strategy of
"selective breeding" promoted by the upper-class to preserve white "racial purity" and to "cure" crime, insanity and
other social ills. Given this history, there is good reason for
Blacks, Native Americans and Latin and Caribbean
migrants today to be suspicious of sterilization programs
3
aimed at them-particul arly in a period of high unemployment and economic recession.
Recent disclosures about the dangers of the birth control
pill and the fact that some drug companies and researcher~
in the 1960s and 1970s minimized those dangers, have
made women wary when we are told a method is "perfectly
safe" and "worry-free." We are right to question whether
people have been fully informed of all the risks and disadvantages of sterilization; and, most of all, whether their
decisions are in every case truly voluntary.
What Do We Mean By "Voluntary"?
"Voluntary" means more than just not having a gun
pointed at your head. It means: you decide to become
sterilized, after being given full information about all the
possible consequences, risks and alternatives;
• you decide without any pressure from doctors,
spouses, parents, social workers, employers or
others;
• ideally, you are not forced into this decision by financial problems such as the threat oflosing a job, lack of
housing or of child care;
• and safe and effective non-permanen t methods of
birth control are also available to you. If sterilization
is your only choice, it's not really a choice.
By 1976, surgical sterilization had become the most frequent method of contraception for married couples and
had surpassed all other methods ·but the pill among
widowed, divorced and separated women. Almost 1/3 (30
percent) of all married couples and widowed, divorced and
separated women in the U.S. have been sterilized through
some surgical means. Family planners talk about this
trend, and advertise sterilization as though they were selling another consumer good, like stereo sets and cars. But
female sterilization is a serious operation that permanently
ends women's ability to have children and, like any othe r
surgery, poses health risks. Stressing the sudden "popularity" of sterilization often minimizes the risks involved both to a woman's health and to her reproductive freedom.
Whether you are a provider of reproductive health services (nurse, counselor, doctor, midwife) or a woman who is
thinking about your future birth control plans, you should
consider the following:
4
Some Common Myths And Facts
About Female Sterilization
Myth: Sterilization operations can be reve rsed - you can have
your tubes "untied."
•
Fact: Many women believe that having th eir "tubes
ti ed" is something that can be undon e at a later tim e.
Doctors' failure to inform women about th e facts , and also
recent publicity about "reconnecting" the Fallopian tubes,
help to promote this myth. At present, sterili zation for both
men and women is definitely a permanent method of birth
control. The rate of successful "reversals" is very low; and
even when th ey work , women run a 10 tim es high er than
normal risk of tubal pregnan cy - which can be fatal.
(Besides, th ese expe rim ental "reversal" procedures are difficult and very expe nsive.) When a sterilization is performed without a pe rson clearly und erstanding that it is
irreve rsibl e, that is sterilization abuse.
Myth: F emale sterilization today is an easy, risk-free procedure - "band-aid" surgery.
Fact: Calling sterili zation "band-aid" surgery is misleading because it implies that th e procedure is totally safe.
In reality, all me thods of female sterili zation, whether or
not they require hospitalization , are a form of major surge ry and in volve certain physical and psychological risks to
health - such as infection, menstrual discomfort, and feelings of loss or regret. In addition , all such procedures especially the "Japaroscopic" (an outpatient) type -require
unusual skill and precision by an expe ri enced surgeon .
One of th e most dan gerous procedures is done by electrocoagulation (electric current is used to burn and close _th e
fallopian tubes), which can cause burns to th e abdommal
wall and th e bowel. Several women in the U.S. have died
from such "mishaps" in the last few years. The overall risk
of death from tubal sterilizations is higher than for any
other accepted form of contraception - and around 25
times high e r than the death risk for vasectomy (considered
a very minor outpatient procedure). Yet in 1975, 2 tim es
more sterili zations (including hysterectomies ) were pe rformed on women than on me n.
5
Myth: Because sterilization is perman ent, people ge t ste rilized
onl y if th ey do not want more children.
Fact: In recent years, numerous instances of ste rilization ahuse - that is, involuntary sterilization - have
reach ed the courts and th e media. For example:
• Alabama, 1973: two black teenage girls were sterilized in a gove rnm ent-operated family planning
clinic without th e knowledge or consent of th e girls
or th eir parents. The judge in this case found that "an
estimated 100,000 to 150,000 low- income persons"
have been sterilized annuall y in governm ent funded
programs.
• Los An geles, Ca., 1977: te n Mexican -Am e rican
women los t th eir lawsuit against the co unty hospital
and doctors for ste rilizing the m without th eir knowledge or conse nt .
• Willow Island, Wes t Virginia, 1979: fi ve youn g
women chemical workers were told by employers to
get ste rilized or lose their well-paid jobs which were
hazardous to their reproductive health and future
offsprin g, w hile men were not warn e d of th e
danger.
In all th ese cases, the women's own desires about having
more children didn 't count. Many of the m looked f01ward
to future children; all of them wanted the choice.
Myth: If you're going to ge t ste rili zed , you might as well have
a hys terectomy.
Fact: H yste rectomy is th e surgical re moval of th e ute rus
and sometim es th e ovaries and tubes, and thus an automatic form of sterili zati on. It carries a risk of death that is
15-20 times greate r than that associated with tubal sterilization. Most doctors, family plann e rs and govern ment
health officials agree that hysterectomy fo r contracepti ve
purposes is ove rkill. Yet, in 1978 U.S. Congressional hearings on unnecessary surgery revealed a "staggerin g" rate of
hysterectomies pe rforme d on American women-many of
the m fo r sterilization alone and many considered medicall y
unnecessary. In such cases, wo men are told that this d rastic measure will prevent future gynecological probl ems or
cancer, plus eliminate "messy" periods and the need fo r
b irth control. For women who have no_sign of uterine
6
disease, such "advice" exploits their fear of cancer and their
worries about birth control to promote a cos tl y, dangerous
form of surgery. This is ste rilization abuse at its worst .
(NOTE-Hys terectom y in some cases is a necessary and
life-saving treatm e nt. If a doctor recommends it, the
woman should seek a second opinion.)
Myth: Today, those who ge t sterilized are mainl y "swinging''
heterosexual co upl es and singles of the middle class.
Fact: As of 1976, sterilization rates were actually higher
among low-income wom en and wo me n with little educa7
tion than they were among middle-in come and college
educated women. A recent governme nt study shows that
women on Medicaid are sterilized at 3 to 4 times th e rate of
women who are not on Medicaid . Moreover, poor and
minority women are sterilized at younger ages, on the
whole, than white middle-class women. And, among poor
and minority couples, it is nearly always the woman who
gets ste1ilized, not the man. (Vasectomy is mainly perform ed on white middle-cl ass men.) As the cases we
mentione d earlier suggest, poor Black, Latin and Native
American women are more likely than middle-class white
women to be th e victims of involunta ry sterilization. On
th e other hand , some doctors refuse to sterilize white middl e-class women with no children who request th e operation, because of either prejudice s about the "natural destiny" of th ese women to be. mothers or fears of a lawsuit.
Not everyon e who gets sterilized has had all the children
she wants, nor does every woman want to have children.
Sterilization and its abuses are experienc ed differently by
different groups of women.
Myth: Sterili zation will improve your sexual re lationship(s).
Fact: Popular magazine articl es, subway ads and other
media messages convey the false idea that sterilization will
bring you "sexual freedom ." Counselin g and clinical studies show that some women get sterilized because th ey
believe th at sterilization will help their sex lives or improve
their marital relationships by relieving them of the worry
about pregnancy. Freq uently, howeve1~ wom en who are
sterilized for this reason regret their decision later and
enjoy sex less; marriages ofte n fail anyway after the sterilization, and a remarriage suffers from the woman's desire to
have more children when she no longer can. Relief from
anxieties about pregnanc y may temporari ly improve sexual e njoyme nt, but sterilizati on is not a cure-all for
unhappy sexual relationships.
Myth: Deciding to ge t sterilized is a personal, private choice.
people's individua l choices 'about having children or not. In
1970, the medical profession shifted its policy on sterilization; after a long practice of denying sterilizati ons to
women who were not a certain age or did not have the
"right" number of children, doctors endorsed and promoted surgical sterilization as a routine method of fertility
control. Doctors have a lot of prestige in our society and
greatly influence patients' decisions. Besides, commerci al
health insurance plans cover sterilization at higher rates
than contracep tion or abortion ; and medicaid pays 90 percent of cost for sterilization and family planning, yet pays
nothing for almost all abortions. Whether people have
secure jobs, child care, health care, and adequate housing
also affects whether sterilization is a choice or a necessity.
Finally, the right-wing political attack on abortion and family planning programs may soon leave sterilizatio n as the
only governme nt-funded birth control "choice." The state
of Illinois recorded a dramatic increase in Medicaid sterilizations after abortion funding was restricted .
Myth: Sterilization is th e answer to "over-population. "
Fact: Until recently, sterilization and family planning
were touted as the answer to reducing populatio n growth
in developin g countries, and therefore to ending the proble ms of hunger and poverty. With funding from the U.S.
Agency for International Developm ent (AID), large-scale
family planning programs , some of which emphasiz ed
sterilizati on, were instituted among poor populatio ns
throughou t Asia, Africa and Latin America, as well as in
Appalachia and other poor sections of the U.S. In Puerto
Rico this policy was conducted for 30 years and resulted in
th e sterilization of 35 pe rcent of women of childbear ing
age. These programs alone, however, did not suceed either
in re ducing populatio n growth or in alleviating poverty.
Today, "vi1tually all the authoritie s on world hunger agree
that the problem is du e not to over-population or a lack of
food availability ... The cause of hunge1~ it is agreed, is
pove rty and poor income distributi on in most of th e
affected areas. " (New York Ti1nes, 8/17/81)
Fact: In reality, a complex system of medical practices,
governm ent policies and economic condition s de te rmines
8
9
Summary
In sum, the facts are: - - - - - - - - - ,
Sterilization is not reversible
not always voluntary
not risk-free
not a solution for sexual problems
not just a "private choice"
not a cure for "ove rpopulation."
Women have been the traditional clientele of reproductive medicine, just as they have been considered the ones
required to take the main responsibility for birth control.
Doctors, family planners, medical researchers and drug
companies-who have the most influence over which contraceptive methods are available to which women - ofte n
emphasize_the effectiveness of a method without regard for
women's health. They assume that women want a birth
control method that is "fool-proof' no matte r what the
risks. In fact, most women are concerned about our own
health and well-being and re sent being exposed to risks
and discomforts wh e n we have n 't bee n adequate ly
informed about them or whe n safer alternatives are available. And we want to decide for ourselves what risks we are
willing to take. But until recently, wom en as a group have
had little power over the kinds of contraception that have
been developed and marketed .
Current Sterilization Regulations
In the 1970s, this began to change, as fe lllinist health
groups publicized health and consent issues related to th e
pill, injectible chemical contraceptives, and sterilization.
One important atte mpt to win more power over reproduction for women has been the fight to establish regulations
against involuntary sterilization. In the 1970s, women's
groups, health workers and community organizations
fought strenuously to enact laws to pr0tect women from
th e most blatant forms of abuse which were primarily victimizing poor and minority women. In 1977, New York City
enacted a sterilization law, and shortly afte rward the fe deral government adopted similar regulations to govern all
federall y funded sterilizations. Government regulations
10
cannot protect women from the economic and social conditions which may force them to "choose" sterilization. But
they can make health institutions and professionals more
careful and create a standard of care which places women's
health and freedom of choice at the top of birth control
priorities.
Some of th e most important provisions of th ese new
regulations are:
• consent cannot be given during childbirth, labor,
abortion, or while under th e influe nce of drugs or
alcohol;
• patients cannot be threatened with loss of welfare
or Medicaid be nefits if th ey refus e to consent to
sterilization;
• patie nts must be fully informed in their own language about the irreversibility and the risks, benefits
and alternatives to sterili zation;
• th ere is a 30-day waiting period between consent
and th e operation (to give one tim e to trunk over this
major decision);
• no one under 21 can be sterilized.
There is widespread evide nce that many doctors and
hospitals do not follow these regulations. The only e nforcement power the federal government has is to withhold
payment when the regulations are violated; similarly, th e
N. Y ~-_law i_mposes on ly a fin e of $1000. Now, the Reagan
adrnm1stration has mounted a campaign against all the
form s of government regulation of businesses and institutions. Women, workers, consumers and environmentalists
have fo~ ght for these regulations to protect people's health
and safety. The sterili zation regulation s, which must be
reviewed in 1982, could be weakened or even eliminated.
In any case, this administration cannot be exp ected to lift
a finge r to enforce th e m. It is up to us as consumers to
insure that regulations are both maintained and e nforced.
And because th e regulation s do not protect everyon e, it is
up to us as women to know our rights and protect ourselves. Only then will ~very woman be able to make a truly
volu_nta1y and_ ':"ell informed decision about permanentl y
endmg her ability to bear children.
11
Methods of Sterilization
WHAT YOU CAN DO:
Know your rights.
Pass this pamplet along to a friend or co-worker.
Write to your representatives in Congress.
Find out what is going on in your local hospital or clinic
regarding sterilization and other reproductive health
services.
Call CARASA for more information or invite a speaker to
your church or neighborhood group, union, or home.
All the methods of female sterilization require blocking
the fallopian tubes to prevent sperm from reaching the
eggs, which are produced in the ovaries and normally
travel through the tubes where they can be fertilized, causing pregnancy. The different names for tubal sterilization
refer to the various surgical methods used to reach the
fallopian tubes. The tubes are then blocked by either cutting and tying (ligation), burning (cauterization, electrocoagulation), or blocking (clips or bands). Following is a
short description of the most commonly used methods of
surgical sterilization.
Laparotomy: An incision is made in the abdominal wall
through which the tubes are reached and either tied and
cut, clipped or burned. Considered major surgery, this
procedure requires general anesthesia, several days' hospitalization and a five-six week recovery period.
FEMA LE REPRODUCT IVE
ORGANS
Mini-laparotomy: A smaller (mini) incision is made in
the lowe r abdomen. A second in strum ent, in serted
through the vagina, into the uterus, allows the uterus to be
turned to easily expose each tube. This procedure is commonly done on an oupatient basis, takes about 30 minutes
and allows women to resume normal activities within a few
hours. It is suitable only for women who are less than 20%
above their ideal weight and who have a normal and freely
mobile uterus and tubes. It is routinely done with local
anesthetic.
(S IDE VIEW)
vagina r---i~--\-l+---41■
rect um - i - - -\ ------,"rl--•
bladde r
uri nary
opening
Laparoscopy: The abdomen is inflated with carbon dioxide gas which lifts the intestines away from the uterus and
tubes. Then a laparoscope or special lighted telescope is
inserted through a small incision which allows the doctor to
see the tubes and through which s/he can insert the operating instrument, or it can be inserted through a second
small incision. As the procedure takes about 30 minutes, it
is freque ntly used on an outpatient basis.
13
12
Culpotomy: An incision is made in the upper portion of
the vagina for access to the tubes.
Culposcopy: Similar to laparosc opy, this procedu re
involves an incision through the vagina for insertion of the
laparosc ope.
Hysteroscopy: (experim ental) The laparosc ope is passed
through the vagina and ente rs the uterus through the cervix. Once in the uterus, a probe is passed through the
laparoscope to burn or plug the tubes.
Hysterec tomy: This procedu re always results in sterilization but should never be perfonn ed strictly for sterilization purposes. It involves th e removal of the e ntire uterus
and is the refore a much more complica ted and dangero us
operatio n than tubal sterilization procedu res.
Methods of closing the tubes:
Ligation: tying and cutting the tubes.
Clip: Each tube is clipped with a small surgical clip
which provides a barrier to sperm. Eventua lly scar tissue
develops at the point where the clip pinches the tube.
Band: The tube is looped and a ring, like a rubber band,
is applied at the base of the loop, cutting off the blood
supply to the looped section and allowing scar tissue to
develop to block the tubes.
Male Sterilization: The male sterilization procedu re is
called vasectomy. The operatio n prevents sperm from getting into th e semen during sexual intercourse. While the
man will still ejaculate fluid , it will not contain sperm. It
requires local anesthes ia. Incisions of about one-half inch
are made on eith er side of th e scrotum. The vas deferens ,
the tube that carries the sperm from the testes to the penis,
is reached through the incisions and a small section is cut
out. The remainin g sections are cut ·and/or tied. The cuts
are the n closed with stitches that are self-dissolving. The
operatio n takes about 30 minutes.
LIGATIO N OF FALLOP IAN TUBE
Sperm cannot reach egg.
Egg (ovum)
MALE REPRODUCTIVE ORGANS
urinary bladder
vas deferens
(seminal duct)
I
seminal
ve~icle
TRADITIONAL TUBAL LIGATION . Ends of tubes are
actually folded back into surroundi ng tissue . Tubes
cauterized (burned) during laparosco pic sterilizati on
look different from those in this drawing.
corpus
cavornosu m
epididym is
prepuce
(foreskin)
Cauterization: An electric current creates a spark which
either divides or coagulates the tube. In coagulation the
spark dies out and chars the cells of the tube, blocking
them.
scrotum
t ----
~pen is
I
urethra
14
15
$1.00
CARASA
Committee for Abortion Rights and Against SterillzaHon Abuse
17 Murray St., 5th Floor, New York, NY 10007, (212) 964-1350
.
1
.
OSID\.ap~Rls d~is10n
iit sterilization:·cases~'~'
"
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The Occup ational Safety~ i Qnd•
, _ • MORGANTOWN , W.Va. - Federa \ ) Health ~dministratio
n (OSHA,) 'con• ' s~fety officials are a_ppealing ~ deci- : tends tha~~ the stetiliz
sion"in 'faVor of American ,Cyanamid , prompted by ~ri illegal ations' were
c6tttpi!ny poli1 Co. in a· case. il\volvlng five female
cy that precluded .fertile \\)Omen
e'mployees who said they were forced from workl~g ~fth lead,
to· have themselves sterilized In or- . cause genetiG ·~ change whl~h ca1f ,
s•iin male "or
der to keep .t heir jobs: •
•
female reproductive .cells; the· worn,
•1
en Were .forced to-taJjobs, they said 1 or ha_ve themselves
sterilized. ' . .,
• '. ., . ,
.uaoc1o1ec1Prm • •·.
/
.
...
,
•
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I
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"
1
1' f
••
f
' Administrative·Lav,, Judge William
1 E. •·Brennan last month !vacated
1OSHA's citation against the compa
ny
• on / technical grounds without ad., dres~ing the question of wh,1:ther: the
Cyanamid policy led to the sterilizations.
,
, :·
"' .
.I
Brennan questioned OSHA's juris• diction in ·the case, and said that by
the time OSHA inspectors cited the •
company, a six-month statute of,lilJ!.i• .
tations had expired. He said the 'cita-..
tion was issued more than six
months after the last sterilization::.,
---. took place.
•
OSHA, however, maintains that -its
d ta ti oil _was actually against ' the
. company policy leading to the sterilizations and that,,th e policy was still '
in effect. .
,
••
, ..
The decision, is~ued July .1S, already has been contested by OSHA
and sent to the agency's te:vlew
commission, which could-,- overru le
the administrative 1aw judge. • / ~
The casefovolves !l tonipany policy ·
that precluded women of child-bear• ing capacity from working in the
lead pigmen~s department of Cyana- 1
mid's Willow lsland plant near- St •
Marys; the, employees in that depart, ,
ment are paid more than¥workers, in
other areas. ' :
~
' -•
, 'I
\
Company officials ;mnounced -~iii '
-Janua ry 1~78 tharth e fertility policy__ ,
would take effect in October of thii~ 1
year: Between Febr:_uary and July,
, five women employees of the depart'., ment un~e.rwent st~til;jzation·.
. t-....
~~
~
~
•
:-·
'\
They said later that they felt the ·.
. st~p· was necessary to keep the company-from :t ransfer ring them to lower-paying 'jobs.. Union ,. officials ~occused the com~any _o_fcoerc\9n. ·,,,
.
•
• I.
. . ....
Affor the policy'.- took ··effect ;',.tw.o '
womeri who had qeclineq to unde-r~o
sterilization were • transfe rred to
other departments. , '
•
I
.
. ..
• ·The OSHA citation sairl the policy
showed that _Cyananiid had· fai)cd to
provide a plac~ of employment "free
from recognized _h~z~rds that_were •
causing or were Hkely to cause death
or serious physical harm to employees."
...
··:
·• ! \ 'T
.tJ~.
.,
1.
)
Tll~ citation was accompanied by a
Sl0,000 fine. •
_
.
~
Sept-Oe
~~
-----.
...... -. . . ...... .,..,..,
~
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S.KOREA REACHES FOR FREEDOM
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BANGLADESH:
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scandal
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I
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A massive tidal wave has
wa shed away years of work by
Bangladesh's people to claim and
cultivate land in the Delta region.
A survivor was on board
the survey vessel 'Anwesha' when
the cyclone hit ... 'At the island of
Char Pir Baksh there was nothing
left- it was just one mud flat and
an a wfullot of bodies'.
Millions of survivors face
hardship. we are sending
emergency funds through our
project partners for food, water,
clothing and shelter, and we will
continue to assist the
construction of killas - earthen
mounds-to protect people
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'
•1 .. .~
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Up to 40,000 peopl
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luU,(~
Claire Whittemore
BIAG Coordinator
---------------- ------------------------------
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THE CA11PAl6N
foQd s,c~ •IQd steel Itzatton - poou1atton Control ,lo Baogladesb breakS new ground tn
exam1n1ilg the coritroverstal nabre or 1ntemattona1 1nterventton 1n populatton
~ e s Within deVeloplng COtl\trt~.
Thts book has already played a c.ructaf part tn Influencing the negottattons ·of potential
donor COtlltrles to the World Bank's $270 mtlUon .populitlOI) proJect:_tri,;Bangladesh.
~
t
4
Final deelstons have yet to be taken. The .Issues ~lsed •1n.tt)e . , •• M'~larly the
questton or tncenttve payments., are very_much alive 80d still.need tfbe-~11~.
. Is ·co-author with James Boyce or "A outet Vtolenct! V.tew ... rrom a
,Village'., LondOn., Zed -Press, 1983. She ts w-rently ComJ)letlngabOOk on
~
POPUl• ,-i control, entitled 'The R~t to Ltve: Poverty, Power anci Pooulatlo1fControt·
Betsy ~
rorthci1ffl1ng·rrom the Institute ror Food and Develc,pment Polley., san Francisco.
►
Hllarr Standing lecbns at the School of African and Asian Studies, untverstty of
~x. She has worked extensively In South ~la, ~1cu1ar,y on women's Issues. She
~•·!Pember of the British Bangladesh SOltdarlty Committee.
.
idms ·
~
•
•
1,
'·/\~'' ••.
'--
'
'
To.date., Food, Saris and Sterl11zatlon has been reviewed by the following :
The6Ulrdlan
New ~tenttst
Mornl
ly
Lat>our.....
Catholtc:1ifera1d
Gemini • s service
People MagaZtne
12th september
19th september
22nd OCtober
27th September
20th 5eptember
5ePtember
JanUary
1985
1985 CArtlcle attached>
1985
1985
1985
1985
1986 (Coming)
Radio Interviews were broadcast on the BBC programme 'The World Tonight" and on the
BBC World Service and on Irish Radio.
EOOQ, SARIS lff) STERILIZATION - PQP\J.-ATION CONTROL IN BANGLADESH
T,... DlltrlldlM ardrS sllauldM llftl .-.Cl to:
ThlrdWarld MlicaUonl,
151 Stratford Rold, 8lrmlnpm 811 111>, tillted Kingdom. Ttlephanl (021) 773 6572
lndividull' Ordlrs lhould be llnl to: BIA&, PO BOX 94.
ISBN
O 948633 00 X
landDn NS lllf, twted Kingdom.
_,_[__
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,,~,-
l tance for the population programme".
Bangladeshis coerced into sterilisation
Starving women in Bangladesh have been offered food aid in return for being sterilised. Last
week European governments condemned plans to step up a programme of sterilisation there.
Gail Vines
T
HE WORLD BANK is being forced
to rethink its latest plans for population control in Bangladesh.
European 11overnmental aid agencies,
including Bntain's Overseas Development
Adminstration (ODA), opposed its
programme of sterilisations with financial
1nccntives and disincentives at a meeting in
Paris last week. Britain and like-minded
governments will decide this week whether
to support the World Bank's project, Population Ill, which would channel $270
million into Bangladesh. "We want reassurances built into the scheme that will
minimise the potential for abuse." says
Miles Wickstcad of the ODA.
Last year, women from four districts of
Bangladesh were refused food aid unless
they agreed to be sterilised. Field workers
from British voluntary agencies interviewed women who were given wheat
provided by the UN World Food
~mme only when they agreed to be
stenlised. This happened during food shortages that followed heavy 0ooding late last
year. These most blatant instances of abuse
arose in the final stages of the Second Population and Family Health Project for
Bangladesh ( 1980-85), which is also funded
largely by the World Bank.
" Women were uked to make a choice
between sterilisation and starvation," says
Naila Kabeer, a Bangladeshi researcher at
the University of Sussex. Details are now
published in a report• by Betsy Hartmann
and Hilary Standing of the Bangladesh
International Action Group (BIAG), an
organisation of some 600 people who have
worked or travelled extensively in
Bangladesh. The ODA accepts that these
"'cases of abuse" arc true,
Food aid may no lon(!:Cr act as
an .. inducement
for stenl isation in
Bangladesh. Afler pressure from the World
Bank, and from the United States Agency
for International Development (USAID),
which contributed $30 million last year to
family planning in Bangladesh. the government of Banifladesh issued a circular to its
famil y planning workers instructing them
to stop this practice. The government has
now also withdrawn the Anny's help in
enlisting clients for sterilisation. In June
1983, the Bangladesh Anny forcibly rounded up some 500 women with more than
three children in the Mymensingh region
and took them in trucks to local sterilisation clinics, says BIAG .
Despite such reforms, many people
argue that the present system of financial
incentives and disincentives inevitably
introduces an clement of coercion in a
country where both poverty and corruption
arc widespread. The system involves
payments to clients for sterilisation, family
planning workers and members of the
public who motivate clients, combined
with sanctions against health workers who
fail to meet sterilisation targets.
"Far from being isolated instances of
local officialdom, the abuses arc the logical
and inevitable outcome of the policy implemented under the auspices of the World
Bank," says Hilary Standing, who lectures
in the School of Affican and Asian Studies
at the University of Sussex.
The ODA and other European aid agencies have objected to the World Bank's next
fi ve-year project for Bangladesh ( 1985-90),
largely because the financial incentive
scheme was to remain intact. "The ODA
would like to see steps taken to ensure that
the system of incentives and disincentives
is substantially changed with a view to
scrapping it in due course," says Wickstcad.
Britain, West Germany, the Netherlands
and Norway demanded last week that
the World Bank immediately abolish
disinceotivco--unctions against health
workers who do not meet sterilisation
targets. They also sought assurances that
the incentive scheme itself will eventually
be dismantled. The governments asked for
stricter monitoring of the scheme by
regional teams and annual surveys by independent assessors.
Sweden has already withdrawn its pledge
of support to the World Bank's latest
scheme. The Swedish International Development Authority concluded, in a paper
published earlier this year, that the combination of incentives and disincentives may
contravene the principle of "free and
informed choice as to contraceptive
method" endorsed in the UN World Population Plan or Action.
The ODA stresses that the World Bank's
scheme " has extremely positive aspects to
it ". Britain'scontributron of£8 million, for
instance, would fund groups to evaluate
development
schemes
and
nongovernmental agencies "who can work
most effectively at the grass roots level ".
Wickstead adds: "The contraceptive/
sterilisation is a very small part of the
World Bank's project. But we have to be
concerned to try to get it all ri,iht."
T he current finan cial incentive for sterilisation is part of a dri ve, begun in the early
1970s, to increase the "contraceptive prev-
alcnce rate" in Bangladesh. Then, only 5
per cent of couples or a child-bearing age
practised any form of contraception .
The 11overnmcnt of Bangladesh established its first five-year plan ( 1973-78).
That scheme attempted to integrate family
planning with health and economic development schemes. The second five-year
plan (1980-85) shifted away from a
"cafeteria" approach to family planning-i n which people are offered a wide
range of contraceptive methods-to an
emphisis on clinical methods: intra-uterine
devices (IUDs) and sterilisation, particu-
steri lised, says USAID, is intended as
"surgical ~nncnts". " We would be irresponsible 1f we did not provide that assistance." says David Oot of USAID. In
response to reports from field workers from
voluntary agencies that the saris or lungis
arc usually distributed after the operation,
Oot comments: "We are not in a position
lo stand there and see that surgical apparel
is used in the way it is intended."
Fi nancial incentives or disi ncentives to
staff who motivate clients for sterilisations
seems more at odds with the concept of
"compensation". But USAID is convmced
that no clement of coercion has crept into
the programme. "Peol'lc working as helpers
may give more attcntJon to voluntary sterilisation," says Oot, "but no one would
submit against their will. I doubt that
anyone is scllillg their reproductive rights
on the basis of encouragement from someone else.• He points to the consent form
clients arc required to sign.
BIAG reports the result of an
investigation last rear by the Programme
for the Introduction and Adaptation of
Contraceptive Technology (PIACT), a
consulting finn based in Seattle, Washington. Its survey pinpoints ways that financial
incentives and d1since nti ves can lead to
widespread abuse. It found:
• No cooperation between health wokcrs.
Family plannin~ workc.rs and. village
midwives, in 1'3rt1cular, compete for clients
for sterilisation. disrupting supposedly
complementary services.
• A neglect of other kinds of contraception
that might be more acceptable. Choice and
lari~or,,:;;~ci~incentivc scheme for IUDs
and sterilisation led to a particularly
dramatic increase in the number of tubectomies (female sterilisation). There were
IOOO tubectomies in I973-74 and more
than 334 000 in 1983-84. The number of
vasectomies performed on men remains
considerably lower, although the number
of men sterilised has more than doubled
since 1983, when payments for va.sectomy
and tubectomy were equalised.
Today, some 22 per cent of people of
reproductive a,e in Bangladesh use some
form of contraception. Of these, 34 per
cent, or 1·6 million people, have been sterilised. The government aims to increase the
total to 3 · 5 million people, by 1990. The
goal is to reduce the annual rate of population growth, now estimated at 2· 7 per
cent, to I · 7 per cent by the year 2000.
The World Bank and USAJD defend
incentives by arguing that cash payments to
clients arc intended as "compensation" for
the cost of travel to clinics and time off
work. USAID is particularly adament in its
refusal to speak of incentives, even though
the government of Bangladesh and the
World Bank UIIC the tcnn. The 1982/83 US
Foreign Assistance Act prohibits the use of
US fund, " to pay for the performance of
involuntary sterilisation as a method of
family planning or to coerce or provide any
financial incentive to an y person to
undergo sterilisation ".
The clothing provided to people being
Financial incentives for sterilisationt
C
URRENTLY, payments to sterilisation clients consist of 175 Taka,
which is equivalent to about three weeks
average wages for men and six to scven
weeks for women, and a sari worth I00
Taka for women or a /llllgi worth 50 Taka
for men . Those who acocpt an IUD arc paid
25 Taki.
Family planning workm are paid l 5
Taki for every sterilisation or IUD cue
referred. Mcmben of the public receive 20
Taka if thcy. _" motivate" _another pellOn,
attendants) receive
45 Taka for the same
111rvicel.
Doctors
receive 20 Tab (or
each
lllerilisation
operatlan Derf'onned,
and clink:al Uliatanti
at operatio111 teceive
10-15 Tata.
This
comi,lex
ty1te111 of paymenu
bu heel! IIC00ffl·
puled by anctions
("dithdalha") to
pcnalile tllQdl:, p1an.
ni111 WOlbl'I who fail
,,~,-
CERTIFt1£
r, . I ro ,.,,Ill' '""' Mrl r--· w/ o .......... ,/11 ••••••• •••
.~:.: .......... dlo1 .......... "I ,,.,;,;,ed In rh• h... h
cen"' tod•Y th• 25 6.1141h• 11 g/,en no<"'"'
rri«dle iflflf, ,e,i et1d m
ltf give" thf ,,
vnd" go""",,,."' ,.,,.,.
Femitf p,,,,,,;ng Offic•'
198-'
to meet monthly
sterilisation targets.
These targets are set
on a nationwide
basis. Such workers
first receive warnings
in the form of letters
from supervison, followed by the withhoklina of salaries if
they continue to fall
below WF!, Plans
have uo been put
fonmd to reward
individual worlten
wltll cash llwudl few
"ouutanding
performance"
□
The effectiveness of a genuinely voluntary programme ofstc.rilisation may also be
in questjon . Sterilisation may well be a
boon to women who desire no more children . David Oot of USAID claims that
"most women sterilised have had between
four and five children and want no more".
Yet the World Bank's report of 1984 states
that "payments for sterilisation have litUe
impact on fertility if families ha ve already
had four or more children ".
Evidence that less drastic methods of
contraception have been inadrquatcly
promoted in Bangladesh comes from a
survey conducted under the auspices of the
Association for Voluntary S1crilisation
based in New York. More ths 900 women
sterilised in clinics run by the Bangladesh
Association for Voluntary Stcrifisation
were asked which contraceptives they had
ever used: 16·4 per cent had taken the pill.
2•7 per cent had worn an IUD and 7·6 per
cent use condoms .
In BIAG's view, the debate ultimately
rests on an analysis of the causes of poverty
suitabilty arc overridden by a conmct of and its solution. The World Bank, USAID
interest between workers and clients. and the United Nations Fund for PopuFamily planning workers, PIACT reports, lation Activities (UNFPA), which donated
spend half their time, and village midwives $4 million last year to family planning in
most of their time, recruiting IUD and ster- Bangladesh, see poverty as primarily
caused by overpopulation.
ilisation acceptors.
As Oot USAID comments, "It is unfair
• Lack of proper follow-up care and a
neglect of even basic mother and child to say we do not give enough to promote
health. About half of the sterilised women the health of mothers and children . The
interviewed by PIACT said that no one most important thing for maternal health is
visited them for post-operative care. Some to prevent births." In a similar vein, Francis
women interviewed had suffered perma- Pietersz of the giant International Planned
nent disability as a result of infections and Parenthood Federation, says: "You can't
other complications.
discredit the principle of incentives, with
• Payments to clients arc pocketed by such a massive population problem." The
middlemen. " Rake-offs arc extremely organisation gives Sl million a year to its
common in Bangladesh," said Miles Wick- affiliate in Bangladesh, which runs clinics
that perform sterilisations under the
stead of the ODA.
• Fiddling of books so that reliable government-funded scheme of incentives.
demographic data arc lacking.
He dismissed reports of abuse as "old
• A thriving traffic in clients. " Male agents st.ones based on two women".
BIAG see the rapidly growing population
scour villages to find suitable clients to sell
to family planning workers for a fee", says of Bangladesh as part of the broader probHilary Standing. "There arc stories of as lem of inequality. "The demographers",
many as six people being involved in cha.ins say Kabcer. " view the world with neoto recruit chents," say Wickstead.
Malthusian spectacles." The result is "a
• Coercion . "The agencies don't seem to total disregard of human rights."
understand what it is to be poor in a counIn 1984, Walter Holzhausen, UNFPA 's
try like Bangladesh." said a worker for a representative in Dhaka, questioned the
British voluntary agency.
concept of "voluntarism" in a letter,
Even the World Bank docs not seem reprinted in BIAG's report. to UNFPA's
entirely happy with its financial incentive headquarters in New York . " What is a
scheme. Its 1984 Development Report human right in one country may not be a
described schemes of "deferrcd incentives" right in another." he wrote.
that arc being considered, it says, by the
BIAG objects to "the panacea of family
government of Bangladesh. These schemes planning in a complex issue of underwould provide a bond to women aged 35 or development", Standing says. Fertility rates
less, or men aged 40 or less, with on ly 2 or have dropped in the West, the $T_OUP
3 li vi ng children. The bond would mature argues, since better economic conditions
afler 12 years to provide a basis for loans and a more equitable distribution of wealth
wort h half its value during that time.
reduced people's reliance on children as a
Listing the advantages or such a scheme, source of labour and support in old age.
the World Bank says, "a deferred payment Increasing the chances that an infant will
avoids the risk of people volunteering reach adulthood, through comprehensive
simply because they need the monc)' health schemes, would also encoura~
immediately. If they later regret their dec,- people to have fewer children. "Women 10
sion, they can do nothing about it." Bangladesh do want family planning," says
Further, "it avoids the need for a large Standing, ",but not population control
number of cash payments to be made by forced upon them."
□
j unior officials and thus minimises the
potential for corruption." Unfortunately, • Food, - - S r -. b y l l o l o y - the World Bank concludes, such a scheme ~ ~ ~ , : n e v = .!o°'"eo~ 9 ~
would .. require an increase in foreign assis- N5 IUN. CI •95 .
.c
Cl)
ca •
Cl)
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8
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..,en ca
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No.5
a.. ca
ca en
bi>
~
September-October 1985
E-c
.., C
.
;:•;!'/
CONTENTS
Gi) · -
::c
INSI DE ASIA
a bi-monthly magazine
of Asian affairs,
published in the UK by
Inside Asia Ltd,
242-244 Pentonvlfle Road,
London N1 9UP.
Telephone 01·278 3806.
India & the superpo wers: A fine balance
lnalde Asia Ltd. is a collective enterprise.
Tamils' struggle in Sri Lanka: The roads to Eelam
EDITORS
Larry Jagan & Tony Kahane
DESIGN
Sang-usa Suttitanakul
Conrad Taylor
ADVERTISING/PROMOTIONS
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EDITORIAL TEAM
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Tony Kahane, Yasmin Kureishi,
Sang-usa Suttitanakul
and Conrad Taylor
EDITORIAL ASSISTANT:
PICTURE RESEARCH
Alan Johnson
Labour Affairs ConsuHant
David Neller
This issue was produced with the help
of Gawin Chutima and Ariana Vakas.
ISSN 0267-2227
© copyright Inside Asia Ltd Sept. 1985
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Distribution. In UK: Central Books,
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In Japan: Nauka, 2-30-19, Minamilkebukuro, Toshima-ku, Tokyo 171.
Editoria l: Fora nuclear-free Asia-Pacific
4
POLITICS & INTERNATIONAL AFFAIRS
Showdo wn in S. Korea?: Towards a Sixth Republic
Gavan McCorm ack
Martin Smith
Dilip Hiro
Victor Karuna n
Elizabeth Marlow
Ben Kiernan
Burma's Shan rebel groups: Politics of opium
Executi ons in Indones ia: Jakarta 'justice '
ASEAN and Indochi na: Asian drama unfolds
Indones ia's resettle ment scheme : Settling for trouble
- -20
Robin Osborn e
Zawaw i Ibrahim
Malay peasan t consciou sness: People versus power
23
Betsy Hartma nn & Amand a
·- -
W,OME,VN ASIA
-
-
n
Milligan
- -
FOCUS: AID_TO.JANGLADESH
Report on aid agencie s: Bypassing the poor
Relief in the cyclone zone: Harvest and disaster
_
After the Newha m 7: 'Self defence ' is not enough
--
-
-·
-
Ariana Yakas
--
ECONOMY & QEVELOPMENT
Nepal's deepen ing crisis: Clouds over Kathma ndu
25
Larry Jagan
John Cunnin gton
BRITAIN A-NP ASIA
Develop ment theory revived : Friedrich List lives!
-
Aidan Foster- Carter
Piers Blaikie
Elizabeth Marlow
TRAVEL
Tibet prepare s for the tourists: Lama's lament
Phnom Penh revisite d: Gone is the gloom
Anthony Shang
Michael Vickery
31
33
35
39
-
- -
LITJRATURE
China's literary freedom : Perman ent waves
J
27
28
--
LABOUR AFFAIRS
Indones ia's trade unions: An instrum ent of control
10
12
15
17
--
SOCIETY & CULTURE
Populat ion policy in Banglad esh: Corruption & coercio
5
7
Gregory Lee
--
41
43
46
BOOK REVIEWS
on India's commun al strife, history and peasam
consciousn ess in S.E. Asia, the Tamil struggle in
Sri Lanka and tunnel warfare in Vie111a111
48
-
POCITICS &INTERNATIONAL AFFAIRS
EDITORI-AL
For a nuclear-free Asia-Pacific
T
HE ATOMIC BOMBS on Hiroshima and
Nagasaki in early Augu st forty years ago brought
an end to the war in South East and East Asia . They
also ended the Japanese occupation of the region and
an empire that had extended from Manchuria in the
north to Papua New Guinea and the Pacific islands in
the south .
From the Western , military point of view the
bombs were the culmination o f an existing fire bombing campaign which , since the spring of 1945 had
unleashed immense horror on Japanese cities , similar
to that inflicted on Dresden and other German towns.
In a single night in March 1945 , over 130,000 people
in Tokyo were killed by the fire bombing , a similar
number as were killed outright by the atomic bomb
dropped on Hiroshima .
In retrospect it would appear that the Japanese
were already on the brink of surrendering ; one reason
for the American use of the atomic bombs was to
bring that surrender forward and physically to occupy
Japan before the Soviet Union could do so. A second
purpose clearly was to test the destructive capacity of
this new, hitherto untried weapon; a third was to
make a spectacle to the world of the Japanese
surrender . A stark reminder to the world of what the
bomb achieved is the existence of the hibakusha,
survivors of Hiroshima and Nagasaki who still
suffer from the effects of radiation and whose
children as well are victims of the after-effects.
The slaughter in Hiroshima and Nagasaki was
less the final act of the Pacific War than the beginning
of the Cold War in Asia . Throughout the forty years
of the ensuing arms race, the bomb has cast an
ominous shadow . On several occasions , during the
Korean War and again over Vietnam, use of the bomb
was seriously considered . As relations between the
superpowers oscillated between detente and frigidity
during the 1960s and 1970s, the arms race escalated .
Nuclear weapons were increasingly stockpiled , their
refinement in terms of range and accuracy was
immensely improved , and their power boosted to
the point where most of those who survived a nuclear
exchange could well die in the subsequent postulated ' nuclear winter'.
While the Soviet Union and the United States are
the major offenders, there are countries in Asia India , China and quite possibly Pakistan-who have
developed nuclear weapons , and others , such as
South Korea and the Philippines , who have encouraged their proliferation in the region by harbouring
them on their territories . All the while France, which
4
INSIDE
never signed either the Test Ban Treaty or the NonProliferation Treaty , has continued unashamedly to
use the Pacific to test its nuclear bombs above
ground .
Things are changing , however, in Asia. Growing
voices are being raised against this nuclear folly. One
such voice is from the Japanese peace movement that
has , from first-hand experience, a commitment and
international outlook that is to be commended. But
there are other examples: the struggle , against
American wishes , of Belau in Micronesia for a
nuclear-free constitution ; the efforts in New Zealand
of the Prime Minister , David Lange, who claims the
support of two-thirds of the country for his government's non-nuclear policy; and the increasing support
for the new Nuclear Disarmament Party in Australia ,
where earlier this year it was revealed that the
government had given secret permission to the US to
test its MX missiles on Australian soil , a promise
which in the ensuing protests had to be revoked .
It is above all the continuing French tests at the
Mururoa Atoll which have aroused the fury of many
countries of the Pacific and provided a rallying point
for peace movements in the region. The apparent
involvement, at a high level, of the French secret service in the sinking of the Greenpeace protest ship
can only have raised their determination even more.
Besides France, the US has used Kwajalein Atoll
since 1960 for its tests, and is intent on testing the
MX missile in the region , and the Soviet Union tests
its own missiles using the Kamchatka peninsula as
target area (though frequently overshooting and landing in the Pacific). China conducts tests from its
centre in Gansu province, sending inter-continental
ballistic missiles into the Pacific; in 1982 it delivered
a submarine-launched missile into the East China Sea
between Taiwan and Okinawa, while later tests have
landed as far south as Kiribati. There is little wonder
that resentment against such tests is rising in the
region.
The moves for a nuclear-free zone in the Pacific ,
led by New Zealand and supported by other states,
are by far the most important developments so far.
Despite bullying by the United States , tht, New
Zealand government has steadfastly stood its ground.
This important lead should be vigorously supported
and extended to the creation of nuclear-free zones in
East Asia and South Asia . The countries of Asia
should take up New Zealand's example and begin the
fight back against the nuclear colonization of the
region .
ASIA
September-October 1985
-
-&
The forces of repression are challenged by Korea's veteran democratic politician, Kim Dae Jung.
SHOWDOWN IN S. KOREA?
ToWarOs :a Sixth Republic
Developments in South Korea have adopted a new significance with
the talk of possible reunification. Gavan McCormack examines the
underlying political trends and concludes that US influence is paramount in determining the country 's future political solutions.
1985
IS A YEAR heavy with
anniversaries in Korea : 75 years
since the country's long unbroken history of
national independence was broken and Japanese
colonial control established ; forty years since
the bitter summer of 1945 when independence
from the Japanese was accompanied by division into American and Soviet spheres; thirtyfive years since the outbreak of the fratricidal
war which was turned by UN intervention into
a holocaust taking three million lives ; twentyfive years since the uprising by students in the
South led to overthrow of the dictator Syngman
Rhee ; twenty years since the ' normalization '
of relations between South Korea and Japan ;
and five years since the present ruler, Chun
Doo Hwan , drowned the renascent democratic
movement in a bloodbath on his way to
power. Loss of national autonomy, loss of
September-October 1985
national unity, war, repeated setbacks in the
struggle for democracy , continuing foreign
interventions-the great economic gains of
recent years make so much more bitter the
failure on these other, crucial fronts.
The return of veteran politician Kim Dae
Jung to Seoul in February 1985 and the rapid
sequence of changes in the political landscape
that it accompanied (and partly caused) is an
indication either that a time of historical
reckoning is approaching or else that another
reversal is at hand .
Outstanding politician
By any reckoning Kim Dae Jung is one of the
outstanding democratic politicians of the late
twentieth century. During a presidential election
campaign in 1971 he survived several
assassination attempts and against all odds was
INSIDE
ASIA
defeated by a hair' s breadth. The government
then declared martial law and a new
constitution-there has been no presidential
e lection since-and , when Kim extended his
campaign to the United States and Japan ,
government agents were despatched, in
August 1983, to abduct him from his Tokyo
hotel room . Were it not for an interruption
they would have dropped him in the sea. Back
in Seoul , along with the best and most
courageous of his country ' s poets, priests ,
professors, workers and students , he spent
most of the rest of the decade in prison or
under house arrest. After the death of Park
Chung Hee he was released in early 1980, but
when he seemed on the point of winning a new
(projected) presidential election the army stepped
in to re-arrest him. He was tried for treason
and , in a farcical court martial, sentenced to
death. After a brief burst of outrage around
the world the sentence was commuted to twenty
years , of which he served three and was then
allowed to leave ' for medical treatment' in the
United States. The circumstances of his return
show that after fifteen years of repression ,
5
= POLITICS & INTERNATIONAL AFFAIRS
POLITICS & INTERNATIONAL AFFAIRS
----
imprisonment , torture and attempts to kill
him, he is still his co untry's most respected
and charismatic so n.
The reason that Kim is less than a
household name in the Western world is simple
enough. His struggle for democracy against
his cou ntry 's generals and bureaucrats-and
their foreign sponsors-is identical in
substance to that of 'Solidarity ' and Lech
Walesa in Poland, but while 'democracy· in
Poland is considered something to be applauded,
since it might help to weaken or embarrass
the Soviet Union, it is regarded as intolerable
in South Korea , where it might weaken or
embarrass the United States. South Korea's
assig ned role within the ' free world ' , like
Poland's within the counterpart system , is that
of 'security state', base and buffer. It is its
geographical location that accounts for the
pec uliarly intense and intractable character of
Korea 's problems.
Since the US-created Republic of Korea
was established in 1948 there have been five
' republics' in South Korea , the transition between them regularly marked by mass struggle
in the streets, military coups, or both . In 1960
Syngman Rhee was overthrown by a studentled mass movement; in 1961 Park Chung Hee
spearheaded a military coup ; in 1972 Park
initiated a new constitution which , among
oth er things, made him effectively life ruler ;
in 1979 Park 's security chief assassi nated him,
inaugurating the brief ' democratic spring ' of
1980; and in 1980 General Chun and his
associates moved to forestall the ' threat ' of
democracy. The question now is whether the
civ ilian democratic forces , reunited around
Kim Dae Jung since his return and mobilizing
for another bid fo r power , will be able to
escape the fate of their histo rical antecedents
of 1960-61 and 1979-80.
US intervention
The obstacles are formidable. It is hard to see
why South Korea should prove any exception
to the general histo rical rule that those who
hold power do not give it up unless compelled
to do so by superior (and not merely moral )
force. In Korea power is firmly in the hands
of the military, and the Korean military , under
the command of a US general , is in an important
sense a branch of the US forces. The US
position was made quite clear in 1980, when
the US commander had no hesitation in releasing forces from his command in order to crush
the popular ri sing at Kwangju. So long as
South Korea continues to occupy the crucial
frontier that it does in the Cold War , in close
proximity to China, the Soviet Union and, of
course, North Korea , and facing Japan across
a narrow sea, and so long as it continues to
sustain the sixth or seventh largest armed
forces in the world (the seventh or sixth
largest , depending on whose figures you
believe, are those of North Korea) and to
'host' a substa ntial US nuclear arsenal, the US
position is unlikely to change. South Korean
democracy-a free press , free universities and
6
students, deep into the new working class. The
results of the February 1985 elections show
this c learly.
The constitution of the ' Fifth Republic· is
one designed to concentrate and prese rve
political power in executive (military) hands
within a formally democratic parliamentary
structure . The gove rnment party - th e
Democratic Justice Party (DJP)-employs all
the perks of power and office, and all the
ci rcui ts controlled by the military , police, and
local administrations, to achieve the desired
electoral results. Initially , an opposition was
simply created by Chun Doo Hwan who, having
dissolved the existing political parties, created
new ones and chose their leaders (as well as
creating his own government party) . Just 26
days before the February 1985 election,
howev e r, a new party , the New Korea
Democratic Party, was licensed and this
:r immediately developed into a broad political
opposition front. With both its acknowledged
leaders (Kim Dae Jung and Kim Young Sam)
General Chun , dictator since 1980.
under house arrest, and with few resources
and against all odds , it swept South Korea 's
free political parties- might weaken the
major cities and won just under 30% of the
system, and so General Chun , or any other
national vote, as against 35.2% for Chun 's
general , is to be preferred to Kim Dae Jung ,
DJP. Because of the peculiar electoral system,
or any other democrat.
which awards substantial extra seats to the
There is no doubt that the military , created
maj ority party , the DJ P's margin in seats was
and nurtured by the US , remains the key instimuch greater : the DJP's 35 % of the vote gave
tution in South Korea, with 600,000 regular
it 54 % of the seats (o r 148 seats) , while the
troops , nearly three million reserves, about
NKDP's 30 % gave it only 24% or 67 seats,
35% of the budget , and six to seve n million
in a 276-seat assembly. However, defections
ex-officers and soldiers seeded throughout the
from other minority parties immediately after
soc iety , co ntrolling eve rything from the
the election were such that by April the
higher reac hes of nat io nal government and
NKDP's ranks had swollen to 106 seats.
industry to local village government. Military
credibility , though, was damaged in 1980 ,
Showdown likely
perhaps irrevocably , when army units blooded
This is not the tame opposition that Chun had
in Vietnam turned their guns on their own
people at Kwangju , massacring hundreds , planned for. Its demands-including an end
to press censorship , removal of police spies
possibly thousands, in a Vietnam-style dawn
from university campuses, direct election of
assault . Since then General (President) Chun's
the next president, and reinstatement of Kim
justification of South Korea in terms of its
Dae Jung- make it clear that the stage, now
value to the defence of Japan and the United
States has exposed the fundamentally craven , cleared of supporting actors , is once again set
for a frontal clash between Chun and Kim .
even mercenary character that belies the
It see ms beyond hope that Kim 's moral
pretence of nationalism, while the US adoption
strength, popular support, and growing tactical
of a strategy of horizontal escalationskill wi ll be enough to gain him dominan ce
' retaliation' in (North) Korea (or Cuba, or
Libya) for a ' Soviet ' advance in the Middle over the US-backed military-bureaucratic
bloc; yet the alternative is a renewed
East or elsewhere-indicates that a concern
for 'security· within th e narrow confines of showdown , most likely greater in scale eve n
than Kwangju . Another episode in Ko rea ' s
the Korean peninsula is meaningless when
long and tragic modern history looms. The
plans conceived in Washington reduce the
United States is directly involved as the
whole peninsula to the status of a nuclear
pawn, to be sacrificed if necessary in order creator of the South Korean military and, in
particular , as Chun 's sponsor; and , via
to gain appropriate advantage elsewhere .
nuclear weapons and the alliances through
Growing opposition
which Korea is locked into the structures of
the Cold War , so is the rest of the world .
But , if the military bloc and its US backing
seems unshakeable , the popular bloc too ,
Gavan McCormack teaches history at La
si nce Kwangju , has gained unprecedented
Trobe University, Melbourne. He writes 011
strength . Industrialization , for all its negative
Japanese and Korean affairs and is coeditor
attributes of exploitation and dependency , has
of Democracy i11 Contemporary Japan, to be
wrought profound changes, and the base of
published shortly.
the democratic mov ement has been extended
from intellectual s, religious people , and
INSIDE
ASIA
September-October 1985
'
.. --- -
-- -
- •~--. f;
The Shan United Army, 011e of the many i11surgent armies depe11de11t 011 income from opium.
BURMA'S SHAN REBEL GROUPS
Politics 'of opium
Burma's Shan state produces 80% of the opium grown in the Golden
Triangle. It is also home to a greater variety of insurgent armies than
anywhere else on earth. Martin Smith investigates the politics of opium
and uncovers a morass of constantly shifting and , at times, unlikely
alliances .
CROSS THE FORESTED mountains of
the Golden Triangle as the first rains
begin , hill tribe farmers are busily trading the
last of this yea r's opium harvest. Estimates
of the crop vary, as they do every year, from
between 300 and 800 tons , but as every year
the simple truth is that nobody really knows .
The opium poppy is notoriously susceptible
to vagaries in the weather. But in Thailand
where the crop is most strictly monitored, narcotics police are pred icting a bumper harvest
for the fourth successive year .
In Thai land itself the annual opium crop
has been reduced with the aid of various UNsponsored crop substitution programmes from
a peak of over 140 tons twenty years ago to
an estimated 35 tons today . Although it is on
Thailand that most international attention
focuses as the region's major transhipment
point for narcotics, it is across the Burmese
A
September-October 1985
border . and in the rugged Shan State in particular , that an estimated 80 % of the opium
crop is grown today.
Wild and lawless
Shan State is a wild and lawless place . A vast
highland plateau, the size of England and
Wales and divided by deep mountains and
precipitous rivers. it plays host to a greater
variety of insurgent armies than perhaps any
other place on earth. In British days it remained
in a state of chronic underdevelopment. administered separately by over thirty ' sawbwa· or
princely families. each with their own fiefdom.
Only at independence in 1948 were these
merged and incorporated as a federal state into
the new Union of Burma , but with the unu sual
right of secession after a ten-year trial pe riod
granted in the constitution as a concession to
nationalist sentiment.
INSIDE
ASIA
However, from the outset, unity amongst
the various indigenous races proved elus ive .
Shortly after independence a rebellion broke
out amongst Pao hill tribe farmers in the west
of the state . But more se riously tense relations
betwee n the majority Shans and the largely
Burman gove rnment in Rangoon deteriorated
considerably in the early 1950s when seve ral
thousand Guomindang (KMT) remnants from
China blundered into the state bringing in their
wake the first Burmese troops . whose reco rd
of behaviour often proved little better. It was
the CIA-backed KMT with their vital overseas
connections who first elevated the opium trade
to its international proportions and who also
showed the growing number of young Shan
separatists the potential for armed rebellio n.
It was to head off this movement that
Burma' s present military ruler. General Ne
Win. already faced with serious Karen and
Communist Party insurgencies. seized power
in 1962. However this only served to fuel the
rebellion further. Within a few years armed
uprisings , often based on old feudal or territorial loyalties. had broken out across the state.
The rebellion soon spread to the minority hill
tribe groups who make up a third of the state· s
estimated six million population .
7
= POLITICS &INTERNATIONAL AFFAIRS
POLITICS &INTERNATIONAL AFFAIRS
Separatist forces
Today there are no less than three major Shan
separatist forces: the Shan State Army (SSA),
politically the most influential but much reduced
after a series of assassinations and factional
splits; the well armed and disciplined Shan
United Army (SUA) of the 'opium warlord'
Khun Sa , which draws much of its popular
support from Khun Sa's home district of Loi
Maw ; and the Tai Revolutionary Army ,
formed last year by veteran Shan nationalist
leader and one-time communist, Kwon Jerng ,
alias Mo Heing , from an alliance of SSA
defectors and the now defunct Shan United
Revolutionary Army. SURA itself had for
many years been closely allied with SUA 's
bitter rivals in the opium trade , the KMT, who
still play a pivotal role in the cross border
traffic.
However the combined forces of these
three probably do not equal either of the two
strongest forces in the state-the 10,000
strong 'People's Army' of the Communist
Party of Burma (CPB) which built up a large
' liberated zone' along the Chinese border in
the north in the 1970s (which includes the
prize poppy fields of the Kokang and Wa
substates) and the Kachin Independence Arn1y
(KIA) whose main force is based in the Kachin
State to the north but whose powerful 4th
Brigade operates amongst the Kach in villages
to the south .
To complicate matters even further there
are several Lahu , Wa , Palaung , Kayan (Padaung) and Pao hill tribe forces , each several
hundred strong and themselves split into left
and right factions .
All the insurgent groups profess political
objectives to varying degrees but for most survival depends on the ability to raise arms,
either through seizures or purchases on the
blackmarket. Although some do have their
own sources of income (for the KIA it is jade,
for the CPB , China) in this impoverished
backwater opium is the only lucrative cash
crop. As the late General Tuan Shi-wen of the
KMT 5th Army once explained to the Sunday
Telegraph, 'To fight you must have an army,
and an army must have guns and to buy guns
you must have money . In these mountains the
only money is opium.'
Revenue from opium
Perhaps only the SUA of Khun Sa , who on
his own admittance has handled up to 250 tons
of opium a year, is totally dependent on the
opium trade, but most raise at least some
revenue through it, either through taxes on the
farmers or levies on the convoys which pass
through their territory , or even on occasion
running convoys themselves. In their defence
they argue that on their own, and without the
sort of aid given to neighbouring Thailand ,
they simply do not have the means to introduce substitute crops.
The Burmese government for its part
claims last year to have seized over 4 ,000
8
kilos of opium and 62 . 17 kilos of heroin . But
many observers, denied access to the state by
the Rangoon government, are sceptical. Certainly the government's own accounts of
military operations against rebel groups
involved in the opium trade , especially the
SUA, suggest a lack of commitment. In this
year's anti-narcotics offensive of February
and March, the Burmese army claims to have
killed twenty insurgents for the loss of two
Government troops, figures which indicate a
level of fighting far below current operations
against Karen and Kachin insurgent forces
elsewhere in Burma .
It appears that the Burmese government,
faced with such diverse insurgencies , has little
interest in moving against the opium trade ,
not least because trafficking in opium tends
to obscure the political aspirations of the
rebels from the outside world . Moreover , the
anti-narcotics fight can be a useful source of
aid and support . As a popular saying in the
state goes, 'Everybody knows opium is good.
It's good for the people and it's good for the
government. When there's a good crop the
farmer can buy a car and if ifs really good
the government can get a helicopter.' Of 18
Bell helicopters donated to the Burmese
government by the USA under an antinarcotics programme at least two have been
shot down by Karen insurgents in the south
of Burma who adamantly renounce any involvement in the opium trade .
Offer rejected
In recent years only one serious attempt has
been made in the west to investigate the
narcotics situation inside Shan State. In 1973,
in an offer repeated in 1975 , an alliance of
INSIDE
ASIA
Shan rebels , led by the Shan State Army but
including key rebel leaders such as Khun Sa
and Lo Hsing-han , proposed to sell the entire
opium crop of some 400 tons passing through
their hands to the US government for approximately $20 million, a fraction of the amount
the US was then spending annually on antinarcotics programmes. It was an offer several
congressmen took very seriously and led to
several meetings with Shan leaders and a
series of Congressional hearings filmed by
British film -maker Adrian Cowell in his
remarkable documentary trilogy on the opium
trade .
Eventually President Carter turned the offer
down . To have accepted would have meant
virtual recognition of the minorities' political
goals, though many analysts were rather more
sceptical about the enforcement of such a deal.
A similar pre-emptive puchase from the KMT
on the Thai border in 1972 ended in farce
when , after the US government had contributed $1 million for the public destruction
of the KMT 's opium stockpi le of 26 tons, a
27th ton suddenly became available in return
for more funds .
New developments
Although many observers have long seen the
situation inside Shan State as one of unending
chaos there are signs that a series of
developments over the last three years, while
symptomatic of the general confusion , could
well break this deadlock. The initiatives for
this come from across the Burmese borders
from China, where aid has been steadily
reduced to the Communist Party of Burma and
relations with the Burmese government increasingly normalized , and perhaps more impor-
September-October 1985
=
tantly from Thailand where the government
renewing speculation about the health of the the activities of the SUA as a major impedihas traditionally tolerated the activities of the 52 year-o ld Khun Sa. In January the Bangkok
ment to getting outside help for their struggle
various insurgent groups on its borders .
press gave front page coverage to one report
and may well be using Khun Sa's present difThe two groups most heavily involved in
of his death , but although Khun Sa is known
ficulties as an opportunity to regain lost
the narcotics trade, Khun Sa ' s SUA and the
to be suffering from diabetes , such stories are territory.
KMT, have long been regarded as antialmost certainly premature .
Moreover the TRA 's long-time allies in
communist buffers in an area of rural comHowever the new alliance cannot be the KMT appear unlikely to join the new
munist insurgency. However , with the rapid
dismissed completely. A number of leading
alliance despite several entreaties from the
decline of the Communist Party of Thailand
Shan political figures are behind it , such as
TRA. Indeed last year the SUA and KMT
in the last few years and the growing involvethe TRA 's secretary-gene ral, Chao Norfah , continued their long rivalry which appears to
ment of the Communist Party of Burma in the
himself a minority Palaung and the son of one
have reached a new pitch of hostility . On 11
opium trade since the reduction in Chinese
of the Shan hereditary sawbwas, and Khwan
March the SUA is believed to have been
aid, this role has been increasingly called into
Mong , a one-time high-ranking left-wing
behind the bombing of KMT leader General
question . With the CPB controlling the best
officer in the Shan State Army who was a
Lee Wen-Huan 's Chiang Mai residence and
poppy fields and the SUA convoys the major
regular visitor to China in the 1970s. They
KMT elements are largely seen as responsible
traffickers in the state , the conclusion that they
have been holding meetings with many of the
for the murders of three of Khun Sa's key
have come to some kind of deal is inescapable .
Shan leaders past and present over a two year
men, including his nephew, in northern
American pressure on the Thais to act was
period . Uppermost is the realization that
Thailand betweeen last November and
considerable.
without outside support, and in particular from
January this year.
It was against the SUA that the Thai
Thailand, the Shan rebellion could soon be
There has been no official reaction from
government first moved , seizing their
finished . As a TRA policy statement warned
the Thai government to date. In private many
stronghold at Ban Hin Taek on the Thai side
in January. ' The drugs problem isn't a drugs
Thai army officers are sympathetic to the
of the border in January 1982 after a fierce
problem but a political question . It can be
struggle of their Shan ethnic cousins but
battle . Then last June the government turned
settled only politically , only by the Shan
currently the priority in Bangkok is unagainst the KMT . The remaining border
people and the political organization which
doubtedly to clear any group involved in
militia were ordered to disarm, take out new
speaks for them. In the past, however, the
opium trafficking or heroin refining from the
identity cards and send their children to Thai
Shans have not been able to take up thi s Thai side of the border. Last November Thai
schools. To back this up raids were carried
responsibility . But if they do not today, they ' ll
troops clashed several times with SUA troops
out on KMT villages in which several KMT
perish once and for all. '
apparently trying to infiltrate into northern
troops were killed .
As the first step in the new Council's antiMae Hong Son province and in March Thai
At first the new Thai policy appeared only
narcotics programme a survey is being underRangers launched a savage and largely unexto inflame the situation. Far from finishing
taken of the total opium trade in Shan State
plained attack on the KMT village at Pieng
the SUA as many analysts had predicted the
before possible methods of crop substitution
Luang which left over thirty villagers dead .
loss of their Thai sanctuary prompted SUA
are considered. This process is strikingly
In the battle inside Shan State in April Thai
commanders into urgent action. New recruits
reminiscent of the lead-up to the 1973 proofficers appear to have been supporting the
were enlisted as they began rapidly to expand
posal s to the US government. Whether they
hill tribe NDF troops. After the battle NDF
their territory in the south of the state, largely
will be any more successful this time is unlikely
commanders handed over a large quantity of
at the expense of the Shan State Army and
but the intention no doubt is to gain more
opium captured from the SUA to Thai officers
various hill tribe forces along the border. With
favourable recognition for the Shan cause. As
at the border. But whether the Thai governthe capture of a Pao base at Mae Aw in March
the TRA statement asked, ' Why are the
ment will continue with this hard-line attitude
1984, most of the Shan-Thai border with the exAfghans and the Pakistanis not annihilated but
is rather doubtful. It will not have been forgotten
ception of a narrow enclave controlled by the
aided with every possible means?'
that it was the outrig ht American rejection of
Tai Revolutionary Army was in SUA hands . A
In the short term more crucial for the sucthe 1973 and 1975 proposals which pushed
battle between the two appeared only a matter
cess of the USSPC is how far the other nonmany insurgents into the communist camp.
of time. As the TRA 's 'Foreign Secretary ' .
communist minority forces can be encouraged
But whatever the political outcome, few
Khern Sai , remarked ominously at the time ,
to join this alliance. In principle many of the
observers serious ly expect any dramatic
'We are fighting a different kind of war now.
minorities welcome this development. As
change in opium production. The three cornera war of nerves.·
Aung Kham Hti , President of the Pao National
stones of the trade , hill tribe farmers who
Army which has clashed with all the Shan
grow it, the rebel groups who transport and
Shan front
groups in the past explained, 'Our attitude has
refine it, and the Chiu Chau syndicates who
In one of the dramatic changes of alliance
been from the very beginning we need the
export it , will remain largely unaffected.
which make Shan politics so baffling to outkind of front that can represent the whole of
Indeed by January prices on the border had
siders , a new Shan front , the United Shan
Shan State , including all the minority peoples .
dropped as low as 2,000 Baht (£60) for ajoi
State's Patriotic Council (USSPC) was suddenly
Our problem in Shan politics has been that if ( 1.6 kilos) of opium and 12,000 baht (£360)
announced on 7 April this year. Formed from
you ally with one side the other two will attack
for a kilo of heroin. There is already ample
a coalition of the SUA ,TRA and southern SSA
you. But if they can unify into one alliance
evidence to suggest that traffickers have any
it marks the first time since the Shan rebellion
we can cooperate with them very easily.'
variety of well-oiled smuggling routes and
began that all the Shan groups on the Thai
have stockpiled supplies for any contingenborder have been in alliance. As yet military
Unity still elusive
cy. Indeed when prices last sky-rocketeddetails of the new formation have not been
However despite these sentiments the initial
as they did in 1979 and 1980-the answer was
disclosed but it is open to all groups in Shan
response of other minorities has not been
much more straightforwa rd-two successive
State who support a three-point platform; antigood. In mid-April, Pao, Wa and KMT troops
years of drought.
the governing Burma Socialist Programme
under the apparent direction of Karen officers
Party . anti-Communi st Party of Burma and
from the pro-western National Democratic
most significantly anti-narcotics.
Front (NDF) fought a fierce five-day battle Martin Smith is a freelance journalist who
Of Khun Sa no mention has been made but
with the SUA near Mae Aw in which at least has specialized in Burmese affairs and has
the TRA's President Kwon Jerng has been
150 troops from both sides were killed or spent considerable time in the region.
elected •Prime Minister· of the new council.
wounded. The NDF alliance has long regarded
September-October 1985
INSIDE
ASIA
9
= POLITICS & INTERNATIONAL AFFAIRS
POLITICS & INTERNATIONAL AFFAIRS E=
Washington ·s respon se was that the Pentagon would be willing to sell sophisticated
weapons to India. But for this to happen the
US administration has to liberalize the strict
clauses that govern such transactions. There
is no sign as yet that it is about to do so .
Wider dimension
There is another, wider dimension to this conflict between Delhi and Washington. For th e
past many years India has observed with ris ing disquiet and frustration an escalating
militarization of the Indian Ocean by the
superpowers , initiated by America. The US
has dramatically built up its naval strength in
the Indian Ocean , with the Diego Garcia atoll
as its main base 1,600 km from India 's
southern-most point.
Remembering Washington ' s despatch of
one of its aircraft carriers from the Pacific to
the Bay of Bengal during the Indo-Pakistan
war of 1971 , the Indians fear that the next time
around the US will intervene on Pakistan 's
side with its forces in Diego Garcia and the
American battle carriers stationed in the Arabian Sea around the Hormuz Straits .
That such fears are not idle was impressed on Delhi by the statement made by Deane
Hinton, US ambassador to Pakistan , on 10
October 1984: ' If the contingency you're talking about is from the east (ie. India) , then we
will not be neutral if there is an act , committed by anybody, of flagrant aggression. There
are all kinds of things we can and would do ' .
IND/A & THE SUPERPOWERS
A fine;balance
Opposition to foreign bases
Rajiv Gandhi has adopted an aggressively non-aligned stance. Breaking the pro-Soviet mould inherited from his mother, he has been quick
to warm to the US. Dilip Hiro examines India's relations with the superpowers, suggesting that only minor realignments are likely in the near
future.
M
OSCOW IN MAY , Washington in June.
If this is a dramatic way of
demonstrating one ' s non-alignment with the
superpowers , then the Indian prime minister,
Rajiv Gandhi , opted for it.
In each of the superpower capitals ,
however , the agenda and the priorities were
different. In the absence of any diplomatic
conflict between India and the Soviet Union ,
Rajiv Gandhi and Mikhail Gorbachev concentrated on strengthening economic links while
their defence ministers engaged in ' a very
fruitful exchange ' on cooperation in the
weapons production field.
It was a different tale in Washington. Here
Gandhi brought up the subjects of American
relations with Pakistan , the blue-eyed boy of
the Reagan administration; keeping the Indian
Ocean free from superpower rivalry ; the
lowering of American tariffs for Indian imports ; and the securing of concessional loans
frorn the World Bank' s soft loan affiliate. The
10
American response varied from noncommittal to negative .
When Gandhi stated that the US was not
doing enough to dissuade Pakistani president ,
Mohammed Zia ul-Haq , from pursuing his
military nuclear ambitions, the Indian prime
minister was urged by American leaders to
sign the Nuclear Non-Proliferation Treaty.
The Indians pointed out that the heavy
tanks and 155mm howitzers supplied by
Washington to Islamabad, as part of the
$3 ,200 million arms deal of 1981 , are suitable
for plains warfare along the Indo-Pakistan
border and not in the mountainous terrain of
the Afghan-Pakistani border. They are still
upset about the Pentagon 's sale of 40 F-16
fighter bombers to Pak is tan , and fear that if
the current negotiations about the E2
' Hawkeye ' AWACS system , with a radar
range of 640 km , are successful , the sale will
make the Pakistani air force superior to their
own.
INSIDE
ASIA
Finally, there is the issue of foreign bases in
south Asia. As a leading non-aligned nation,
India is opposed to the idea of any of its
neighbours leasing ' strategic bases ' to either
superpower. This suits the Soviet Union ,
which has not shown any interest in acquiring bases in this region-but not the US .
Having signed a military pact with
Pakistan in 1954, the US began using
Pakistani airbases for the flights of its U-2 spy
planes over the Soviet Union. Over the past
few years the Pakistani port of Gwadar has
been built up as a base for the US Rapid
Deployment Force. In addition the Pentagon
has naval facilities at Trincomalee in northeast
Sri Lanka . Rajiv Gandhi has voiced disapproval of Sri Lanka ' s close relations with the
US, and is opposed to Sri Lanka offering
' strategic bases ' to America .
As the largest , most populous, and
strongest country in south Asia, India feels
that it is the natural leader of the region. While
the Soviets have not challenged this view, the
Americans have never taken it seriously. Having drawn Pakistan into a military pact in the
mid- I950s, the US has steadily converted it
into a client state, and integrated it into its
strategic defence plans for the Middle East.
Following the defeat of the left-of-centre
government of Srimao Bandaranaike in 1977 ,
the US has gradually brought Sri Lanka under
its wings, and is actively working towards the
September-October 1985
same aim in Bangladesh.
Military cooperation
In contrast there has been no clash of political
interests between Delhi and Moscow. In fact
on the issue of Kashmir-a bone of contention between India and Pakistan-the Soviets
have backed Delhi by repeatedly vetoing proPakistani UN Security Council resolutions .
Delhi and Moscow formalized their cordial relations in August 1971 by signing a
20-year Treaty of Friendship and Cooperation . 'Each of the High Contracting Parties·
declared it will maintain 'regular contacts with
each other on major international problems
affecting their interests' , and ' it shall not enter
into or participate in any military alliance
directed against the other party'. Furthermore,
in the event of either party being subjected
to 'an attack or a threat thereof, the High Contracting Parties shall immediately enter into
mutual consultations to ensure peace and the
security of their countries'.
When India attacked the then East Pakistan
in December 1971 to help Bengali nationalists
to found an independent state of Bangladesh ,
the Soviet Union supported India all the way
through the two-week long war.
Military cooperation between Delhi and
Moscow began in the mid-1950s when,
following its failure to secure production
licences for advanced weapons from Western
arms manufacturers, India made a successful
approach to the Kremlin. Since then defence
production ties between the two countries have
grown stronger as India has tried to outdo
Pakistan ' s acquisition of sophisticated
weapon s from America. Today India
manufactures MiG-l9s and MiG-2l s , and is
about to commence producing MiG-23s.
Last year the Soviets tried to discourage
India from diversifying its fighter aircraft procurement by offering it highly attractive
terms. For instance, it sold a MiG-27 jet at
about a quarter of the price of the comparable
French Mirage 2000. What is more. the
Kremlin contracted to let India manufacture
not only the MiG-27 but also its successors:
MiG-29 and MiG-31.
In recent talks between the defence officials of the two countries , the Kremlin was
ready to supply the Indian army and navy with
all-weather tanks , a land-to-sea missile
system, a radar system covering the Indian
coastline, and nuclear submarines (along with
the technology).
During his visit to the Indian port of
Visakhapatnam in March 1984 , Marshal
Ustinov , the Soviet defence minister, made
a highly significant statement. ' In the conditions of the present complex situation, including the one in the area of the Indian
Ocean, it is important that the armies and the
servicemen of both (our) countries increase
their combat readiness in order to be able, in
the event of necessity, to give a resolute rebuff
to any schemes of an aggressor· , he said.
All this corroborates the belief of many
September-October 1985
US officials and legislators that India has been
according preferential treatment to the Soviet
navy in its ports. India has neither confirmed
nor denied such reports .
Traumatic experience
Following Delhi ' s decision last year to diversify the procurement of advanced weapons,
India opened talks with the US regarding the
purchase of certain arms. Nothing came of it
because , to quote Rajiv Gandhi , ' the
Americans put conditions that were just not
acceptable to us· .
The Indians underwent a traumatic experience , during the Carter administration, of
the American conditions in the case of fuel
for the US-supplied nuclear power plant in
Tarapore. US Congress opposed the sale of
nuclear fuel because India is not a signatory
to the Non-Proliferation Treaty. In the end a
compromise was worked out; but Delhi is not
prepared to undergo something similar ever
again.
Yet the prospect of Washington selling
weapons to Delhi is not dead altogether. During his recent visit to the Indian capital, Fred
Ikle , US under-secretary for defence, discussed the possible sale of C-130 transport planes,
anti-tank missiles and artillery.
But the Indians are more anxious to purchase advanced computers from America than
weapons. Their request for 19 computers
worth $11 million was held up due to the Pentagon·s objections voiced through Richard
Perle. The Pentagon wanted watertight
assurances that the computer knowhow would
not find its way to the Soviets. To smooth the
way for Raj iv Gandhi's visit to the US, President Reagan intervened. The computers in
question have either been cleared or alternatives proposed to the Indians.
The timing of Gandhi ' s visit to America
also accelerated the negotiations between the
Indians and American officials to reach an
agreement for implementing the memorandum
of understanding , signed last November , on
'lndo-US High Technology Transfer' . The
implementation agreement was signed in midMay , and includes computers, microprocessors.
lasers , semi-conductors and sensors . The
Gandhi government believes that injecting
high technology into the Indian economy will
boost its growth rate.
Economic liberalization
Washington is well pleased with the economic
liberalization that Rajiv Gandhi has carried out
since assuming office in November. His first
budget, presented to parliament in March. was
so favourable to large companies and the rich
that a Wall Street Journal editorial on the subject was entitled: 'Rajiv Reagan's Budget".
The headline was apt. The budget curtailed
poverty alleviation schemes and limited the
increase in public sector outlays to 6 .5 %
(compared to the previous rise of 30%). wel I
below the inflation rate.
In interviews with Times. Los Angeles
INSIDE
ASIA
Times and Financial Times Rajiv Gandhi has
repeatedly welcomed the idea of foreignmeaning Western-investment in India.
Ministries in Delhi have been prodding
businessmen to come up with proposals for
joint ventures. Foreign collaboration is
nothing new in India . During 1956-65 there
were 2 ,500 joint ventures ; and the figure for
1975-84 was 9 ,000. The difference is not only
in scale but also in kind. The earlier ventures
were mainly in heavy and capital goods industries; now the stress is on consumer
durables.
Such developments have not been frowned upon by Moscow. Firstly , the Kremlin is
unable to offer high technology. Secondly,
and more importantly, the Soviets have always
followed a policy of aiding Third World countries to build up their infrastructure of roads,
irrigation facilities and power plants-and
basic and capital goods industries. They have
stayed away from setting up soft drink factories or distilleries or washing machine
plants.
Agreements signed
Significantly . of the two agreements that Raj iv Gandhi signed during his Moscow visit,
one was for Soviet credits of $1.200 million
at 2.5 % interest . repayable over thirty years ,
for major mining and power projects. The
other document was a 15-year Trade and
Technical Cooperation Pact. The trade between the two countries has been rising sharp1y; at $46 ,200 million this year it is 20 %
higher than last year. It will make the Soviet
Union lndia·s number one trading partner , a
position now occupied by the US .
Delhi"s economic links with the superpowers fit into the Indian economy very well .
For India has a mixed economy, basically
developing along capitalist lines . As Indira
Gandhi pointed out in an interview with the
US News & World Report in February 1982:
•All agriculture is private. and all small industry and a considerable part of medium and
large industry.· The goods and services produced in the public sector account for only
15 % of the Gross Domestic Product.
All of the Soviet aid has gone into developing and expanding the public sector which extends into both civilian and military fields .
Most of the American aid has been channelled into increasing production in agriculture.
which is in the private sector.
India has been able to do the fine-tuning
of the aid , financial and technical. from the
superpowers without compromising its
sovereignty. This is due to its physical size.
strategic location. the magnitude of its population and thus of its local market, and the quality of its top political leaders and planners . All
these factors give India a place in the nonaligned world which many Third World countries envy.
Dilip Hiro is a freelance journalist and writer;
he is author of Inside India Today.
11
= POLITICS &INTERNATIONAL AFFAIRS
POLITICS &INTERNATIONAL AFFAIRS
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Tamil Nadu in S. India offers escape fro,.
For the Liberation Tigers of Jamil J:,etam,
TAMILS' STRUGGLE .IN SRI LANKA
The roads to Eelam
The recent resurgence of violence against the Tamils in Sri Lanka has
shocked world opinion and highlighted the deep social divisions in the
island. Victor Karunan describes the historical background to the present situation and assesses the chances of a Tamil Eelam state being
established.
HE HISTORY OF TAMIL ethnic conprevailed in Ceylon: the Kandyan highlands ,
T sciousness
in Sri Lanka has been marked
the maritime provinces, and the northern
by a significant shift-especially in the
post- 1976 period-from Tamil ethnicity to a
social consciousness geared towards ' national
liberation'. Ethnic (minority) consciousness
has often asserted itself in response to a dominant ruling class that belongs to another ethnic
(majority) community. The social consciousness of the dominant community incorporates itself in the powers of the state and
its ideological institutions, resulting in the subjugated minority struggling for 'se lfdetermination' and ' national liberation '.
During the British colonia l period,
1815- 1948, three main social formations
12
pen insula . By 1840 the British had inserted
a ' plantation economy ' in the Kandyan
highlands with migrant labour from South India . British rule brought all this under one administrative control and so recruited a class
of 'med iators'-both Sinhalese and Tamilto liaise between British colonialism and the
ordinary people.
Historically , the Jaffna Peninsula had been
known for its crops: rice , tobacco, chillies,
and also salt, meat and milk products. During the Dutch and the British periods, these
crops provided the necessary commodities for
the island . However , re-investment in these
INSIDE
ASIA
areas was lacking and , in fact, deliberately
neglected by government, especially after independence . The meagre availability of infrastructural facilities and the few industries
in the Jaffna peninsula are therefore a result
of historical factors, and not merely explained in terms of the unproductiveness and barren nature of the land in this region .
The Tamil areas were, however , attractive to missionaries. Increasing ed ucational
opportunities and knowledge of English
resulted in Tamils bei ng recruited into the
British administration. The social origins of
the 'Colombo Tamils' can be traced back to
this group of educated and e lite Tamils of the
high 'vallala ' caste in the Jaffna peninsula .
The 'Colombo Tamils' were to take their
place besides their English-educated Sinhalese
counterparts in their common quest for
political office.
The religious riots of 19 I 5 (SinhaleseMuslim), coupled with a railway strike, were
basically an abortive 'bourgeois national
revolution'. Although this was an expression
of resistance to foreign domination by both
September-October 1985
the Sinhalese and the Tamils and showed signs
of the two bourgeois interests merging in opposition to British rule , it fa iled to materialize
primarily because of the contradictions of colonial ism itse lf: ' the bourgeoisie that colonial
capitalism created had vision of neither nation nor class.' Hence , bourgeois interests
among the Sinhalese and Tamils reso rted to
building up their respective communal bases
to assert their identity vis-a-vis British colonialism and each other. The formation of the
Sinhala Maha Sabha by S .W .R.D . Bandaranaike in I 937 and the Tamil Congress by
G .G. Poonambalam are c lear indications of
this. Besides , the possibility of a secular working class movement was also offset by the
Sinhalese directing their attacks against the Indian estate Tamils during this period . In
retrospect , both communitites reso rted to
asserting their ethnic identities before independence in I 948.
Tamil suspicions
At the time of independence Sri Lanka was
a country with a dominant Sinhalese population that expressed itself in communal terms
in the ruling United National Party (UNP);
a minority Tamil population resenting its lack
of representation in the UNP government and
suddenly deprived of British patronage ; a
million or so (Indian) plantation Tamil s who
were about to be disenfranchised and declared
'citizen less·; and a minority of other communities all apprehensive of their own identity in the now independent Ceylon.
September-October 1985
A series of pieces of legislation aroused
United Front government (a coalition of the
Tamil suspicions and set the stage for the SLFP , LSSP and CP) further aggravated thi s
crystallization of Tamil ethnic consciousness . situation by introducing a new constitution
The chief laws included: the Ceylon Citizen- which registered Sri Lanka as a Buddhist state
ship Act, 1948, which disenfranchised the one with Sinhala as its official language .
million plantation Tamils; the Ceylon
Moreover, it introduced the 'standardization
Parliamentary Elections Amendment Act,
sc heme' in education which resulted in those
1949 , which deprived them of the right to sitting in the Sinhala medium needing fewer
vote; and the Sinhala-Only Act of 1956 which marks to get into university than those sitting
made Sinhala the official language .
in the Tamil medium. These developments
With a section of the Tamil leadership destroyed all illusions the Tamil people had
under G.G. Poonambalam capitulating to the of eq uality with the Sinhalese and provided
UNP government, the Tamils turned to the the basis for the separatist demand of 'Tamil
newly-formed Federal Party (FP) led by
Eelam'.
Chelvanagayam to voice their sentiments. The
Tamil Eelam
resolution adopted by the FP at its National
Convention in 1956 voiced the grievances of On 14 May 1972 the Federal Party , the Tamil
the Tamil minority : the need for a democratic Congress, the Ceylon Workers' Congress , the
constitution based on the federal principle and Eela Thammilar Otrumai Munnani and
the establishment of one or more Tamil several Tamil youth and student organizations,
linguistic states; the restoration of the Tamil
formed the Tamil United Front (TUF). The
language as an official language of the coun- TUF gained the Tamil people's mandate in
try together with Sinhala; repeal of the citizen- the by-elections of January 1975 and voiced
ship laws ; and immediate cessation of col- the call for separatism:
onization of the traditional Tamil-speaking
I wish to announce to my people and to
areas with Sinhalese people.
the country that I consider the verdict
The FP resorted to 'non-violent
at this e lection as a mandate that the
satyagrahas' campaigns to press these
Tamil Eelam nation should exercise the
demands . The first-ever military occupation
sovereignty already vested in the Tamil
of Tamil areas in the north and the north-east
people and become free . On behalf of
took place in June 1961 in response to these
the Tamil United Front I give you my
so lemn assurance that we will carry out
satyagrahas. Tamil regions were cut off from
this mandate (Chelvanagayam) .
the rest of the country , and the Tamil
resistance found its geopolitical base in the The TUF was reconstituted as the Tamil
north and the north-east of the country . The United Liberation Front (TULF) in I 976 and
INSIDE
ASIA
13
== POLITICS &INTERNATIONAL AFFAIRS
reaffi rmed this dema nd.
Whi le the TU LFs call initi ally ra ll ied
togethe r the youth and students, the post- 1976
period saw the TULF preocc up ied with co nstitutional politicki ng and unab le to effectivel y
resist the state rep ression of the Tam il populati on, es pec ia ll y th e militant Tam il yo uth who
too k to 'd irec t act ion· to ac hieve a separate
T amil state . Increasing d isi ll usionment with
the T ULF produced a rad ical shift in th e
Tamil liberation struggle: ideolog ically, from
·separatism' to ·liberation · and strategically ,
from the ·parli amenta ry path ' to ·armed
stru gg le'.
The period 1976-79 saw the emergence of
numerou s mil itant organizations o f Tami l
youth , all pledged to armed strugg le to counter
state rep ress ion. and in the process achieve
a separate Tamil state . In Ju ne 1975 the Tamil
Eelam Libera tio n Organization (TEL0) was
set up advocatin g direct ac ti on through armed strugg le. In 1976 the Ee lam Revo lutionary
Orga nization of Students (EROS) was set up
in Lo ndon w ith similar objectives . The next
year , th e Liberation Tigers of Tami l Eelam
(L TT E) eme rged , ra lly ing togeth er militant
yo uth and stude nts and issuing the call fo r
armed strugg le to ach ieve a ·soc ialist Tam il
Eelam·. Wh ile the LTTE was ga in ing in
popularity fo r its ·successful military act ions· ,
personal ity co nfl icts between its leader,
Pra bakara n, and a close assoc iate , Uma
Maheshwa ran , res ulted in a major split , with
the latte r sett ing up the Peo ple' s Liberation
O rga nization ofTami leelam (PLOT) in 1977.
Meanwhile , a major effort at unity was reali zed in 1980 when th ree group s came togeth er
to constitute a 'United Revolutionary Fro nt '
(U RF): the Eelam People ' s Revolutionary
Liberation Fro nt (EPRLF) , TEL0 and EROS .
With the LTTE prosc ribed by the government
in 1979 , the mil itant res istance of these
po liti cal gro ups was effecti ve ly dri ve n
un de rg round .
Two definite strategies
By 1978-79 two defi nite strategies to ac hieve
' Tam il Eelam ' had emerged . T he TULF was
by now the main parli amentary opposition
pa rty seeking to establish ' Eelam ' through
parliamentary means and within the co nstitu tional fra mework of th e Sri Lankan state,
while the LTTE and othe r militant g roups
gained increas ing popularity fo r their agg ressive progra mmes of actio n, seeking to
establish ' Eelam' by weakening the Sri
Lankan slate from within , and ensuring social
and po litical sec urity fo r the Tamil people .
Variatio ns in the political perspecti ves of
Eelam and the strategies available to achieve
this demand , have brought about conflicts and
factionalism within the Tamil liberation movement. These political diversities are based on
ideo log ica l pe rs pec ti ves a nd pe rso na l
d iffe rences .
Yet it is clea r that the broad masses of the
T amil people are dete rmined to achi eve
' Eelam' . What fo rm of protracted struggle this
14
POLITICS &INTERNATIONAL AFFAIRS
count ry, identify w ith or support the ' Tami l
Eelam· cause? The political gro ups of th e
Tamil liberation strugg le must be prepared to
g rapple with these issues.
Shifts in direction
Sri Lankan police.
wo ul d enta il and what precisely the natu re of
the ' Tamil Eelam' shoul d be , a re questio ns
that have not yet evo ked a res ponse from the
Tam il people. T he present stage of the struggle is inev itably oriented toward s self-defe nce
and co unter-vio lence aga inst the Sri Lanka n
milita ry powe r in th e Tami l a reas.
The wo rd 'Tige rs ' has now ta ken on a
po pulist connotati on in the Tam il reg ions of
Sri Lanka. It has come to symbol ize the armed res istance of th e Ta mil yo uth and politica l
gro ups to establish ' Tamil Eelam' . For th e
maj ority Sinhalese people , howeve r, 'Tige rs '
is the ' te rro ri sm ' of the Tamil people aga inst
the gove rnmen t and the Sinha lese , threatening to divide the co untry into two. The
Sinhalese people see the mselves as a ' minori ty', compared to the ' majo rity' Sri Lankan
Tamil s and over fifty million Tamil s in
neighbouring Ta mil Nadu in India . It is this
suspic ion on both sides that has now rendered
the Sinhalese and Tamil communities into two
irreco nc ilable groups in Sri Lanka.
The re are two specific dimensions of the
po litical pe rspecti ves o f ' Tamil Eelam ' that
pose a probl em fo r the Tamil liberatio n
strugg le . The fi rst is th e status and possible
future within a separate Tamil Eelam of the
\ tno1anJ p1a m a 11 u n t a mll ~ .11 11.1 me mmu nty
community of Tamil Muslims , both antagonistic lo the Sri Lankan state and the Sinhalese
populatio n . Seco ndl y, ho w sho uld th e
predominantly Sinhalese left parties , who
have so fa r been preoccupied with parli amentary po litics and who have fa iled to build up
a militant wo rking cl ass movement in the
INSIDE
ASIA
T he development of Tam il ethn ic consciousness points to defi nite shifts in directi on and strategy . The Tami l people , having
ass erted thei r identity as a mi nority
community , assert a ' collective ident ity of
Ta mi l nationa lism ' . Th is raises the urgent
questio n of how far the ideology o f Tam il
nat ionalism indica tes a revo lutionary prog ramme for a fundamenta l tra nsformation o f
Sri Lanka n society as a who le .
There a re defini te str ength s a nd
weak nesses of the Tami l liberation struggle
that pose prob lems for the political groups in
te rms of a mobi lizatio n towards ach ieving a
' socialist Tam il Eelam· . Firstly , the historic
eco nomic boycott of the Tamil areas by th e
Sri Lanka n govern ment has left the Tamil people with a reg ion of th e co untry that remains
too neglected in terms of infras tructu re and
industry to susta in any prog ress ive economic
deve lopment. The stunted process of capitalist
deve lopment in these areas has left the Tamil
people without the necessary preconditions fo r
a revo lutio nary sociali st transfo rmatio n and
a 'soc ialist Tamil Eelam'. Seco ndly , th e
leadership of the Tamil resistance is controlled
by a gro up of militant Tamil youth and sections of the radical Tam il inte lligentsia. Whi le
the TULF continues to cherish hopes of a
negotiated settlement with the non-committal
po litical bac king of the Indian government ,
the potential leadership of the Tamil res istance
conti nues to rema in with the Tamil militants.
Howeve r, any transformation of the present
Tam il resistance into a mo re broad-based
political move ment wo uld enta il a rad ical
change in the class nature o f the leade rship
o f the Tamil libe rati on struggle . This woul d
itself impl y a broadenin g of the soc ial base
of the move me nt and a tra nscending of the
narrow 'ethnicity' and ' nationalism' that have
so fa r been the motive fo rce o f the Tamil
resistance in Sri Lanka .
EXECUTIONS IN INDONESIA
Jakarta 'justice'
The recent execution of a leading trade unionist in Indonesia, after
seventeen years ' detention , has shocked the international community . Elizabeth Marlow examines the background to the case and suggests that a new dimension to military rule has been added .
N 14 MAY the Indonesian military regime
secretly and without warn ing executed
Mohammad Munir , a leader of the SOBSI
trad e union federation lin ked to the Indonesian Communist Party (PK1) . Though arrested
in 1968, he was not bought to court until five
years later . He was then tried under the 1963
Anti-Subversion Law (a d raconian piece o f
legislatio n which makes vi rtu ally everyth ing
potentially 's ubversive' ), fo und guilty and
sentenced to death . T hat was in April 1973.
Since then he had been languishing in jail , fa iling at eve ry level of appeal to have the death
sentence commuted . Eventuall y he declined
to reappeal, and a final appeal from his wife
was also turned down . Then, suddenl y , he
was taken from his cell and shot.
On 19 July reports from reliable so urces
we re received o f the further executi ons , in
East Java in early July , of Rustomo , Gatot
Lestario and Djoko Untung, all prominent
members of the Communi st Party of East
Java . There are some 45 other prisoners from
th e late I 960s still under sentence o f death ,
and these recent exec utions have led to fears
for their lives too, in particular fo r Ruslan Wijajasastra . Like many others the ir 'crimes'
111P r P
tn
h 'll'1t>
h ,:u ;t.n
<"l ,... t ; u o
; ...
t h .-. DVI &... .,.. &',.... _ .,..
ment haEast Timor- by say ing that these are purely
' internal affairs ' . This time , however, the daily newspape rs were full of commentary on
and attempted j ustifications fo r the execution .
Such unu sual sensiti vity to internationa l
criticism may be linked with President Suharto's
wide ly-rumoured inte rest in the leadership o f
the non-al igned movement. Also , one of th e
European resolutions stated that the death
sentences were imposed aga inst Muni r and
othe rs ' because of their political oppos ition
to the military regime which ca me to power
in Indones ia in 1965 by means of a violent
coup ', th e accuracy of which turns the
regime's version o f the 1965 events on its
head , and may be at the heart of Jakarta ' s
di sco mfo rt. The executions of Munir , Gatot ,
Djoko and Rustomo , though , still remain to
be expla ined , for it seems they were not the
first to reach the end o f the appeals procedures.
Of all the political priso ners o f the late
1960s, several hundred are still being he ld .
Many of them face severe problems in the
'judic ial' process, being kept uninformed o f
.. .... ....
.. .. ... .. . . ...
-
I:
.. 1- _: _
____ _ , _
-
.
temple , a majo r tourist att raction in Centra l
Java . There are many , however , who see the
hand of the mil itary in these crimes , probab ly
by infiltrating the Muslim opposition and acting as agents provocateurs .
Through these tri als the regime appea rs
anxious to prove th at ' Muslim fanaticism ' is
about to terrorize the popul ation. T he public
prosecutors , reported uncriticaJly by the press ,
refer constantl y to a ' Holy War Comma nd '
(Komando Jihad) . There is no doubt that there
are well-o rganized networks among the
Muslim opposition. They have mobilized very
large numbe rs amo ng the di saffected population, with the most popular preachers speaking to crowd s numbering tens o f thousands
at a time . Howeve r, not a shred of evide nce
has yet been produced by the government that
a ·command ' - a phrase with clear militaristic
implications-actually exists.
Political trial s
These are political tri als and not criminal
ones. The Anti-Subve rsion Laws are again
be ing used as the basis fo r prosecution . The
judges a re finding the accused guilty of try ing to replace the state ideology of Pancasila
being used as the bas is fo r prosecut io n. T he
judges are findin g the acc used guilty of trying to replace the state ideology o f Pancasila
(Five Principles) with Islam , of arou sing
hatred against the gove rnment , and even o f
denouncing the o ffici al family planning pro-
.
.
.
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excellent - here's
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Good luck!''
- John Pilger
Victor Karunan is an acti vist and writer. This
article is a shortened version of a report
prepared fo r the Research Institute of Oppressed Peoples, Amsterdam .
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POLITICS &INTERNATIONAL AFFAIRS
POLITICS &INTER_NJIIONAL AFFAIRS
reaffi rmed this demand .
While the TULF" s call initiall y ra ll ied
together the you th and students, the post- 1976
period saw the TULF preoccupied with constitutional politicki ng and unable to effectively
resist the state repress ion of the Tamil population, es pecia ll y the militant Tamil yo uth who
took to •di rect act io n· to achieve a separate
T amil state. Increasing di sillu sionme nt with
th e TULF produced a rad ica l shift in the
Tamil liberation struggle: ideologically , from
·separatism ' to ' liberation ' and strateg ically ,
from the ' parliamentary path· to ' armed
st ru gg le ' .
The period 1976-79 saw the emergence of
numerous militant organizations o f Tamil
youth , all pledged to am1ed struggle to counter
state repression , and in the process achieve
a separate Tamil state . In June 1975 the Tamil
Ee lam Libe ration Organization (TEL0) was
set up advocating direct action th ro ugh armed strugg le . In 1976 the Eelam Revolutionary
Organization o f Students (EROS) was set up
in London w ith s imilar objec tives. The next
year , the Liberatio n Tigers of Tamil Eelam
(LTTE) emerged , rallyin g togeth er militant
yo uth and students and iss uing the call fo r
armed strugg le to achieve a 'socialist Tamil
Eelam ' . While the LTTE was ga ining in
popularity for its ·successfu l military actions',
personality co nflicts between its leader ,
Prabakaran , and a close assoc iate , Uma
Maheshwaran , resulted in a maj or split , with
th e latter setting up the People 's Libe ration
Organization ofTamileelam (PLOT) in 1977.
Meanwhile, a major effort at unity was reali zed in 1980 when three gro ups ca me togeth er
to constitute a ' United Revo lutionary Front'
(U RF) : th e Eelam People's Revolutiona ry
Liberation Front (EPRLF) , TEL0 and EROS.
wou ld enta il and what precisely the nature of
the ' Tamil Eelam ' sho uld be , are questions
that have not yet evoked a res ponse from the
Tam il peo ple. The present stage of th e struggle is inevitably orie nted towa rds self-defence
and counter-violence against the Sri Lankan
military power in th e Tamil areas.
The word ' Tigers· has now taken on a
The development of Tamil et hn ic consc ious ness points to definite shifts in direction and strategy . The Tamil people, having
asse rted the ir identity as a minorit y
co mmunity , asse rt a ' collecti ve identity of
Tam il natio nalism ' . This raises the urgent
questio n of how far the ideology of Tamil
nati onalism indicates a revolutionary program me for a fund amenta l transformation of
Sri Lankan soc iety as a whole .
Th e re a re definite str ength s an d
weaknesses of th e Tamil liberation struggl e
th at pose problems for the politica l groups in
terms of a mobili zation towards achieving a
·soc ialist Tamil Eelam' . Firstly , the histo ri c
eco nomi c boycott of the Tamil areas by th e
Sri Lankan government has left the Tamil people with a region of the co untry that remains
too neglected in terms of infrastructure and
industry to susta in any progressive eco nomic
development. The stunted process of capitalist
deve lo pment in these areas has left the Tam il
people without the necessary preconditions for
a revolutionary sociali st transformation and
a 'sociali st Tamil Eelam · . Secondly, the
leadership of the Tamil resistance is controlled
by a group of militant Tamil youth and sections of the radical Tamil intelligentsia. While
the TULF co ntinues to cherish hopes of a
negotiated settlement with the non-committal
political backing of the lndian government ,
the potential leadership of the Tamil resistance
continues to remain with the Tamil militants.
Howeve r , any transfo rmation of the present
With thP I .TTF nrnsrri h e,rl hv thP POVP.rnme nt
n n n11li,t rn nnnt ~tinn in th P T ~ mil rPo in n, nf
Tamil rps ista n rP into a more, hrniirl-h ii secl
country , identify with or support the 'Tamil
Eelam· cause? The political gro up s of the
Tamil liberation stru gg le must be prepared to
grapple with these iss ues .
Shifts in direction
Sri Lankan police.
. . . . . . ...
;~ . . . ,.'.~ . . , , ,
""!"
l'ioam.Chomsky
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EXECUTIONS IN INDONESIA
Jakarta .'iustice'
The recent execution of a leading trade unionist in Indonesia, after
seventeen years ' detention , has shocked the international community. Elizabeth Marlow examines the background to the case and suggests that a new dimension to military rule has been added .
N 14 MAY the Indonesian military regime
sec retl y and without warning executed
Mohammad Munir , a leader of the SOBS!
trade uni on federation linked to the Indonesian Communist Party (PKI) . Though arrested
in 1968, he was not bought to court until five
years later . He was then tried under the 1963
Anti-Subversion Law (a draconian piece of
legislation which makes vi rtually everything
potentiall y 'subversive' ), fo und guilty and
sentenced to death. That was in April 1973 .
Since then he had been languishing in jail, failing at every level of appeal to have the death
sentence commuted . Eventually he declined
to reappeal, and a final appeal from his wife
was also turned down . Then , suddenly , he
was taken from his cell and shot.
On 19 Jul y reports from reliable sources
were received of the further exec utions , in
East Java in early July , of Rustomo, Gatot
Lestario and Djoko Untung , all prominent
members of the Communi st Party of East
Java . There are some 45 other prisoners from
the late I 960s still under sentence of death ,
and these recent executions have led to fears
for their lives too , in particular for Ruslan Wijajasastra . Like many others their 'crimes '
were to have been active in the PKI before
1965 (though it was then a legal organization,
even including cabinet ministers), and attempting to revive the Party after it had been banned by the military .
It took the Indonesian government two
weeks to confirm Munir's execution, and at
the time of writing the execution of the others
has still not been confirmed. However, news
of them abroad, and fears that others were in
imminent danger, spurred many outside Indonesia into lodging protests with the Indonesian government. Most significantly , two
resolutions were passed in the European
Parliament on 13 June condemning in the
strongest terms Munir's execution . The timing of the resolutions co uld not have been
more unfortunate for the Indonesian government , coming just before the arrival of an
annual delegation to the European Parliament
from the ASEAN parliaments, headed by
Kharis Suhud , the deputy speaker of the Indonesia n parliament.
International outcry
The row in Europe led to an uncharacteristically angry and public response within Indonesia . Until recently the Indonesian govemSeptember-October 1985
mem had brazeneo out embarrassi ng issuessuch as its co ntinuing problems in pacifying
East Timor- by say ing that these are pure ly
' internal affairs'. This time , however, the daily newspapers were full of commentary on
and attempted j ustifications fo r the execution .
Such unu sual sensitivity to international
criticism may be linked with President Suharto's
widely-rumoured interest in the leadership of
the non-alig ned movement. Also , one of the
European resolutions stated that the death
sentences were imposed against Munir and
others ' beca use of their po litical opposition
to the military regime which came to power
in Indonesia in 1965 by mea ns of a vio lent
coup ', th e accuracy of which turn s the
regime ' s version of the 1965 events on its
head , and may be at the heart of Jakarta' s
disco mfort . The executions of Munir , Gatot,
Djoko and Rustomo , though , still remain to
be explained, for it seems they were not the
first to reach the end of the appeals procedures.
Of all the political prisoners of the late
I960s , several hundred are still being he ld.
Many of them face severe problems in the
'judicial ' process, being kept uninformed of
the status of their appeals, not obtaining
remission , or not eve n being released long
after the due date .
New scapegoats
It appears that a new generation of political
detainees is being created, this time from
among the Muslim opposition to the military
regime . The scale of this crack-down is only
just coming to light , with courts throughout
Java and in Sumatra currently hearing cases
against scores of such defendants .
As a result of these new show trials ,
reminiscent of those of the 1970s against the
left , lmran and Salman Hafidz have already
been executed. Azhar bin Mohammad Safar,
Bambang Sispoyo , Abdullah bin Umar , and
Timzar Zubil all await the firing squad . Others
have received the full range of sentences;
many more-probably several hundredawait their turn before the courts.
The crimes many of these Muslim
prisoners are charged with are serious : hijacking a plane to Bangkok in March 1981 , the
murder of two men , and several bombing attacks including one on a bank owned by a
leading Indonesian Chinese financier close to
the President, and another on the Borobudur
INSIDE
ASIA
temple , a major tourist attraction in Cent ra l
Java. There are many, however , who see the
hand of the military in these crimes , probably
by infiltrating the Muslim oppos ition and acting as agents provocateurs.
Through these trials the reg ime appea rs
anxious to prove that ' Muslim fanatici sm ' is
about to terrorize the population . The public
prosecutors, reported uncritically by the press,
refer constantly to a 'Holy War Command '
(Komando Jihad). There is no doubt that there
are well-organized networks among the
Muslim opposition. They have mobilized very
large numbe rs among the disaffected population, with the most popular preac hers speaking to crowds numbe ring tens of thousands
at a time . However, not a shred of evide nce
has yet been produced by the government that
a 'command ' -a phrase with clear militaristic
implications-actually ex ists.
Political trials
These are political trials and not criminal
ones . The Anti-Subversion Laws are again
be ing used as the basis fo r prosecution . The
judges are finding the acc used guilty of try ing to replace the state ideology of Pancasila
being used as the basis for prosec ution. The
judges are finding the accused guilty of trying to replace the state ideology of Pancasila
(Five Principles) with Islam, of arousing
hatred against the government, and even of
denouncing the official family planning programme . Others have been sent down me re ly
fo r ' insulting the President ', or for distributing
leaflets and cassette recordings of speeches
which challenge the army's account of events
during the riot of 12 Septembe r 1984 at Tanjung Priok in north Jakarta, when the army
fired on unarmed demonstrators, killing over
sixty and seriously wounding over a hundred .
Twenty-eight of the wounded were themselves
charged with · waging violent resistance· . and
sentenced to one to three years' imprisonment.
To the 'communist threat ' of the past two
decades has been added the ' Muslim threat' .
The government's version is that it is trying
to steer a course between ' left-wing extremism·
and 'right-wing extremism· . But it is by these
means that the Indonesian military attempts
to justify continuing to impose its will.
October 1985 marks the twentieth anniversary of the military takeover in Indonesia,
with General Suharto continuously in power
since that time. Some, especially the Western
governments, talk of this as twenty years of
·stability '. Others would argue that the
political and humanitarian costs have been
excessively high-and may yet soa r even
higher.
15
POLITICS & I
THE MAKING OF
FOREIGN POLICY IN CHINA
ASEAN AND INDOCH/NA
by A. Doak Barnett
A systematic analysis of the process and structure by
which China's foreign policy is made, drawing on
extensive research by one of the West's foremost China
specialists. Essential to understand ing Sino-Soviet and
Anglo-Chin ese relations as well as China's role in the
Third World.
ISBN 1 85043 008 X
£16.95
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''It ~sren years since theKhm er
A MIRROR FOR SOCIALISM
RouJe seizeo/, JJ~Qi,i ) Kampu2
\ hea
and lnstitutetd a reign '()f terror and
brut4lit y tlufr·sfiockedjhe wo~ 'd. ''
Soviet Criticisms of China
by Gilbert Rozman
The author's exhaustive research shows how the issue of
"China" is being u sed by Soviet officials and intellectuals
as a vehicle for traditionalis ts and refo rmists to debate the
future directions of Soviet socialism. An original and
highl y significant contributio n to und erstanding the
political trend s within th e Soviet Union and the
Communis t world.
ISBN 1 85043 004 7
£24.50
This b'rk tells~ e--story~
-young stud/nt,
Bunheang ~g, who lived ttiroug!J th,
It is ill~ated with his drawings.
The Murderous Revolution by Martin Stuart-Fox.
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LINKS issue 22 • September 1985
DYIN G ,FOR PRO FIT
1,
THE REAL CAUSES
OF FAMINE IN AFRICA
This issue of Links demolishes the view that famine is
a natural disaster. Authors with a variety of viewpoints
look at what is happening today in sub-Saharan Africa and
conclude that it is human economic and political systems
that are at fault, not the climate. Authoritativ ely written ,
it includes articles by Keith Griffin, head of an ILO team
which was invited by the Ethiopian governmen t to report
on the country's economy, and a woman fighter in the
Tigrayan People's Liberation Front.
£1.50 (incl. p&p) from Third World First, 232 Cowley Road ,
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16
INSIDE
* Nuclear Disarmam ent; Nuclear Winter
* Political Murder In New Caledonia
* Constitutive Abstractio n and Social Practice
* The Death of Liberal Imperialism
* Reflections On Meanjin
* For A Free West Papua
* Political Economy of Mining
* Computer Culture
Arena is $5.50 Aus posted for single issues or $16
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ISSN 004-0932, indexed in APAIS
ASIA
September-October 1985
Asian dra ma unfolds
Anti-colon ial sentimen t once linked the divergent nationalis ms of South
East Asia, but now the region is dominate d by the hostility between
Indochina and the ASEAN states. Above all, South East Asia has
displayed a talent for confound ing prophecy ! Ben Kiernan examines
the missed opportun ities for regional cooperati on, and dares to make
a few prophecie s of his own.
T
EN YEARS ago few people would have
predicted that such diverse countries as the
Soviet Union, China and Papua New Guinea
might have agreed on anyt hing at all. Even
fewer would have predicted that they would
agree in support ing a New Zealand stand prohibiting v isits by nuclear-armed ships. even
allied ones. to New Zealand ports . This has
provoked considerable US animosity. which
in turn provoked Papua New Guinea's
Foreign Minister to make the unprecedented
remark th at Washington was acting like ·a
reckless bully·. Change can be dramatic in deed in a historically short period of time .
Likewise. however . few would have
predicted in 1975 that the Indonesian Foreign
Minister would ten years later be urging
Washington to establish diplomatic relatio ns
with Hanoi as a means of countering Chinese
pressure on Vietnam. Not many people would
have thought in 1975 that American pique and
bloody-mindedness would last a decade and
that it wou ld still in 1985 refuse to exchange
embassies with its victim turned conqueror.
Neither would many have expected Indonesian suspicions of China to so persist after the
death of Mao and the subsequent revolutionary changes in Beijing, yet Jakarta
declines even today to establish an embassy
there. Con tinuity can also seem dramatic.
And who in 1975 would have believed that
1985 would see th e apparently amazing thaw
in Sino-Soviet relations, following the death
of President Chernenko recently? The Chinese
Vice-Premier even described the new Sov iet
leader as 'Comrade Gorbachev·, the first time
for many years that any contact has occurred
between the two giant communist parties. Furth er, as another Ch inese offic ial pointed out:
•At first after the spli t we called th em revi sion ist. then socia l-imperialists, and for the
past few years we have ca lled them a superpower.· ·A great socia list neighbour· was th e
term used by the leader of the Chinese delegation to Chernenko ·s funeral in Moscow. to
describe the USSR a short tim e ago .
The past decade has also seen the demise
of two major alliances in th e region. In 1975
there was the collapse of the South East Asia
Treaty Organization (SEATO) , and in 1985 ,
September-October 1985
change and continuity. In the past decade
Kampuchea has had three regimes , with two
dramatic upheavals in 1975 and 1979. After
the first communist ' liberation ', the Far
Eastern Economic Review published an
analysis predicting that 'as in Laos, th e Russians will move slowly into Cambodia at the
heel s of the Vietnamese ' (7 May 1976) . This
in fact occurred only three years later and not
the ANZUS (Australia. New Zealand, and the
slowly at all. An invasion had proved
United States) Treaty. The United States was
necessary to establish Vietnamese and Rusth e major power behind both alliances. And
sian influence. Events in Kampuchea have
it now appears th at the USA, as well as the confounded many analyses over the years
and
countries of the region, will have to adapt to
in this instance th e author could not have been
th e medium-term entrenchment of Labour
more inaccurate about the affiliations of th e
gove rnment s in both Canberra and WellKampuchea n leadership in 1976. ' Th e
ington , somthing not easily predictable in the
hardliners and the pro-Hanoi faction have won
wake of the anti- labour election debacles of the struggle' was not a good description
of
1975 .
the consolidation of what became known as
• Democratic Kampuchea'. It was indeed a
Continuity and change
hard-line regime , but it also massacred ' proFor South East Asia the most important issue
Hanoi· Khmers and launched murderous atof the past decade has been the Kampuchea
tacks on Vietnam. even tually provok ing a
conflict, a conflict which has given li fe itself V ietnamese invasion ; only after th at did
th e
to the Association of South East Asian Napredicted Soviet foothold take shape.
tions (ASEAN)- or at least tran sformed it
More important continuities include the
from a reg ional mailbox to a political bloc of presence of Vietnamese troops in Kampuchea
world significance, with six members :
in 1985 , just as Vietnamese forces (from both
Malaysia, Indonesia , Singapore , Thailand , the
the northern and southern reg imes) occupied
Philippines and Brunei. The Association of Kampuchean territory in the early I 970s.
South East Asian Nations has deve loped in
The rest of South East Asia , which
this way largely by means of repelling and
escaped pulverization by the American
isolating three other Southeast Asian nations :
military machine and has also managed so far
Vietnam , Laos and Kampuchea.
to avoid communist revolutions , has seen over
The Kam puchea issue symbo lizes both
the past decade remarkable economic develop-
'hi Minh-one of Asia's postwara,fricolonial leaders, still revered today.
INSIDE ASIA
17
POLITICS_& INTERNATIONAL AFFAIRS
LITICS &INTERNATIONAL AFFAIRS
-
ment for some and di sillu sioning material
paupe rization for others . Po litical movements
have ri sen and fa llen in consequence .
Political pluralism
11
One o f the most dynamic economies in the
reg io n is that of Tha iland , which desp ite
mil itary rule has witnessed the most signifi cant democratic advances- in parti cul ar , a
reaso nably free trade union movement and
press despite the murders of 4 7 investigative
journalists. It is also a country of widesp read
child labo ur , where health authorities are c0ncerned about serious malnutrition amor.g half
th e country's chi ldren, and only 30 % of the
population has a safe water supply.
After the 1976 mili tary co up in Bangkok ,
the e xod us of ed ucated activists to the jungle
looked set to make the unde rgrou nd Commu nist Party of Tha iland (CPT) a rea l conte nder for powe r. Few wo uld have pred icted
the extraordi nary dogmatism of the proChinese CPT leaders that sent most of the new
recruits back to Bangkok in disg ust by 198 1,
virtuall y ec lipsi ng the C PT as a real political
oppositio n. The Party rema ins outlawed , but ,
with the fo iling of last yea r's push fo r increased powers on the part of the military, the re
are so me grounds fo r optimism concern ing
social and political plu ra lism in Tha il and .
The Philippines , home of Magsaysay , was
once the showpiece democracy of So uth East
As ia , and ten years ago , despite having come
under marti al law in 1972, its economic prospects looked extreme ly bright. It was one of
As ia ' s New ly Indu stri alizi ng Co unt ries
(NICs) , a developmentalist concept that seems
to have relegated to a po litical m useum the
o lde r rad ical noti on, dear to the fo rmer Indonesian President Suka rno , o f the New
Eme rgi ng Fo rces (NEFOs). But the Philippine econom ic bubble has burst , and political
reasons seem to have co ntributed to the outcome : the Marcos reg ime appears to be increas ingly repressive as it loses its grip on the
social fo rces o f the nation , whil e the ' proC hinese • Communist Party of the Philippines
has demonstrated greate r fl ex ibility than its
Tha i counterpart .
The military ' s assass ination in 1983 of the
oppos ition leader Benig no Aquino, like the
brutal military coup in Bangkok ten years
earlier, was a political disaster fo r the government and a windfall for the communist movement. Unlike the C PT , the Philippine New
People ' s Army (NPA) has doubl ed its fo rce
levels since 198 1, and now boas ts an army
o f 15 ,000 activ e in at least half the country's
73 provinces. Recently the two stalwarts of
ASEAN governments, Suharto of Indonesia
and Lee Kuan Yew of Singapore, expressed
' very great concern' to the Philippines government at the rising tide of NP A fortunes in
one o f the major countries o f the reg ion. And
a promine nt Filipino Cabinet Mini ster has
concurred , notin g that the insurgency is growing beca use its root causes are ' right he re
whe re we a re'. ' The most visible ex pression
18
Souphanouvong of Laos .
of state power is pe rceived as be ing used
aga inst a helpless pop ul atio n'; th is only increases popula r support fo r th e NPA
rebell io n . Accordin g to hum an ri g hts
organizations mo re than 380 Filipino civ ilians
we re gunned down by govern ment forces in
1984. As the head of the country ' s biggest
m ining company put it; th e ' g larin g reality'
is that ' brutal repress ion, rampant co rruption
and lac k o f principle .. . have been the principal
reaso ns for the alarm ing growth of the New
People's Army in recent years .'
It seems th at ten yea rs afte r the Vietn am
War ended , anoth er Vietnam is bre wing just
across the So uth Chin a Sea from the last one .
O ne o f those who , a lo ng with Suha rto and
Kuan Yew , ex pressed co nce rn about th e
Phil ippines was Henry Ki ssinge r. Further,
Lee Kuan Yew , acco rding to Asiaweek , invited Ki ss inger to a d iscussion in Singapore
beca use he ' rec koned the Ameri ca n' s vi ews
on Cambodia .. . would be useful ' . And now the
US Co ngress wants to prov ide military a id to
Kampuchea ' s ant i-co mmunists, on the tenth
anni versa ry o f the ir de feat.
the United Nati ons in favo ur of Indo nesia 's
forc ible anne xatio n of East T imor . T here is
still , in South East As ia , o ne law fo r frie nds
and a noth e r fo r o ppo ne nt s. Bu t th is
phenomenon is by no means limited to Sout h
East Asia.
Silence echoes
Perhaps the two most signi ficant features
of the document are firstly , its advocacy
of a United States or federation of the
countries of South East As ia.. and
secondly that the memo is a j oint document ... Presen t hostilities between the
V ietnamese and the French are likely to
spread and .. .Free Laos and Free Cambod ians may be expected at any time to
j oin in attac ks on the French, feeling that
present developments furnish an opportunity of ac hiev ing their aspi ra tions by
fo rce. The result therefo re may well be
that virtu all y all of Indochina w ill be
engulfed in vengeful strife, which will
further embitter relations between the
nati ve peoples of Indochina and the
French and result in general chaos. It is
also conceivab le that neighbouring countries in South East A sia may become
either directly or indirectly in volved . It
is ce rtain that the sympathies of such
neighb o urin g co unti es as Siam
1985 is a lso the tenth anni versa ry of th e Indones ian invas ion of East Timor, in December
1975. Since the n a lmost one- fi fth of the
T imorese po pulation has perished . Although
th e te rritory is much smalle r, the death to ll
is proportionally simila r to that under Pol
Pot' s regime (st ill recog ni zed by Jakarta).
Rece ntly the leader of the majority Timorese
Catholic faithful called on th e outside wo rld
to help his country ac hieve self-determination.
But few ears we re listening , for Indones ia is
o ne of the Western world 's mos t impo rtant
a llies. Silence echoes aro und the ASEAN
countr ies also; Malays ians who claim that the
principle of non-intervention must be resolutely applied in the case o f Kampuchea , in order
to ga in it international respect , have long
fo rgotten that Kuala Lumpur always voted in
INSIDE
ASIA
Regional co-operation
O n 7 Ja nuary 1947 , the American diplomatic
representative in Thailand cabled his Sec retary
of State in Washington, in fo rming him of a
note that had rece ntl y co me into hi s possession. It had been handed to his military attac he by a Lao prince , Souph ano uvo ng (who
became Pres ident in 1975). He had hoped the
US gove rnment wo uld pass the doc ument on
to th e Sec retary-Genera l of the United Nations. The doc ument was signed by the
represe ntativ es o f th e Lao, Kampu chea n
(Khme r lssarak) and Vietnamese (Viet Minh )
independ ence movements, th en loc ked in a
mil itary strugg le w ith French coloni alism .
The summary provided by th e US
representati ve , Edwin Stanton , who thought
th at the document was a signifi cant one , read :
September-October 1985
(T hai land) , Burma. Malaya and Indonesia lie wi th the Vietnamese. Laotians and Ca mbod ians. Serious and
widesp read contl agration in Indochina
is therefo re a matter which may very
definitely affect the peace of South East
A sia. In those circumstances it appears
to me th at the si tuat ion in Indochina is
one which very defi nitely comes within
the purview of the UN .. . It also ra ises
the question of what if anything the US
could do by way of offe ring its good offices to assi st in prevent ing the spread
of hostil iti es and in the wo rking out of
a j ust and equitable solu tion. It is
th erefore my ea rnest hope th at the
Department will give this whole problem
its most ca reful consideratio n . ..
Washi ngto n dec lined to do so . The State
Departme nt ' s reply was: ' You should ... return
the docume nt in question.' The US had taken
its dec ision- a fat e ful one fo r South East
As ia- to ba nk ro ll French co lo nia lism in Indochina. Ma ny of America ·s natu ra l allies and
many de mocratic po litic ians in South East
Asia we re thu s left out in the cold , and others
who had been amenable to good relations with
th e US . suc h as Ho Ch i Minh and the Viet
Minh, we re fo rced to re ly increas ingly on
C hinese aid . The tensions res ultin g from that
process are still ev ident ; in fac t they fuel the
reg ion· s major wa r.
St a nt o n a lso no te d th a t Prin ce
So uph a nouvo ng hoped to be able to oust the
French from Laos and place on th e th ro ne a
nationa list. ·possi bl y Prince Phetsarath'. Now
Prince Phetsarath - never a communist like
Souphanouvo ng- has le ft his ow n reco rd o f
th ese yea rs. inc luding so me interesting
re ma rks about th e community of fee ling that
was abroad in South East As ia at th e time.
He says th at. like Laos,
V ietnam . Cambod ia. Burma and Indonesia we re also thinking of national
liberation .. .Since the national liberation
move ments of the fi ve countries com-
September-Ocrober 1985
ASEAN foreign ministers: divided over how to fa ce Vietnam.
pe ted in the purc hase of gun s.
[agreement was reached whereby ] i f any
of the countries found weapons sources.
they would be the sole buye rs and others
woul d not compete. When their needs
were met. the other countries woul d
buy. Countries without money would be
helped [by the others] .
All this was decided upo n at ·a sec ret meeting
of rep rese ntati ves of the fi ve co untri es·. ac cord ing to Phetsarath.
And on the mai nl and at least. the re was
a ·south East As ian· fl avour to the wa r agai nst
the French . Kampuchea (und er Son Ngoc
T hanh . late r a US protege) and Thai land
(under Pridi Phanomyo ng. late r a C hinese
protege) we re amo ng th e fi rst co untries to
establish d iplomatic re lati ons w ith th e Vi etnamese communist gove rnment afte r it was
established in Hano i by Ho C hi Minh on 2
Septembe r 1945 . In 1946 . Prid i sec retl y provided Ho with twenty tonn es of ca rbines
which had bee n give n to the Free Thai movement by th e US gove rnme nt during Wo rld
War T wo . In th e second halfof 1947. French
inte ll ige nce reported th at combined LaoVietn amese un its had establi shed sanctu aries
and bases in both of Kampuchea·s north wes t
prov inces. wh ere th ey were soo n jo ined by
400 Thais. led by a suspected communist. who
had fl ed the ir country a fter th e Nove mber
1947 anti -Pridi military co up the re .
Political settlement
The re is a good deal o f irony in all thi s . Ca n
th e spirit o f reg ional cooperati on that
developed in th e fir st flu sh o f anti- colo nia l
awakening . ever be recovered now th at th e
South East Asian count ries are all free of
Weste rn dominance? Othe r post-colo ni al experiences suggest th at it is unlikely. But one
feature th at distingui shes the currently deep
reg ional di visio ns over Kampu chea from th e
conflict over Afghanistan , fo r instance , is that
a ll sides a re se rio usly talking . The obstac les
to a se ttl e ment are not ones o f princ iple. they
INSIDE
ASIA
conce rn th e te rm s. And th ere has bee n progress . at least among the South East As ian
parties to the di sp ute .
Nea rl y all the facto rs mentioned th at have
marked the last decade of deve lopments in
So uth East Asia are capable of promoting a
regio na l reconc il iation that wo ul d guarantee
se ttl ement o f the Ka mpu chea dispute. Th is
does not mean a political settl ement is inev itable or imminent. But each fac tor militates
in fav our of one. The Sino-Sov iet thaw
red uces C hina · s interest in pursui ng confl ict
with Vietnam , and at any rate the decline of
th e C PT red uces C hina's ab ility to influence
T hailand by wav ing the CPT ' sti c k' . O n the
other hand th e ri se of the ·pro-C hinese· NPA
in the Philippines is suffi c ient to strengthen
th e anti -Chinese conce rn s of Singa po re and
Indonesia . countri es which do not recogni ze
Be ijing . The collapse of the America n trea ty
relationships in th e region red uces the us ·s
ability to • isolate Vietnam· . whil e the ri se o f
Labo ur gove rnments in Austra lia and New
Zea land . both wi th strong anti - Po l Pot
reco rd s. strengthens th e independence of
medi ating fo rces . And the strengthenin g of
ASEAN as a bloc . eve n tho ugh it was occasioned by the conflict itself. will have the long
term effect of enh ancing a regio nal foc us
among its membe rs. and so fos tering reco nc iliatio n with Vi etn am .
The re a re other , mo re immedi ate fac tors
as we ll . These inclu de Vietnam 's pro pensity
fo r making d iplomatic concess ions even whil e
it is sco rin g military victo ries.
Ben Kiernan is posr-doctoral Fellow al rh e
Cenrrefor Sourh Easr Asian Studies ar Monash
University, Melbourn e. He has wrillen exrensively on Kampuchea and his fares/ book How
Pol Pot Came to Power (Ve rso) , has jusr bee11
published.
Note
I . See illside Asia Nos. 2 and 3/4 .
19
SOCIETY & CULTURE
SOCIETY & CULTURE
clear political goal of act ing as a 'vehicle to
promote national stability and integration ' . In
Irian Jaya the reverse has occurred , as transmigration has exacerbated local dissent: a
number of the Melanesian refugees who fled
across the border into neighbouring PNG last
year complai ned about the threat that land acquisition for transmigration had caused to
local culture .
Target transmigration populations in rural
Java /Bali are identified by the department in
Jakarta in conjunction with local officials. The
advantages of leaving home are explained at
some length, with emphasis placed on how ,
often for the first time in their lives , transmigrants will own land on a freehold basis.
As a result , settler communities volunteer for
the scheme unlike in former days; in the late
I 960s, Time magazine wrote that settlers were
being sent into trackless zones with little more
than an axe and a government exhortation to
grow rice . Now transmigratio n sites are
cleared prior to the newcomers' arrival,
houses built and anc illary services such as
schools and medical clinics laid on. The settlers are now airlifted by Lockheed Hercules ,
a company whose local agency is owned by
a re lative of Indonesia ' s president , General
Suharto (during court hearings into the
' Lockheed scandal' in the US in the 1970s it
was revealed that the president had intervened
persona ll y in the case).
INDONESIA'S RESETTLEMENT SCHEME
Settling for trouble
Financial support
of the central government's deve lopment
allocation; in Kalimantan 34 %; and in
Sulawesi (formerly Celebes) 25% .
On the surface , the sc heme looks
appealing-it must be to have attracted such
support from international bodies. Java and
Bali together account for only 7% of Indonesia's
total land area but have 65% of the country's
140 million people. Further, the population
increase remains alarming, despite active promotion of the official birth control programme. Yet according to a projection released
in April by the chairman of the National Family
Planning Coordinating Board , Dr Haryono
Suryono , Indonesia's population wi ll be between 208 million and 250 million in the year
2000, depending on the programme's success .
Up to 1989 , some $600 million of international funding has been made avai lable to
Indonesia for the programme. Among the
major donors are the World Bank , the Asian
Development Bank, the Islamic Development
Bank, the EEC, the UN Development Programme, and several major western countries
(including USA , France and West Germany).
In addition, Indonesia will allocate significant
proportions of its own budget towards the
scheme. For example in 1978/79, transmigration expend iture in Sumatra represented 23%
One of the transmigration's aims is to provide
a 'breathing space ' on Java until the longer
term birth control measures can take effect.
Another, obviously, is to better the settler's
lot. In addition , the scheme is justified for it
helps spread development to the outer provinces by providing an agricultural labour
force more skilled than local people; this is
especially important fo r plantation crops such
as oil-palm, cocoa and rubber. It also has the
Indonesia's 'transmigration' programme has been described as the
largest voluntary land settlement scheme in the world. But the people
in the outer islands where the transmigrants will make their new lives
are far from happy. Robin Osborne looks at what has become Indonesia 's most controversial development policy.
VEN IN THE DUTCH colonial period,
Indonesia's most crowded island, Java,
was seen as a population time bomb; so, early this century some 200,000 rural Javanese
were moved westwards to Sumatra. This first
wave of transmigration had an added advantage: the 'coolies' provided a cheap source of
labour for the colonial plantations. It was felt
that they were superior farme rs to the local
people and less likely to cause trouble. There
are, no doubt, some parallels with Indonesia's
rationale for contemporary transmigration .
The modern programme has larger targets
and budgets than its colonial predecessor.
Under Indonesia's current five year development plan, Repelita-IV ( 1984-89), transmigration of up to three and a half million people
from Java (including Madura island) and Bali
to the outer islands is planned. Sumatra is no
longer the prime target area as it is fe lt migration there is likely to cause severe social fric-
E
20
tion . Already there have been protests from
local farmers who resented the influx of
Javanese in Lampung province, in south
Sumatra. It is the less crowded provinces of
Kalimantan (Indonesian Borneo) and lrian
Jaya (West New Guinea) which have been
earmarked to accept the major shares.
INSIDE
ASIA
Unintended result
September-October 1985
appeal, Java containing 690 people per square
kilometre, Kalimantan only twelve and Irian
Jaya three. But major problems have been presented by the logistics of trying to settle large
numbers in places where local terrain is harsh
a nd indigenous populations often hostile to
receiving immigrant influxes. These impediments have seldom been explained
thoroughly to the Javanese settlers , with the
resu lt that when they emerge from their
Hercules they are not always pleased to see
what confronts them: thick jungle, in the case
of Kalimantan , and both jungle and inhospitable Melanesians in the case of Irian Jaya . •
International interest
Military presence
At the conc lu sion of their journey ,
transmigrants are given 3.5 ha of land
(originally it was 2 ha, later 4-5 ha), most of
it cleared and ready to plant food and cash
crops . They also receive free food for a year ,
as well as tools, seed, fertilizer and a fuel
ration if firewood is not readily available.
Recently emphasis has been placed on
group ing transmigration projects around areas
deemed appropriate fo r large-scale plantat ion
cropping , usua lly as part of the state-run
nucleus estate and smallholder programme
(NES) . Under this sc heme, transmigrants
have the chance to sell their labour , thus
augmenting their subsistence lifes tyle .
Overseas bodies have shown interest in this.
For example , the British-fin anced Commonwealth Development Corporation has provided
'soft loans' for a transmigration-associated
cocoa estate at Ransiki, on Irian Jaya's north
west coast, which will supply the raw product
to the CDC-initiated choco late factory, P.T .
Ransiki , nearby .
By promoting endeavours of this kind , albeit in the enclave mode, the government
hopes to attract what are known as spontaneous migrants (spontan) who wi ll travel to the
ou ter provinces al their own expense. These
larger projects ca n accomodate up to 2,000
settlers. The smaller sites average a few hundred people .
When analysed on the basis of comparative
population density, the government-backed
decentralization plan would seem lo have great
Equally disconcerting for the settlers is the
military presence which accompanies them at
most of the remote sites. Without the attendant
army, many more attacks wou ld occur than
c urrently do; as it is , transmigrant centres in
lrian, especiall y along the PNG border, are
imbued with a seige mentality : at night,
beyond the perimeters, lurk the guerrillas of
the OPM (Free Papua Movement) whose main
goal, short of an independent 'West Papua ',
is to end transmigration to the province. Since
the transmigration to Sumatra was scaled
down two years ago , the surplus has largely
been allocated to lrian ; in the previous
Repelita plan, this was targeted to receive 7%
of the national total . It is now earmarked to
receive around 20% by 1989; a total of
137,000 fami lies , or about 680 ,000 people.
While the target is unlikely to be met
(s hortfalls have become a hallmark of transmigration Indonesia-wide, due to inefficiency,
the poor identification of sites and the high
cost- up to $ 15,000 per family) , the Melanesians of Irian are deeply offended at the
government ' s openly declared policy of matching, then surpassing, the indigenous population (of just over one million) by the time that
two more five-year plans have expired. They
suspect that the aim is not so much to help
so lve Java ' s problems-and even if it were,
they would be unsympathetic-than to swamp
the locals. Ever since the territory passed from
Dutch hands to Indonesian in 1962 - 3, the
people have harboured hostility towards the
September-October /985
INSIDE
ASIA
-
Asian race from the west.
Across the border in PNG, similar sentiments have been expressed. One vocal critic
of transmigration was PNG's former deputy
prime minister, Iambakey Okuk , who described the settlement as 'inhumane ' and akin
to ' cultural genocide' . Indonesia was relieved when the government of Sir Julius Chan ,
and Okuk with it , lost office in 1982.
However, even the present Somare government recently has been less than diplomatic. During the height of the refugee crisis
last year , acting foreign minister, Tony
Siaguru , urged that PNG should intercede
with Jakarta to ensure that no Melanesians
were being dispossessed of their land. In so
doing , he raised the key issue of how land was
being permanently alienated there. In Melanesian custom, land is owned by the clans in perpetuity. In accordance with custom, it cannot
be sold or transferred on a freeho ld basis.
Land may only be leased in the short term.
Indonesia' s disregard for the Melanesian
belief that land can be 'in use' even when it
is uncleared has also caused friction. The problem is that Indonesian law does not recognize
the rights of societies which traditionally hunt
in the fores ts o r prac tise swidden agricultu re
(which some of those in Irian do) .
Wooing the 'translocals'
In an attempt to overcome some of the conflict , the government, in accordance with a
presidential decree, has ruled that up to 25 %
of places in transmigrant settlements should
be reserved for local people- 'trans locals'
they are called. But there has been Iittle
e nthusiasm for the idea , particularl y from
those who have been forcibly removed from
their clan land and then faced with the double
insult of being told to move back again.
By the beginning of 1985, about 70,000
transm igran ts had been settled in Irian Jaya,
joining some 150 ,000 non-Melanesian spontaneous migrants . About 760,000 ha of land
had been claimed for the sc heme, much of it
along the 760 km border zone wi th PNG .
Local Papuans as well as foreign observers
strongly believe that the prime aim has been
to create a 'cordon sanitai re' along the border
21
111
SOCIETY &CULTURE
E SOCIETY &CULTURE
which will inhibit the movement of OPM
guerrillas, although the government deny this.
It is also felt that the newcomers have included
many former military men and their families.
Said the OPM 's northern commander,
James Nyaro , in 1984 : ' Don ·t think of these
settlers as ordinary civilians. They are trained
military personnel disgu ised as civilian
settl ers'.
There is no doubt that the publicity ari sing
from transmigration's impact on lrian has
placed the whole scheme , Indo nesia-wide,
under an increas ingly critical spotlii;ht.
Resea rchers in Jakarta, including some close
to the government , have raised doubts about
the cost effectiveness of the programme and
the dangers inherent in alienating local populations. Even the fo rmer military commander
of lrian, Brig-General Sembiring, has expressed
concerns to his superiors in Jakarta, and urged
a slowing down of the numbers. His view was
recently echoed by the new commander, LtGeneral Kahpi , who listed transmigration as one
of the 'eight basic problems' affecting the provi nce at present.
Government unperturbed
However, the government's determination to
press ahead was repeated in April by transmigration minister Martono while laying the cornerstone of a new Transmigration Ministry in
Jakarta's Kai ibata district. Referring to recent
criticism of the scheme by a team from
Yogyakarta 's Gajah Mada University, which
had just returned from a fact-fi nding tour of
lrian , the minister said it was 'the right of
everyone to agree or disagree with the government programme' but added that the scheme
would proceed as planned . He said that one of
the main impediments was the language barrier:
most of the ' Irianese' were unable to speak the
national Indonesian language and so could not
communicate well with the settlers.
Signifying that settlement in lrian had been
stepped up recently , Martono said that I0 ,000
people moved there in the financial year from
early 1984-85 , representing nearly 15 % of the
achievement in the past decade. He also mentioned that transmigration wou ld be extended
to Indonesia's 'youngest province', East Timor,
which was annexed by force in 1975. Some
hundred fam ilies from Java had already been
resettled there and more are moving in on a
regular basis.
Foreign concern about transmigration has
been allayed to an extent by a recent tour of
sites (in Sumatra, nor troubled lrian nor
Kalimantan , where tribal people and primary
rain forest are also coming under threat) by nine
ambassadors from Jakarta and staff members.
The Swedish an1bassador, Ame Lellki, said he
was most impressed by the project at Batumarta, Sumatra, which had been aided by World
Bank money . At this site, each fam ily had
received one hectare of land planted with rubber trees in 1978. The 4,500 ha estate is run
by a government company. The transmigration
tou r, which was also accompanied by officials
from international fund ing bodies , was held in
response to questions raised about transmigra-
tion by Indonesia's overseas backers.
Support and opposition
Less qua lified support was raised last year
when, according to Indonesian officials, several
African embassies in Jakarta asked fo r experts
to be sent to their countries to advise on how
the programme could be implemented there.
However, the scheme has been unsuccessful
in the eyes of non-governmental organizations
such as Survival International and the Minori ty
Rights Group (New York). The latter has sent
a long letter to World Bank president A. W .
(Tom) Clausen, a friend of Ronald Reaga n,
aski ng him to explai n the apparent inconsiste ncy of the bank' s publication, Tribal
Peoples and Economic Development , and the
bank ' s funding of Indonesia's transmi gration
policies, whi ch seem to have had the opposite
of the desired effect , namely to be protecting
the rights of tribal populations. The gro up
urged Clausen to withdraw the bank 's funding
as far as lrian Jay a was conce rned.
Signs are that Indonesia will not be
prepared to back down from its present stand ,
and if foreign observers continue to judge
tra nsmigration by the showpiece exam ples in
Sumatra , Jakarta may be able to keep its
important backers on its side .
Robin Osborne is a freelance journalist and
author of Indonesia's Secret War-The Guerrilla Struggle in Irian Jaya (George Allen &
Unwin) . He was formerly press secretary to
PNG 's former PM, Sir Julius Chan.
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MALAY PEASANT CONSCIOUSNESS
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22
Classical marxist question: under what circumstances do peasants attempt to resist exploitation?
Although race permeates most aspects of Malaysian life, Zawawi
Ibrahim argues that class consciousness can still develop among the
peasantry. In a major theoretical contribution to the debate on ethnicity he suggests that peasant values and norms could be liberating.
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INSIDE
ASIA
-
September-October 1985
ALAYS STILL CONSTITUTE the
bulk of the peasantry in multi-racial
Peninsular Malaysia today . In a country once
torn by bloody racial riots, it is almost impossible to discuss the nature of peasant ideology
and consciousness in Malaysia without taking
into account that its peasantry lives in a society
where ethnicity permeates almost every facet
of social life .
There are, of course, various reasons why
Malay peasants normally view their problems
and the world around them in ethnic terms .
Some of the fundamental causes are historical.
Under British colonial rule. though many of
the non-Malay immigrants (Chinese and
Indians) were exploited as cheap proletarian
labour in the tin mines and rubber plantations.
the economic position of the Chinese.
especially the established merchant class. also
flourished in strength . Their strong position
in the new economy stood in marked contrast
to the position of the Malays-most of whom
were relegated by colonial rule to a neglected
peasant base. Though still subordinate to
colonial capital. Chinese capital. via the proliferation of merchants, businessmen, traders
September-October 1985
and shopkeepers . became a dominant and visible economic force linking the wider market
economy with the Malay rural producers, and
vice-versa. At this level of social relations.
the Chinese confronted the Malay peasantry
on unequal terms as sellers, buyers . creditors
and middlemen . The nature of such contact
did not endear the Chinese to the peasantry :
it only served to reinforce their ethnic differences. and the Malay sense of ambivalence.
dependence and relative deprivation vis-a-vis
the Chinese community. Among the Malays.
a certain stereotype image of the Chinese also
began to emerge and became reified: all
Chinese were ·tow kays· and rich . The tradi tional lack of contact between the Malay
peasantry and the non-Malay working class
(as a result of the segmentation of labour along
racial lines generated by colonial policy)
obviously helped to reinforce such views of
the rural Malays.
Alliance with Malay elite
The peasantry's relations with the state also
went a long way towards fostering ethnic consc iousness. Triggered by the fears of being
INSIDE
ASIA
overwhelmed by the economic position of the
Chinese, the Malay peasantry forged an ethnic
alliance with their Malay political leaders who
promised them 'protection· of their rights as
·sons of the soir as the country was mov ing
towards formal independence . They found
their ·protectors· in the English-educated and
westernized Malay elites. initially drawn from
the traditional ruling class . These new political
leaders had not only a leg itimacy of traditi o n
and hierarchy behind them but also the
privilege of colonial education and the ·appropriate· political culture . It was through the
ethnic-based nationalism of these leaders and
their political party (the all-Malay UMNO,
which is the dominant Malay faction of the
multi-racial ruling coalition party) that the
Malay peasantry ·s road to the modern world
was opened up .
In post-colonial society. the UMNO-led
gove rnment has embarked upon various
development strateg ies to alleviate th e
economic conditions of the peasantry and to
redress the imbalances between the Malays
and the non-Malays. In order to legitimize
their position. the Malay leaders in government consistently politicize and play upon
their so-called ' protector" role of the Malays .
In so doing. ethnicity is continuously reinforced
in society and has become a co nsc ious
ideologica l structure which defi nes the continuing relations between state and Malay
peasantry.
23
WOMEN IN ASIA_:
SOCIETY& CULTURE
POPULATION POLICY IN BANGLADESH
New inequalities
But the Malaysian agrarian society, as in other
Third World countries, is not totally unaffected
by its internal class relations as a result of the
logic of capitalist development. Under colonial
rule, the Malay peasantry was left to 'develop
on its own'. This did not mean, however, that
the rural sector was insulated from the forces
of capitalism. Apart from transforming Malay
peasants into producers of exchange-values,
dependent on the market economy for their
subsistence and social reproduction, colonialism radically altered the traditional land tenure
system by imposing on the peasantry its own
system of private property (the Torrens
System). As a result, the once egalitarian property relations within rural society gave way
to new forms of inequality and social differentiation . But since the peasant sector, by virtue
of colonial policy , had become a predominantly
Malay enclave, the new basis of class and production relations which emerged remained
relatively ' uncomplicated' by ethnicity.
This meant that at the level of production
relations, Malay peasants entered class relations
with fellow-Malays ; Malay and not Chinese
landlords were the class opposites of Malay
tenants and landless or poor peasants. But even
here, the production of class consciousness or
ideology is not so straightforward. As is common to most peasant communities, even without
the 'complication' introduced by ethnicity , both
class and non-class bases of ideological production co-exist in Malay rural society. Such
non-class elements are innumerable-personalism, kinship, patron-clientism , religion, village and so on. Some may indeed be coterminous with peasant relations of production ;
others which are not merely add to the number
of bases available to the Malay peasantry in the
production of ideology at this every-day level
of their social relations in contemporary village
society.
Theoretically, the function of these non-class
components underlying peasant social relations
is twofold: they may actually mitigate against
the emergence of class consciousness , or else
their relationship to class may not be mutually
exclusive. Hence by incorporating elements of
popular culture or certain universal norms (such
as egalitarianism, or notions of justice and
reciprocity) , they may give strength and expression to class ideas which arise from the
peasantry.
Balanced approach needed
It would appear, therefore, that the Malay
peasantry may not be totally doomed to ethnic
primordialism . Students of the Malay peasantry
should not focus only on the ideology generated
at the level of peasant exchange (market) relations
and peasant relations with the state, hence
ignoring what happens at the level of everyday peasant class or production relations in
village society. A balanced approach is essential
si nce Malay peasants are simultaneously
caught up in all these three types of social
24
CotruptiOn & coercion
Women always bear the brunt of family planning policies, particularly
in the Third World. Bangladesh is no exception, and recent revelations
about abuses of the sterilization campaign have found women the main
victims . Betsy Hartmann and Amanda Milligan examine these abuses
and argue that international support for the scheme should be
withdrawn.
relations. Each is capable of constituting the
Malay peasant individual in its own particular
way-be it in ethnic or class terms , or in terms
of a combination between class and non-class
ideas.
The search for the genesis of class consciousness, however this may be defined ,
must inevitably focus on the images and
expressions which emerge at the level of production. The richness of Malay peasant
experience in terms of 'class', conveyed
through words, proverbs, idioms, metaphors
and symbols, has been captured meticulously
in a forthcoming book by James Scott , author
of The Moral Economy of the Peasant . My
ow n work amongst Malay peasants as proletarians in plantation society also indicates
the possibilities of making sense of the various
components (class, non-class, ethnicity,
universalism) of Malay proletarian consciousness at a specific level of ideological
discourse. Notio ns of Malay dignity
(ma ruah), empathy (timbang rasa) , or
reciprocity (jasa), are capable of transcending
the boundaries of ethnicity to be translated ,
by Malay proletarians themselves, into a more
universal language of protest, giving added
strength to their ' class struggle ' against the
moral assault of capitalism which constantly
attempts to reduce their human status to a
mere commodity of labour.
'People versus power'
In the context of multi-racial Peninsular
Malaysia, the above observations are very
pertinent. Considering the lack of social contact in the past between the Malay peasa ntry
and non-Malay labour it" is essential that
seriou s note is taken of the moment when
labour shows a capacity to articulate its class
experiences in universal terms , even if these
experiences are initially handled in specific
ethnic-cultural terms. Ultimately, for the
possibility of some ideological 'sharing' between the different ethnic fractions of labour
in this country , the search for the genesis of
their class consciousness must come to grips
with the task of unravelling this common
universal thread regardless of ethnic or
INSIDE
ASIA
c ultural specificities. This is not to deny the
relevance and force of ethnicity, but the ethnic
identity of labour is surely part and parcel of
a broader, more universal ontological base .
This also means that it is not enough to look
for 'class-type' contradictions in society'people versus power-bloc ' contradictions are
equally pertinent. In the end, both modes of
analysis must be combined to understa nd the
ideo logical synthesis underlying peasant or
proletarian forms of 'class struggle', however
everyday, symbolic or ephemeral these may
be. In this context it is interesting to note that
whilst the Malay peasantry and state relations
are formally defined by ethnicity , peasant
modes of protest agai nst the state in the postcolonial period are not. Examples of the latter
includes: the Hamid Tuah case over the Teluk
Go ng squatter issue towards the end of the
. I960s; the 1974 Baling demonstration by
peasants over the downturn of world rubber
prices and increasing inflation; and the more
recent Alor Setar demonstration by ' Green
Revolution ' farmers over the issue of conversion of government rice price subsidies from
cash payments to forced bank deposits . It is
obvious that both the ' people versus powerbloc' and class analyses are equally pertinent
in understanding the above. It is also all the
more reason why it is necessary to know in
more detail the interconnection between the
ideological synthesis reached at the level of
production relations and the forms of sy nthesis
unde rlying other areas of peasant relations
during such moments of praxis. What happens
at the specific level of ideological practice is
more complex than what normally meets the
eye of a ' pure' class , or et hnic or 'whatever·
a nalyst. We need to know how the Malay
peasantry combine their various capacities and
identities as 'people' , as Malays, and as a class
at a specific level of ideological discourse and
social practice .
Zawawi Ibrahim is an anthropologist in the
Rural De velopment Division of the Faculty of
Economics and Administration at the University of Malaya, Kuala Lumpur.
September-October 1985
T A MEETING to be held later this
month the World Bank is hoping to
smooth the ruffled feathers of the co-financiers
of its proposed $271 million population plan
for Bang ladesh . The project has run into trouble because of concern that the country 's family planning system pushes sterilization too
hard .
The five year project , which is the third
in a series , was scheduled to start in July but
it was not approved by all its co-financiers at
a pledging meeting last February in Paris .
Representatives from official aid agencies of
the UK, Holland , Sweden, Norway and
UNICEF raised worries about sterilization
abuses in the programme and demanded further assurances from the government and the
World Bank before making final commitments.
Some of the most serious incidents have
been uncovered by field workers from British
voluntary agencies . In the aftermath of last
year' s devastating floods, agency personnel
interviewed a number of destitute women who
had been denied relief wheat provided by the
United Nations World Food Prog ramme
unless they agreed to be sterilized.
'The Union Council Chairman told me, " if
you have the operation, you will get wheat;· '
sa id twenty-year-old Rohima, a divorced
mother with only one baby son who lives in
a village sou th west of the capital Dhaka .
After the operation Rohima received a card
co nfirming that she had been ste rilized, and
authorizing her to receive food aid . However,
she onl y received a small proportio n of the
wheat she had been promised . He r sterili zation effectively ends her chances of remarriage, and her only son may not survive, for
her breast milk has dried up and he is feed ing
only on barley water.
A
Directed at women
According to a health worker in the area, 80%
of the women steri li zed during t,he floods had
done so to receive wheat. Similar cases were
reported from Barisal, Jessore , Comilla and
Pabna Districts. Of 85 women sterilized i11 one
location in Pabna , two allegedly died of side
effects from the operation .
Gove rnment figures reported in the
September-Oc1ober 1985
Bangladesh Observer indicate that an ' unprecedented ' 257 ,000 sterilizations were performed in last year's flood months , from July to October-almost one quarter of the total
performed in the entire decade from 1972 to
1982 .
The government Agency for International
Development (AID) undertook our investigation of the abuses and agreed that 'some
incidents may in fact have occurred but were
not widespread.' The World Bank maintained that any abuses were probably due to
·overzealous local officials' taking ' undue
advantage of food shortages to improve their
family planning records '. Pressures on
official s to meet sterilization targets are institutionalized in the Bangladesh government's
population programme. Over e ighty-seven
million people live in the country 's 140,000
sq km and they are in theory offered a broad
range of contraceptive choices . But in practice , female sterilization is the main method
promoted-a survey in 1983 revealed that
80 % of those who underwent the operation
were women. Today, 34 % of Bangladeshis
using a family planning method are ste rilized , and the government aims to increase this
figure to 41 % by the end of the decade
through the use of financial incentives and
disincentives.
Financial incentives
While the linking of sterilization and food aid
may not be official government policy , it is
the logical outgrowth of the incentive system
operating in Bangladesh . Doctors and clinical
staff receive special payments for each
sterilization they perform , and health and
family planning workers, as well as members
of the public , receive a fee for each sterilization patient they bring forward. Until very
recentl y fami ly planning workers who failed
to meet monthly targets had their salaries
withheld. People who are sterilized receive
a new item of clothing and a cash payment
of 175 taka (£6) which is almost one tenth of
the annual per capita income.
Eighty-five percent of the incentive
pay ments' costs are funded by the AID. Such
assistance contravenes section 104(f) of the
INSIDE
ASIA
US 1982/83 Foreign Assistance Act , which
prohibits the use of US funds ' to pay for the
performance of involuntary sterilizations as
a method of family planning or to coerce or
provide any financial incentive to any person
to undergo sterilization '. In Bangladesh AID
skirts the law by calling the incentives 'compensation payments'. Officials maintain that
the money is intended to cover transportation ,
food costs and wages lost due to the operation. The free clothing is justified as 'surgical
apparel '.
International disquiet
But European donors are more critical of the
system. Christopher Allison , population adviser to the British Overseas Development Administration, wrote to the World Bank on 28
March saying, ' the UK would like to see the
entire system of incentives and disincenti ves
abandoned'. British Labour MP , Jo Richardso n, put down an Early Day Motion in the
House of Commons on 4 Jul y calling on the
ODA to withhold its intended £6 million contribution to the forthcoming World Bank programme until abuses are rectified . The motion has so far attracted signatures from 38
MPs .
A January 1985 Position Paper of the
Swedish International Development Agency
(SIDA) has expressed concern that the system
'carried the danger of unacceptable pressure
being exerted on potential accepters and may
amount to indirect coercion '. The SIDA paper
also warns that the threat of punitive action
against family planning workers who fail to
meet quotas may lead to ·a neglect in counselling, a vital element. This is most serious when
it comes to ster ilizatio n, s ince it is
irreve rsible.·
These fears are borne out by a 1983
25
=
WOMEN IN ASIA
sterilization review for the donors, which
revealed that in more than 40% of the
sterilization centres, patients •were not adequately informed about the permanent nature
of the operation'. A 1984 investigation by the
Independent Programme for the Introduction
and Adaptation of Contraception Technology
(PIACT) found that family planning personnel generally did not tell women about possible side effects from sterilization or the IUD,
and did not offer other contraceptive methods
or provide follow-up services.
The PIACT study also reported the existence of male agents who scour the villages
for potential sterilization patients, sometimes
'selling' them to family planning workers who
need to meet targets. 'These agents have no
information about advantages or disadvantages of family planning methods or their side
effects,' says SIDA.
Resources diverted
Today over a third of the country's health
budget is spent on population control and its
share is growing. Although the World Bank's
third project includes the provision of Mother
and Child Health (MCH) services, according
to SIDA: 'There are good reasons to suspect
that an expansion of MCH services will be
significantly hampered by the present system
of incentives and disincentives,· since •health
workers are likely to favour the activities
which bring money and are set by target.·
AID doesn't attach such significance to
MCH services: ·a population control programme does not depend on a functioning
primary health care system,· it says. And the
United Nations Family Planning Association's
Dhaka representative, Walter Holzhausen,
claims no one seriously believes , 'that
Bangladesh has the money or the time to
establish better MCH services . . . as a
precondition for making voluntary family
planning more successful.'
Bangladesh's more liberal Western donors are
worried that the sterilization programme is
diverting resources from the country ' s pressing health problems and they challenge the
premise that birth control alone is sufficient
to bring down the country's population growth
rate. Instead they stress the importance of ensuring decent health care, employment opportunities for men and women, education and
old-age security, which would reduce people's
dependence on large families and set the stage
for a population decline.
The Bangladesh government frankly admits
population control is its number one priority, a priority vigorously supported by
hardliners like USAID. With 80% of the
country's development budget coming from
foreign aid, Bangladesh is unlikely to stand
in the way of what key donors now see as the
solution to its problems.
However the government has tried to calm
concerned World Bank donors by circulating
Government sidesteps
assurances that the sterilization system is not
abused. It has said that measures to punish
family planning workers for not meeting
sterilization targets were never put into practice and that the legislation has been abolished.
Only a few changes to the existing system
are proposed and donor reactions so far are
not enthusiastic. UNICEF has already decided not to become involved in the World Bank
programme because of reservations about the
strong emphasis on sterilization. According
to Dr Richard Jolly, Assistant General
Secretary of UNICEF, 'you will get a much
more enthusiastic response from people if
family planning methods are part of a Mother
and Child Health programme.'
All the indicators are that this month's
meeting is not going to be a smooth ride for
the World Bank . As one informed source put
it, 'everything is still wide open-liberal
donors are using these negotiations as their
only lever to get improvements in the
programme.'
Betsy Hartmann is co-author with James
Boyce of A Quiet Violence: View from a
Bangladesh Village, Zed Press, 1983, and
author of The Right to Live: Poverty, Power
and Population Control, forthcoming from the
Institute for Food and Development Policy in
San Francisco. Amanda Milligan is a
freelance journalist.
----------------.
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Islam, Politics
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THE PAKISTAN EXPERIENCE
edited by
1 aide"' '11' J anuszczak
J ;11,~upert Murdoch
,i~ ,
ASGHAR KHAN
A major analysis of the nature of Zia ul Haq's Islamicization measures . Air Marshal Asghar Khan is leader of the
Movement for the Restoration of Democracy opposed to
General Zia.
Hardback £18 .95 US$29 .50
Paperback £6 .96 US$10.75
ZED BOOKS
57 Caledonian Road , London N 1 9BU .
01-837 4014 .
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Also from BIBLIO:
81 Adams Drive, Totowa , New Jersey 07511 , USA .
SPECIAL FOCUS: AID TO BANGLADESH
Geography of poverty
BANGLADES H almost entirely co nsists
of an alluvial plain formed by the annual
deposition of ferti le silt fro m the great
Pad ma (Ganges), Jamuna (Brahmaputra)
and Megh na rivers. The great fertility of
the all uvial soi l has been able to support
a nation of peasant farmers concen trated in one of the world's highest
population densities , though in recent
years despite growing crop yields there
has been increasing rural poverty. High
population growth is often cited as a
cause of poverty , but the poor point to
the extreme maldistribution of land
ownership.
The physical features and
geographic location of Bang ladesh
make it particularly vulnerable to natural
disasters . The low-lying plain is susceptible to flooding during the annual rainy
season (June-September); southern
Bangladesh is regularly struck by tidal
waves and cyclones sweeping up from
the Bay of Bengal . The severity of both
floods and cyclones varies from year to
year, although the flood problem has
been
recently exacerbated by
Himalayan deforestation , prompting the
Bangladeshi government to call for a
Ganges dam located in Nepal.
The past two years have been particularly bad for both floods and
cyc lones : 1984 brought the worst
fl ooding for a decade and the 1985
cyc lone left 30,000 dead and caused untol d damage to houses, crops and
lives tock . In response to events of this
sort, Bangladesh receives disaster relief
aid from around the world . Howeve r,
Ban gladesh has also become a major
rec ipient of long -term development aid ,
given by OECD governments and the
World Bank.
INSIDE
ASIA
September-October 1985
l3Ei.fC A
BANGLADESH: Relief, drainage and settlement
Po,"to1"1ude
obov11M11onSeole,.el
KllOMET~ES
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REPORT ON THE AID AGENCIES
Bypassing the poor
Depend ence on aid
Western aid commitments between
1971 and 1984 totalled some US$16
bil lion. This year, aid commitments will
pay for four-f ifths of Bangladesh 's
developme nt programme and some
60 % of its ex pected US$2.7 billion import b ill. The dependence of the regime
on foreign aid has given Bangladesh 's
internat io nal creditors , co-ordinated
within th e Ba ngladesh Assistance
Group , trem endous leverage over the
country 's econ omi c policies. Ershad
recently moved to return jute and textile
factories to their pre-nationalization
owners, and scrap ped subsidies on rice,
kerosene and f ertili zers following
pressure from the IMF.
The poverty-creat ing pol icies of the
reg ime, drafted by the 'experts ' seconded from the international ag encies , are
leaving the rural poor more vulnerable
than eve r to natura l disaster.
Sep1e111ber-Octoher 1985
26
D
84V J
Criticism of aid to Bangladesh has mounted as increasing evidence
suggests that, far from alleviating poverty, it has increased the gap
between the haves and the have-nots. Larry Jagan examines a recent
confidential report on poverty in Bangladesh and concludes that radical
land reform is an essential prerequisite.
B
ANG LAD ESH is one of the world ' s
poorest nations. Like most Third World
countries some 85 % of the population live and
work in the rural sector. According to an FAO
report, in 1977 , 83 % of the rural population
lived below the poverty line. The proportion
of poor has continued to increase despite
massive injections of aid. Some aid agencies ,
concerned at the lack of impact the projects
have had on the level of poverty , commissioned an independent report on ' rural poverty in
Bangladesh ' .
This confidential report has angered the
Bangladesh government , for its findings were
INSIDE
ASIA
critical of the government ' s development
policies and the direction of aid projects. Its
primary purpose was to explore the causes of
poverty and to suggest ways in which these
could be alleviated in the future.
The report's findings document an increasing pauperization of the rural population. According to the report , households with less
than two acres (0.8 ha) of land cannot produce
enough for their basic needs and in only
20-30% of households does ' the land they own
alone provide their basic subsistence'.
For the 70-80 % of rural households who
co11ti11ued 011 page 30
27
=AID & BANGLADESH
AID & BANGLADESH
=
t
I
Devastated: this man 's house was entirely washed away and his family killed by the May cyclone.
RELIEF IN THE CYCLONE ZONE
Harvest and disaster
Bangladesh has recently been hit by the worst cyclones in fifteen years.
The devastation in terms of human life and livelihood has been
immense; but for some, John Cunnington found, there have been opportunities to exploit the misfortunes of others.
L
AND IS THE KEY RESOURC E in rural
Bangladesh, for it not onl y produces in
come and employment but also represents the
main source of security , provides the basis for
access to other resources , and is the prerequisite for credit. Land is increasingly
owned by a small minority as a growing proportion of the impoverished rural population
is forced to sell its land in ord er to finance
debts. The proportion of landl ess people has
ri sen from 35 % of rural households in 1960
to over 50 % . Consequently the landless , with
little opportunity for alternative employment,
striv e to gain some measure of security and
employment on the chars-new lands created
by silt depos its in the Bay of Bengal .
Earlier thi s year a cyc lone drove a huge
tidal wave over parts of southern Bangladesh .
Hundreds of thousands of people suffered
losses. Homes were washed away-many
with their occupants sti ll inside. Over 12,000
people have been reported dead , but the exact
number of people killed may never be known .
Hundreds of thousands of animals were killed ,
including draught cattle, so crucial to the area.
Large areas of agricultural land were flooded
when embankments and road s were washed
away .
The affected char areas-including both
islands and parts of the mainland- while very
fertile , are constantly being threatened by
flooding , and therefore offer a precarious
28
r
existence. Only poor people live on the chars ;
as a result only poor people lost their lives
and homes in the recent disaster. Chor land
is co nsidered as khas-government land-for
any land submerged for more then twenty
years , under ex isting laws , is to be distributed
to cooperatives of landless peasants. With
increas ing landl essness migration is common
in the coastal region-to settl e on khas land
is the goal .
Corruption and coercion
The landlord s in the region- th ej odtars-are
anxious to co ntrol access to char lands , and
indeed to other resources. They are not ,
however , interested in inhabi ting the chars ,
but instead attempt to subvert the government's efforts to distribute khas to genuinely
landless groups. The intentions of the government are disrupted both by illegal occupation
(land grabbing) as well as by control bein g
gained over land through th e exercise of
patronage. L andowners have established
ow nership of land by cu lti vating it ,
particularly on newly accreted land. The
opportunity now exists for unscrupulous jodtars
to establish 'ownersh ip ' of land temporarily
vacated by marginal and small farmers during the cyc lone and tidal wave. This means
that people are being forced to stay on their
land instead of taking refuge , and as a result
even more deaths have occurred . Land is also
INSIDE
ASIA
Flooding regularly hits Bangladesh's low-lying deltaic plains. In some places special shelters have been built (right).
acqu ired by thejodtars ' fa lsifying documents
to prove th ei r ' ownership ' . In some cases
occupants of land are encouraged to move on
the basis of promises by the jodtars offeri ng
them ' protection and shelter ' . Whatever the
motivation for the move , th e landless are
expected to pay cash to their patrons . For
anyone tryi ng to by -pass thi s patro nage setup the risks are high ; pressure will be exerted
on the intending offender and the person conce rned may well be forced to fl ee the area
following intimidation.
In much of the char area jodtars have amply
demonstrated their power, and settlers have
increasi ngly been fo rced to buy protection.
M ore and more, co ntrol of the area has come
into the hands of jodtars and of the local and
regional elite.
The disaster has had two major co nsequences. Firstly, there has been th e physical
damage caused by flood s and cyc lonic
winds- the loss of li fe, loss of assets (cattl e,
houses and household possess ions) , and loss
of communal resources such as drinking
water . Secondly , it has given rise to th e
impoverishment of small and marginal
farmers, through the !ms of ownership of their
land. Ass uming, therefore , that the attempts
of th e agencies to relieve and rehabilitate are
designed to alleviate suffering and reduce further
impoverishment , then their efforts must be
directed toward s the needs of those occupying the lands. Relief supplies made ava ilable
in respon se to disasters are not neutral. They
have the potential to prop up a system of
patronage as well as to provide relief to
victim s. In designing programmes- whether
of relief, reh abilitation or longer term
September-October /985
development- account must be taken of th e
cha racteri stic s of th e area.
Cooperatives need support
(
l
The cooperativ es of land less and small
farme rs on the chars should be strengthened.
Simply mak ing ex tra resources ava il able in
the expectation th at those in greatest need will
somehow benefit is inherentl y dangerous.
Follow ing the cyc lone and tidal wave,
needs have been identified and ac ti on taken.
The agency War on Wa111 has well-established
contacts w ith proj ects and groups who have
been worki ng in the area for a number of
years . This first began after the I 970 cyc lone
and has continued ever si nce. One such loca l
group , Nijera K ori , has establi shed training
programmes for peasants and women. Working
with some of the most disadvantaged sec tion,
of the rura l poor they have helped to set up
more than two hundred groups, which in turn
has helped them ga in access to key resources
in the area, including land. A close working
relationship with local peopl e meant that
groups such as Nijera Kori were on th e spot
at the time of th e tidal wav e to make an
immediate assessment and to respond appropriately . Through thi s group War on Want was
able to channel relief aid - particularly of
food , water and clothing- to the affected
people. A ration ca rd system was immediately
introduced , and there was quick response to
a request to send medica l teams.
Th e impact of a cyc lone and tidal wave
is devastatingly short and sharp co mpared
with that of a lingering dro ught. Aft er the
initial shock , surv ivors are forced to con tinu e
with th e dai ly struggle for li fe. Now , a
September-October 1985
rehab ii itation prog ramme is under way. Food
and cas h for work programmes not only provide valuable employ ment opportunities , but
they are also important for reconst ruction. To
protect against future cyclo nes is clearly an
important task. In 1984 War on Wa111 provided
the necessary funds to construct an ea rthen
mound (kil/a ), which proved successful in
saving people and animals during the
flooding . Even on a str ictly econom ic assessment th e kil/as showed a co nsiderab le return
on cap ital. M ore of these killas will be built
in coas tal areas, giving a long term asset as
wel l as generating short term empl oyment.
Multi-use cyclone shelters are also being
designed, to serve as community health centres
and schools.
Direction of aid
Economic programmes have also been undertaken. Provision to cultivate land for th ose
who have lost draught animal s has been made
th rough contract cultivations-both with
mechanized as wel l as animal power. Arrangements have also been made for the provi sion
of seedlings essential to the next planting date .
In addition to land damage the tidal wave
caught many fi shermen unprepared. and lives.
boats and nets were all lost. It is common
practice for fi shermen to hire nets. and there
are co nsequently plans to strengthen the
women ·s cooperative s by enab ling them to
make fishing nets to hire out.
Because the affected area is new . it lacks
even the barest infrastructure and service s. It
is important that ways are sought of complementing the setting up of cooperatives of
land less people and women· s groups. with
INSIDE
ASIA
phys ica l inputs such as water supplies, health
and educational faci lities and communications.
Such development would strength en land
reclamation effort s in the area . The Land
Rec lamation Project (LRP) , funded by the
Dutch government. has constructed a pilot
stretch of reclaimed land of some 4,000 ac res
( 1.620 hecta res). and people who were
previously landless now occupy the area.
Pl ans for a further 60,000 acres (24.300
hec tares) are already well advanced, and a
cross-da m from Sandwip to Noakhali should
be ready within fiv e yea rs. The LRP is not
only co ncerned with the technical feasibility
of_ th e project but also with settl ement policy
as regards th e new lands. No amount of projects will prevent future cyc lones or tidal
waves, but with ca refull y designed schemes
it ought to be poss ible to minimize their
impac t and to make the chars a safer pl ace
to live and work.
The effect of th e tid al wave and cyc lone
has been devastating. Aid agencies, however .
needed to be awa re of th e difficulties of
operating in the area if furth er polarizati on
between people li ving in the chars is to be
avoided . Not everyone fares equally in such
disasters. for. as th e Bengali proverb states:
Kaaro poush maash , kaaro shorbonaash• for some it is harvest. for some it is disaster.·
John Cunnington is Programme Officerfor
South Asia for War 011 Want.
29
=AID & BANGLADESH
cannot subsist on their land , additional income
needs to be earned. This is generally done by
sharec ropping o r workin g fo r others. With
unemploy ment in excess of 30 %, with the in- ,
sec urity of contract labour which is mostly for
2-3 days , and with the low wage levels , which
the World Bank argues have fa llen substantiall y during the last decade , this prov ides a
so lution for only a few . The net result is that
fa milies with insufficient incomes are fo rced
to reduce ex penditure; ' as little mo ney as
poss ible is spent on the purchase of clothes
and medi cine ' . The co nsumption of bas ic
foodstuffs is o ften reduced , ' ri ce is taken only
once or twice a day , and sometimes th e
members of the household , parti cul arl y
women, girls and o ld people , go without ri ce
fo r several days.' Starvation has become a
calcul ated strategy fo r ex istence .
The pauperization process is not onl y confin ed to the consumption of essenti al needs .
It pe rvades all as pects o f rural life. There are
inadequate housing fac ilities , with 63 % of
ho useho ld s hav ing less th an 400 sq ft (37 sq
metres); onl y 4.9 % of villages have a primary
health centre; 8 % o f landless children attend
sc hoo l and the overa ll literacy rate fo r
Bangladesh is 27 % .
The repo rt fo und th at whil e the rural
population was being increas ingly depri ved
of the bas ic necessities of life , women in ru ral
households faced a double depri vation. Males
on average consume some 20 % more calori es
and prote in per day than women; whil e male
literacy is 30 % hi gher than fo r women, and
onl y 38 % of school attende rs are women.
Causes of poverty
In ex pla ining the root ca uses of poverty , the
report fo und land ownership to be central. For
not onl y was it the bas is o f producti on but it
offe red access to other resources , particul arl y
credit. As a res ult of inc reasing pove rty
poo rer peasa nts have had to sell off land to
raise extra inco me , or have fo rfe ited it to
money lenders when unable to repay loans. Inheritance rul es , under Islamic law , mea n that
each son inherits an equal share of land , which
in practi ce has also led to land be ing increasing ly frag mented into smaller and sma lle r
plots, inevitabl y hitting the poo re r far mers
hard est. Access to c redit fac ilities is re lati vely easy fo r the large landow ners . The small
fa rmers are faced with a greater problem , fo r
they get only 14 % of their credit requirements
from instituti onal sources and are fo rced to
rely on moneylend ers and others, pay ing in
excess of 50 % in interest. This also rein fo rces
th e polarization of landowne rship.
In 1960 , 35 % of ru ra l househo lds we re
fun ctionally landl ess owning less than half an
acre (0 .2 hecta re) ; in th e 1977 Ag ricultura l
Census thi s had grow n to 46 %, and 50 % in
1978 as meas ured by the Land Occupancy
Survey . At the same time land ownership was
co ncentrated into fe wer hands , fo r 8.5 % now
ow n 4 8 % o f th e land . This is despite th e at30
]
POLrr1cs & INTERNATIONAL AFFAIRS
=
Distribution of income among rural households
(who constitute 83% of the total population)
Top 5% of households
Upper middle 15%
Middle 40%
Poorest 40%
1963/64
1976/77
16.8%
24.1%
38.0%
20.1%
17.3%
25.4%
39.0%
18.3%
Source, Osmoni, S.R . ond Rohmon, A. - A study on Income Distribution in Bongfadesh (Dhaka, 1981 ).
tempts at land refo rm , o rig inall y in 1972 and
aga in in 1983 , when a limit of 100 bighas (405
hec tares) per fa mil y was enac ted. However ,
th ere is neither the admini strati ve machinery
nor political will to ensure that radical land
refo rm is implemented .
The first part of th e report concl ud es that
it ' is clear that the rural development strategies
pursued in Bangladesh ove r the years have not
effecti vely co untered the processes which
have contributed to the growth in the incidence
of rural pove rty ' .
The report then examines the ro le of aid
in Banglades h and co nc ludes that instead of
helping th e poo r, it has co ntributed to their
paupe ri zati on , fo r it has generall y bene fit ed
the urban population as aga inst rural people ,
and where it has been centred in ru ra l projects it has been to the bene fit of the wea lthier
fa rmers. This is particul arl y th e case with
irrigation sc hemes , where the report suggests
th at large landow ners have been ab le to extend the ir ho ldings and po we r at th e ex pense
of marginal fa rmers .
Urban concentration
Commodity aid has ce rtainl y benefited the urban centres whe re ' th e gove rnment has a lso
used subsidi zed food rati ons to he lp pay its
empl oyees, whose salaries have declined
signifi ca ntl y in real te rms ove r the last fi fteen
yea rs. Co nsequentl y, urban rati on cardholders, government empl oyees , the military,
po li ce, teac he rs, e m p loyees o f la rge
establishments and a few " priority " gro ups
received almost two-thirds of all publiclydi stributed food in the late 1970s .' Health
progra mmes have also large ly benefi ted th e
urba n popul ati on .
Project aid has also generally fl owed more
to the urban ce ntres. During 1972-82
ag ri culture, ru ra l institutions and fl ood contro l received 17 % of project fund s , health
2.7 % and educati on 2.4 %; whil e tra nsport
and communications received 25 %, power
and fu els 19 .3 % and indu stry 18 .2 % . With
rur a l pove rty th e majo r p rob le m in
Bangladesh is that the direction o f project a id
is not like ly to have a major impac t on its
allev iati on.
Much of the report ' s criticism of aid is that
it is e ithe r in the interests of the Bang lades h
po litical leade rship or o f the donor co untry.
It suggests th at so me a id is inappropriate; it
INSIDE
ASIA
find s th e va lue of EEC concessional buttero il
and skimm ed milk of 'dubi ous va lue· whil e
suggesting that although No rth Ameri ca n
wheat is useful , thi s is onl y beca use
Bang ladesh 's needs match US inte rests , with
th e ir large g rain surplu s. The report also
po ints out the dangero us e ffects po litical
motiv es o f do no r co untri es ca n have , po inting to the exampl e of the US, wh o during the
1974 fa mine withheld aid in order to persuade
Bangladesh from trading with C uba.
More app ropriate aid , the report suggests ,
coul d be re fl ected in policies towa rd s fertil ize rs. C urrentl y, 90 % of fe rtili ze r imports
have been finan ced from co mmodity aid ,
representin g 69 % of all commodity aid given
to ag riculture. Policy, th e report suggests ,
should be di rected towa rd s increas ing local
prod uction which is substantiall y cheaper . At
present there is a heavy use of nitrogen, which
is produced at three fa cto ries, one of which,
the Ghorasal plant , is be ing ex panded with the
help of C hinese a id , whil e phosphate and
potas h is underused due to its lack o f
ava ilability. ' There is no domestic capac ity
fo r produ c ing potas h fe rtilizer' , and lack of
fo re ign exchange prevents the importatio n of
phosphate roc k. The report concludes that aid
could red ress thi s situation by increasing the
importation of phosphate rock ' so as to utili ze
domestic capac it y mo re full y ' and poss ibl y
establishing a potash manu facturing plant.
The report sto ps short of suggesting th at
there has been misappropriation of aid , preferring to blame the inappropriateness of aid and
th e domesti c social structure fo r its ineffecti veness. Two things clea rl y emerge from the
repo rt . Aid should be directed more towa rd s
ag ri culture, and in parti cul ar the poo r. The
landl ess and ag ricultu ra l coopera ti ves should
fo rm the bas is of future aid projects. The paramount theme o f the report is th at onl y radi ca l
land refo rm can hope to counter poverty in
Banglades h.
Although the report is not as revealing or
hard hitting as it might have been, it is hoped
that more noti ce will be taken o f it than was
of prev ious reports , which have e ither been
ignored or suppressed . For its limited recommendati ons are rea li zable and would be
e ffecti ve.
Larry Jaga11 is co-ediror of Inside Asia .
AFTER THE NEWHAM 7
,,
'
'Self. defence' ;is .not enough
The past few years have witnessed a frightening new trend within British
racism-the growth of a systematic violence against Asian families.
In some areas Asians are living under a virtual state of seige. The police
have largely ignored these developments, prompting Asians to form
their own self-defence groups. Now 'self-defence' itself is under
attack-in the court room. Ariana Vakas examines the recent case of
the ' Newham Seven ', and considers the options that are now open to
the anti-racist struggle.
I
N RECENT months the case of the Newham
7 , seven As ian youth s c harged with affray,
has inc reas ingly featured in the press. It has
bee n established by the media as a ' landmark
in the history o f both the relationship between
bl ac ks and whites and th at betwee n blac k
peo ple and the po lice' .
On 7 April , 1984, a gang of whites in a
ca r went round the boro ugh of Newham , in
the East End of London , carry ing out a series
of assaults aga inst the Asian community. Five
As ians were ki dnapped in turn and attac ked
with a hammer. Amongst them was a 16 yearo ld phys ically hand icapped As ian boy who
was a lso bungled in to the car , attac ked and
th en abando ned in a d itch .
These assa ults qu ic kl y beca me know n to
the Asian com mun ity, and a group of youth s ,
so me of whom we re the New ham 7 , qui ckly
retaliated aga inst the attacks . They went to the
Duke of Edin burgh pu b whi ch was tho ught
to be where the se ries of attac ks had been
Sepre111ber-Ocrober 1985
September-Ocrober 1985
planned , and a two minute street battle betwee n the Asian youths and a group of whites
fo llowed. Missiles were th rown and windows
were bro ken but no one was hurt. It was fo r
this inc ide nt th at the Newham 7 were charged wi th affray , fo ur of them , Bahadur Khan ,
Mohammed Hanif, Zafa r and Parva iz Khan,
being fo und guilty and th e rest, Amj ad Ali ,
Athar Chaudri and Jothi Rajappan, not guilty .
Acco rd ing to the th ree guilty defendants
and thei r supporters the onl y th ing they were
guil ty of was defending themselves and their
commu nity . The attac k was clearly more than
j ust a street braw l, it was a reta liatio n from
a commu nity be ing attac ked by rac ist thugs .
Unmesh Desai, who wo rks for th e Newham
Monitoring Project. a G LC fu nded body
which deals with racist attacks, and who was
at the fore fron t of the campaign , had th is to
say: ' It' s not j ust the New ham 7 on tri al, it ' s
the whole community . It's not the case as such
but th e issues be hind it.· One of these issues
INSIDE
ASIA
is that the Asian community can no longer rely
on the po lice to protect them and they have
had to fi nd the ir ow n methods of protecting
the ir community .
No isolated incident
But the Newham 7 is not the first instance
where Asian youth s have found it necessa ry
to take matte rs into the ir own hands foll owing the fa ilure of the po lice to protect Asians
from vio lent attacks. T he first and most
fa mous of the de fe nce cases was that o f th e
Bradfo rd 12.
On 17 Jul y , 198 1, the police in Brad ford
found two crates of petrol bombs which had
been hidden behind a nu rses ' home . The
twe lve As ian youth s were charged with ' conspiring to make explosive substances ' . T he
defendants were in jail fo r three months before
being allowed out o n bail. When ba il was
eventu all y set, one of the conditions was
that they did not attend any political meetings.
All of the twelve had been membe rs of the
nasce nt United Blac k Youth Movement
(UBYM) , an o rganizatio n that despite its lac k
of statements on policy showed signs , through
its activities, of beco ming a rad ical black
youth movement. It was clearly ev ident from
their bai l cond itio ns that the twe lve were a lso
being prosec uted fo r the ir political activities.
One Asian youth had made the petro l bombs
after they had hea rd that a coach load of rac ist
thugs we re on their way to attack the Bradfo rd As ian comm unity . The petro l bombs
31
=
BRITAIN ANQ ASIA
were manufactured to create a wall of fire and
to act as a deterrent against the impending
attack.
English common law upholds the right of
self defence and the jury found the twelve·s
reasons for self defence adequate and found
them not guilty. Unfortunately in the Newham
7 case, it was not seen fit to extend the common law of self defence to the defence of the
community.
Both cases point to a breakdown of communications between the Asian communities
in Britain and the police . The number of such
attacks increased in 1984 by at least 50% and
a Home Office report in 1981 stated that the
number of racist attacks numbered approximately 7,000 and that Asians were fifty-five
times more likely to be attacked than any other
section of the community.
Some local reform
'l j
I
I
After the Newham 8 trial, similar to that of
the Newham 7, there was an overhaul of top
police personnel within Newham. The local
police chiefs are now much more articulate
and public relations orientated . They ar·e now
well equipped , both mentally and physically,
to disarm their critics . They have even
changed their tactics by putting both black and
white youths in the same dock (as in the case
of the Newham 7) and calling the incident
' gang-warfare· . More often than not racist
attacks are not taken seriously, the most recent
example being the death of a pregnant Asian
woman and her three children , when their
house in II ford was petrol-bombed in July this
year .
Parvaiz Khan , one of the Newham 7 , said,
' We do not trust the police anymore. They
are out to get us. All they want is to see us
get into trouble . ' Detective Constable Bonczoszek who interviewed the suspects, had this
to say to the Guardian: 'I am aware of them
(the Newham 7). I believe that they are involved
in causing trouble. '
Such attitudes are not going to lessen the
mistrust and the anger the black community
feels against the police. The situation is also
aggravated by the continuous harassment of
Asian youths by the police themselves . The
Newham Monitoring Project dealt with seventy
such cases last year. It is not surprising that
Asian youths have decided they have had
enough and have started looking seriously into
defending their communities themselves .
But racism is present not only in the streets
of Newham where, incidentally , there is a
very high National Front presence. (In the
1983 general elections, the NF polled 2300 ,
4 % of the vote in Newham South , the highest
in the country) . Racism is part of the very
fabric of British society and is entrenched in
every institution , from government to the
health service, to education. These are not
new phenomena, but have a historical base in
Britain"s colonial past , which created the myth
of racial superiority.
The Asian youth organizations have risen
32
ECONOMY &DEVELOPMENT
to challenge this racism through campaigns
such as the Newham 7. However there are
problems and contradictions which the movement must confront. Talking to two of the
Newham 7, Parvaiz and Bahadur, it is clear
that they think that the main stumbling blocks
in their fight against racism were the elders
of the Asian community and the segregation
of the community into various religious
groupings .
Community split
'The problem with Asian people is that they
don't stick together. If they stuck together
right from the start we would not have this
trouble (racist attacks). West Indians don't.
They stick together as one people and they
fight together,· said Bahadur.
'These Asian people have their own differences, you know, like religion-Muslim,
Hindu, Sikh. In Newham the community is
split, you have different religions ,· said
Parvaiz- a rather simplistic and superficial
analysis of the problems that beset the antiracist struggle.
Talking to the two, there seems to be a
lack of understanding, in some cases understandably so, of the older generation . They
were disappointed with the support they received from their elders. ' We felt bitterness
at the way the mosque leaders supported
us . . . They weren ' t brought up here and they
think when someone calls you Paki then the
best thing is to ignore them,· said Parvaiz.
The elders of the community, with a few
exceptions, according to Parvaiz and Bahadur.
don't want to fight back . But history has
shown otherwise. Much of the groundwork
for the anti-racist struggle was laid down in
the 1950s and 1960s. The Indian Workers·
Association (IW A) played an instrumental role
in the formative years of the struggle . It began
life as a cultural and social organization, but
faced with the increasing number of strikes
by Asians in factories , it was quickly transformed into a political organization . But un fortunately its mass base was concentrated on
Punjabi workers and so it failed to become
a vehicle for the struggles of other Asian
communities.
Campaigns such as that of the Newham 7
should make it clear to young activists that
the Asian movement does have a history of
its own and one which should not be ignored,
despite Sunder Kangesen's comment at the
Newham Monitoring Project , ' We're not here
to indocrinate them, we're here to defend their
rights-their history , they will learn in the
course of their life. · However this type of
history is not found in school history books ,
so there is all the more reason for it to be addressed at the same time as fighting racist
attacks.
A new beginning
" '·
Now that the Newham 7 case is over. apart
from the impending appeals, where does the
campaign go from here?
INSIDE
ASIA
The three defendants found guilty, Zafar.
Parvaiz and Bahadur. are planning to set up
a business in Newham after they come back
from a planned holiday in Pakistan. Unlike
some of the Bradford 12, they will not be
entering the booming industry of race
relations.
The Asian youth organizations have arisen
with the central task of self defence . 'Self
defence is no offence · was the slogan used by
all the defence cases. This generation, one
under direct physical attack, is determined to
defend itself and the community. 'The campaign will go on defending the rights of black
people against racist attacks. And if it takes
thousands and thousands of campaigns we'll
still carry on· said Sunder Kangesen.
But defending the community is a daunting task . It means creating and mobilizing a
community prepared to retaliate at every instance of racial attack . This has not happened yet. Could it be because the movement
has neither the experience yet nor the historical understanding to take on such a task?
It should also be prepared to learn from
other experiences to further its struggle and
to realize that its case is not unique. One
valuable lesson could be learnt from the West
Indian youth movement in the 1960s and the
1970s . They too were besieged with court
cases in the early 1970s and a constant need
to form defence campaigns-from the
Mangrove case to the trial of Cliff McDaniel
of the Black Youth Movement. Such valuable
experiences should not be ignored .
The lessons
But one thing is clear-the National Front and
their supporters are also learning from the
black struggle. The three whites on trial at the
same time as the Newham 7 all pleaded cases
of self defence . It is for this precise reason
that campaigns such as the Newham 7 that
have considerable political potential start to
politicize Asian youth and take the cause further than being just defence campaigns.
The campaign, despite some of its
drawbacks, does have a valuable contribution
to make to the black struggle. First of all, it
illustrated the importance of a good publicity
campaign. Secondly, it showed to the police
that it is not possible to depoliticize a case by
making ·token arrests ' of the racist thugs and
then treating both parties as members of rival
gangs in order to deny the presence of a racial
motive in the attacks .
The Asian youth movement has managed
to provide an important identity for British
Asians by establishing cultural, social and
sports organizations . But the challenge still
remains as to whether these organizations will
be able to channel the sporadic enthusiasm
generated during defence campaigns into
grassroots political work-which will not only
change attitudes but will also give birth to the
new generation of Asian activists.
Aria11a Yakas is a freelan ce journalist.
September-Octobe r 1985
-
DEVELOPMENT THEORY REVIVED
Friedrich List livesl
Theorizing about development is in a mess. Dependency theories, once
thought to have discredited earlier modernization approaches, now find
themselves in trouble too. Aidan Foster-Carter suggests a new
approach-wh ich turns out to be a very old one.
EVELOPMENT. as a self-conscious and
institutionalized field of scholarly enquiry, was a product of the post-war era . (The
very word ·under-developme nt" does not
predate the 1940s). As it crystallized. development studies visibly carried the birthmarks of
those origins: that time and place, that context. Two factors loomed largest: the anticolonial revolution and the Cold War. Contemporary European experience also fed into
the mix by what would later turn out to be
questionable analogy. for example, Marshall
Aid as prototype for all •aid" .
Thus was born what became known as
modernization theory. By and large it assumed West was best; hence the development task
was to help 'new nations· along this well trodden path, being careful to avoid 'diseases of
the transition· such as communism . While
there might be 'strains· along the way. this
process was seen as conflict-free. whether between or within nation-states : thus dirty words
like class and imperialism were banished from
the vocabulary. In fact , development was conceived as a doubly internal process: internal
to societies, and often (in the more
psychologistic of these theories) internal to individuals too. 'Modern man· (sic) must acquire the 'need to achieve·.
D
Enter dependency
Twenty years later, in the late 1960s, a new
paradigm arose which radically challenged the
modernization approach . Once again.
theoretical change had real-world correlates :
perceived failures of the 'development decade'
over much of the Third World; doubts raised
by US policy towards Cuba and intervention
in Vietnam ; and increasing awareness of
China as a different development model. all
contributed towards dependency theory. an
original Latin American mix of previous
reformist critiques associated with Raul
Prebisch and neo-marxism.
The dependency world view was very different. Firstly there was a world view : you
had to see the global system in its totality, and
·societies· as units within it. Secondly. that
September-Octobe r 1985
structure was a hierarchy: metropolis-satellite.
centre-periphery. Thirdly. that hierarchy was
in no way ·natural'. with an international division of labour according to comparative advantage. but was historically created. Consequently the system was racked by clashes of
interest at every level. both within societies
and between them (class struggle and imperialism: the dirty words were back) . As a
conclusion. dependency insisted that the Third
World would not and could not ·evolve· along
Western lines . Rather. it must make a revolutionary break with past models and the
capitalist world economy to establish
socialism and self-reliance .
For a while, the dependency approach
seemed to sweep all before it. although this
was always in part a delusion as modernization theory never died. But dependency took
a firm hold among Third World intelligentsias everywhere. and many of the sixties
generation in the West also. Yet now history
has moved on again . Almost another twenty
years later. dependency theory in its turn has
taken some knocks. Once more. it is a changing world that has delivered the blows. For
one thing, there are the N!Cs (newly industrialising countries) of East Asia and Latin
America. to controvert the dependency claim
that capitalism had shot its bolt in the Third
World. For another. China has radically
changed direction and talks these days about
modernization rather than struggle . In Kampuchea, 'dissociation· led to genocide ; while
revolution in Iran produced no socialism but
a reactionary theocracy .
As a result. dependency theory is increasingly under fire . Yet the critics offer no new
paradigm. If anything. the dominant note is
a neo-orthodox marxism (eg. Warren) with
an unmistakable whiff of the inquisition :
dependency failed because it strayed from the
truth of Das Kapital. For those who find that
direction unpromising. is there another way
out of the morass? I believe there is: not so
much a new approach . as it happens. but a
very old one whose lessons had either been
forgotten or never fully learned.
INSIDE
ASIA
Dependency stumbles
The stumbling block for dependency theory
lay in its conceptualization of the cqnstraints
of the world system. Most versions of
dependency pictured structures as straitjackets. and allowed no scope for human intervention and agency-other than the drastic
option of a total break. To allow that
capitalism could in some circumstances
develop the Third World was to break faith.
and to concede that modernization theory had
been right all along . As Clive Hamilton has
put it. to abandon ' impossibilism· was thought
to imply 'inevitabilism· .
But of course this is absurd. logically and
empirically . There are not that many N!Cs.
for one thing: hence there is no reason to suppose that a global process is under way here .
Indeed, everything suggests there is not. As
Manfred Bienefeld and others at the Institute
of Development Studies at Sussex University have argued. examination of what NI Cs like
South Korea have actually done is at one level
surprisingly comforting to broad dependency concerns. Despite neo-classical myths to
the contrary. these are highly etatiste regimes.
Development has been planned. not left to
market forces alone. although markets have
been used. Foreign investment has not been
uncritically welcomed . but carefully selected.
monitored and controlled . Great care and skill
have been exercised to ensure effective
technological transfer. And so on.
Certainly. some dependency nostrums
must be abandoned in the face of the N!Cs '
success . For some countries. patently. external orientation can work . But it is not
·capitalism·. as some abstract force . which has
done this. Rather. it is the conscious and skilled intervention of human actors such as policy
makers and planners. clearly well aware of
the perils and pitfalls of an unequal world
system. who spotted a potential niche in that
system and moved swiftly and effectively to
fill it. For South Korea. market forces - and
indeed external orientation itself-were never
an end. only a means by which a resourcepoor halt~country could strengthen its national
economy. industrialize. and generally augment its productive powers .
That last phrase- unfamilar. probably. to
those schooled in the vocabulary of productive forces and relations-gives a clue to the
paternity of the approach I am suggesting
33
== ECONOMY &DEVELOPMENI
here. It comes from the vocabulary of another
German, born a generation before Marx in
1789. Vastly inferior as a thinker to Marx,
he nonetheless had one crucial insight that
Marx missed. In his own day a prophet
without honour, especially in his native Germany , he took his own life. Yet within a
generation his theories were being put into
practice; and since then almost every country that has industrialized owes something to
him .
Friedrich List is his name: founder of the
German school of 'national economics' ,
rightwing nationalist; mostly ignored in
Anglo-American economics, or else confined to a footnote about tariff barriers to protect infant industry; and recently rebaptized
by his compatriot Dieter Senghaas , Mormon
fashion, as the implicit grandfather of
dependency theory. It would be more exact
to say that List was the first to pose the problem of 'late development ' : that is, how do
countries 2, 3, 4 ... n industrialize, in a world
which already contains at least one or more
industrial nations?
What Marx missed
What List grasped (and Marx missed, or at
least never systematized) here was the crucial
relational dimension of capitalist development, as distinct from-and in a sense
concretizing-its more obvious character as
a process . For Marx, capitalism is a process
which unfolds. For dependency neo-marxists,
capitalism is a set of structures which strangle.
For List, the former view (which he called
'cosmopolitical economy') is seriously incomplete: to accept it would run the risk of
the latter. Then as now, the dominant ideology
preached free trade as beneficial to all. This
List roundly rejected. Free trade benefits those
already industrially strong; if other states are
seduced into adopting it, their markets will
be overrun and they will remain backward and
agrarian. Rather, late developers should protect themselves, in the first instance industrializing behind tariff barriers, creating
a well proportioned economic structure in
order to emerge later as strong national
economies.
Anachronistically, we could say that List
in a sense combined elements of both modernization and dependency perspectives. On the
one hand, countries already developed do provide a model and a point of reference. On the
other hand, the model is simultaneously a rival
and an obstacle. Its very existence forces attempts at emulation (on pain of domination);
while equally making successful emulation not
only very difficult, but also likely to entail
somewhat different strategies than the original
model itself pursued, and now preaches .
Such a conceptualization has several advantages . For one thing, it re-establishes two
important connections which both of the
postwar development paradigms had
sundered: between left and right, and between
past and present. For opposite but in both
34
§§
cases essentially ideological reasons, most
modernization and much dependency thinking shared a sharply polarized view of
capitalist versus socialist development
strategies: a notion which the actual economic
history of the last hundred years reveals to be
seriously misleading. Late developers of left
and right, from Japan and Russia to North and
South Korea, have all in their different ways
and degrees perforce played the Listian game:
reculer pour mieux sauter, or what Wallerstein in an ugly but insightful phrase calls
semineo-mercantil ist
'temporary
withdrawal'.
For any late developer, it is a sine qua non
to first insulate yourself against the powerful
gales blowing from those already advanced;
a task almost inevitably entailing pervasive
state economic intervention, at least in the early stages.
The other broken link which a Listian approach can mend is that between past and present. Specifically, despite the denials of many
dependency perspectives, Europe is relevant
after all. Provided that modernization's
pollyanna unilinear evolutionism is replaced
by Listian conflict and realpolitik, then we
see in how many ways the Third World situation is not new (other than in degree
sometimes) . Much of Europe, especially
eastern and southern Europe, was there
before. Thus it turns out that development
studies did not really spring into being only
after 1945. Daniel Chirot, for instance, has
shown that just about every analytical and
political move in the development spectrum
had already been anticipated-in debates in
Romania before 1920! Further comparative
research would no doubt reveal similiar cases
elsewhere.
Four further merits of the Listian synthesis
may be mentioned. First, it effectively
transcends the dreary old 'external' vs 'internal' false polarization, which has plagued
debates between dependence and both its
modernization and marxist critics. As it turns
out, constraints are indeed external, but solutions must be internal-in a sense by definition in both cases. Second, it is strategically
pragmatic . Neither 'capitalism· nor
·socialism' (whatever these fine words mean)
offers a royal road. Practice, not a priori, is
the only test. In their different situations,
North Korea did right to break out; South
Korea did equally right to break in. Third,
Listianism avoids both the characteristic
economism of dependency (as well as some
mainstream development economics) and the
culturalism of moderniz.ation theory, by firmly
'putting policy in command'-to adapt a
phrase from Mao Zedong. What policy or
politics will of course crucially vary: China
is not South Korea, and one should not bend
the stick too far.
Active theory
not something that just happens, but
something that people make happen. This is
the major Listian merit , in a sense encapsulating all the others, and in the final analysis
the point is a methodological one . As against
either modernization's insistence that you
need do nothing (except swim with the tide)
or the dependency claim that you can do
nothing because your hands are bound, Listianism posits a more dialectical view: a
theory and model of the (re-)acting subject.
Structurally constrained, to be sure, but never
reconciled to the inevitability of such a fate.
such actors (regimes, in this instance) can kick
back. It's a tough struggle, requiring both
strength and skill. Many fail; some give up;
others scarcely even make a serious start. But
some make it: a motley crew, often an ugly
one (primitive accumulation being no tea party), but effective for all that. Later, some of
the political roughness may be softened by
economic success ; perhaps this too is a ·stage·
theory .
I make no great claims for the originality
of this perspective. Many, from various starting points and via diverse routes, are reaching
similar conclusions. Among recent writing,
I would particularly cite the case studies edited
by Bienefeld and Godfrey, and by Ruggie; the
work of the 'Sainsbury project" group at IDS,
Sussex; and the still little known oeuvre of
Senghaas and his associates. Moreover, within
the broad development spectrum there were
all along those who resisted easy pigeonholing into either the modernization or
dependency camps. Often steeped in continental European as much as Anglo-American intellectual traditions, such figures as Reinhard
Bendix, Alexander Gerschenkron, Albert
Hirschman, and Gunnar Myrdal all elaborated
important aspects of what I have here called
the Listian development dialectic. We can still
learn much from them.
As for the dialectic of development
theorizing itself, perhaps in retrospect we can
see modernization as Hegelian thesis, and
dependency as its antithesis . But if we are
neither to remain stuck in antithesis, nor to
effect escape by retreat back into modernization theory (marxisant or otherwise), then I
believe the only way forward is the Listian
synthesis. It does, after all, synthesize so
much rather than polarizing, or constructing
hierarchies . Internal and external; economic
and political (cultural , too); left and right; past
and present; structure and action-all are linked in a working model whose broad outlines
seem confirmed by both logic and history.
Thus armed, development studies can come
of age, and (to borrow from Marx) its
prehistory can end and its real history
commence.
Aidan Foster-Carter is a lecturer in sociology
at the University of Leeds.
But, vitally, development in this model is active, not passive; transitive, not intransitive;
INSIDE
ASIA
September-October 1985
ECONOMY &DEVELOPMENT
-~
•··
•
I
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"---.
NEPAL!S DEEPENING CRISIS
Clouds over Kathmandu
Growing political discontent, economic dependence and resistance to
social, political and economic change have characterized modern
Nepal. Piers Blaikie considers recent developments and suggests that
change in the future is uncertain .
the people of
The 198 I census identified 93 % of the
economic prospects for
are quite gloomy-but this is nothing new.
Foreign agencies have written reams of
reports full of quantified decline and dire
predictions . But criticism alone is insufficient.
Critics should also take the responsibility of
reviewing the possible means of remedy .
While there are no simple solutions, this article
looks at the problems of the Nepalese people,
speculating on the techno-political process that
may alleviate these problems , and what
developments in the Nepalese political
economy may make these processes happen.
peasantry work for part of their living as
agricultural labourers, households which produce for use and not for the market with
household labour are in a large majority.
Yet this class faces a number of crucial
inter-related problems. Population pressure ,
declining crop fields for the past two or three
decades and serious soil erosion (see Inside
Asia Feb/March 1985) have all tended to
reduce the ability of the peasantry to feed itself
from its own land . There is a constant search
for land in the plains of Nepal (or the terai,
PROBLEMS faced by
population as rural, the vast majority of whom
T HE
Nepal are very serious indeed . Long-term
are peasants. Although as many as 20% of the
the bulk of the people
September-October 1985
INSIDE
ASIA
where land can still be cleared of jungle), and
to a lesser extent on very steep slopes in the
hills . Additional incomes to make ends meet
can sometimes be earned , as labourers in
Nepal or in India as coolies, workmen ,
houseboys and in the Indian army . These are
vital to the support of many households. In
west central Nepal, for example , as many as
60% of households have such incomes.
Surpluses are small and annual household
budgets are often balanced within a few tens
of rupees every year.
Cooperation in agricultural production is
1imited to some reciprocal labour called panna.
However, individual and mutually competing
strategies for survival in the face of
deteriorating availability of resources (land,
water , pasture and fuel) have helped to limit
communal political action . Political representation is confined only to the local level (the
local village council panchayat). On occasion
35
ECONOMY &DEVELOPMENT ==:
==: ECONOMY &DEVELOPMENT
they have been able to cooperate on certain
limited issues-for example, the government's
attempts to tax ghee or the evasion of eviction
orders by large numbers of illegal settle rs
searchin g for land in the fo rests of the terai.
Undoubtedly the importance of earnings outside Nepal enabl es peasants to adj ust to the
adverse conditions at home more sati sfactorily
without losing their land , but at the same time
it reduces the ir ab ility to mount sustai ned
political or confrontational ca mpaigns, due to
th e absence of the most act ive members of the
ho usehold. Protest ca n take the form of
hunger-ma rches to Kathmandu on iss ues such
as ext reme hardship .
Sometimes on spec ific iss ues too, protest
has taken a more ove rtl y po litical fo rm . For
exa mpl e in 1982, a number of village counci l
boundaries were redrawn as a res ult of the
effo rts of an aspiring mem ber of the District
Council , in such a way that the v illage
headmen (pradhan panchas) who voted
against his e lect io n could have the ir pan chayats amalgamated into others, and thus
effectively be disenfranchised in the election.
Thus a form of crude gerrymandering was
success full y engi neered. The voters were
small hill farmers, with a high propo rti on o f
ex-soldiers. About 1,000 marched into
Baglung , the Zonal headquarters in west central Nepal , overturned ballot boxes , burnt
them outside the chief Zonal officer's house,
and called for the culprit 's blood. Interestingly,
th e Zonal officer le nt the culprit his horse, to
fl ee and stay away. The boundaries of the panchayars have sti ll not been red raw n. Such
d isturb ances are not very common (two o r
th ree a year reach the nat io nal newspapers),
and as yet do not threaten the statu s quo.
The cent ra l problem fo r peasan ts is the
fai lure to produce enou gh to eat, or to sell
e noug h to purchase the range of ho useho ld
requirements . ' Mode rn ' capitalist agriculture
has , by and large , fai led to take root , eve n
in the terai where fl at land and irrigation make
commercial farm ing of paddy wheat, o il seed
a nd sugar-ca ne attractive. In the hill s, th ere
are not enough sav ings to purchase chemical
ferti lizer; high-y ie lding seeds are often un suited to th e hi ghly var iab le environmental
conditi ons there; and markets are often many
days ' wa lk away. So th e Nepalese peasa ntry
remains eco nomicall y and po liticall y conservative, and under severe pressure to mainta in
its viab ility.
Labour surplus
Wo rkers and labourers are th e next most
nume rous group in Nepal. Rural labo ure rs
constitute some 30% of a ll households, and
represe nt peasant producers, who have lost
the ir land , un empl oyed 'occupational castes'
and hopeful immigrants from India , who, like
their Nepalese counte rpa rts, are looki ng fo r
land to settl e or eve n buy, provided they have
access to a loan. A labour surplu s ex ists and
bargaining is limited to indi vidual labourers
a nd thei r employers. Their lack of political
36
ticul ar fo rm of representation and gove rn ment. the panchayat system , or adopt a ' multiparty system· (more ak in to western notions
of uni versa l franchise) in which vote rs decide
betwee n co mpeting po litica l parties. The
referendum was brought about by (and fuelled)
no isy, open po liticking and criticism of the
statu s quo . During the months leading up to
the referendum , political ra llies we re once
more permitted, and a large number of
demon strations took place . Student leaders
were arrested, kept in prison and then released
weeks or months later. Members of the intel1igentsia and petty bo urgeoisie too k part in
many of the demonstrations. However, these
were an urban phenomenon: the countryside
and sma ll hill towns remained untouched .
Since the referendum po litical protest has
fa ltered. opposition parties (again banned after
the panchayat system continued after receiving
51 % of the vote) fragmented, and the ir leaders
incorporated by vario us induce ments.
Foremost, there is a crisis of production
both in agriculture and industry . There is little
sign of a business class emerging in soc iety .
who co uld perhaps take ove r the state and
mould it along •efficient ' . ·rational' and
' business- like· lines. Also there is littl e
evidence of a ri sing working class. Instead.
a peasantry ex ists without th e political or
economic mea ns to tran sform itself.
"'-'
'\.. ~ ,
State to intervene?
Capitalist agriculture has so far failed to take root.
o rga ni zation refl ects the ir wea k position with
employe rs . They seldom manage to secure an
elected post as wa rd mem bers in the local
village assembly, althoug h a few such examp les do exist.
Urban workers are very few, si nce urban
development is so limited. The only large concentration of workers occ urs in the j ute mills
of Biratnagar , pockets within th e terai and in
the Kathmandu va lley. Other urban workers,
inc luding those in hotels, cafes and ga rages,
are usually very low paid and bad ly organized ,
since eac h establishment is small , the turnover of the labour fo rce hi gh, and empl oyeremployee relatio nships tend to be perso na l.
Although workers ' associations ex ist at the
local level they are unab le to strike legally nor
ha ve th ey any national negotiatin g rights. At
present they fulfil (as the trade union movement o riginall y did in the UK) a mutual
welfare function, and have little political
power. The main problem is that with few
exceptions, th e landless and urban workers
tend to be spatially and soc iall y fragmented ,
and it is th ese exceptions which spea rheaded
organized protest in the past. While most protracted labo ur di sputes have only reac hed the
zonal leve l of official acti on (which is almost
always taken in favour of employers, and after
using fo rce and impriso nment as weapons
aga inst workers), some strikes and loc k-outs
in the town of Biratnagar and other terai towns
have necess itated national level enquiri es. In
INSIDE
ASIA
a number of cases improvements in working
conditions and pay have been won. However ,
the restrictions upon an overtl y political form
of ex press ion have not been se riously
challenged. The problem of fo rming an
industrial base in Nepal lies in Nepal 's dependent relation with India . The 'open fronti er'
allows imports from large-scale and relative ly
efficient factories in India such as cloth , shoes,
household utensi ls and machinery. It is difficult for Nepalese businessmen to compete,
and indeed Indian imports have put many
Nepalese occ upational castes o ut of wo rk
(shoemake rs, tai lors and blac ksmiths) who
now join the ranks of landless labourers.
Absentee landlords
Landlord s are conce nt rated in th e terai with
far fewer in the hills. These are co nfined to
the irrigated , paddy-growing valley floors. In
the terai many landlord s have large holdings
often exceed ing ten hectares. in spite of land
refo rm measures, and fa rms will produce two
or three cro ps a yea r. Howeve r, even he re
capitalist ag riculture has failed to penetrate
far. The class ic fe udal pattern of absentee
landlords, share-cropping tenants, and a
marked disinclination to use surplu s to
increase prod uction (eg, sinking tubewell s,
buying machinery and modern inputs) can be
found here. However, this class is the traditional
c lass in Nepal and many of the present
landl ord s are descended from those who
September-Oc1ober 1985
rece ived huge land grants from the king and
from the ruling family in return for political
favo urs or military service in the past. Many
of them are absentee landlords, li ve in
Kathmandu and are involved in senior administrative positions, in real-estate and other
business enterprises, particularly those involving
tourism and housing fo r fo reig n residents. In
addition many individual families have invested
in state power through education and other
Kathmandu -based non-productive sources of
revenue .
Mercantile power
Merchants and contractors are an economically
important c lass in Nepal. Their po litical
representat ion te nds to be informal and
behind-the-scenes, which belies their deg ree
of re presentation in government. Since most
of Nepal' s trade is linked to India. there is
a distributory network of Indian inports, handled
by very large traders o perating in the terai
town s on either side of the borde r, who then
despatch goods to sma ller wholesalers in the
hills. The major exports from Nepal are wheat
a nd rice or paddy, and the surplus from the
terai tends to move south to India both legally
and illegally , rather than to the food -defic it
hill s. Enormous fortunes are to be made
smugg ling across the open frontier- usuall y
gold (brought bac k to Nepal by returning
mercenary soldiers), mac hinery and cloth
from India: and wheat, rice/ paddy , 'fa ncy"
September-October 1985
goods ( impo rted from Hongkong and Japan
and sold to Indian customers): foreign currencies: and fertilizers. because of high subsidies
paid to Nepalese fa rmers, it pays them not to
use them on their own land in Nepa l, but to
sell them illegally in India . Because of th e
penetration into Nepal of Indian goods, capital
and increasingly personal control of enterpri ses by Indians, the latte r· s industries and
handicrafts have bee n destroy ed along
c lassical underdevelopment lines. The
accumulated surpluses that certainly exist are
used in me rchanting, rea l-es tate. labour contracts and smugg ling, rather than commited
to productive enterprises. The enormous di fficulties of running industrial enterprises in
Nepal can eas il y be imag ined . In these ways.
Nepal is locked into a mercantili st stage of
development , which is the main reason why
the industrial bourgeoisie, the 'business
class · , is virtually absent as a c lass there.
Organized student protests
The most o rga nized forms of protest. rath er
than class strugg le , have come from students.
the university and the very small , but spatially
concentrated p etty bourgeoisie in Kathmandu
and in seve ra l other large towns . This was
most clearly seen during one of the few opportunities the Nepalese people have had to participate legall y in politics. On 2 May 1980 a
referendum was he ld to dete rmine th e people ·s choice ove r whether to co ntinue a par-
INSIDE
ASIA
The state so fa r has been un able to intervene
effec tive ly. There a re many issues which are
beyond the power of one state to influence in
any way at all. Nepal ·s prob lems-both th e
failure to produce enough and the rather slow
pressures fo r po litical change-are ve ry pronounced, but the technical requirements of an
effective state in an environment such as
Nepal" s are formidable.
Nepalese history has not res ulted in th e
development of the institutions of state which
could meet these challenges. Nepal has neve r
been colonized . It fought a militaril y inco nclusive war with the British East India
Company to keep out direct British coloni al
occupation. Since the Treaty of Sugouli in
1816. Nepal has managed to prese rve its independence . The rulin g class of the day. a
milita ry and land-ow ning aristocracy. was
able to sign a treaty with the Briti sh which
preserved Nepal" s political independence , and
fro m then on it kept Brita in at arm · s length.
In esse nce Nepal was a 'tributary" state in
which surpluses were created by a peasa ntry
who were coe rced into clearing and working
the land and providing corvee labour for local
military ad ministrators and land owners. Part
of thi s surplu s was passed onto the ruling
c lique in Kathmandu . Control of trade betwee n India and China plus the sale of
valuable timber in the terai also provided additional va luab le sources of revenue . Naturally.
the maintenance of law and order . sec urity of
the country and surveillance o f riv al factions
in the capital were the main objectives of those
37
-
LABOUR AFFAIRS
POllTICS & INTERNATIONAL AFFAIRS
gro wth of bilate ral aid durin g the late I 960s
and 1970s has made Nepal one of the world ' s
highest rec ipients of aid per head. Since 1970
budget de fi cits ha ve been steadil y grow ing
(from around Rs. 450 million to Rs. 2, 500
million in 1982), and these have been fin anced
by fo re ign grants, so me fo re ign borrowin g
and to a diminishing extent by domestic borrowing . Currently about two thirds of Nepal' s
total public sector outl ay and 90 % of Nepal's
development budget is fin anced by fo reign aid
or soft loans. The economic impact of aid is
ove rwhelming . Politically , fo reign aid has
both modified but has also ex tended th e
viability of the state . It has put off the process of social change, particul arly at the heart
of the political power in the Kathm andu
va lley.
Ii
Constructive pessimism
in power. An effective administration with
widespread legitimacy and support did not
need to be built up .
The economic problems of the country
began to appear more acutely in the twentieth
century. There was and still is a conspicuous
failure to rai se revenue- at present it is
estimated that government revenue amounts
to less than 5 % of Gross Domestic Product
(GDP) . The peasantry are simply too poor to
pay much tax , and the rich merchants , contractors and the few landlords merely evade
taxation altogether. Secondly , as the hill areas
increasingly suffered from population
pressure and produced less surpluses for the
ruling class , the terai became increasingly
vital to the maintenance of that ruling class
and the viability of the state itself. However,
the state has shown a continuing inability to
control the remaining surpluses which were
being produced in the terai because of increasing lndian control of trade and land , and
powerful class forces, including elements of
the landed aristocracy , which benefited
privately from this national haemorrhag e of
smuggling and flow s of resources into lndia.
A lack of options now is all too plain . Taxes
cannot be increased, saleable timber is running
out , and the Tibet-lndian trade has been
slowed to a trickle by the incorporation of
Tibet into China .
Foreign aid intervention
During the past fifteen years or so, those
dilemmas were removed by the massive interventions of foreign aid . lndeed, foreign aid
in some ways fills the gap created by the inability of the state to raise revenue, to undertake the staggering task of raising agricultural
production, mobilize savings , invest in irrigation and power plants and so on- but only fills
the gap for the more fortunate classes who can
benefit.
Nepal, as a small country , has tended to
attract much more multilateral aid per head
than its larger neighbours, and indeed the
38
As in most countries necessary and progress ive change requires the implementation
of a series of ' techno-political ' decisions. Produ ction needs to be raised , through reafforestation , field terrace levelling, new
varieties of foodgrain, minor irrigation works
and so on . But all of them have strong political
implications and precondition s. In the case of
hill agriculture, for example , many soil and
water management and forestry decisions can
only be taken communally . Such cooperation
should and sometimes is encouraged by discretionary grants to successfully cooperating
villages. However, most of the production
improvements in agriculture will have to accept
that the rural population is a peasantry , or
aspires to be part of it. Micro-credi t for very
small farmers , as is being successfully supplied
by the Asian Development Bank , and research
and developmen t into improved seeds and
agricultural practice are ways forward . There
is , as yet, simply no other political initiative
which might lead in time to a ' mixed agricultural economy ' such as in Vietnam or
China . The problem is that very little can be
done for those who do not have access to land ,
and such developmen t strategy aims only to
tread water at best. Still , there are technical
opportunitie s for increased production .
Impetus for social change , however , does
not come from the countryside , so much as
from students , the new class of technocratic
and often foreign-trained bureaucrats, and
other politically-motivated people in the
Kathmandu valley and terai. A string of
cosmetic constitutional changes to the present
unrepresentative form of government will probably not be enough to divert slowly growing dissent. The political form of protest for
more effective and less corrupt government
at present is fragmented . Opposition parties
are officially banned and ideologically split ,
and incorporation of their leaders into
lucrative economic opportunities constantly
undermines organized political opposition .
The main force for change therefore probably
comes from the growing body of skilled and
politically aware bureaucrats and state func-
INSIDE
ASIA
tionaries, some of whom have succeeded in
reac hi ng positio ns of effecti ve dec isionmaking. T ime and time aga in , it is the personality and skill of a Nepalese administrato r
whic h has pro ved to be th e decisive fac to r in
successful projec ts (a nd the same can be sa id
of fo reign co nsultants).
Nepal' s relati onship with India is another
major cause of its underdevelo pment. The
problem lies in the ' leaky frontier' and th e
powe rfu l class interests on e ither side which
maintain it in that co ndition. There are
resources and surpluses for in vestment in
Nepal, but , like Nepal's soi ls, they too slide
so uth . Renegotiatio n of trade and transit
treat ies is very diffi cul t indeed , given the
powerful interests ranged aga inst an outcome
which may benefit the poorer classes in Nepal.
C learly , better po licing o f the frontier would
help , but smuggling is a normal mode of transaction (as elsewhere in the world), and a new
political mobilization would only help dam the
flow . Only a radical change in the nature of
the state and the class that controls it would
bring this about. Indian cooperation is al so
required. It may be rational for India to be
very generous to Nepal and allow Nepalese
goods into India , but to forgo that right for
selected Indian goods to have access to
Nepalese markets and hence encourage
selected Nepalese industries to develop. It
may be rational for India to finance massive
soil and water managemen t projects in Nepal
and so reduce the extent of flooding and siltation of irrigation ditches in the Indian plains.
But politics works rather on the balance of
power of sectional interests , and not usually
on the state intervening above the competing
interests for 'the good of all '. So India continues to exact conditions from Nepal that help
to keep Nepal in a state of dependence and
underdevelo pment-and pays the price for it
in terms of flood s and siltation in its most
populous areas.
It is not so much impoverishment of th e
Nepalese peasantry and landless which will
bring about progressive social change. It will
be the slow but growing dissent and , when
the time comes , the fast-moving and unpredictable nature of political change which will bring
this about. A demand for a more genuine
representative form of government , a reaction
against corruption , a more nationalist (and
frequently anti-Indian) spirit , the politicization of a hunger march-all of these have an
increasing chance of mobilization for more
permanent political change . But the technical
challenge of growing enough food and producing the daily needs of the people of Nepal
remains .
Piers Blaikie teaches in the School of
Development Studies at the University of East
Anglia and is a member of the Overseas
Developmen t Group , a non-profit making
research and consultancy organization o wned
by the University.
September-October 1985
Workers at a cigarette factory in Java: the government aims to keep labour cheap and under
control.
INDONESIA'S TRADES UNION S
An ·instrument of·control
On her recent visit to Indonesia , Mrs. Thatcher told President Suharto:
'Our cultures are diverse, but when it comes to defending independence
and freedom , we are at one with you'. Here Elizabeth Marlow analyses
the independ ence and freedom available to Indonesia n workers to
organize genuine trade unions.
has hit Indonesia 's weak
HE RECESSION
T
industrial sector hard , resulting in mass
layoffs and a declining value of real wages .
An inquiry into workers' basic needs and
wage levels in 1983-4 carried out by the AllIndonesia Labour Federation (FBSI) , sponsored by the Brussels-based International Confederation of Free Trade Unions (ICFTU) ,
has revealed that official minimum wage
levels are some 50-80 % below minimum
physical needs . Such minimum wages are
advisory rather than statutory , and actual
wages are usually even lower. In Greater
Jakarta only some 10,000 industrial workers
receive a wage equal to , or higher than , the
local minimum , while 200,000 receive less.
Not surprisingly , 'the demands of the belly ',
as Indonesian workers put it , lie at the base
of many industrial actions . The response of
the military regime has been to strengthen
September-October 1985
further the hand of the state in cracking down
on worker unrest.
For the past five years , a group in Holland
has been monitoring trade union rights in
Indonesia , publishing annual booklets on the
theme ' Indonesian workers and their right to
organize' . The 1985 ' update ' was issued
recently. This documents the particular combination of brute force and mass ideological
manipulation which characterize the Suharto
regime ' s approach to labour relations , and
reveals how the handling of labour relations
is being centralized into the hands of an
increasingly militarized Ministry of Manpower.
The Indonesian Ministry of Manpower is
headed by Admiral Sudomo . Sudomo was
previously head of the notorious KOPKAMTIB
Operational Command for the Restoration of
Security and Order, which , as its name suggests,
INSIDE
ASIA
is a major instrument of repression of the
Suharto regime ; he was transferred to the
Ministry of Manpower early in 1983 , especially to head off industrial strife resulting from
the recession and the 1983 devaluation of the
rupiah.
'Father figure'
Sudomo tries to cultivate a populist image, and
has promoted himself as the ' guiding father
figure ' for all labour problems. He appears
in the press on almost a daily basis , appealing
in a chatty way to workers to bring their problems to him . However , no one should be
fooled by Sudomo's apparent championing of
workers' rights. When he went to the ministry
he took most of his close KOPKAMTIB
aides with him , and has since been busy
militarizing his civil servants . One Indonesian
newspaper revealed in February that, in an
attempt to ' increase discipline and productivity ',
all employees of the ministry are to be
organized into brigades and battalions and
given uniforms . Those at head office will be
trained by soldiers from the Jakarta district
military command.
When challeged , Sudomo is not above reminding his audience of his KOPKAMTIB
background and his readiness to use its
39
:ii:
LABOUR AFFAIRS
methods. The direct interventio n of military
or police units in particular industrial
incidents, often under KOPKAMTIB command, remain s common.
Meanwhile the nationwide programme of
mass ideological indoctrination is being intensified. The state ideology , recently made compulsory by law for all organizations, is based
on ' five principles', or Pan casila . According
to thi s, and in stark contrast to everyday
reality , everything is supposed to be resolved
on the basis of ' togetherness, family principles, and consensus deci sion-making · -c1.
conscious attempt to root out any notion s of
class struggle. The head of the body overseeing the Pancas ila Indoctrination Programme
is General Sarwo Edhie Wibowo, a man
notoriou s for hi s part in the rout in 1965-66
of communists and many others in Jakarta and
Central Java , in which hundreds of thou sa nd s
were massac red. His appointment underscores
the violence which lies behind the indoctrination programme .
As with other areas of Indones ian life ,
Pancasila has been applied to industrial relations. Workers are enjoined to be the 'partners'
of their employers and government. Although
the right to strike is still guaranteed by law fo r
all enterprises except ' vital' ones, it is held to
be incompatible with Pancasila and thus deemed
subvers ive. As Sudomo said in September 1984:
' In giving life to Pancasila and putting it into
practice, it is certain that there will be a decrease
in the cases of restlessness, slowdowns, voicing of fee lings o r dismissals'.
Pancasila no panacea
To get the message across , compul sory Pancasila indoctrination courses , held for several
years fo r civil servants, teachers, academics and
others, have now been extended to the industrial
workforce. In 1984, such courses were held ,
for example , at PT Unilever Indo nesia and the
Jakarta Hilton Hotel. On these occasions, it is
also usual for a new-style 'common agreement'
to be forced onto the workforce. These common agreements replace the collective labour
agreements of before, and , being drawn up to
a standard fom,at , are further than ever removed
from any semblance of collective bargaining .
Another such indoctrination course was held
in 1984 at PT Sandratex , a textile factory in
Tangerang, in West Java. In 1982, 4,000 Sandratex workers went on strike for a wage increase
to the official minimum level and the implementation of a collective agreement to which the
company had agreed in 1977. Following the
joint intervention of local officials of the
military , police, manpower office and the FBSI,
and a meeting between workers and management at which most workers refused to speak
for fear of dismissal , the 35 who did speak up
lost thei r jobs . Since then the Indonesian textile
sector has suffered from both the recession and
western protectionism, and it is li kely that this
facto ry will have ca rried out mass layoffs. For
the remainder, Pancasila courses set the tone.
No one yet knows the extent to which wo rkers
40
who have suffered such treatment can both see
through , and mobilize against these indoctrination courses.
On occasion Sudomo has argued in favour
of trade unions. Like many other repressive
regimes , the Indo nesian military feels that the
presence of ·yellow· trade unions in certain sectors is useful for channelling and containing
workers· grievances. All Indonesian unions must
be affiliated to the FBSI , the sole labour federation, which was set up by the military in 1973.
Not surprisingly , this federation has a long
record of collaboration with the military and the
employers, for example in several types of tripartite organization set up to 'detect and defuse·
discontent. However, it appears that Sudomo
has not been impressed with the ability of the
FBSI to keep workers' grievances in check , and ,
whereas he used to refer to his relationship with
the FBSI as a ' partnership ', he is now increasingly treating the FBSI as little mo re than an
extension of his ministry.
The presence of the FBSI and its member
unions , however collaborationist and corrupt at
the top , has served to remind Indonesia 's workers that they do have a right to organize in
defence of their interests. At the tum of the
1980s, before the current recession began to bite
hard , there was a sudden upsurge in worker
demands for organization, as well as protests
against their appalling working conditions and
wage levels. In many cases, the workers chose
to organize themselves within the FBSI, this being the only way they could do so leg itimately.
They soon found their initiatives taken over by
FBSI officials and channelled into inactivity . But
organize they did, and this is likely to be one
source of Sudomo's di scontent with the FBSI.
More restrictions on unions
T here are signs that Sudomo wishes to limit further the narrow area in which FBSI unio ns can
operate. At present, only private sector workers
are allowed to form unions. By Presidential
Decree No. 82 ( 1971) all public sector workers
must belong to KORPRI , the Public Servants'
Corps , whose job it is, also according to decree,
to maintain political stability and to increase the
alleg iance of state employees to both state and
government. KORPRI 's organization runs parallel to that of the government's hierarchy , with
its central board chaired by the Minister of Internal Affairs.
Enterprises in which the government owns
part or all of the shares are amongst the largest
in Indonesia , and include companies operating
in the steel industry , oi l and natural gas , construction , chemicals, transport , import and
export, as well as banks and agricultu ral estates.
T he plantatio n secto r alone, fo r exa mpl e ,
accounts for two mi llion fami lies. All these
workers have no right to unio nize .
Plantation workers in particular suffer gross
abuse. An Indonesian journalist recently concluded that it was better to be a contract-labourer
on the colonial estates than a day-labourer under
today 's conditions. Contrast this to the
1946- 1965 period, when SARBUPRI , the plan-
1 NS IDE
ASIA
TRAVEL
=
talion workers' union associated with the Indonesian Communist Party , was a mass o rganization , successful in obtaining many changes to
the benefit of its members.
It seems that KORPRI' s sphere of influence
is being extended to exclude ever more workers
from the right to organize. A Pres idential
Decree passed last year (No. 4 1984) states that
all employees of private enterprises in which the
government owns a share (sic) must belo ng to
KORPRI.
US links
On the international front , the FBSI was intended
to appear independent and so deflect any
criticism that Indo nes ian workers mi ght not
have the right to o rganize . For many years,
a nd in contrast to its inability to carry out the
domestic task set for it by the Suharto regime ,
the FBSI see ms to have been successful
enough in its international role . Its head. Agus
Sudono, with the backing particularly of the
American AFL-CIO (according to the AmericaAsia Free Labour Institute, US trade unions
co ntributed US $2 ,740,000 to the FBSI during the period 1974 to 1984) , has achieved
considerable prominence in both the ILO and
th e ICFTU.
All the same, a top-level ICFT U mission
to Indo nesia in January 1984 , which included
Moss Evans of the British TUC , Wim Kok
of the Dutch FNV , as well as Irving Brown
of the AFL-CIO , has led , in spite of filibustering by the Americans and Asians , to ICFTU
criticisms of both the Indo nesian govern ment
and the FBSI leadership. Wim Kok in particul ar saw th e si tu at io n very clearly . Followin g his visit , and to the co nsternat ion of the
Americans , Kok stated in the Dutch press that ,
'on ve ry esse ntial points there is no ri ght for
the Indonesian trade union movement to defend
the interests of its members·. He added that
• in Indonesia it appea red to the delegation that
the officia l trad e unio n movement , j ust like
th e whole of li fe in that co untry , is ent ire ly
dominated by the military. They occupy the
administration at all levels.·
For the past two years, as a resu lt of the
ex treme difficulties brought to Indonesian
workers by the recess ion , the previous leve l
of industrial unrest has substantially died
away . But the desperate need for a living wage
co ntinues to push workers to air thei r discontent , and to demand the freedom and independence to form gen uine trade un ions denied
them by a brutal military regime and its inte rnational suppo rters .
Indonesian Workers and Their Right to
Organize, published by INDOC (Indonesian
Documelllarion and Information Cenrre) .
Posrbus 11 250 , 2301 EG Leiden,
Nerherlands. Book , 198 1 £3; Updates 1982 ,
1983, 1984, 1985, 50p each. All available
from TA POL, Brirish Campaign for th e
Defence of Polirical Prisoners and Human
Rights in Indonesia , 8a Treport Srreer, London SW/8 28P.
Sep /ember-October 1985
Tibet is now open for tourists: the Da/ai Lama 's former palace is one of ilie attractions.
TIBET PREPARES FOR THE TOURISTS
lania~s lament
As Tibet prepares for its twentieth anniversary, it is also ready for an
enormous influx of tourists, the basis of its new prosperity. On his recent visit there Anthony Shang found the Tibetan culture under greater
threat from consumerism than from Han chauvinism .
N
EW HOTELS. shopping arcades. and a
modem workers' sanitorium in Lhasa are
the most visible signs of a massive construction
boom on the eve of Tibet' s twentieth anni versary as an Autonomo us Reg ion thi s
September .
Life is indeed changing fas t for th e
Autonomou s Reg ion 's 1.8 million Tibetans.
Beijing is now co nvinced it has introduced th e
right policies to enable Tibet to catch up , the
reg ion having lagged in eco no mi c terms behind the rest of China for the las t three
decades . The official nod has bee n g ive n to
the rapid deve lopment of the se rv ice sec to r .
notably tourism , in an attempt to boost
incomes.
Today, nea rl y 35.000 people. half of
Lhasa's workforce. are wo rking in restaurants, sho ps. hotel s and transportation.
This represents a threefold increase since 1983
and in recent mo nth s the Chinese press has
September-October /985
high Iighted doze ns of Tibetan success sto ries,
including a thriving pri vately owned tax i company in Lhasa.
Tourist flood
As Tibet's doors open to fo reign to uri sts
-40,000 expected thi s sum mer a lo ne-there
is mo ney to be made; at least for Tibetans in
Lhasa, Shigatse and Gya ntse.
Most of the to uri sts so far have been low
budget travellers coming from o r en route to
Nepal. Movement between the two countries
has increased significantly since the opening
of the commo n border in March this yea r.
Preparations for the tourist boom are visible
a lmost everywh ere . A new road is be ing built
between Lh asa and the a irpo rt 90 km away.
cutting the present 4-7 hour bus journey across
th e Tibetan dese rt by more than half. New
hote ls . such as th e lu xu ry 2000-bed Lhasa
Hotel. are near co mpl eti o n and will acco m-
INSIDE
ASIA
modate ri ch to uri sts who are bei ng cha rged
anyt hing from $5.000 fo r the Tibetan tour.
On the surface. it see ms that Tibet' s harsh
climate. poo r soil and bac kwa rd infrastru cture would prec lude any opti on oth er than
deve loping commerce and service trades. Successive climatic di sasters-heavy sp ring snow
followed by summer droughts-have to so me
extent blunted th e impact o f th e economi c
reforms int rod uced in 1980. Li ves tock sa les
have ce rtainly suffered. although the 1984
gra in harvest showed an impressive 30 % in crease ove r the prev io us yea r.
Political obstacle removed
It was o nl y after the sac kin g of Ren Rong .
T ibet's hard line Party Secretary . and hi s
replaceme nt by Yin Fatang. a Tibetanspeaking veteran to the region. in 1980 th at
the eco nom ic reforms really got un de r way .
Compul so ry gra in proc urement by the state
was abolished, allo wing farmers to di spose of
th eir produce as they please. Tibetan fa rmers
were also allowed to return to traditional crops
such as chin gko (h ill barl ey) and changes in
th e co mparati ve price of barley and whea t
were orde red so as to increase barl ey supply .
Households could also breed livestock belong41
TRAVEL
== TRAVEL
ing to brigades, with a free rein to dispose of
the produce.
Further reforms last year were announced
in an attempt to boost rural incomes. Tax
holidays on agriculture and animal husbandry
were extended to 1990 and contracted leases
on land extended to thirty years , enabling
farmers to make forward plans on land use.
With the abolition of compulsory labour,
Tibetans recruited on state construction projects can now actually earn lucrative incomes.
It is true that per capita income has increased 50% to farmers earning Rmb 317 between 1983 and 1984. Tibet can also boast its
share of farmers earning Rmb 10,000 per
year. However, these figures obscure the stark
poverty in which most Tibetans, particularly
those outside the cash economy , still live .
Even in Lhasa , living condition s-in particular hygiene and basic sanitation -are
appalling. Health care delivery is poor and the
literacy rate embarrassing low . Beggars ,
young and old , roam freely in the market
place and some are permanent 'fixtures' in
popular eating houses.
Enter consumerism
1,,
This state of backwardness is not due to a
shortage of fund s as since 1952, Tibet's
dependence on state subsidies has been almost
total. The central government has so far
pumped over Rmb 8 billion (US$3 billion)
into the region . But rather than vitalizing
Tibet's productive capacity, most of the funds
have been swallowed up by Tibet 's burgeoning administration and by purchases of fuel
and consumer goods from neighbouring provinces. Sunglasses , cassettes and TY sets are
today easily available in Lhasa, an irony
perhaps, since it is almost impossible to find
a shop selling pens or pencils.
In an attempt to supply southern Tibet with
essential consumer items such as matches, tea
bricks, biscuits and glassware , Beijing has
encouraged cross-bord er trade with Nepal .
Poor transport links mean that consumer supplies can be more easily transported across the
Himalayas than from the neighbouring provinces of Yunnan , Sichuan or Qinghai.
With the development of commerce and
service trades, the demand for fuel is also likely
to increase . At present most of Tibet's fuel
supplies have to be transported by tankers
from Xinjiang Autonomous Region in the far
north west of China. Developing the region 's
own energy resources is therefore a priority ,
and a UNDP-as sisted geothermal project
located 90 km north of Lhasa is currently in
its exploratory phase.
Initiatives needed
Low educationa l standards are a burning issue
for Tibetan leaders who are worried that
without better educational opportunities, very
few Tibetans will reap the fruits of modernization . Enrolment rates, even at primary
level, are shockingly low. Last year, only 600
Tibetans graduated from college and technical
42
schools .
To increase the number of graduates, a
10% increase in state expenditure in 1985 has
been announced . Mandatory grants are now
available for Tibetan and other ethnic minority
students, even for primary education . This
year , I ,300 Tibetans will be sent to special
middle schools in Shanghai , Lanzhou ,
Chengdu and other cities, and plans have been
approved to build a university in Lhasa.
The shortage of skills is being made up by
a further inflow of Chinese. Over the next few
years, 2,500 teachers from other provinces are
to be drafted in . Construction workers have
been sent from as far away as Zhejiang province on the eastern seaboard to build a new
hospital and gymnasium , just two of the 43
prestige projects planned to mark the twentieth
anniversary of the Autonomous Region.
Whil st generally pleased with th e
economic reforms , Tibetan leaders like
Baingen Erdini Qoigyi Gyaincai , vicechairman of the Standing Committee of the
National People' s Congress, have expressed
anxieties over the status of Tibetan culture and
language. Although 60% of local government
posts are filled by Tibetans , many jobs still
require examination passes in Chinese.
It will require more than economic
measures to mollify the suspicions and even
hatred that many Tibetans have of the Han
Chinese. Memories of the destruction of
monasteries by Red Guards are difficult to
erase. In a complete reversal of policy, Beijing
now encourage s Lama Buddhism and
monasteries , and shrines are being restored
at the state' s expense .
Chauvinism ever present
The extension to Tibet of the natio nwide
crackdown on crime in 1983 has, however,
affected the goodwi ll earned by Chinese
I N S I DE
ASIA
leaders for their economic reforms . Tibetan
exiles claim that prominent Buddhists and
political dissidents , such as Lama Geshi
Lobsang Wangchu and Tamden Tsering, were
among the 2 ,000 Tibetans arrested in the summer of I983 for alleged anti-social and
economic crimes.
Han chauvinism , however, is primarily
manifested in personal attitudes rather than
institutionalized forms of discrimination . The
disrespect for local customs shown by Chinese
day-trippers, when visiting the sacred Potala
palace with their straw hats , sunglasses and
blazing stereo cassette recorder is hardly conducive to better race relations. The fact that
most of the Chinese in Tibet did not settle
there by choice does not improve matters
either.
Scuffles are now almost daily occurrences
at the sacred burial site outside Lhasa . Crowds
of pleasure-seeking Chinese , keen to catch a
glimpse of Tibetan corpses being chopped up
and fed to the vultures , are regularly stoned
off by funeral workers.
Yet it is not the influx of Han Chinese that
poses the only threat to Tibetan culture in the
future. Already the growth of tourism is
creating new expectations and habits. Yo ung
Tibetans are exposed to the latest pop songs
from the West and kung fu movies are shown
to packed houses every night. Tourists are
frequently being surrounded by cash-thirsty
Tibetans eager to sell their jewellery, antiq ues
and religious ornaments.
This surge towards modernity has happened
so fast that nobody has really bothered to ask
the average Tibetan whether they would really
be willing to abandon their traditional
lifestyle.
Anthony Shang is a freelance journalist.
September-October 1985
..
Small private businesses flourish in Phnom Penh: customer at a traditional medicine
stall.
.... •a.,...• • ..., .,.a••• .-..-, ,,,..,~,-.. ..,
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-
=
TRAVEL
~
TRAVEL
-
ing to brigades, with a free rein to dispose of
the produce.
Further reforms last year were announced
in an attempt to boost rural incomes. Tax
holidays on agriculture and animal husbandry
we re extended to 1990 and contracted leases
on land extended to thirty years, enabling
farmers to make forward plans on land use .
With the abo li tion of compulsory labour ,
Tibetans recruited on state construction projects can now actually earn lucrative incomes .
It is true that per capita income has increased 50% to farmers earning Rmb 317 between 1983 and 1984. Tibet can also boast its
share of farmers earning Rmb 10,000 per
year. However, these figures obscure the stark
poverty in which most Tibetans , particularly
those outside the cash economy , still live .
Even in Lhasa , living conditions- in particular hygiene and basic sanitation-a re
appalling. Health care delivery is poor and the
literacy rate embarrassin g low. Beggars ,
young and old, roam freely in the market
place and some are permanent ' fixtures ' in
popular eating houses.
Enter consumerism
This state of backwardne ss is not due to a
shortage of funds as since 1952 , Tibet's
dependence on state subsidies has been almost
total. The central government has so far
pumped over Rmb 8 billion (US$3 billion)
into the region . But rather than vitalizing
Tibet' s productive capacity , most of the funds
have been swallowed up by Tibet's burgeoning administration and by purchases of fuel
and consumer goods from neighbouring provinces. Sunglasses, cassettes and TV sets are
today easily available in Lhasa, an irony
perhaps , since it is almost impossible to find
-::1
r-1 .. ,.. : ... a. t ,.,. h otto.- .-n ,-.o ral-,,t:nnc
hPPn 1-:p,nt frnm ~H: f~r !:l \11!:ll\/ ~ c;: 7hPii-::1nn nrn_
c hnn 1;:p)lino nPnc: nr nPn r ilc
ent
-"Excell
leaders for their economic re forms. Tibetan
exiles claim that prominent Buddhists and
political dissidents, such as Lama Geshi
Lobsang Wangchu and Tamden Tsering , were
among the 2 ,000 Tibetans arrested in the summer of 1983 for alleged anti-social and
economic crimes .
Han chauvinism , however , is primarily
manifested in personal attitudes rather than
institutionalized forms of discrimination. The
disrespect for local customs shown by Chinese
day-trippers , when visiting the sacred Potala
palace with their straw hats , sunglasses and
blazing stereo cassette recorder is hardly con-
schools.
To increase the number of graduates , a
I0 % increase in state expenditure in 1985 has
been announced. Mandatory grants are now
available for Tibetan and other ethnic minority
students, even for primary education . This
year , I ,300 Tibetans will be sent to special
middle schools in Shanghai , Lanzhou ,
Chengdu and other cities, and plans have been
approved to build a university in Lhasa.
The shortage of skills is being made up by
a further inflow of Chinese. Over the next few
years, 2,500 teachers from other provinces are
to be drafted in. Construction workers have
Chomsky
ing that is very l,,acllj,aeecled now" . -- - Noam
...
.....;.. ·
- someth
..
·
-
.
'•
•• •
'·
•
;·,
,·•
·,
,•
•. •
,
.'
.·'
-·
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Go ne is the gloom
After six and a half years of existence , during which it has been ostracized by a large part of the world communi ty, the People's Republic
of Kampuch ea has begun to develop an identity and a quiet selfconfidenc e. Michael Vickery reports on his impressio ns from his recent
visit there, and on the changes since his previous visit four years earlier.
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Small private businesses flourish in Phnom Penh: customer at a traditional medicine stall.
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Inside Asia, 242-244 Pentonville Road, London Nl 9UP, United Kingdom.
N JANUARY THIS YEAR the People·s
Republic of Kampuchea (PRK) celebrated
its s ixth anniversary , a longer life than either
Pol Pot's Democratic Kampuchea (DK) which
lasted from April 1975 to January 1979 or Lon
Nol ' s Khmer Republic (March 1970 to April
I 975). It is also as long as Sihanouk' s
Sangkum lasted after the Prince cut loose from
US aid in 1964 and attempted to conduct his
Royal Buddh ist Socialism on the country ' s
I
September-October 1985
own resources. Not only has the PRK enjoyed
a relatively long life for a Cambodian regime,
it has made steady , if slow progress , whereas
its predecessors were in decline long before
their terms came to an end.
Tangible, if superficial , signs of progress
in comparison with my last visit in I981 were
visible from the moment of arrival at Pochentong airport, with the Soviet aircraft and crew
supplied to the new Cambodian airline . The
INSIDE
ASIA
airport was neater and official personnel wore
new well-cut uniforms . Amongst the arrivals
was Dr Nuth Savoeun , an official in the
Ministry of Health , returning from a trip to
France, dressed in a spiffy grey suit and with
a cargo of medicines. He is one of the PRK
officials without any revolutionary past and
yet is able to undertake missions to western
countries.
The next day, a Sunday, we travelled with
a foreign ministry guide to a rural area 30 km
north of Phnom Penh , to Phnom Prasith , to
visit a kathen, the annual festival for presenting new robes to monks and other donations
to temples.
The lively crowd in holiday finery proved
that old traditions are still alive , and the
copious dishes prepared for monks and cele43
=
brants and to which odd guests like ourselves
were eagerly invited, proved that hunger had
long been banished, even though we were not
in one of the country's most fertile areas . The
following Sunday we went to Oudong Hill ,
north west of Phnom Penh and previously
inaccesible for 'security reasons '. I found it
to be , as it was twenty years ago, a favourite
weekend picnic spot where people stroll
among the old royal tombs . There was a lively
kathen at a neighbouring temple ; and the lack
of private automobiles was the only clear difference from pre-war times.
On the streets of Phnom Penh people are
slightly better dressed than in 1981 , appear
somewhat better fed , and there are visibly
more private shops for repair of radios , tape
recorders , and assorted appliances , for
photography and film processing , even
automobile repair and upholstery. Although
importation of private vehicles is virtually
non-existent , and private ownership of cars
is not guaranteed by law , some people have
managed to recover cars not totally destroyed
during 1975-79, and painstakingly repair
them . One proud relic was a 1960s Lancia
with traces of dents still in its panelling , being outfitted with plates on a Phnom Penh
street.
Another indication of increasing prosperity
were the numerous colourful stalls set up for
kathen cash collections from passers-by , to be
used for repair of temples and support of
monks.
Economic elite
Individual incomes originate in state salaries ,
market trading , or private artisanal work, all
of which are legal. The economic elite in this
nominally socialist society in which the state
lays claim to all land , all dwellings , and even
all cars , are not state functionaries existing
on salaries , but private traders and artisans,
and probably farmers in the better agricultural
areas.
On an excursion just a few kilometres outside of Phnom Penh on Highway I, the road
to Ho Chi Minh City , we saw a woman seated
beneath her traditional stilt-supported house
at a hand loom . She was making a chequered
type of cloth used for head covering, bathing
sarongs or for wrapping possessions on trips .
The weaving , she said , was her full-time
occupation. After calculating the prices of her
raw materials, the number of pieces she wove
in a day , and their sale price , her gross
monthly profit averaged 1800 riels . This was
$120 at the official rate of exchange or $36
in the free market, and constitutes more than
three times the highest state salary. This
amount will buy 360 kilograms of rice,
enough to feed 24 people for a month, or 40
kilograms of beef, or 90 of sugar.
State salaries, in contrast, even after two
rises since 1980, are only between 140 and
500 riels. There was probably a dual purpose
in setting them so low when money was
reintroduced in April 1980-to check infla44
~
TRAVEL
tion , given the penury of goods , and to
demonstrate that PRK officials , unlike those
of Lon Nol or Sihanouk , were not meant to
accumulate wealth by virtue of their positions.
This is emphasized in the frequent political
education sessions which all state employees
must attend. They are considered as cadres
who are to serve the people and the country ,
not use their places in the system to become
a privileged class . The difference in pay between experienced workers and their bosses
is small , and the director of a pharmaceutical
factory told me that his skilled employees with
bonuses and family allowances may take home
more than he does.
Everyone agrees it is impossible to live on
a salary, and all must engage in extra income
producing activities , even it is only resale on
the free market of part of their subsidized
rations of kerosene , cigarettes , soap, rice ,
condensed milk and sugar. Restaurant prices ,
for example , are about the riel equivalent of
1960s prices , whereas salaries are a tenth of
the earlier level. Nearly all officials maintain
personal vegetable gardens, as do schools and
Buddhist temples , worked by pupils and
monks, and these, in addition to supplying
cheap food, serve to keep urban inhabitants
aware of rural realities .
Solidarity groups
The rural sector, which has always produced
most of the country's wealth, has been subjected to a minimum of discipline. With prewar usury eliminated and all state land allotted for use , peasants no longer fear debt and
the resulting loss of land , and the pledging of
land for debt is forbidden by the constitution
which guarantees land allotments for production and the inheritance of such rights .
Until 1983 there were no taxes or forced
state deliveries , and all surplus beyond the
farmers' own needs could legally be sold on
the free market. If the country has not yet
achieved self-sufficiency in rice , it is primarily
because of several years of flooding or
drought , compounded in some areas by improperly devised irrigation works of the Pol
Pot period . Another problem , which may be
the crucial limiting factor , is lack of draught
animals , water buffalo and cattle , a legacy of
the 1970-1975 war and careless slaughtering
in the inter-regime anarchy of 1979 .
Farmers are organized in 'solidarity
groups' ranging from family cultivation on
plots allotted at the beginning of the season,
through an intermediate stage, including over
half the rural population , in which preparatory
field labour is communal, but subsequent
work, harvesting and disposal are family
affairs , to the most advanced type in which
all labour is communal and the participants
are rewarded at the end of the season in kind
and in cash according to a point system. Tools
and animals, except for those purchased by
the group, remain personal property.
Each family also has a private house and
cultivation plot of 1500-2000 square metres
INSIDE
ASIA
TRAVEL
At an officers' training school in Kampuchea,
trainees practice with their Soviet-made weapons. Some may even train in the USSR.
which they may use as they see fit as well as
dispose freely of all its produce.
The solidarity groups are encouraged to
sell surplus to the state and in fact are expected
to plan for such sale. In 1984 the state was
prepared to buy rice, maize , beans and tobacco. Other products, such as sugar cane , watermelons , poultry and ducks, were not included
and could be sold on the free market.
From 1983 , a 'patriotic contributions' tax
has been levied on agricultural produce at the
rate of 80 to 120 kilograms of paddy per
hectare according to productivity of the land.
Other crops may be taxed in cash .
A major problem , recognized by the authorities , in obtaining surplus from agriculture
for feeding the town , investment and export ,
is the production of tools and consumer goods
to exchange with the rural sector; and this
determines the direction of industrial redevelopment. In the present and near future
the tasks of the country ' s small industrial base
are to satisfy the demand for agricultural implements and articles of daily use, and to
transform agricultural products into
commodities .
hand, that lack of local raw cotton prevents
them from operating at capacity or satisfying
public demand . The same problem impedes
production at the jute bag plant in Battambang.
Although such basic raw material deficiencies may be overcome by local efforts, and
the energy problem is being alleviated (a new
USSR-built electricity plant was opened in
November), some imports , such as chemicals ,
are required in nearly all industries, and Cambodia will have difficulty acquiring them as
long as its trade and financial positions are
exacerbated by western opposition to the
Slow economic growth
Industrial reconstruction since 1979 has been
disappointingly slow. The only industries satisfying both demand and plan are the cigarettes
and soft drinks factories . Otherwise both plan
and need remain unfulfilled , and the two main
reasons , as given both by the Ministry of
Industry and personnel in three factories
visited, are insufficient raw material and lack
of electrical power. A prime example is the
rubber industry, one area in which Cambodia
has the potential for raw material selfsufficiency . According to the workers , raw
rubber supplies are now adequate, but the
factory operates under capacity because of
insufficient chemicals which must be imported.
Textile factory staff complained , on the other
September-October 1985
PRK.
In the face of insufficient production and
with the impossibility of normal foreign trade,
commodity demand is satisfied by the free
market, supplied by smuggling across the Thai
border or by ship from Singapore, and tolerated to an unexpected extent in a 'socialist'
country. Until 1983 there was no state control of the market, nor even any taxation.
Now, however, second-hand book stalls pay
90 riels tax per month, rice dealers 180 riels,
and the wealthy silver and gold shops 320 and
1000 riels respectively. These rates are very
moderate for traders in a country starved of
even basic commodities and in which market
wealth contrasts strikingly with low salaries.
Unfortunately , frivolous and even noxious
items occupy important places in the markets .
A doctor at one of the largest hospitals said
that they often have to send patients to the
market for prescribed drugs instead of supplying them free, even though the quality is
uncontrollable and counterfeit drugs have occasionally caused deaths.
Cultural revival
If the economy gives cause for concern ,
cultural revival after the bleak Pol Pot years
offers a brighter picture. When the PRK came
to power in 1979 they promised a restoration
of Buddhism, and that promise has been kept.
September-October /985
Temples have been reopened and repaired,
monks ordained , and traditional festivals, such
as the kathen , revived . There are limits
though , due to the country's precarious economic situation. Men under fifty are not supposed to be ordained , as they are needed in
productive work , but exceptions may be seen .
Temples are normally opened at local request ,
but where several once clustered in wealthy
neighbourhoods, only one is now permitted
to function, and temples which once might
have housed 20-30 monks are now limited to
four or five.
Islam , Cambodia ' s second recognized
national religion, and the faith of the Cham
minority, is also flourishing. No previous
regime made such efforts to integrate the
Chams into the country's mainstream. At
Chrui Changvar, a Cham community across
the river from Phnom Penh, an imam told me
that over half the pre-revolutionary population have returned and the three mosques are
functioning again. The Chams there, as
before, cultivate fruit orchards and raise fish.
which they sell on the free market, earning
40-60 riels per day per family, and paying
taxes of 100 riels per year for each 100 square
metres of orchard land, an amount which the
imam considered very reasonable.
Education is another area of enthusiastic
revival, with as many students as in pre-war
times enrolled in the ten-year primary and
secondary schools, where much time is devoted to Khmer language and literature. No
foreign languages have yet been introduced
in the schools, and the claims by PRK enemies
about Vietnamization of education are without
foundation.
There is also little sign of the alleged Vietnamese colonization . Pre-war Vietnamese residents have returned and settled in their old
neighbourhoods ; and there is also a small
floating population of illegal Vietnamese who
move back and forth along the rivers to trade.
INSIDE
ASIA
-
dodge the draft, or simply to enjoy an easier
life in Cambodia . Western aid workers who
have travelled extensively in the border provinces report no massive influx of Vietnamese
settlers there; and in a trip to a border area
in a part of Takeo province where Vietnamese
might have been expected, I found new
Khmer settlers in a government scheme to
develop agriculture where insecurity had
prevented cultivation all through the 1960s
and 1970s.
The Vietnamese presence is in general
restricted to the troops concentrated in the
north and north west to combat infiltration by
Pol Pot , Son Sann and Sihanouk forces from
the Thai border. The danger is real, and tension
prevails in those regions . In 1981 1 was able
to travel by car from Phnom Penh northward
to Battambang and Sisophon , then east to
Siemreap and Angkor, but now the northern
roads are closed to foreign visitors .
Because of the military situation, national
defence consumes scarce resources. contributing to the slow economic growth, imposing strict security measures , and requiring
mobilization of the population for onerous
tasks such as military service and civilian construction groups near the Thai border.
Given the situation facing the PRK in 1979
their record in most areas is good. but further
progress is problematic so long as their
enemies enjoy increasing support from such
powerful backers as China, ASEAN and the
USA . The Cambodian people need peace. and
peace in favour of the PRK or a coalition in
which the PRK nucleus is prominent.
Michael Vickery is a research fellow at the
Centre for Asian Studies, University of
Adelaide. He is the author of Cambodia:
1975-82, South End Press/George Allen &
Unwin, 1983.
45
~
E LITERATURE
CHINA'S LITERARY FREEDOM
Permanent waves
The end of the Cultural Revolution seemed to herald a new era of literary
freedom in China. However, writers and artists have still had their share
of problems, as Gregory Lee argues in his review of a recent analysis
of the current literary scene.
IA NG HENG and Judith Shapiro will
long be remembered for their poignant account of life during the Cultural Revolution
in Liang Heng's biography, Son ofthe Revolution. Liang Heng is typical of those sons and
daughters of the revolution, described as the
'lost generation', taking part in what they
believed was a great egalitarian crusade .
Liang Heng was a zealous Red Guard at the
age of twelve and he and his father even turned against his own mother , labelled as a
'rightist' during the Hundred Flowers Movement in the 1950s. Liang Heng and his
generation want those appalling times never
to return and it is doubtless out of a wish to
protect and nurture the freedoms that will prevent another Cultural Revolution that this
more recent work stems.
Although the title of their latest book suggests an emphasis on 1983-the year of the
'spiritual pollution campaign'-it does in fact
cover the whole of the post- 1949 period , and
in particular provides a detailed survey of intellectual and artistic life in China since 1976.
Arthur Miller, who produced his play
Death of a Salesman in Beijing and Tianjin
during 1983 , has written a remarkably perceptive introduction and seems to have grasped
the workings of Chinese society during his
brief stay. Miller has , of course, a long
association with 'intellectual freedom' ,
manifested notably in his play The Crucible,
which was written as a reaction to the McCarthy witch-hunts. Of the current situation in
China he writes : 'Life is immeasurably more
hopeful ... If regressions like the recent campaign against "spiritual pollution" have again
broken out, it is also true to say that they have
had to be quickly turned off again.'
The latter part of the book is very much
concerned with the potentially destructive
'spiritual pollution campaign' which now
seems to have died a timely death . As a
resume of the campaign alone, this is a useful
book; but it also provides a general discussion of post-Cultural Revolution intellectual
activity, covering such events as the experiments with democracy , the local elections
L
111
46
of 1980 and the consequent challenges
presented to party authority.
Political activity
Those 1980 elections, and their concomitant
hustings and meetings , seemed at the time to
create more fuss and publicity than their scale
and nature warranted , such was the sensitivity and effervescence of Chinese intellectual
and political life at the time. Much of the fuss
was due to the fact that the students involved, many of whom had suffered the rigours
of the Cultural Revolution , were for the first
time in their lives given the opportunity to
show their dissatisfaction with the way things
had gone; the resultant naive exuberance was
perhaps to be expected.
Subsequently, much of the testing of the
limits of democracy and party patience has
taken place in the world of literature. In this
field the ambivalence of the Communist Party to the artistic treatment and interpretation
of the history of the Cultural Revolution
manifested itself in the reception accorded to
the filmscript of the writer Bai Hua . His film
Unrequited Love was criticized by the Party,
while having earlier received its acclaim . The
subject of the film is a patriotic artist returning from overseas who meets his death during the Cultural Revolution. Films , plays and
books about the Cultural Revolution and its
mistakes and tragedies had been popular for
several years, but suddenly, in 1981 , the Party
decided to call a halt. The campaign against
the film lasted almost a year, Bai Hua personally escaping severe criticism but his film
being denounced for its 'bourgeois
liberalism '.
Unreported by Liang and his wife is the
fact that Ba Jin, the famous pre-Liberation
novelist and author of The Family, had supported Bai Hua, and rumour had it that he too
was to be reprimanded. Sanity prevailed,
however, and both are now exerting a
liberalizing influence within China 's literary
circles.
All this serves to illustrate the complex
INSIDE
ASIA
situation facing the Party when the Cultural
Revolution was under discussion. Formally
it was the Party that was respon si ble for the
Cultural Revolution and its excesses, and
although roundly condemned by the current
leadership many of those cadres who had
taken part in the Cultural Revolution were still
in positions of power. At that time Deng
Xiaoping still found it necessary to accommodate some of the old guard, especially the
conservative-minded military. The process of
removing these ' left-wing' members of the
Party still continues and only recently has it
been deemed timely to institute wholesale reselection of grassroots members . But however
much the Party purges itself, it is inevitable
that criticism of the Cultural Revolution by
outsiders may be seen as criticism of the Party
itself. Consequently, for the time being at least
the line is fine for Chinese writers who turn
their attention to that period of Chinese
history.
One writer who has successfully attempted to address the problems of guilt and
responsibility experienced by those who participated in the Cultural Revolution is the
outstanding young playwright Li Longyun ,
whose play Little Well Lane discusses the life
and attitudes of a small backstreet community in Beijing from 1949 to the end of the
Cultural Revolution . Written several years
ago the play was shelved during the 'spiritual
pollution campaign ', and it was only in th e
spring of this year that this stimu lating and
controversial production was finally staged.
LITERATURE=
The one-sided way in which the ·spiritual
pollution campaign· was handled was the main
reason why some of its saner points seemed
so incomprehensible to the Chinese populace.
Condemning permanent waves was ludicrous
and superficial. when a more effective
approach might have been to underline the pitfalls of Western consumerism.
New freedoms
The question of freedom of belief is given a
good ai ring in this book and those interested
in religion will find it illuminating. The
discussio n of freedom of speech is also treated
fully and fairly , again mainly in relation to
the quoshed 'spiritual pollution campaign',
and some inci sive observations are made. It
is observed that the problem is not that all
Chinese want to broadcast their complaints
from on high, but rather, that they want the
'freedom 1101 to speak' . During the Cultural
Revolu tion people were not allowed to keep
their own counsel, as we were reminded when
the spectre of 'self-criticism ' once again
reared its head in the recent campaign.
On the whole Liang Heng and Judith
Shapiro give a positive gloss to their concern
about the future of intellectual freedom in
China. Where it appears negative it is so
because events at the time of writing led them
to fear that the mistakes of the past might be
repeated. The 'spiritual pollution campaign '
is now truly buried and its chief architect,
Effects of tourism
The 'spiritual pollution campaign' itself was
in many ways a Cultural Revolution writ small
and it led to more than just the banning of
literary manuscripts: it encompassed every
facet of life from cultural influence from
abroad to ear-rings and the permanent waves
of Chinese women's hairstyles .
Liang Heng and Shapiro wrote this book
when the 'spiritual pollution campaign' had
not yet received its final death-knell, and many
of the points made by them about the 'campaign ' have an ai r of perceptive immediacy.
Yet their treatment of the problems of the
Chinese when faced with the confusing
melange of both positive and negative Western
influences has a more long term significance .
For instance, they ask what the Chinese people are supposed to make of the presence of
those brash foreign tourists who throw their
money around. Naturally their behaviour will
create envy and the desire to emulate them.
The Chinese people are, after all, being encouraged to take a more materialistic attitude
to life and to respond to work incentives in
order to buy desirable goods with the fruits
of their labour. As the authors put it: 'They
see foreign tourists, in their colou rful Western
clothing , pull out what seems like a lifetime's
savings in shops. They envy them the luxury
hotels and their travel in imported airconditioned buses.'
September-October 1985
Deng Liqun , has recently been demoted . But
eve n though its end was still uncertain when
the book went to press , the authors nevertheless felt a certain optimism: 'The door is
firmly open , however , and if Deng Xiaoping
can retain power for another few years, there
will be no going back to the Maoist
xenophobia which kept China cut off from the
rest of the world for so long. '
The book also admits that the problem of
intellectual freedom is confined to a tiny fraction of China 's vast population and points out
that far more people are co ncerned with 'corruption and abuse of privilege '. Indeed it is
only with the exposure of such practices by
the fine investigative reporters now springing up in Ch ina, that the leadership will be
a le rted to the extent of this problem. ln order
for this to come about these journalists need
a certain latitude of expression. There is now
every sign that they will get it.
The problem is more tricky when it concerns poets: what do they have to offer? The
answer is, a lot, and if they are permitted to
flourish they will put China back on the
world 's literary stage. To a large extent
China 's young poets interpret the lack of confidence of the young , especially the ' lost
generation ' of the Cultural Revolution. But
here again the authors are optimistic, believing China ab le to 'strike at some of the roots
of the disillusionment and the "crisis of
belief '.'
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Gregory Lee specializes in Chinese literature.
He lived and studied in China in 1979-81 , and
1982-3. He is currently a research fellow at
the Institute of Literature in Beijing. The book
reviewed is Intellectual Freedom in China
After Mao. With a Focus on 1983 by Liang
Heng and Judith Shapiro. A Fund for Free Expression Repon, New York, $10.00.
Dai Houying
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•
And there we have it. It is not the poets
who give vent to genuine frustration who
should be chastised for their pessimism but
rather the causes of the frustration itself which
should be tackled. One must agree with the
concluding sentences of this book: 'greater intellectual freedom . .. cannot help but accompany modernization and the new emphasis on
education and skills. Political and economic
stability, ironically, are the surest ways of
bringing about change in China. In this
regard, China 's intellectuals wish Deng
Xiaopeng's reformers success.'
The final acknowledgment of the importance of intellectuals to Chinese society and
recognition of the shabby and sometimes barbaric way in which they have been treated
came from the Communist Party leadership
in July of this year, when a two year deadline
was set for the rehabilitation of all intellectuals persecuted since 1949. The intellectuals
and artists have been given back their voice:
one can only hope that China is ready to listen .
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September-October 1985
INSIDE
ASIA
47
=: REVIEWS
Will communalism kill India?
India: The Siege Within by M. J. Akbar.
Penguin Books, London , 1985. £2.95 (paper).
The centrepiece of Akbar's publication is
India's unity and the power house of forces
that threatens it. He raises the same old
question: Can India survive, particularly
now in the 1980s? Having marshalled all the
bits of fact and evidence , both historical
and contemporary, on which he could lay
his hands as a competent journalist, Akbar
makes a positive case for India in three well
defined sections.
First he unravels the ways in which unsuspecting Muslims were manipulated and
forced to accept Pakistan . This country is
essentially a creation of an ideological
Muslim elite led by theocratic forces , who
successfully 'managed , in the midst of
deliberately provoked violen ce, to sell the
thesis that a Hindu majority would either
subjugate them or swallow them . The Muslims were told that the Hindu 's secularism
was a pretence, his democracy a trick to
disguise a sinister ambition-to turn the
Muslims into slaves '. Hardly had Pakistan
come into being , when it became clear that
contradictions were built into the very concept and structure of Pakistan . The geographical separation between its two units
by over a thousand miles raised immediate
doubts about its future. The unbridgeable
cultural distance between them proved
even more damaging . That Islam was not
adequate to glue all Muslims together into
one nation-a repudiation of the logic of
the birth of Pakistan-was proved by the
secession of East Pakistan (now Bangladesh) in 1971 . By rejecting secularism and
democracy, Pakistan was left without 'a
controlling cohesive idea which could
generate a genuine nationalism among the
masses or the leaders' . This explains persistent political and constitutional crises
in Pakistan. There are other issues as well.
Why were forty million Muslims left behind
in India? Why was it created in Muslimmajority areas where the Muslims least
needed protection from the Hindus? Why
was Urdu selected as the official language
of Pakistan when Bengali was spoken by
56 % of the population , Punjabi by 37 %, and
Pushtu , Sindhi, Baluchi and Urdu by the remainder? Before long 'Pakistan discovered
that it was not a country at all '.
Can Pakistan survive?
Can Pakistan , or what is left of it , survive
and retain its territorial integrity? Yes , provided it practises secularism and
democracy-the very principles the acceptance of which contradicts the rationale of
Pakistan 's birth. The future , therefore,
' looks as tenuous as the past' . Despite the
48
REVIEWS
-,
National Assembly elections of February
1985, in which political parties were not
allowed to participate, Akbar's assessment
apparently continues to hold out. All power
is still concentrated in the hands of an
unelected President, Zia-ul-Haq , who is yet
to lift his martial law in what is becoming
an undiluted theocracy.
In sharp contrast, the commitment to
and the practice of secularism and
democracy enabled India both to survive
and to thrive. Even Mrs Gandhi , who flirted
a while with fascism by declaring the
Emergency in June 1975, wisely chose to
return to democracy which , however, voted
her out of power in March 1977. 'Nor did Mrs
Gandhi try to rig the polls , or attempt to re main in office after her defeat '. For the
same reason , Hindi was not forced as the
only national language upon recalcitrant
citizens. Secularism pervades because ,
among other things, ' nine out of ten Hindus do not believe in violence against the
minorities '. All this does not mean ,
however, that there are no mortal threats
to India's democracy, secularism and unity . One such danger, Akbar's second
theme, surely comes from Punjab where the
Sikhs have raised the secessionist demand
for a sovereign homeland-Khalistanapparently to safeguard Sikhism from its
absorption by Hinduism. Punjab is India's
'success story', for it is where India is now
harvesting the fruits of an expanding
agrarian capitalism.
The Sikh religion was founded by 'Guru'
Nanak in 1499. But it was Gobind Singh, who
redefined Sikhism in 1699 by giving the
'Sikh ' (disciple) a strictly military identity ,
called the Khalsa or the ' pure'. As a
defender of the faith , his cry at every time
of prayer is Raj Karega Khalsa, 'The Khalsa
Shall Rule '. This is the historical and religious origin of the political demand by the
'Akali ' (immortal) for his Khalistan which
has the same meaning as that of
Pakistan- 'the land of the pure' . The first
independent Sikh kingdom was set up in
1799, but disappeared in 1848. The Akalis ,
who constitute the political wing of the Sikh
religious movement, did not give up the
dream of Khalistan . 'At the back of the Akali
mind , whether put into words or not, would
be the belief, first expressed by Guru Gobind , that it was not possible to protect the
faith without the control of political power.
Since such power would never be possible
without an area in which the Sikhs were a
majority , it was imperative to get a Sikh
homeland' . The Sikh bargaining strategy
was accordingly devised . Each concession
they might extract is to be considered a
staging-post for a fresh demand, and this
is to continue until the dream of homeland
INSIDE
ASIA
\W:@,Jl1Wt{flJI••
"'
INDIA:
.;;;.)4
50 I
-
t~
.• . .-.,~-J:;',._~·<(-~--~%~
I
;;:;. ~\:lt¾
::i.<>;s. :ti
comes true.
New Sikh state
A new Sikh-majority state of Punjab was
created in November 1966 basically to
reward the Sikhs ' contribution to India 's
defence during the two wars of 1962 and
1965. Even then , the Akal is persistently failed to draw such mass support as to enable
them single- handedly to wield political
power in the state. There Congress remains
a veritable contender for power since it
keeps on attracting enough voters, much
to the chagrin of the Akal is who, after each
defeat, tried to buy more Sikh votes by increasing their own militancy as well as by
provoking religious sentiments of the Sikhs.
For the outright Sikh extremists led by Bhindranwale , the Ayatollah Khomeini- cumJinnah of Punjab secessionism, the conversion of Punjab into Khalistan was inconceivable without violence, which was in
fact directed at the Hindus and Sikh traitors
from the last quarter of 1981 . Initially it was
Mrs Gandhi and the Congress (I) that
promoted Bhindranwale. Nevertheless , in
June 1984 she moved decisively against the
extremists who converted the Golden
Temple and other Sikh shrines into their
armed bastions. Along with others, Bhindranwale was killed in what was almost a
full scale modern war between the
extremists and the Indian Army, otherwise
code-named Operation Blue Star. A few
months later, on 31 October, Mrs Gandhi
was killed in revenge by two of her own
security guards. Ironically, Mrs Gandhi was
the person most responsible for the creation of the Sikh-majority state of Punjab.
The extremist campaign of violence has not
ceased altogether, as is attested by the
bombings in May 1985 in Delhi and three
other neighbouring states of India. Akbar
correctly reminds us that it is the same
theocractic elements that forced the creation of Pakistan in 1947 who are now the
September-October 1985
June 6th co111me111oratio11 by Sikhs of last year 's seizure of the Golden Te111ple by /11dia11 troops.
vanguard of the struggle for Khalistan ,
which can hardly be defended on economic
grounds. The per capita income in Punjab
is the highest in India-being Rs 2,768, as
compared with the Indian average of Rs
1,571. Though just under 2% of the total
Indian population, Sikhs account for 8% of
all central government employees, more
than 6% of the directly recruited officers
in the Indian administrative service , more
than 5% of the parallel Indian police service, and about 8% of the Indian army. The
Sikhs' gains are obviously such that any
other ethnic or other minority group in India 'would give an arm and a leg for such
statistics'.
'Laboratory' of democracy?
Finally Akbar's book deals with the states
of Jammu and Kashmir, particularly the latter. Sheikh Mohammad Abdullah and
Jawaharlal Nehru regarded Kashmir as 'the
laboratory of secular and democratic India.
The idea of India will succeed or fail in this
Muslim-majority state'. There is no better
repudiation of the two-nation theory that
divided India and created Pakistan , if
Muslim Kashmir could live in India. In reality, however, Kashmir has been a continual
political mess for which Akbar blames both
Hindu communal ism and the Congress (I).
In 1956, after six years of his rule since independence, Sheikh was sent to jail , mainly
at the instigation of the Hindu and Sikh
communal forces that suspected his
sincerity to keep Kashm ir within India. It
was in February 1975 that he came back to
power as chief minister of the state, but by
this time ' he knew that the chan ce of any
kind of independent status for Kashmir was
Sepremher-Ocrober 1985
over'. Despite Congress (I) hostility ,
Sheikh 's party, the National Conference ,
won an overwhelming victory in the July
1977 Assembly elections. He remained in
office until 8 September 1982, the day he
'died an Indian'. The office, as it were, passed to his son , Farooq Abdullah , who called Mrs Gandhi mummy and regarded Ra jiv as his good friend. But this didn 't help ,
and history repeated itself in Kashmir.
Even though the National Conference
won by a landslide in the next elections in
June 1983, Farooq was out of power by early July 1984. The Congress (I) engineered
a coup d'etat by defection , replacing B.K.
Nehru by Jagmohan , the latter being 'a
governor with very lax attitudes towards the
truth '. The new chief minister was Farooq 's
own brother-in-law, G.M.Shah . If this pattern of toppling the legitimate government
by questionable and unconstitutional
means continues to find favour among
power brokers in Delhi , the Kashmiris may
be tempted to leave India altogether. 'If
those who win elections are not allowed to
rule, then Pakistan could yet win the war
it lost in 1947. But if Kashmir has self-rule ,
then Islamabad dur ast (Islamabad is too
far) '.
However, there are a few drawbacks in
Akbar 's analysis. Religious communalism
that created Pakistan and is now threatening India's unity in Punjab and Kashmir is
only one of the major problems facing India in the 1980s. Far more fundamental are
the problems of removing poverty and hunger, creating employment, and securing a
just distribution of India's resources and
wealth . Akbar's guiding assumptions and
conceptual vocabulary are firmly anchored
INSIDE
ASIA
in the age-old liberal political tradition . He
does not provide a marxist analysis , even
though he occasionally borrows some of its
concepts. For him the difference between
British India and pre-British India is
equivalent to 'the difference between a new
technology and an old one ', but not that
between a capitalist India and a feudal India. Thus, he is led to underemphasize the
enormous significance of the unity and
nationhood which India as a capitalistic nation state experienced directly as a result
of the intervention by British capitalism during the period of colonial ism (1757-1947).
That unity and nationhood is certainly different from , but not unconnected with , the
'geographical and cultural sense of a single
entity' experienced by 'an assortment of
feudal kingdoms '.
Similarly, the responsibility for the partition of India should not fall on 'Indian
shoulders' only, for it was the British who
set the ball of religious communal ism roll ·
ing in the first place, for their own imperialistic interests . For the same reason
it is a facile generalization to say that
Pakistan was created within just seven
years. Neither did the mullahs win Pakistan
simply by the strength of Islam. The Muslim
landlords were alienated by the anti-landlord/
feudal pronouncements and actions of the
Indian National Congress. The Muslim peasant masses resented the intermediary Hindus intercepting a portion of their produced surplus. The tiny minority of educated
Muslims , apprehensive of their failure in
what was already an over-crowded job market of an exploited colonial economy, found
Pakistan promising and , accordingly, ideologically propagated an historical mission
49
-
== REVIEWS
of Islam. Using Islam, the mullahs only lin ked the landed and educated elite to the
peasant masses. The Hindu communal forces duly strengthened that linkage as much
as they could.
Critical of Akalis
Akbar is crit ical of the political role of the
Akal is and the ext re mists in the current
Pun jab crisis. However, when it co mes to
Kash mir, his emphasis undergoes a
characteristic change. He blames almos t
en tire ly Hindu communalism and the Congress (I), not the Abdullahs and the National
Conference, for all Kashmir's ills. He
fo rgets that when the Congress (I) meddles
in the political affairs of a state, it does so
in order to wield polit ical power at the state
level. Akbar does not tell us that the cry of
communalism among a 'religious ' minority, instead of being real , may just be a com fortable cloak to achieve goals otherwise
unattainable. This certainly applies to
Sheikh who, among other things, harboured
'the old ambition to remain independent' or,
failing that, preferred 'autonomy within the
Indian union ', an autonomy denied to other
Indian states. Akbar fails also to convince
why Muslim Kashmir alone, but not any
other Indian state , is especially the
laboratory of India 's secularism and
democracy, and why it should enjoy a
special political and constitutional status .
It is neither enough to say that Sheikh and
Nehru agreed to such status nor particularly satisfying to point to past feudal exploitations of Kashmir. Therefore , if this Muslimmajority Kashmir has to be appeased by according it self-rule and special status in
order to prevent its joining Pakistan, then
surely this is not exactly a repudiation of
the two-nation theory that created Pakistan.
On the contrary, it is rather a veiled affirmation precisely of that theory which Akbar
rejects. The reason is that keeping Kashmir
in that case amounts to maintaining and
paying for a sort of Pakistan within India
by all Indians outside of Kashmir.
Despite all his shortcomings, Akbar has
to be credited for having conveyed a very
powerful message in his tour de force ,
containing plenty of juicy anecdotes,
toothsome sarcasms, racy interpretations,
and brilliant touches of calculated objectivity that make reading more than three
hundred pages both worthwhile and pleasurable. Since there are ample misguided interests who would welcome the collapse of
Indian democracy and secularism, the
challenge for the Indian politician in the
1980s is quite extraordinary, and it is this:
'the balance has to be found between
serving a minority's economic needs and
its emotional and religious fears, and maintaining the democratic environment where
the majority may, in fact, resent any particular attention being paid to the minority'.
Bipul Kumas Bhadra
50
REVIEW_S
-
And what do peasants think?
History and Peasant Consciousness in
South East Asia edited by Andrew Turton
and Shigeharu Tanabe . National Museum
of Ethnography, Suita, Osaka 1984. £10
(paper).
People act in terms of the world as they
understand it. They take political action in
terms of what they remember previous responses to such action have been , in terms
of what they bel ieve their role is in the state
in which they live. People evaluate their
strength and weakness according to their
folk theory of economics and politics. They
count on allies, whether natural or supernatural , according to their image of the
natural and supernatural world . Because of
this simple, but often forgotten , fact , no
history of resistance or compliance on the
part of any group or class can avoid studying their consciousness, since it is only in
terms of that consciousness that their
action is understandable.
This is the starting point of this book
edited by Tanabe and Turton and written by
a number of anthropologists and historians
from Asia and Europe. The editors are asking the classical marxist question : under
what circumstances do peasants attempt
to resist the exploitation to which they are
subjected? They explore this through a
number of specific instances drawn from
Japan, Indonesia, Malaysia, the Philippines
and Thailand . They need these examples
because they know that abstract theories
about world capitalist penetration , colonialism, the articulation of modes of production and so on will always be insufficient,
since these do not explain things in the way
those who actually resist, take up arms or
take risks see things.
Theoretical limitations
Theoretically, the approach to consciousness raises the many issues which have
surrounded the concept of ideology. Perhaps the central question in this respect is
linked to the idea of hegemony. How far
does the ideology of ruling classes mould
the consciousness of the dominated?
Clearly if the ideology of the ruling classes
totally dominated the consciousness of the
peasants, there would be no resistance and
no peasant rebellions. Strangely, much
marxist writing seems to imply precisely
this. This is for two reasons. First, many
recent theoreticians, amongst whom
Althusser figures prominently , have been
fascinated by the ability of ideology to hide
the real conditions of existence from the ex-
INSIDE
ASIA
ploited, so that, instead of resisting , they
actually participate in the reproduction of
their own alienation. Secondly, for a very
long time, marxi sts , starting with Marx ,
have grossly under-estimated both the historical and the political significance of
peasants .
For many marxists peasants were a
transitional form with little historical permanence, who could therefore be forgotten .
Modern history has shown this view to be
quite wrong . There is still a very large
section of mankind which is adequately
described as peasant. In proportional
terms, they may still be as numerous as
they were in Marx 's time. Politically, too ,
peasants have proved a much more
dynamic force than those , who believed
that only a pure proletariat could be revolutionary, supposed. As a result, classical
marxists have been of little help in the
understanding of peasant consciousness .
Because of this situation, the writers of this
book have had to turn to those theoreticians who have discussed critical consciousness. Naturally, they have first
turned to those who have analyzed working class consciousness-writers such as
Lukacs and Thompson-but they have had
to adapt their theories to the peasantry .
Obscured reality
This presents a historical difficulty, as
peasant consciousness has proved very difficult to grasp. First of all , the world view
of peasants is not as dominated by class
relations as is that of the proletariat.
Peasants attempt to interpret the world , at
one level almost as though they were alone
in it, and in this they try to harmonize
nature, society and history in a static and
all encompassing model, which seems
almost deliberately to ignore intrusions
from encroaching political and economic
forces . Many anthropologists have made
the mistake of thinking that this was all
there was to the peasants' world view and ,
as a result, have represented it as though
there was no difference between them and
hypothetical isolated tribal peoples living
in a universe which they have constructed .
In fact, careful studies, such as here, indicate that peasants, like everybody else,
are much more complex, much more self
contradictory or, perhaps, much more
subtle. They also have a view of the world
which recognizes and even emphasizes
their subordinate economic and political
situation. This view is illustrated in an alternative vision of history, as is well illustrated
September-October 1985
by several studies in this volume, or even
by an alternative conceptualization of time.
It becomes clear in the way peasants, who
a moment before might be perceiving their
exploiters as the standard-bearers of
civilization , suddenly show that they also
see them as usurious landlords; it may
appear in the way they see such things as
combine-harvesters. The complexity of the
peasant consciousness is made all the
more difficult to study by the fact that
peasants are not academic theoreticiansthey live their lives, they don't theorize
about them. As a result, their views are not
to be found in well-rounded theses but in
passing asides , hearty jokes or horseplay ,
or in mystical religious practices . In any
case, peasants know better than anyone
the dangers they run in making their
oppositional views too open and , as a
result, they will often disguise these views,
even to themselves, only letting them
appear in rare and precious moments of
perhaps exceptional anger or exceptional
elation.
Essential task
Because of this, the task of social scientists who wants to study this type of consciousness is very difficult. They must train
their sensitivity and their receptiveness to
September-October 1985
such a degree that they quickly notice passing remarks and note significant, but apparently ephemeral , types of action . This
study is only possible for people who have
a long and intimate association with those
about whom they write; something which
is possible for anthropologists who carry
out long-term fieldwork in a limited area or
for historians who find occasional informal
documents. Only in this way will peasants '
words reveal the complexity of their consciousness.
However, some of the studies in this
volume are disappointing. They lack direct
information from peasants , which must be
the basis of any study of consciousness.
Indeed, one of the contributors repeats the
now over familiar criticisms of the traditional community studies of old-fashioned
anthropology, without seeing that the great
merit of such studies was that, at their best,
they gave the opportunity for the views of
ordinary people in all their subtlety to be
researched and made worthy of study.
However, this type of data is not entirely
absent; in particular, it is to be found in
James Scott 's chapter on attitudes to the
'green revolution ' in Kedah . Despite some
shortcomings there are some studies on
various peasant revolts which bear witness
to the importance of critical peasant con-
INSIDE
ASIA
sciousness. These make fascinating read ing and show just how important the topic
actually is . This book irrevocably challenges the old view that the peasants of Asia
are an apathetic and pitiful mass, unable
to analyze historical events and do something about them . For example, the Japanese historian Yasumaru tells us that during
the period from 1590 to 1877 there were over
3,700 recorded peasant revolts, which probably underestimates the real number.
Actually Yasumaru's contribution raises
another question: how far has the state in
some cases almost institutionalized peasant rebellions so that various forms of
social tension could be dealt with within
bounds which did not really shake the foundations of the social order? If this were the
case, yet another way in which the dominators succeeded in blunting the political implications of the consciousness of peasants would have been illustrated. However
this is the topic for another book. The quality and interest of the present volume will
surely make the reader hope that there will
be many others from the same group of
writers .
Maurice Bloch
51
REVIEWS
REV(EWS
SRI lANKA:
rHr Ho,ocausr
A splintered island
Sri Lanka: The National Question and the
Tamil Liberation Struggle by Salehi Ponnambalam. Zed Books, London, 1983.
£19.95 (cloth); £6.50 (paper). Sri Lanka: The
Holocaust and After, by L. Piyadasa. Marram
Books, London , 1984. £4.25 (paper). Sri
Lanka: Island of Terror: An Indictment, by
E.M. Thornton and R. N iththyananthan .
Eelam Research Organization , London ,
1984. £2.95 (paper)
i
I
The political kingdom, shakily sustained by
military and paramilitary forces, of the
Sinhalese Buddhist majority i n 'Sri
Lanka'-was there ever, really, such a state
except on post-colonial paper?-is slowly
being consumed by fire. The precepts of
Buddha notwithstanding, a vicious but
suicidal theocratic state structure has been
erected step by step in this 'democratic
socialist republic'; in a multi-ethnic island
of some fifteen million people, governed
now under the illegal 1978 constitution , a
state which was once (falsely) regarded as
a model of Westminster rectitude and
welfare provision , an Asian emblem of
every democratic virtue . Today, Amnesty
lnternational's dispassionate term for the
continuous pogroms against the Tamils is
'extra-judicial killing '.
For Sate hi Ponnambalam-and for the
reader also-the crux of the matter is to
diagnose rightly the juridical, political and
moral entitlements on the island of the
indigenous population of 'Ceylon Tamils '.
He argues, in a well-informed political
history, that they 'are not a minority subcultural group ... such as the Asian immigrants
in Britain. ' Instead, they are a 'separate and
distinct nation with an exclusive homeland
of their own to which they owe patriotism
as the land of their birth and of their
forefathers. They are a nation possessing
the capacity to alter the existing state
structure'-as the Sinhalese army of occupation in the Tamil 'homelands' now knows
to its increasing cost- 'and to constitute
themselves a political state by their collective self-determination.'
To Ponnambalam , this sense of nation
is , at one level , inscribed in a history
which-despite the claims of 'Sinhalese
Buddhist ethnocentrism' that the Tamils
are Dravidian invaders-shows the Tamils
to be the 'lineal descendants of the original
inhabitants of the island.' Though he
elsewhere confusingly describes the Sinhalese and the Tamils as 'co-settlers with
a shared descent ', his basic standpoint is
that it is the Tamils, not the Sinhalese, who
are the 'aboriginal people of Sri Lanka'.
52
ANDAPflR
Even the name 'Sri Lanka', he acidly points
out, is Sanskrit, while Buddhism itself-a
' relative latecomer' to the island in the third
century BC-is Hindu in origin , as was
Buddha. If Irish atavism has a long memory,
this is positively prehistoric.
And at another level , Ponnambalam argues, it is a sense of nation which has been
provoked by intolerable 'national oppression ' at the hands of the Sinhalese majority since independence. Moreover, the
Tamils, he implies, both in exile and in their
embattled ghettoes on the island , are now
plainly ready to promote this sense of
nation by prolonged armed struggle.
Democratic failures
It is a tale, for him , which has been marked
since independence by the failure, in a
multi-ethnic state, of the Sinhalese to
'evolve a culturally neutral , secular nationstate ... on the foundations of freedom ,
equal rights and social justice, embracing
the various ethnic, linguistic and religious
communities'. Instead, 'through the arithmetic of the ballot box ... freedom .. .
became the prerogative of the Sinhalese ';
the spoils of democracy, as well as custody
of the political right5 of the Tamils, were
delivered-as the rules of liberal democracy themselves dictate-to the majority.
In consequence, Tamil citizenship, suffrage and language rights came not only to
be inadequately protected, but systematically eroded. Nevertheless (or therefore)
' national integration' failed to 'take root ';
instead Sinhalese 'chauvinism ' (vainly)
attempted 'conquest and assimilation ' of
the Tamils , rather than 'nation-building' .
Certainly , the record of the relentless
and cruelly discriminatory Sinhalization
('we are the masters now') of the polity can
hardly be gainsaid. It involved, inter alia , the
immediate disenfranchisement, upon independence, of the Tamil plantation workers,
one million becoming stateless and tens of
thousands 'repatriated' to India, a country
most of them had never seen; the 'Sinha la
Only' official language act of 1956 which
struck a drastic blow at Tamil aspiration ;
the programme, which has created violence, of Sinhalese 'colonization ' of 'Tamil
areas'; and the continuous Sinhalese mob
and army butchery of the Tamils-as punishment for their refusal to accept
Sinhalese domination of a state system run
increasingly for the latter's benefitwithout redress, official apology, or even
inquiry.
At the same time, Ponnambalam complains, intensely communalist Sinhalese
' negotiators' have consistently betrayed
INSIDE
ASIA
naive Tamil expectations of a political
accommodation of their grievanceswhether in the form of a federal distribution
of powers, or by some other arrangement
for regional autonomy. For no such accommodation, he correctly suggests, was being seriously entertained by the Sinhalese
during these long decades of mounting
brutality against the Tamils. Instead, the
very 'negotiators' on the Sinhalese side
were and are the architects of the violence
from which the Tamils were seeking protection at the conference table. And to make
matters worse, the Tamils ' own leadership ,
until the growth of the militant liberation
movement, was composed of 'reactionary '
and 'deracine' 'bourgeois nationalist politicians ', 'middle-class lawyers to whom
politics was an out-of-court pastime '.
'L. Piyadasa', the (Sinhalese) pseudonym
for a 'multi-communal group ', acknowledges the brutalities suffered at the hands
of the Sinhalese by the Tamils; bravely admits the systematic racist falsification of
Sinhalese history; and argues that a postindependence 'patrician ' Sinhalese ruling
class (of right, left and centre) has 'subverted the democratic process' and plunged
the island into violence. Yet, it is a measure
of the scale of the problem before us that
Tamil and Sinhalese 'Sri Lankans' of the
left, with their basic common political sympathies, and in pursuit of a clarification of
the same issues , can nevertheless entertain such different perceptions about them.
Courageous position
For Piyadasa's Sri Lanka, seen through the
eyes of the secular and democractic anticommunal Sinhalese left-such as it isbears only a superficial resemblance to the
truth as it now appears to most of the
Ceylon Tamils. True, in Piyadasa's account,
'goon squads ... publicly burn men and
women to death on the streets without
hindrance ', with 'the armed forces joining
in ' and 'the nation 's President . .. public-
Dialectic of oppression
The consequence has been a 'dialectic of
oppression and radicalization', in a complex context-ably unravelled-of ideological , class, constitutional and economic
questions , in which at issue has been 'subjugation ' of the 'Tamil nation'. Now ' life in
a unitary state' has become ' impossible' for
incorrigibly separate ' nations', unified in
1833 only for the convenience of British colonial administration. Indeed, 'parity of
status ' for the Tamils itself appears to
threaten Sinhalese paranoia with the spectre of racial and religious extinction. Hence,
Ponnambalam concludes, 'national unity'
as a 'sensible political goal ' can 'no longer
be advocated', even if 'at the level of the ordinary Sinhalese and Tamils there is no
conflict'. It is a retrospect, in fact, this
judgement, in which the increasing ferocity
of the armed struggle is not taken for
granted, while at the end of a dark tunnel
the promise beckons of freedom-or rather,
secession-from 'rule by the Sinhalese'
and from the sinister influence of the Buddhist clergy, in an independent state ofTamil
Eelam .
September-October 1985
ly justifying the pogrom ', as happened in
July 1983. And it takes courage, even if it
is a revealingly anonymous courage, for any
Sinhalese now to speak of his 'agony and
shame'-as this book does-at the atroc ities being carried out against the Tamils .
Yet such sentiments , Piyadasa claims ,
'express the views of a large proportion of
Sri Lankans , a maj ority '. This is wishful
thinking. There is no longer such a 'majority',
nor is it possible, except in illusion , to
reconstruct the integrity of a unita ry polit y
in Ceylon on the old-or any other-basis.
Similarly, Piyadasa argues , in a way that
Ponnambalam 's case does not permit , that
Sinhalese and Tam ils can share again a
common patriotism towards 'our coun try . . . the country of the Sri Lankan people and nation '; a 'patriotism ' albe it disrupted by cynical 'right wing ' Sinhalese and
Tamil communalists (indiscriminately
lumped together in this reading), by autocratic Sinhalese rule , by the 'horrible barbarism which falsely claims to be Budd hist', by 'chronically retarded economi c
development ', by the ' lawless violence of
the state ', and by the 'terrorism ' of the
' noisy ' and 'spurious ' Tamil separatist
movement.
Moreover, in the 'real Sri Lanka', says
Piyadasa-wherever that Sri Lanka is, or
was-'there are no Sinhalese areas and no
Tamil areas '. Worse, the separatist Tamils
themselves are blamed for the 'strengthening of fasc ist tendencies in Sri Lanka';
blamed for 'preventing movements which
would have won Sinhalese support in opposing Sinhalese racism' ; blamed , ultimately ,
for their own ' increasing isolation '. With
Our'' reviewers
Bipul Kumar Bhadra is a lecturer in sociology at McMaster University,
Hamilton, Ontario, Canada.
Maurice Bloch is Professor of Anthropology at the London School of
Economics; he has written extensively on marxism and anthropology.
"'
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September-October 1985
Tom Fawthrop is South East Asia correspondent for the Irish Times.
David Selbourne lectures in politics at Ruskin College, Oxford. He has
written extensively, including on India and China. His latest book is
Against Socialist Illusions: a radical argument (Macmillan).
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INSIDE
ASIA
53
= R-EVIEWS
political friends such as these-whose
predecessors once blamed the Jews for the
excesses of the Nazis-the Tamils have little
need of enemies. Indeed, their growing
predicament as scapegoats and martyrs of
Sinhalese political and economic failure is
merely made more bewildering by this type
of Sinhalese 'sympathy' for their ' fellow Sri
Lankans'.
Atrocities continue
The trouble is that the Tamils are no longer,
if they ever were, 'Sri Lankans'. Without any
effective protection of their political rights
under the law and constitution of Sri Lanka,
driven from pillar to post (and from
Colombo to Jaffna) In a continuing round
of massacre and fake negotiation, they are
now fighting their own way out of the trap
which the Sinhalese have so meticulously
sprung upon them. Piyadasa's book was
out of date when It was written-the
passage of events inexorably carrying the
'noisy' Tamils, with or without approval ,
towards a last stand for their freedom,
dignity and survival as a people. To
Piyadasa, the demand for Tamil Eelam is
itself 'racist'; but to the Tamils, the 'restoration of democracy in Sri Lanka' , for which
Piyadasa, calls, now itself depends in large
part upon the gaining of Tamil rights to selfdetermination.
How far they have to go, and the dangers they face, is made all too clear in
Thornton and Niththyananthan's account
of the crimes committed against the Tamils
up to and during the 1983 carnage. It is a
chronicle of unremitting horror, the more
telling for being unembellished. It ends with
an appendix of simple personal testimony,
in diary form, of the burning alive of innocent
Tamils in the streets of Colombo. In its very
simplicity, it has few equals in the literature
of political terror.
'I had a feeling ', says the author, trembling at every sound in his house after
witnessing, from his window, a Sinhalese
gang-rape and the beheading with an axe,
on the pavement outside, of the young
Tamil victim, 'that death was knocking at
my door'. But the knocking was of a Sinhalese Catholic neighbour, warning him, as
the Tamil bodies burned in the streets, to
'go to a refugee camp for safety' in what
turned out to be a staging-post to yet
another exile. Indeed, at the last, it is plain
enough that it is to stop a slowly and intermittently advancing genocide-punctuated
by periods of calm repose from bestial
killing , camouflaged by state censorship
and state lying, and aided by the world 's
apathy and connivance-that the Tamil
separatists are fighting . Between them ,
these three books provide an adequate
introduction to the complexity of the
issues .
David Selbourne
1 1:
54
WORLD WIDE1RAVEL
Vietnam's underground war
The Tunnels of Cu Chi by Tom Mangold and
John Penycate. Hodder & Stoughton, London,
£12.95 (cloth).
Only fifty kilometres from Saigon lies Cu
Chi district-one of the Vietcong nerve centres which became the most bombed, gassed, defoliated and generally devastated
area in the history of warfare. Most of the
villages were wiped out and chemical warfare, including a horrendous tonnage of
agent orange, turned the lush jungle foliage
into an overnight desert pockmarked by
huge bomb craters.
Although the area was devastated the
guerillas survived the sustained onslaught
to win the protracted battle of Cu Chi by
vanishing underground into the extraordinary sanctuary of their 300 kilometres
tunnel complex.
It was from the legendary tunnels of Cu
Chi that the Tet Offensive was both planned
and launched, leading to an onslaught on
Saigon from which US forces in Vietnam
never recovered.
This book, by two BBC Panorama
reporters, is the first attempt to piece
together the incredible exploits of Vietcong
guerrillas, who ingeniously defended their
ancestral lands by popping out from their
holes in the ground to strike back at the
mighty armoured columns ravaging their
land from above.
Ten years after the fall of Saigon the US
is still agonizing over how the greatest warmachine ever unleashed failed to subdue
a poorly-equipped peasant guerilla army.
Many of the American survivors from the
battlefields of Cu Chi, according to this account, are in a unique position to supply the
answers.
Unprepared
US forces were unprepared for tunnelwarfare,and for the fact that the real enemy
controlling the hinterland of Saigon was not
the invading hordes of North Vietnamese
(the US propaganda line) but the embittered
farmers of the South, whose relationship
with the land bordered on the sacred.
The tunnels of Cu Chi were first con structed in 1948 to protect the land from the
French. They played an important role in Ho
Chi Minh 's successful struggle for independence from colonial rule. From Viet
Minh tunnels against the French they
became Vietcong tunnels in response to
the sudden escalation of American forces
in the early sixties.
Many passageways had to be redug ,
repaired , and extended . Concealed trapdoors in the jungle were points of entry to
an extraordinary underground sanctuary.
INSIDE
ASIA
Crawling on all fours through the dark,
damp and dimly-lit passages, the Vietcong
could stay in the tunnels for months at a
time, if necessary, to avoid the US search
and destroy operations.
At various points the ingeniously constructed passageways opened out into
chambers with sufficient space for sleeping quarters, supply dumps, meeting
rooms, and even a primitive makeshift
hospital stocked mainly with medicines
captured from the US base nearby.
'Tunnel rats'
Over the course of the five-year battle to
flush out the tunnel fighters, which included
pumping CS gas and planting high
explosives around tunnel entrances, some
sections of this underground defence
system were seriously damaged. However,
it was like chopping off the leg of an
octopus; even the specially trained 'tunnel
rat' commandos (US forces who volun teered to chase Vietcong) also failed to
destroy the bulk of the incredible 300 km
tunnel network. It was still operational right
up until the arrival of North Vietnamese
regular forces in 1975 in preparation for the
final assault on Saigon.
This book beautifully blends narrative ,
anecdote, history and perception from both
sides, based on testimonies of both Vietnamese and American war veterans. It also
sheds light on the basic differences of the
two sides, and their diametrically opposed
approach to warfare.
The US and ARVN troops depended on
awesome firepower, on the brute force of
war technology and on the best equipment
that money could buy. But for Vietcong
peasants their country was not for sale. The
guerrillas relied on courage, commitment
and political will against overwhelming
odds. The tunnels symbolized an intimate
relationship with nature in contrast to the
ecological destruction wreaked by agent
orange deluges above.
The authors show that this was a struggle of a poor peasant society mobilized by
nationalistic passion to defend its
ancestral lands from the global might and
wealth of a twentieth century superpower.
It is curious that Cu Chi has been mentioned only in passing in so many American
books on the Vietnam War. Perhaps it will
finally receive the kind of legendary
recognition it so richly deserves as the
most decisive area of conflict and battle in
the whole of the Vietnam War,and ranking
with the humiliation of the French at Dien
Bien Phu.
_
Tom Fawthrop
September-October 1985
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THE ICASC NETWORK INCLUDES:
\.~~£RNA TI OJV
Women who are active in campaigns and
groups on some or all reproductive rights
issues and related women's health issues
Women health workers - in health centres
and clinics, community health workers,
paramedics, nurses, midwives, etc.
co~'fRACEPTJoN
~-r,ORTION &
~~f;RlLISATJoN
cAMPAIGJV
Women in self-help health groups
and others who support reproductive rights
for women, in the following countries:
Argentina
Australia
Belgium
Brazil
Britain
Canada
Chile
Colombia
Costa Rica
Cuba
Curazao
Denmark
Dominican Republic
Ecuador
Finland
France
Germany
Greece
Holland
Iceland
India
Ireland
Italy
Japan
Luxembourg
Malaysia
Malta
Mauritius
Mexico
New Zealand
Nicaragua
Norway
Pakistan
Panama
Peru
Portugal
Puerto Rico
South Africa
Spain
Sweden
Switzerland
Turkey
United States
Venezuela
WOMEN DECIDE
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JOIN US!
374 Grays Inn Road
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London WCl, England
Tel. 278-0153
THE AIMS OF ICASC
women's right to decide if and when to
have children
- the right to safe, effective contraception
- the right to safe, legal abortion
- the freedom from sterilisation abuse
-
IN EVERY COUNTRY AND FOR ALL
WOMEN EQUALLY!
.,,,,,,,,,,,,,,,,,,,,,.
WHAT ICASC DOES
- build links between new and existing
groups and individuals who support our
aims
- organise international solidarity
- collect and share information on the
situation in every country, and on
research, testing and distribution of
methods of contraception , abortion and
sterilisation, including work being done
by feminist clinics and women health
workers
- build international action on the priority
issues of the Campaign
- participate in international meetings and
work with other organisations on issues
related to women's health
- hold regular co-ordination meetings (in
Europe so far)
- publish and distribute the ICASC Newsletter 3 times a year
- send out regular co-ordination reports to
all ICASC affiliates
(I)
SOME OF THE ISSUES WE ARE
CAMPAIGNING ON INCLUDE:
- dangerous and illegal abortion - a major
killer of women
- coercive and racist policies whose aim is
to stop women from having the children
they want
- dumping of dangerous contraceptives in
the Third World
- women not having full information about
benefits and risks of methods that would
allow them to make informed choices
-- the failure to make all safe methods
available to women who want them
- prosecution and imprisonment s, abuses
and restrictive laws - all violations of
women's right to control their own
bodies without fear
.,,,,,,.,,,,,,,,,4
WHAT YOU CAN DO
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A
- affiliate to ICASC - open to all groups
and organisations who support our aims
- come to co-ordination meetings and
become actively involved in what we do
- send us information about what you are
doing and about the situation in your
country
- inform us if you need solidarity and
support solidarity requests from other
countries
- publicise the information you receive
and raise the issues in groups in your
country
- subscribe to the Newsletter and
distribute it in your country - in
translation if you can
- give money in support of our work
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Forced Ster iliza ti on: l-listoric al Perspective
by Patti Roberts F
Stop Forced Steril izatio n Projec t
Throug hout this century there have existed
a number of reactio n ary allianc es betwee n the
moveme nt for birth cont rol, racist propag a ndists and th e proper tied classe s.
Though the
birth contro l moveme nt has certain ly been a
progre ssi ve one, it is useful to loo k at
certain neg a ti ve asoect s of that moveme nt and
its relatio n to poor and third world women .
The strug g le of women for contro l of their
bodies and an end to biolog ical determ ination ,
includ ing safe and effect ive birth contro l,
has always had stronq opposi tion . We must be
carefu l, howeve r, to protec t our goals and
not be coopte d or us ed by th e govern ment .
We must not over loo k the fact that differe nt
women may have differe nt intere sts depend ing
on their class and race.
The Role of t'1e F'.uaeni cs 11oveme nt ( l)
The moveme nt for eugeni cs, the scienc e that
deals with the improve ment of heredi tary
crualit ies of a rac e or breed, as bv contro l
of human mating , grew rapidly after 1-1orld
War I.
It flouris h ed along with the wave of
Anglo-S ctxon glurif icatio n and .:he Palmer raids
used agains t the left and immigr ants.
A
repres sive respon se to the Russian Revolu tion
of 1917, th e milita nt labor strugg les of the
prev tou s years, it was an ideolog y of the
wealth y.
Margar et Sanger , first well-kn own as a feminist and social ist, impriso ned bri ef l y for
ope n ing a birth con t rol clinic in Brookly n ,
N. Y., advoca ted birth co ntrol as a me thod
for libera ting women from male oppres s i on.
Later, sh e started to araue that birth cont rol
could limit the numbe~ of childre n amona the
"unfit ". She called for immigr ation restric tions and collab orated with member s of the
Americ an Eugeni cs Societ y, the head of which,
Guy Ir ving Burch , suppor ted birth contro l
becaus e its goal was directe d toward s:
"preve n tinq the Americ an people from
being replace d by alien or Negro
stock, whethe r it be by immigr ation
or by overly high birth rates in this
countr y" .
The interch ange betwee n the euqeni cs and birth
contro l moveme nts increas ed throug h the 192O's .
· The idiol ogy of the latter change d, in order
to gain more public or governm ent accept ance.
Increa singly , the moveme nt de - emphas ized the
boncri bution to wome n ' s emanci pation and the '
potent ial result s of a woman - contro lled health
system.
The concep t of popula tion contro l did not
remain on th e drawin g boards of abstra ction ,
or in the heads of academ icians , but instead
becami an integr al part of the econom ic and
politic al polici es of U.S. imperi alism.
While the milita ry was cr u shi nq . the nation alist resist ance and demand for indepen dence
in Puerto Rico in the 193O's , the politic al
arm was institu ting large- scale popula tion
·contro l program s.
Program s of sterili zation
and dis persion of contrac ep tives was massiv e.
By 194 9, roughl y 18 % of all hospit al delive ries were done along wi_ch • sterili zation s.
By
the 19 6O 's over 1/3 of the women of the islan c
were sterili zed.
So well - known , sterili zatio n
was simply called "l a operac ion ".
The !•'omen ' s Libera tion
Abortio n
l 1ovemen t
Fights for
Durin g the late 6O's and ea rly 7O ' s the
Wdl'len 's moveme nt fouqh hard., aaains t the
chur ch and state , for the repeal of laws
prohib iting abortio ns.
By and l arge , this
strugg le was white.
The Bldck ?ower Confer e nc e of 1967 had
consen su s that birth c o ncrol and aoortio n wer e
both form s of Black genoci de .
Third world
people were raisina the s pectre of enforc ed
abortio n.
These women knew that desire d
aborti ons could l ead t o ~a rc e d ste rilizat ion
and that women on welfar e had already been
cut off if they had additio nal childre n.
The state just didn ' t want more poor and thir
world kids.
A Panthe r article of 1970 said
it this way:
"The abortio n law hides behind
the guise of helping women , when
in r ea lity it will attemp t to dest ro y
our people .
How lon g do yo u think
it will take for volunt ary abortio ns
to turn into involu ntary abortio n ,
into compul sory sterili zntion ?
Black people are awar0 that laws
made suppos edly to ensure our wellbeing are often put into practic e
in s~ch a way th~t thev e~sure
our d eath.
Th e curren t welfar e
laws are one of the curren t exa~pl es."
Ey and lar ge, the white women' s li be ration
moveme nt locked in the heat of battle for
&bortio n reform could not hea r that third
world women had a differe nt and valid perspectiv e.
But lack of abortio ns butche red poor and third
world women who couldn 't afford to fly out of
the countr y or pay for a fancy doctor to
perform the ill ega l operat ion.
Far more of
these women died at the dirty hands of an
unqual i fied aborti onis, and
nearly 1 / 2 of
the child-b earin g deaths in New York City
were attribu ted to abortio ns, and out of
thes e 79% were black and Puerto Rican women.
As France s Beal, now of the Third World
Women 's Al li ance, said in 1970:
"We are not saying that Black Women
should not practic e birth contro l.
Black women have the ri g ht and the
respon sibilit y to determ ine when
it is in the intere st of the strugg le
to have childre n or not to h ave them ,
and this right must not be relinqu ished
to anyone ".
3 _.
The population of Puerto Rico, especially the women of ~hildbearin g age, have
become the target of a sterilizatio n program. Accordin~ t o D~. Antoni~ Silva,
\}ead of Family Planning at ·the Department of Health, this ::.s now "official policy."
i,t is a genocidal solution to a problem of political anC: economic organi.zatio n.
It is a program designed by the colonial power to cope with demographic disiocations created by intrusion into and dominance of the econon7 of the co lony,
Puerto Rico.
A study uncovered in 197~ by Claridad revealed tha t e <>i."·"·c:!.nJ. governtnent
_
task . fo~ce considered mass migration and sterilizatio n t:o be GO!.ud..iins to continued high unemploymen t in Puerto Rico. Investigatio ~!'J c.cn~ by Tizi.i.versity of
i>u~rt:o Rico d~grapher , Dr. Jose L. Vasques Calzada in 1968 :/howed '-14~ 1% of
Puert~ Ri~an women of childbearin g age were already sterilize c. ~ !n 1975 alone
5000 wom~n were sterilized in the :!4 "official" sterH i ::c:t:.011. clinic~. Figures
1
coliected by Dr. Silva's office show that not cniy have !-% of t:eena~ womE!h
already been sterilized but 5% of all men as weili The .. G e r e pres ently an estimated ~00,000 fertile women of childbearin g age in i.~uert.c R::. c o conoidered by
the government to b~ the target population for '.'his prog:r:-F.:m.
The quality of available medical care for th~ majority of the population in
Puerto Rico is poor. Yet, over one million doi1ats in FederE'.l. fu~1.:!::; £::rorn the u. s.
Dep~ttment of Health, Education, and Welfare are e~r.me:r:-ke~ np eci~ic ~:ly for the
sterilizatio n program instead of badly needed general be:~·, ::_t:!1 ~c:.r e i~.cilit:i.et .,
The two aspects when pilt together make it clear thef: P , s. hAc'.7.~ ...:-i poiicy for
Puerto Rico i)t designed to assure that many will c le w :.1 0 c c ·_,lG ~~"..! Oc.VCd~ ~~hile
others will simply never beeborn. The effect of a ccnt:~n--.i,-:- d h i ( :1 de a th rate
coupled with the potential of a precipitiou sly decl ir.inc n:.;:t::~::-.'.:", t ~ threatens
generationa l dislocation s affecting the very nature a.:d r.i:: - ,: ·::::-i:f):r ::i f the Puerto
Rican population.
The World Popui,tion Conference in 197':l recoc -::.izr:·d ·:~!J.,·.i'. :Jc.19...--iced popd:.~ti~n
growth results only . from economic development . The c o ·,_·0::.l;;. .:. ·y :~ c -th.::.t f..:Y!: economic development to , take place, population planrd.ng 1.:;:_,.-:;t ::·'::\C T. ond to t :i.a need£
of the country in which the population resides. 'l'bls ~--= 110;: ,)1e c e.ce in Puerto
Rico wltere control of this crucial factor is anti!'Eliy C :.L c,:,,; the hana:J of tho8C
it directly affects. The question is net the advJ. !3.:!b~·-·;.::.-:.:: of J;>:)µ :,.:Ls.tion cont:'.!'."o,
but rather it is the political question of -who controb st:- c ·- ?o:a,~ien dnd in
response to what needs.
The economic aspect of u. s. colcnial polici e s :;.n P 11c•:~..•:~ R~.co ~reated high
unemploymen t by a pattern of investments and develc9m2n.t: i.:r:-c..': o~.L ninated thousands of jobs in the agricultura l sector while nc:: 8::0a ;:fog 2.1 .::: :. :native:J in
either the industrial t1r service sectors. The polit1.cc.: re:::po·(we vie,-~::; the
11
resulting unemployed as 11 overpopulat ion and poH.c:i.ec a:ce de::: igne:::; to eliminate and control this "excess." By present:.ng it solely a:J e. populatio!l problem the United States attempts to obscure the colinial r e:;:...tithe two countries. To date, this has succesafull y prevented discucsion of
the economic and political organizatio n which engendered not only ·::l1e problem
11
of demographic dislocation but the genoci~al policies underi:aken t o :--olve" it.
The people of Puerto Rico must be free to deterrnin~ -their oun po:Julati on
policy, responsive to their~ social, political, and 0:-'.o"'l.om:ic ne2C:,3 a::: a developing nation. The United States role as a colonial pews ..: r:nr.t b2 ,,)q:,osed
in all its manifestati ons and it must be stopped from i1".r1 ;_;:i:t.:::::k o!1 o:- ~ of Pu'-::~t:o
Rico's most valuable natural resources: its people.
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STERILIZATION ABUSE OF HISPANIC WCJvtEN
by Rev. Antonio M. Stevens Arroyo, C.P.
Today, in the United States of America, three thousand men and women
are sterili zed daily. This operati on, which ends almost all possib ility
having childre n, has suddenly become very freque nt, so that since 1970, anof
average of one million persons a year have been sterili zed in the United
States. Many advocates of popula tion limitat ion predic t that sterili zation
will suppla nt any and all forms of birth contro l, replaci ng them with
"ferti lity contro l". Ms. Leslie Aldrige Westoff, writing for the New York
Times (Sept. 29, 1974) sugges ts that one day soon, men and women will be
"steril ized automa tically at the onset of puberty" ... and "perso nal and
social forces ... sugges t that is where we are headin g."
Sterili zation for contra ceptive reasons is a surgic al procedure that
involve s the bilate ral cutting , tying or removal of parts of the reprod uctive
organs. There is a male sterili zation , or vasectomy, which removes a small
portion of the vas deferen s, and the operati on which destroy s the access of
sperm into the Fallop ian tubes of the woman. The most common form of
sterili zation has been abdominal salpingectomy, a "tying of the tubes",female
althoug h laparos copy, the use of high intens ity radio waves to cauter ize parts
of the Fallop ian tubes, is becoming more freque nt. It costs up to $500 in
payment to a private surgeon for the operati on. According to a study carried
out at Princet on Univer sity in 1970, most of those sterili zed in the United
States have incomes of over $10,000 annual ly. When coupled with a nation al
birthra te of less than 1. 9, this sugges ts that the upper middle -class is not
reproducing and does not want to reproduce.
Hispanics in this country , however, are genera lly not middle
~oreover, they profess strong family values , includi ng childre n. -class.
Serious
questio ns must be asked when ~overnment agencie s report large m.unbers of
i·lispan ic poor being sterili zed, especi ally when these sterili zation s are not
volunt ary.
On June 19, 1976, a class action civil rights suit was filed in the
Los Angeles Federa l Court agains t the Univer sity of Southern Califo rnia
Medical Cent er to pressu re Mexican women into signing sterili zation consent
forms. Duri ng the press confere nce, many of the wcmen profess ed ignorance of
the natureAof the operati on and said they had signed no consent forms.
Ralph Nader ' s agency, well-known for its consumer advocacy, release d a report
in January of 1975 through his Health Research Group, which found that
of
the 42 large hospit als that use sterili zation as a fonn of birth contro l 27were
"gross ly violati ng the rules by either having vague or no knowledge of them,
or mainta ining no evidence of compliance". Dr. Louis Hellman, HEW assista nt
for popula tion affairs , did not deny the charge s. On the contra ry, the same
New York based officia l confessed that "Mount Sinai and New York 1-Iospi
tals
not have a written form to comply with the regula tions". A recent survey bydo
CIARIDAD newspaper, found that in the Puerto Rican area of El Barrio ,
-2-
there is an alarming rise in sterilizatio n operations at Metropolita n
Hospital.
It is no secret that an anti-life mentality exists in the United States
of America. This anti-life attitude is based on a concept of material
possession that can best be described as "Nee-Malthusian", using the argument
suggested in 1798 by Thomas Malthus. He said that population increased
geometrical ly; 2, 4, 8, 16: but resources increased arithmetica lly; 2, 4, 6,
8. Thus, he concluded, the population will always create greater demands than
the economy can meet. His solution was for the poor to limit their m.unber of
children. Today's Nee-Malthusians have perfected the techniques for doing just
that. Instead of attempting to improve the quality of life for all, including
the unborn, the efforts of many social planners is to "educate" the poor to
the ideas of the Nee-Malthusians.
This policy of ending poverty by ending life, is not new. It has been a
cornerstone of North American foreign aid to developing countries for more than
a generation. And now it is being "imported" to eliminate pverty in the ghettos.
Millions of dol l ars are spent every year by the largest of North American Foundations to study patterns of fertility in what is called the ''Third World".
There is little doubt that much of this information will be one day used to
convince underdeveloped countries that they need to practice massive sterilization in order to be '_'progressive " (cf. the message of the fonner Secretary
of State, William Rogers to the OAS). In 1964, a study by Carmen Miro of the
University of Chicago revealed that although a large percentage of the population in f ive Christian countries of Latin America knew of sterilizatio n,
no more than 6.1% of the wanen had been operated upon. Yet in Puerto Rico,
also Latin American and Christian 35% of the wanen are sterilized. There is
no facet of United States' policy towards Latin America that does not find its
precedent i n Puerto Rico. This island, a possession s ince 1898, has been a
testing ground for the good and bad in North American programs for the South
of the Border.
In November of 1973, a recOIJ1Ilendation was made to the Governor of Puerto
Rico by a connnission headed up by Teodoro Moscoso, Director of Economic
Development , regarding employment on the island as projected until 1985.
Among other suggestions , the report urged that the index of fertility be reduced
in Puerto Rico from 3.2 to 2.4, so that the net increase in population in a 10
year period would be held to only 500,000. When coupled with an expected outmigration of 8,000 people a year, this would keep the population of the island,
which is today about 2. 6 millions, at practically zero growth level.
Since l ate 1974, a series of episcopal statements from the Catholic Church
have been issued which denounces the government policy of sterilizatio n.
In November, the Bishop of Caguas, Rafael Grovas, refuted the government
position that sterilizatio n is completely voluntary. Bishop Antulio Parrilla-
-3-
wrote to the Vatic an, prote sting t he gr antin g of an honorary degre
e by the
Catholic Univ ersity of Puert o Ri co to Teodoro Moscoso, princ
ipal
archi
tect
of the islan d's Neo-Malthus ian devel opmen t. Unfortunately> the
Puert
o
Rican
Catholic Church leade rs can do very l i t t l e unles s the United State
s
Catho
lic
Bi shops bring press ure to bear in Washington, D.C. It is in Cong
ress,
rathe
r
than on the islan d, where legis l ative decis ion are made which
affec
t
the
lives
of the living and even unborn Puer to Ricans. In other
of the conti nent,
parti cular ly in Centr al and South America, Catho lic hieraparts
rchy
and
offic ials have beccme alanned. In 0.:t ober of 1974, the Mexican other churc hes'
denounced the govermnent's anti- l ife programs. In January of Catho lic Church
Geraldo Flore s of Iaaba in Guatemala, described. the contin uing 1975, Bishop
of wcmen again st their will as "the princ ipal cause of the declisteri lizat ion
socia l life. " He singl ed out as instig ators of these polic ies, ne of family and
AID and the Planned Parenthood Assoc iation of the United State the Peace Corps,
s.
Yet despi t the denun ciatio ns, steri lizat ion incre
And even if one
denounces the viola tion of right s, it cannot be denied ases.
that
incre
of Hispanic women seek out "la O:tJeracion" as a remedy to pover asing numbers
ty. The subtl e
ways of influe ncing perso nalue c1sio ns and the technique of convi
a Chris tian
Latin American country to prefe r steri lizat ion to birth -cont rol, ncing
is
the
product
of the Nee-Malt husia ns. Thus, the case of Puerto Rico, where
all
this
has
happened,
is of monumental importance to those who want to see an end to
massi
ve
steri
lizat ion
abuse. In the second part of this repor t , the techn iques to convi
ncing
wanen
to be steri l i zc>d will be analyzed, ,and speci al descr iption will
be offer ed of
what is going on now in the Uni t ed State s among Hispanic wcrnen
.
PART TWO
The pract ice of induc ing the poor to be s teril ized. has been perfe
cted in
forty years i n Puerto Rico . In an organ ized way, government
can
utiliz
e a
varie ty of programs to wear down oppos ition. The government
of
Puert
o
Rico
consi ders sex educa ti on i n the schoo ls, pre-n atal clini cs , the
Famil
y
Assis tance Program and now food - stamps , as weapons of "educ at i
unders1tood" t owards event ual steri li zat i on. Thi s is possi ble on, widely
where !large numbers are unemployed and socia l struc tures favor inthean econcmy
growth on
a sel~c t few as "middle-cla ss". Ster iliza tion finds its best
targe
t in what
Oscar !Lewis ca led, "The Cultu re of Pover ty".
r her comprehensive study, "Sterilization
and Ferti lity Decline in
Puerto Rico" , Dr. Harrie t Press er considered steri
lizat
in Puerto Rico to
be un~que, s tating , "No ot her count ry has ever achievedion
such a high
of it~ repro ducti ve popul ation steril ized- -male or female".
propo rtion
And she furth er-
-4 -
commented that it is likely that 1nale steril izatio n can become effec tive
through the Family Planni ng Associat ion of Puerto Rico, •~1y
males ... to the actual nature of the operat ion". (pg . 178). the educa tion of
These programs have been extrao rdinar y succes sful i n Puerto Rico becaus
e
of the following factor s descri bed by Dr. Presse r :
1. 'Ine availa bility of d ctors
2. The lack of legal r es trictio ns
3. Active ploi tical suppo rt
4. The lack of r eligious oppos ition
Accordingly, the same pr ograms can rr:e dupl icated abroad, as in the Domin
Republic, which is following Puerto Rico's type of economic development can
, or at
heme, in New York City, Los Angele s and Montgrnnery, Alabama .
Studie s have shown that the single most important governmenta l servic
e to
the Spanish-speaking is health , partic u arly child cares, since Hispan
ic
cultur
e
is center ed around the family ("What Makes Sarni Run" , Valle Assoc iates,
1973).
Overt instan ces of coer cion over the poor to submit to steril i zation
as a condition to continued recep tion of welfar e and other benef its have been amply
documented, includ ing the f amous case of the Black felf sister s in Montgo
mery,
Alabama. Their suit agains t HEW r esulte d in the prohi bition
by
Judge
Gerhar
A. Gesel l again st the use of Medicaid or welfar e funds for steril izatio n . d
The case is being appeal ed by the government which wants to lift the
tion. Moreov er, the gover rnnent pays financ i ally tr ubled city hospit restri c the steril izatio ns. A writer for the Vi]l.age Voi ce discov ered that upals for
$400 was provided to the hospit al f or each operat ion. Thus the stage t o
for collus ion between the government' s welfar e sys tem and ·nscru pulous i s set
or intern s who "make moneytt for the hospi tal by i ducing the poor to be doctor s
steril ized.
Wcmen, such as Dolores Madrjgal of Los Angele s, have s tated tha t they
were induced to sign the consen t f orm when in the delive ry room underg
labor pains. Another Chican a , Jovjta Rivcrn, reported. that she "'igned oing
consen t f orms under sedat ion . Such testimony is frequent. Moreover, . the
an
Hispanic woman enteri ng the hospit al f or a minor operat ion such as appendectany, has a chance of also being steril ized, even if there is no m
edical
necess ity.
Dr. Presse r's study of steril ization in Puerto Rico r eveale that doctor
s
in favor of non- therap eutic steril i zation , would simply tell thedwoman
that
she needed the operat ion. The doctor , as the government , defined "hea
lth" -
-5-
in the wid est po ssi ble way,
acc ept the dia gn osi s. Sin ce and the La tin American woman would un hes ita tin gly
soc ial cla ss tha n the women themost doc tor s gen era llly come from a hig her
opp res sio n of an un jus t cla ss y ste ril ize (cf . Pre sse r, 176 -17 7), the
str uc t ure was uti liz ed to con tin
in a dev elo pin g economy ..
ue tha t opp res sio n
The His pan ics in the United Sta
tes gen era lly bel iev e tha t doc
hel p them. But the y are als
tor s mean to
o
usu
all
y
un cer tai n of the ir rig hts . Sin
do not pro tes t, eit he r because
ce thy
not know how to fin d leg al hel the y :feel the op era tio n was nec ess ary , or do
A5 the stu dy of Ralph Na der p, the re are nex t to no res tri cti on s op era tiv e.
's
neg lec t to sec ure con sen t fonnsgroup dis cov ere d, even the bes t of ho spi tal s
and do so wit h :impunity.
There are sig ns of act ive
Some sta tes have used ste ril iza po lit ica l sup por t for ste ril iza tio n of the poor.
or oth er ins titu tio ns. Lih era tio n as a pre req uis ite for rel eas e from pri son
res tri cti on s on ste ril iza tio n ls lik e Ms. Ald rid ge Westoof, arg ue tha t
ext rem ely dif f i.cu lt to tel l whare im pos sib le to enf orc e sin ce, " ... it is
ret ard ed ... " (pg 89) . And if ether a chi ld is cu ltu ral ly dep riv ed or me nta lly
eff ort s to per fec t a program ofthe for eig n po lic y of the United Sta tes and its
being pur sue d, can the His pan ic massive ste ril iza tio n in Pu ert o Rico are sti ll
poo r in thi s cou ntr y be far
behind?
It is cle ar tha t the Ca tho lic Ch
urch is un alt era bly opposed to
for bir th- co ntr ol rea son s, and
ste ril iza tio n
fin
ds
it
per mi ssi ble onl y for ver y str
apu tic purpos es. But as the
ict the rby pri est s of the ind ivi du als his tor y of Pu ert o Rico has shown, den unc iat ion s
who pra cti ce con trn cep tio n by
act ua lly inc rea ses the po ssi bil
art ifi cia l means
It was found tha t
Ca tho lic women i\'ou ld rat her be ity of ste ril iza tio n.
to rec eiv e the sac ram ent s, tha ste ril ize d, con fes s the sin , and th en con tin ue
con tro l and be con tin uou sly turn to pra cti ce some form of art ifi cia l bir thseem, pas tor al ins ist enc e tha t ned away from th<" sac ram ent s. Tims, it would
avoided at all co sts , act ua lly abo rtio n and art ifi cia l hir th con tro l be
agency can per pet rat e the far cre ate s a fav ora ble cli ma te in wh ich a government
gre ate r sin of gen oci de.
What is nec ess ary for tod
is ahl e to be con tro l led from ay is to rea l1z e tha t the evi l o.f ste ril iza tio n
for the gh ett os. When working Washington- hat h for La tin American cou ntr ies and
tha t the Sp ani sh- spe abn g are wit h peo rle .from the gh ett os one must rea liz e
con dit ion ed hy North Americ an
look forward to ma ter ial ben efi
propaganda to
become immigr ant s to thi s cou ntrts ond abondon tra dit ion al val ues as the y
y.
-6-
Local Ch rist ian s must be wi1 lin g to
make alli anc es wit h sec ula r and
po liti cal groups which arc als o den
oun
cing
inv olu nta ry ste rili zat ion . In New
York Cit y, the Committee to End
Ste
rH
iza
tio
n Abuse wns formed in ear ly 1975.
Ch rist ian s can agr ee wit h the goa ls
of
tlrl.
s
act ivi st group wh kh aims to end
the coe rcio n and dec ept ion inv olv ed
in
ste
rili
zat ion through cit y hos pH als .
Rec ent ly, the CESA asked tha t such
ste
rili
zat
ion
be lim ited to one or two
spe cif ied hos pit als , so tha t the ope
rat
ion
s
cou
ld
be mo nito red . They dir ect ed
themselves to the Cit y llos pita l Cor
por
atio
n.
W
e
mus
t coo per ate wit h the se
po liti cal gro ups , even if our Ch rist
ian fai th tak es us beyond the ir pos
itio n.
There is a need for the loc al Ch rist
i.an community to get the fac ts on
ste rili zat ion . A rec ent par ish cen
sus
i.n
one of t he Roman CJt hol ic Church
in Brooklyn dis clo sed tha t Jbo ut 30~,
of
the
wom en, mo stly Pue rto Rican, whoes .
were chu rch goe rs had been ste rili
zed . This cor res pon ds rou ghl y wit
est ima te for the isla nd.
h the nat ion al
Perhaps one way the chu rch es can hel
p is by inc lud ing some que stio ns abo
"la opc rac ion " to det cnn ine to wha
ut
t
ext
ent
par ish ion ers are (or are not ) inf om
in thi s res pec t. The inf onn atl on
ed
and the cli nic s, even int o the del on rig hts must be tak en int o the hos pit als
ive ry rooms, jus t as the con sen t form
Par t of the ir.s tn1 etio n giv en to cou
ple s bei ng ma rrie d and to tho se exps.
a chi ld must jnc lud e precau tion s,
ect ing
gen era lly done pos t-pa rtum , wh ile sin ce the ste rili zat ion of His pan ic women is
peo ple ade qua tely reg ard ing ste rilithe woman is sti ll in the hos pit al. To inform
zat ion , ste rili zat ion abu ses and
the ir rig hts
is indeed r. mora l ohl jga tjo n whi ch
Chr-lstLm.s shou1
R•:.:!pri ntc
Rev.
Antonio M. Ste ven s Arroyo, C. P.
STOP STERILIZATION
ABUSE/ALTO AL ABUSO
DE ESTERILIZACION
STERI LIZATl ON
WHAT YOU NEED TO KNOW
BEFORE MAKING A DECISION
ESTERILIZACION
LO QUE NECESITA SABER ANTES
DE HACER UNA DECISION
Birth control as an individual right must not be confused with population control as social manipulation .
dad como un derecho individual no debe ser confundido con el control manipulado de la poblacion .
STERILIZATION is an operation performed on women
and men to make them incapable of having or fathering
children again. A sterilization operation is different
from birth control in that it is a permanent operation, it
cannot be undone.
If sterilization is freely chosen, many people may be
satisfied with their decision. Because of its permanence, however, the operation can be used for
political ends. Many coercive or abusive sterilizations
are being performed , especially against poor and
minority people who, because of poverty, language and
literacy problems, are at a disadvantage in asserting
their rights before " professionals" in the health and
welfare fields. This has led to a high rate of regret (as
high as 30 % ) among people who made an uninformed,
hasty or pressured decision to be sterilized.
This makes it very important to learn all the facts
about the operation, how it can be abused , what one's
rights are and how to use them , before making a lifetime decision to be sterilized .
WHEN DOES STERILIZATION ABUSE OCCUR?
• When a person is sterilized without giving informed
consent. That is, when s/he signs a- con.sent form
without being clearly informed that the sterilization
operat ion cannot be undone and that s/he is in fact giving up her/his right to ever have or father children again ;
that female steril ization operations are major surgery
and that serious phys ical and psychological problems
can arise as a result of the operation ; that the decision
to have the operation is solely up to her/him and that
s/he has rights under tbe law not to be coerced into
making the decision; foat if she does not want to get
pregnant or he does not want to cause pregnancy, there
are other alternatives that e,re temporary; that under the
law s/he has to be given tl me to make up his/her mind
and to talk about the dec is i on with others ; and that all
th e informat ion must be ',;i,ven to her/him in her/his
preferred lanquaqe.
• When a women does not want to give her consent
but is threatened w.i th the termination of welfare
payments or medical services if she does not consent to
be steri lized.
El control de la natal i
LA ESTERILIZACION es una operaci6n hecha a mujeres y hombres para hacerlos incapaces de tener hijos.
Es distinta a los metodos anticonceptivos en que es
una operaci6n permanente, no se puede deshacer.
Si la decisi6n de esterilizarse es hecha libremente,
muchas personas pueden estar satisfechas de haber
escogido ese metodo. El caracter permanente de la
operaci6n, sin embargo, hace que la esterilizaci6n se
preste a ser utilizada con fines politicos. Como
resultado, han habido muchos casos de esterilizac iones abusivas , especialmente contra personas
pobres y pertenecientes a grupos minoritarios quienes,
por razones econ6micas, desconocimiento del idioma o
falta de oportunidades educacionales, no pueden
defender sus derechos ante los " profesionales " de los
hospitales o clinicas y el departamento de asistencia
social (welfare). Esto ha causado que por lo menos el
30 % de las personas que han hecho una decisi6n de
esterilizarse sin estar debidamente informados sabre la
operaci6n o que han decidido bajo presi6n, se hayan arrepentido mas tarde.
Esto le da gran importanc ia al conocer los detalles
sabre la operaci6n , coma puede ser usada
abusivamente, que derechos tenemos y coma usarlos,
antes de hacer una decisi6n de esterilizarse para toda
la vida .
CUANDO OCURRE EL USO ABUSIVO DE LA
ESTERILIZACION?
• Cuando una persona es esterilizada sin haber dado
su consentim iento informado. 0 sea, cuando firma una
autorizaci6n para ser esterilizada, sin haber sido
claramente informada del caracter permanente de la
operaci6n , que no se puede deshacer, y que de hecho
esta renunciando a su derecho a poder concebir o
apadrar hijos en el futuro; que la operaci6n de
esterilizac i6n femenina es cirugia mayor y que muchas
veces resulta en serias complicaciones fisicas y
sicol6g icas; que la decisi6n de hacerse la operaci6n
depende solamente del individuo y que existen
derech os bajo la ley a no ser obligado a hacerla; que si
no qui ere tener hijos existen otras alternativas que no
son permanentes; que bajo la ley el individuo t iene
derecho a tener sufi c iente tiempo para hacer la
3
2
• When a woman choses to be sterilized, but is
discouraged or even prevented from undergoing the
operati on.
• When a woman is sterilized because abortion is
unavailable, birth control methods are too expensive or
she is forced to accept steril ization as a condition to
have an abortion .
All over the U.S., women who have been sterilized in
these situations are suing in the courts charging that
their rights have been violated.
ABUSE, however, is not only the results of overt coerci on or lack of informed consent. Abuse also occurs
when an individual is forced to choose sterilization
becau se of her/his economic and social condition. The
history and prevalence of sterilization make it clear that
the social problems that affect the poor have caused
many people to get sterilized , particularly Black,
Hispanics and Native Americans . The lack of employment opportunities , education , daycare, decent housing , adequate medical care, safe effective contraceptive
meth ods, access to abortion, combined with hysterical
" overpopulation " scare stories , have helped create an
atmosphere of subtle coercion . The present policy of
the Depa rtment of Health, Education and Welfare
(HEW), which pays for as many as 150,000 sterilizations
yearl y, reimbursing 90 % of the cost for sterilization
whil e not providing funds for abortion-is an example
of the way in which options are limited and choices
man ipulated . While sterilization , as part of population
control programs , is pushed as a solution to social probl ems, little is done to correct poor living conditions or
end unemploymen t. Not surprisingly, sterilization rates
rise as income levels decrease.
As a result of both overt and subtle coercion , 20 % of
married Black and Chicana women and as many as 25 %
Native American women have been sterilized. Puerto
Ri co serve s as a warning of the dangers in denying true
fre ed om of choi ce in family planning. U.S. government
fund ed family planning programs there, which have
never provided abortion , had succeeded in sterilizing
35.3% of all women of reproductive age by 1968. Many
of t he women were not aware of the irreversibility of the
procedure, and as many as 1/, of them evidenced regret,
at least 72 % of them because they wanted more
children. In 1972, Family Planning Digest, an official
HEW pub lication , stated that " as U.S. professional attitudes change, it is possible that we may see sterilizat ion become as important in the fifty states as it is
already in Puerto Rico." In New York City, Hispanic
women are 6 t imes more likely than white and 3 times
more li ke ly than Black women to be sterilized .
Unn ecessary surgery of all kinds is rampant. As the
bi rth rat e cont inues to drop in this country, doctors wh 'J_
used to ma ke a living delivering babies , have turned to
surge ry to maintain their incomes . The acting director
of the Obstetri cs and Gynecology (OB-GYN) at a
muni cipal hospital in New York City reported recently
that it is common practice to use elective hysterect omies to train residents . " At least 10 % of
gynecologi cal surgery in NYC," he said , " is done on this
bas is, and 99 % is done on Puerto Rican women ." A
survey report ed in 1972 showed a distinct bias among
OB-GYN doctors to recommend sterilizations to their
publi c rath er than their private patients. In the same
st udy, 94 % of th e physicians surveyed favored com pulsory sterili za ti on of unwed welfare mothers with
t hree chil dren. or the withdrawal of welfare benefits if
they re fu sed to be steril ized.
Beca use of th ese attitudes on the part of the medical
pe rsone l and th e use of sterilization for political ends ,
th e ri ght to inform ed consent and to be free from coercion was not established in NYC until 1977, after years
of heated str uggle by CESA , health workers , Black and
Hispa ni c orga nizat ions and womens groups.
½
decisi6n y discutirla con otras personas; y que toda la
informaci6n tiene que ser dada en el idioma preferido
del individuo.
• Cuando una mujer es esterilizada sin saberlo o sin
dar su consentimiento, o es presionada a dar el consentimiento durante un aborto o cuando esta dando a luz,
momentos en que se encuentra en su estado fis ico y
emocional mas vulnerable. Esta es la forma mas comun
•
de abusos.
• Cuando una mujer no quiere dar su consentimiento yes amenazada con la terminaci6n de su asistencia
social (welfare) o la negaci6n de servicios medicos si no
se deja esterilizar.
• Cuando una persona decide ser esterilizada, pero
es desalentada o se le impide que se la haga.
• Cuando una mujer es esterilizada porque no tiene acceso el aborto o porque los metodos antico'nceptivos
temporarios son muy caros, o es obligada a aceptar una
esterilizaci6n como condicion para hacerse un aborto.
En todo el pais, mujeres que han sido esterilizadas
bajo estas condiciones estan presentado demandas en
las cortes judiciales por la violaci6n de sus derechos
civiles.
EL USO ABUSIVO DE LA ESTERILIZACION, sin embargo, no es solamente el resultado de presiones obvias
o falta de consentimiento informado. El abuso tambien
ocurre cuando un individuo es obligado a escoger la
esterilizaci6n como consecuencia de su situaci6n
econ6mica y social. La historia y antecedentes de la
esterilizaci6n dejan ver claramente que los problemas
sociales que afectan a los pobres han obligado a
muchos a esterilizarse, especialmente afroamericanos,
hispanos y nativos norteamericanos. La falta de oportunidades de empleos, educaci6n , cuidado de nii'ios, viviendas decentes, servicios medicos adecuados,
metodos anticonceptivos seguros y eficientes, acceso
al aborto, combinada con una histerica campai'ia sobre
la " superpoblaci6n ," han contribuido a crear una
atm6sfera muy sutil de coerci6n . La presente politica
del Ministerio de Salud , Educaci6n y Asistencia Social
(HEW) de los EEUU-que paga por mas de 150,000
esterilizaciones al ai'io mientras no provee fondos para
el aborto-es un ejemplo de como las opciones son
limitadas y las preferencias manipuladas. Por un lado
se impulsa la esterilizaci6n, como parte de los programas de control natal, una falsa soluci6n a los problemas sociales, y por el otro se hace poco para corregir las condiciones de vida pobre o eliminar el
desempleo. No es por casualidad que la proporci6n de
esterilizaciones sube a medida que los niveles de
sueldo bajan .
Como resultado de esta coerci6n , ya sea abierta o
sutil , se han esterilizado a mas del 20 % de las mujeres
afroamericanas, chicanas y nativas norteamericanas
casadas. Puerto Rico sirve de ejemple de los peligros
que existen en la negaci6n de una verdadera libertad de
elecci6n de metodos de planificacion familiar. Para
fines de 1968, los programas de planificaci6n familiar,
financiados por el gobierno de los EEUU , ya habian
esterilizado a mas del 35 % de las mujeres de edad
reproductiva en la isla. Muchas de las mujeres no
estaban conscientes de la permanencia de la
operaci6n, y por lo menos 1/J de ellas se arrepintieron
mas tarde de habersela hecho, por lo menos el 72 % porque querian tener mas hijos. En 1972, el Family Planning Digest, una publicaci6n oficial del HEW, dijo en un
articulo que " a med ida que las actitudes de los profestionales cambien , es posible que veamos la
esterilizaci6n volverse tan importante en los 50 estados
como ya lo es en Puerto Rico. " En la ciudad de Nueva
York , las mujeres hispanas son esteril izadas 6 veces
mas que las blan cas y las mujeres afroamericanas 3
veces mas que las blancas.
Los casos de cirugia innecesaria ocurren demasiado
a menudo. A medida que el nivel de nacimientos baja en
este pais , los medi co s que se ganaban la vida atendiendo a las mujeres en el parto, han cambiado para la
cirugia para mantener su nivel de entrada econ6mica.
El direc tor del departament o de obstetr ica y
(Continua en la p. 5)
WHAT IS INVOLVED IN A STERILIZATION OPERATION?
There are several female sterilization operations,
known as " tubal ligation" or " tubal sterilization ." In
these operations,- a section of the woman's fallopian
tubes is cut off and each remaining end is closed with
surgical thread or metal clips, or sealed (cauterized)
with electrical current, to block the tubes (see graphic).
This prevents the male sperm from traveling to meet the
female egg (ovum), therefore making pregnancy impossible.
A woman can have a sterilization when she delivers a
baby, when she has an abortion or when she has not
been recently pregnant.
• A tubal ligation done at the time of delivery is called
a laparotomy. It is done under general anesthesia . The
doctor reaches the tubes through a cut in the woman's
abdomen , after which the tubes are cut and then tied or
clipped . A woman 's hospital stay may be lengthened for
•
a day or two.
• If the sterilization is done for a woman who is not
pregnant, she can have the procedure done at any time.
There are two common methods, and, while they are
usually done under general anesthesia , they can also be
done under local anesthesia.
One is the laparoscopy, in which a small incision is
made near the belly button and the abdomen (belly) inflated with gas to separate the organs. This may be uncomfortable. A thin , metal viewing instrument, like a
telescope, is inserted through the incision and the
tubes are burned or clipped closed through the same or
a second small incision.
The second and newest method is the mini-lap. A
local anesthetic is given in the cervix and a uterine
elevator which moves the uterus is inserted . Then
another local anesthetic is given in the skin over the
pubic bone and a small incision made through which
the tubes are reached to be cut, tied or clipped.
The$e kinds of sterilizations are abdominal methods.
However, sterilizations can also be done through the
vagina. A co/potomy is a vaginal sterilization like the
laparotomy and a culdoscopy is like a laparoscopy
without inflating the abdomen with gas. Vaginal
methods carry a higher risk of infection than abdominal
sterilizations and they can be done after abortion or
when the woman is not pregnant.
FEMALE STERILIZATION OPERATIONS are often
referred to as " bandaid surgery, " " a stitch ," " tying the
tubes," and " belly button surgery, " creating the impression that they are very simple, safe and easy operations.
This is a total misconception. All the female sterilization operations are major surgery and as such carry
many risks and the possibility of medical or
psychological complications.
The death rate for tubal sterilization is 25 per 100,000
women . Side effects after the operation include
bleeding, uterine perforation, accidental burning of the
bowels or intestinal injury, infections, abdominal pain
or pain during menstruation and increase in menstrual
bleeding .
Psychological complications after sterilization operations are common . According to a 1973 study, one
fourth of the women who have been sterilized regret
their decision, and , in some instances, a regret rate of
32% has been documented .
HYSTERECTOMY
HYSTERECTOMY is an operation where the whole
uterus is taken out. This operation is performed more
often than any other operation and it is done for
sterilization purposes too readily. A hysterectomy
should only be performed when there is a disease of the
women 's uterus or some other problem that can only be
treated by removing the uterus. It is a more serious
operation than the tubal sterilizations, it takes longer to
do and there are more discomforts, risks and chances
segment removed
(secclon cortada)
@rrS?0
ovary
(ovarlo)
uterus
(utero)
vagina
TUBAL LIGATION
AMARRE DE TROMPAS
of developing serious health problems . The recovery
period is at least 6 weeks.
The complication rate for hysterectomies is 10-20
times higher than for tubal sterilizations, with 300-500
deaths per 100,000 operations.
Dr. Charles McLaughlin, the former president of the
American College of Surgeons, once sa id that to perform a hysterectomy solely to sterilize a woman is " like
killing a mouse with a cannon ." However, 10 per every
1,000 women in the U.S. had hysterectomies in 1976.
VASECTOMY
The male sterilization operation is called a vasectomy. The objective of a vasectomy is to prevent the
sperm from getting into the semen during sexual intercourse. The man will still make flu id, but without the
sperm. The operat ion does not affect the penis or the
testicles.
First the doctor makes about a ½ inch incision on
each side of the scrotum , thorugh which he reaches the
vas deferens, the tube that carries the sperm from the
testis to the penis . He cuts off a small section of the vas
deferens and t ies each of the remaining ends (see the
graphic). The cuts are then closed with stitches that will
dissolve by themselves . The operation is done under
local anesthetic in a doctor's office and usually lasts
around 20 minutes.
Vasectomy is a minor operation , but there are
chances of develop ing medical problems afterwards .
Swelling might develop around the cut made on the
skin . This usually happens right after the operation and
will more likely go away in a few days. Bleeding might
develop under the skin which will cause a bruise. This
usually clears up by itself. An infection might develop
either on the skin or inside the scrotum that requires
another visit to the doctor, especially if the symptoms
last more than a few days or fever develops.
IS STERILIZATION IRREVERSIBLE?
Sterilization is not reversible. The few times that the
operation fails are accidental. Sterilization means a permanent end to the person 's ability to have children.
Many people think that for women sterilization is
reversible because they have heard of an experimental
operation to reconnect the tubes . This operation fails at
least 75 % of the times , and even if it is successful there
is very little chan ce that pregnancy can be achieved .
In men, the procedure to rec onnect the vas deferens
is successful 50-80 % of the times , but the con cepti on
rates are as low as 20-25 % of th e su ccessful reconnections .
4
QUE PASA EN UNA OPERACION DE ESTERILIZACION?
Existen varias operaciones de esterilizaci6n
femeninas, conocidas como "ligaci6n tubal," o
"esterilizaci6n tubal." En estas operaciones, una secci6n de los tubos falopios de la mujer es cortada y los
extremes que quedan son cosidos o cerrados con
broches o grapas de metal o corriente electrica
(cauterizaci6n), para bloquear los tubos (vea el dibujo).
Esto previene que la esperma del hombre se encuentre
con el huevo (ovum) de la mujer, haciendo imposible
que la mujer salga encinta.
Las esterilizaciones femeninas se pueden hacer
cuando la mujer da a luz, cuando se hace un aborto o en
cualauier otro memento cuando no este encinta.
• La llgacion tubal que se hace cua:ndo la mujer da a
luz se llama laparotomfa. Se hace bajo anestesia
general. El medico llega a los tubos a traves de una incisi6n en el abdomen de la mujer. Entonces los corta y
los cierra. La estadia de la mujer en el hospital se
pqdria extender por un dia o dos.
• Si la esterilizacion se hace a una mujer que no esta
encinta, existen dos metodos comunes que, aunque
normalmente se hacen bajo anestesia general, se
podrian hacer con anestesia local.
Uno es la laparoscopfa , donde se hace una pequeiia
incisi6n cerca del ombligo y el abdomen se infla con
gas para separar los 6rganos. Esto puede ser inc6modo. Un instrumento de metal, como un telescopic,
es insertado a traves de la incisi6n para que el medico
pueda ver los tubos y entonces los quema o cierra con
un broche de metal.
El segundo metodo es el mini-lap. Primera se da una
anestesia local en la matriz y se coloca un elevador
uterine para mover el utero. Se da otra anestesia local
sobre la piel del hueso pubico y se hace una pequeiia incisi6n a traves de la cual se puede llegar a los tubas
para cortarlos y cerrarlos.
Estos metodos son metodos abdominales. Las
esterilizaciones, sin embargo, tambien se pueden
hacer por la vagina. Una colpotomfa es coma la
laparoscopia, sin inflar el abdomen. Los metodos
vaginales tienen mas riesgos de infecciones que los abdominales y se pueden hacer despues de un aborto o
cuando la mujer no esta encinta.
LAS OPERACION ES DE ESTER I LIZACION
FEMENINAS muchas veces son llamadas "operaci6n
de curita" (bandaid surgery), "un punto" (a stitch),
"amarrar los tubas" (tying the tubes) y " cirugia de
ombligo" (belly button surgery), creando la impresi6n
que la operacion es muy facil y nada de peligrosa. Esto
es un error. Las operaciones de esterilizaci6n son
cirugia mayor y conllevan muches riesgos y posibilidades de complicaciones medicas y sicol6gicas.
La tasa de mortalidad por ligaciones tu bales es de 25
por cada 100,000 mujeres que se hacen la operaci6n.
Las complicaciones secundarias incluyen hemorragias
internas, perforaci6n del utero, quemaduras accidentales u otros danos intestinales, dolores abdominales,
dolores durante la menstruaci6n y aumento del flujo
menstrual.
Las complicaciones sicol6gicas son comunes
despues de la operaci6n . De acuerdo con una investigaci6n hecha en 1973, una cuarta parte de las mujeres que han sido esterilizadas se arrepienten mas
tarde de haberse hecho la operaci6n yen muches casos
el percentage es hasta de 32% .
HISTERECTOMIA
La histerectomia es una operaci6n donde se le saca
todo el utero a la mujer. Esta operaci6n es hecha mas
frecuentemente que otras operaciones y se hace
muchas veces con el prop6sito de esterilizar a la mujer.
Esto es un abuso. La histerectomia solamente se debe
hacer cuando hay una enfermedad del utero o algun
otro problema que solamente se pueda resolver sacando el utero. Es una operaci6n mucho mas seria que la
esterilizaci6n tubal, se lleva mucho mas tiempo y hay
muches mas riesgos e incomodidades y posibilidades
de desarrollar series problemas medicos. El periodo de
recuperaci6n es por lo menos 6 semanas.
La tasa de complicaciones por histerectomias es de
10 a 20 veces mas alta que por las esterilizaciones
tubales, y la tasa de mortalidad es de 300 a 500 muertes
por cada 100,000 operaciones.
VASECTOMIA
La operaci6n de esterilizaci6n masculina se llama
vasectomfa. El objetivo de la vasectomia es prevenir
que los espermatozoides se mezclen con el semen
durante las relaciones sexuales. La operaci6n no afecta
el pene o los testiculos y el hombre continua eyaculando el semen. oero sin los esoermatozoides .
El la operaci6n, el medico hace una incisi6n de ½
pulgada a cada lado del escroto, a traves de las cuales
puede alcanzar el vas deferens, el tubo que lleva la
esperma de los testlculos al pene. Entonces corta una
pequena secci6n del vas deferens y amarra las extremes que quedan (vea el dibujo). Despues cierra las incisiones con puntos que se disuelven por si mismos.
La vasectomia es una operaci6n menor, pero hay la
posibilidad de desarrollar problemas medicos mas
tarde. Puede haber inflamaci6n alrededor de la incisi6n.
Esto pasa casi siempre despues de la operaci6n y solo
dura unos dias. Puede que haya una hemorragia bajo la
piel que causaria un hematoma, y se disuelve por si
mismo. Puede que se desarrolle una infecci6n en la piel
o dentro del escroto que requiera otra visita al medico
(especialmente si los sfntomas du ran mas de unos dias
y hay fiebre).
i,ES IRREVERSIBLE LA ESTERILIZACION?
vas deferens
segment removed
(secclon cortada)
testicle
(testlculo)
VASECTOMY
VASECTOMIA
La esterilizaci6n no es reversible. Las pocas veces
que la operaci6n falla son accidentales . La
esterilizaci6n quiere decir la terminaci6n permanente a
la habilidad de la persona para tener hijos.
Muches piensan que la sterilizaci6n femenina se
puede deshacer porque han oido hablar de una
operaci6n experimental que reconecta las tubas. Esta
operaci6n falla por las menos el 75% de las veces y
aunque no falle hay muy pocos probabilidades de caer
en estado.
En los hombres, la operaci6n para reconectar el vas
deferens es un exito el 50-80 % de las veces, pero la tasa
de concepci6n es tan baja coma el 20-25 % de las
reconecciones que funcionan .
5
THE ALTERNATIVES
Th ere are temporary methods of birth control that
make it possible to change one's mind about having or
not having children . These are:
Diaphragm with Jelly or Cream, a piece of rubber or
soft plastic a woman places in her vagina each time she
is going to have sex. The jelly or cream are used to increase its effectivene ss . It is 90 % effective and it has
no risks or serious complicatio ns.
Condom, Rubber, Prophylactic, Sate, a thin sheet of
rubber a man places over his penis each time before he
has sex. It is 90 % effective. It has no risks or serious
complicatio ns and it helps prevent the spread of gonorrhea and syphilis . A woman can use the foam at the
same time for extra protection .
Foam or Foaming Tablet, a foam or tablet the woman
places in her vagina each time before havinQ sex. It is
85 % effective and it has only very rare side effects.
Loop, Coil, Intrauterine Device (IUD), a small piece of
plastic and/or metal the doctor inserts in the woman's
womb. It is 96 % effective. It is usually very safe, but it
has occasional side effects and rare serious complications . IUD has been linked in some women with irregular
periods , cramps , increased risk of uterine infections,
and it is not advisable for women who have had
previous pelvic infection , heavy and painful menstrual
periods , blood clotting problems, heart disease or ectopic pregnancy.
Rhythm or Natural Method is a way of preventing
pregnancy in which the woman does not have sex on
the 8- 15 days each month in which she is most likely to
get pregnant. It is hard to tell when these days are and
as a result this method fails more often (70-80 % effeciive). It has no risks or complicatio ns.
Birth Control Pill is a pill that the woman takes for 21
days of the month which makes it 98 % certain she will
not get pregnant. There is, however, recent evidence indicating an increased risk of cancer for women who
have used the pill. The pill has been linked in some
women with minor side effects such as darkening of the
skin of the face , nausea, and vaginal discharge. More
serious complicatio ns include depression , abnormal
blood clotting , increased risk of heart attack or stroke
(especial ly among women over age 40 who smoke) and
an increased risk of l_iver or gall bladder disease. The pill
is not re commended for women who have had migraine,
fibroid tumors of the uterus, asthma, epilepsy, gall bladder disease, breast tumor, sickle cell anemia, infrequent
periods , intestinal surgery or intestinal inflamation .
ABORTIO N
Aborti on is not a method of birth control , it is an
operation to stop a pregnancy that has already started .
It should be done during the first three months of
pregnan cy. It can be done later, but it is more expensive,
less safe and usually requires a stay in the hospital. It
works almost all of the time and there are mild discomfort s and oc casional complicati ons (sometime s
SPrious)
(Continuac ion ...
ginecologia de un hospital municipal de Nueva York dijo rec ientemente que es una practica comun el hacer
histerectom ias electivas para entrenar a los estudiantes de Medicina. " Por lo menos el 10% de las
operaciones ginecol6gic as hechas en Nueva York son
hechas en esta base," dijo, " y el 99 % son hechas a
Puertorriqu efias ." Un estudio de 1972 demostr6 queentre los ainecoloao s existe una tendencia bien acentuada de recomenda r mas la esterilizaci 6n a sus paci entes publicos que a sus pacientes privados. En este
mismo estudio, el 94 % de los medicos favorecian la
esterilizaci 6n obligatoria de mujeres solteras con mas
de Ires hijos que reciben asistencia social (welfare) o la
terminaci6n de benef icios si rehusan ser esterilizada s .
LAS ALTERNATIVAS
Existen metodos anticoncep tivos temporario s que
permiten que uno cambien su decisi6n de tener o no
tener hijos. Estos son:
DIAFRAGMA CON JALEA O CREMA, un aro de goma
o plastico suave que la mujer se pone dentro de la
vagina cada vez que va a tener relaciones sexuales. La
jalea o crema se usan para incrementa r su efectividad .
Tiene una efectividad de 90 % y no conlleva riesgos o
comp I icaciones.
CONDON , PRESERV ATIVO , PROFILAC TICO ,
FORRO, GOMA, ETC. , una cubierta hecha de goma que
el hombre se coloca en el pene cada vez que va a tener
relaciones sexuales. Tiene una efectividad de 90 % y no
conlleva riesgos o complicaci ones. El condon ayuda a
prevenir el contagio de la gonorrea o sifilis. La mujer
puede usar la jalea para mayor protecci6n .
ESPUMA VAGINAL, es una espuma o pastilla que la
mujer se pone en la vagina antes de tener relaciones
sexuales. Tiene una efectividad de 85 % y muy pocas
complicacio nes.
IUD O METODO INTRAUTERINO (ESPIRAL, MU ELLE,
CIRCULO CONTROL INTRAUTERINO), un aro de
plastico y/o metal queen medico inserta en el utero de
la mujer. Tiene una efectividad de 96% . Normalmen te
es seguro, pero tiene varias complicaci ones. El IUD ha
sido relacionado en algunas mujeres con irregularidades de la menstruaci 6n, dolores e incremento
del riesgo de infecc iones uterinas. No se recomienda
para mujeres que que hayan padecido de infecciones
de la pelvis, menstruaci ones copiosas o dolorosas,
cuagulos de sangre, enfermedad es del coraz6n o embarazos ect6picos.
METODO DEL RITMO O METODO NATURAL, es una
forma de prevenir el embarazo donde la mujer no tiene
relaciones sexuales durante los 8 a 15 dias del mes en
que hay mas posibilidad es de que salga en estado.
Estos dias son muy dificiles de pronosticar y el metodo
falla a menudo (efectividad de 70-80%). No conlleva
riesgos o complicaci ones.
PILDORA ANTICONCEPTIVA, es una pildora que la
mujer toma por 21 dias del mes y que le da una garant,a
de un 98 % de no salir embarazada. Sin embargo, hay
evidencias recientes que indican el riesgo de contraer
cancer en las mujeres que han tornado la pildora. La
pildora, ademas, ha sido ligada en algunas mujeres con
otras complicac iones como manchas del cutis, nausea,
flujo vaginal , depresi6n, coagulaci6 n del sangre, incremento de riesgos de enfermedad es del coraz6n
(sobre todo entre mujeres fumadoras de mas de 40
anos) e increment o del riesgo de contraer
enfermedad es del higado o de la vesicula biliar. La
pildora no se recomienda para mujeres que hayan
padecido o padezcan de tumores fibroides del utero,
migrana, asma, epilepsia, enfermedad es de la vesfcula,
tumores del seno, anemia de " sickle cell ," peri6dos infrecuentes o cirugia o inflamacion es intestinares .
ABORTO
El aborto no es un metodo anticoncep tivo, es una
operaci6n para terminar un embarazo. Se debe hacer
durante los primeros tres meses de embarazo. Se
podria hacer mas tarde, pero es mas caro y menos
seguro y una se tendria que quedar en el hospital. Es
efectivo casi todas las veces y conlleva algunas incomodidad es y complicaci ones (a veces serias).
Como resultado de estas actitudes por parte de los
medicos y el uso de la esterilizaci 6n con fines politicos,
el derecho al consentimi ento informado ya hacer decisiones sin ser presionado no se gan6 en Nueva York
hasta el 1977, tras anos de lucha por parte de CESA,
trabajado res de salud y organizac i ones
afroarneric anas, hispanas y de mujeres.
6
THE LAW...
LA LEY...
As a first step to fight sterilization abuse, a public
law, Public Law 37 (PL 37) was passed by the New York
City Council in 1977. The law provided the following
rights and conditions for sterilizations.
• A person must be 21 and legally competent to consent to be sterilized .
• Freedom from threats of withdrawal of medical or
social benefits if the person decides not to be sterilized .
• To be counseled by a qualified person other than
the doctor doing the operation , in the person's preferred
language or using a translator.
• To have a witness of the person 's own choosing, a
friend , relative or spouse, during the counseling session
and signing of the consent.
• To have a sterilization no matter how many children
the person has, even none, and to make the decision
free from the veto of husband or wife.
• To have the standardized consent form that permits
the doctor or hospital to do only the requested sterilization.
• To have a copy of the consent form available for the
person's study at his/her own convenience.
• To be free from pressure or coercion , especially if
the person is in the hospital for abortion or childbirth.
• To have at least 30 days in which to think the decision over and discuss it with others .
• To be given information about the risks, benefits
and alternatives to sterilization, including the different
sterilization methods for men and women as well as
temporary methods of birth control.
• To have temporary methods of birth control during
the waiting period.
• To have the right to change one's mind any time
before the operation .
• To have a// questions answered to the person's
satisfaction .
Como un primer paso para eliminar el uso abusivo de
la esterilizaci6n, la ley publica numero 37 (PL37) fue
aprobada en el consejo municipal de la ciudad de
Nueva York en 1977. Esta ley estableci6 los siguientes
derechos y condiciones para las esterilizaciones:
• La persona debe tener 21 anos y estar capacitada
mentalmente para poder dar su consentimiento para
ser esterilizada.
• Prohibici6n de las amenazas de terminaci6n de
servicios medicos o sociales (welfare) si la persona
decide no esterilizarse.
• La persona debe ser informada sobre la operaci6n
por un profesional calificado que no sea el medico que
va a hacer la operaci6n, en su idioma preferido o con un
traductor.
• La persona tiene el derecho a un testigo de su
preferencia (amigo, familiar o esposoi;a) durante las
sessiones de informaci6n y firma del consentimiento.
• El derecho a hacerse una esterilizaci6n sin importar cuantos hijos tenga, aunque no tenga ninguno, y
libre de la prohibici6n del esposoi;a.
• El uso de papeles de consentimiento redactados
unitormemente y que autorizen al medico y hospital
solamente para el tipo de esterilizaci6n especificado.
• Que la persona tenga una copia de los papeles de
consentimiento para estudiarlos a su conveniencia.
• Prohibici6n de coerci6n o presiones contra la persona, especialmente si esta en el hospital para un aborto o parto.
• Un periodo de 30 dias en el cual poder pensar
sobre la decisi6n y discutirla con otros.
• Obligaci6n de informar a la persona sobre riesgos,
beneficios y otras alternativas a la esterilizaci6n, inc I uyendo diferentes metodos anticonceptivos
masculinos y femeninos.
• Tener metodos anticonceptivos a su alcance mientras espera para hacer la decisi6n.
• El derecho a cambiar la decisi6n en cualquier
momento antes de la operaci6n.
• Que todas las preguntas sean contestadas a la
satisfacci6n de la persona.
WHAT YOU CAN DO ...
• Always get the names of the doctors, nurses or
counselors, keep track of the dates when you visited
them and hold on to any documents they give you.
• Learn your rights under PL37. If you are not given all
the consideration and information just described ... if someone threatens you or pressures you, especially during labor or abortion ... if you are told that you must have
a sterilization for your health (sterilization does not cure
any illness, it will only keep you from having children) or
because you have had babies by caesarean section ... if
someone is in a great hurry to get you sterilized .. . if you
have been sterilized without your knowledge or against
your will. ..
Report it immediately to stop it from happening. Get a
second medical opinion if you are in doubt, There is no
hurry , because sterilization is never an emergency. You
may be able to bring legal action .
(This brochure has been prepared by CESA and
Health Rights under a CETA-TITLE VI grant. Este
boletin ha sido producido por CESA y Health
Rights con fondos otorgados por CETA-TITLE VI.)
Write a complaint letter with details of your experience and send it to the following address.
CESA can also be contacted for setting up educational slide shows and presentations on sterilization abuse.
LO QUE UD. PUEDE HACER ...
• Siempre apunte los nombres de medicos ,
enfermeras o consejeros con los que hable, las fechas
cuando los visit6 y guarde cualquier documento que le
den.
• Aprenda sus derechos bajo la ley 37. Si no le dan
toda la consideraci6n e informaci6n que acabamos de
describir ... si alguien la amenaza o la presiona, sobre
todo durante un aborto o parto ... si alguien le dice que
se tiene que hacer una esterilizaci6n por razones de
salud (la esterilizaci6n no cura ninguna enfermedad
solamente termina su abilidad de tener hijos) o porque
le han tenido que hacer la cesarea para parir. .. si
alguien tiene mucho apuro porque se esterilice .. . si la
han esterilizado sin su conocimiento o aprobaci6n ...
Reportelo inmediatamente. Busque una segunda
opini6n medica si tiene dudas. No hay apuro, pues la
esterilizaci6n nunca es una emergencia. Es posible que
usted pueda establecer una demanda legal.
Escriba una carta detallando su experiencia y enviela a la siguiente direccion. CESA tambien
puede ayudar a organizar presentaciones educacionales sobre el uso abusivo de la esterilizacion.
Committee to End Sterilization
Abuse (CESA)
P.O. Box A244-Cooper Station
New York, New York 10003
Telephone: (212) 788-1775
Second
Thoughts
About Sterilization
by Karen Wynn
In the mid 1960s. when women began
talking to each other about their li ves as
women. one of the recurring topics was
01rth control and the uneasiness even
women with no side effects felt about
the Pill. Out of those conversations
came, too slowly for all of us and too
late for some, national awareness of
longterm problems and eventual recons1derat1on of what had been heralded as
" the modern method of birth control."
Th e modern method, we learned ,
brought us hormonal imbalances. card10 -vascular disease and increased nsk
of cancer.
Th ousands of us have turned instead
to stenhzat1on. now billed as the
" permanent method of birth control ,"
and with enthusiasm and relief we felt
earlier with the development of the Pill.
It may well turn out to be another case
of "here we go again. "
Linda 1s thirty-five. has one child and
1s a social worker at a large hospital. She
is well informed on medical subjects and
has been active in the women 's movemment and · 1n the movement against
sten lizat1on abuse 1n third world countries- the kind of patient who 1s
expected to be capable of making
informed decisions.
Now, two years after her band -aid
surgery, Linda 1s involved 1n what is
beginning to look like a pattern for some
women who have been sterilized heavy irregu lar bleeding leading to eventual hysterectomy .
Three years ago Linda developed a
blood clot at th e bad< of her knee.
Fearing more clots and the possibility of
stroke., she realized that she would have
to go oft the Pill. She turned instead to
sterilization, the most popular form of
birth control for couples over thirty.
s 1977 bv Karen Wynn.
Reprints may be obtained from SISTER ,
250 Howard Ave .. New Haven, CT
06519. Enclose 25 cents for each copy
or S20 per hundred.
From 600,000 to 1 million women are
sterilized each year .
Th e sterilization procedure she chose
was laparoscopy (see detailed description below .) The fallopian tubes are
cauterized shut, preventing eggs from
passing through on th.air way to the
uterus . The operation itself 1s done
th rough a small incision in the abdomen
and 1s often called " band-aid" surgery to
emphasize its simplicity and safety . The
eggs . Linda was told, break down at the
obstruction and are simply absorbed
into the surrounding tissues . No side
effects . No hassles. Safe and permanent
birth control.·
The principle involved in laparosc~
sterilization is not very elegant : caut~
zanon is the medical term for burning,
and the tubes are burned shut . What
makes some people uneasy about the
procedure is that healthy tissue is deliberately destroyed, a contradiction at th
usual philosophy of surgical practice.
But what is unclear is how much
surrounding tissue is destroyed . Because earlier laparoscopic techniques resu lted 1n a high number of subsequent
pregnanc1es. the techniques tended to
become more destructive year-by-year .
Many gynecologists now suspect that
the ovaries may be damaged during
stenlizat,on leading to premature menopause .
Linda noticed an immediate change in
her periods after the sterilization . They
lengthened from five to seven days and
seemed heavier . Then this spring, two
years after the procedure , she missed
two periods entirety . When her period
turned up again the thi rd month. she
was not too surprised that 1t was heavy,
but she bled constantly - one tampon
per hour - for one month .
continued on next page
Enter the British
was too young and that he didn ' t know
red
tape
ng
havr
mos t respected British
the
after
.
,
later
1975
s
In
week
Two
ation . It turned out
oper
the
do
to
how
d a
exIt
medical journal . The Lancet. publishe
off , the bleeding began again .
cologists rn our area were
gyne
two
that
of
rns
d
patte
l
perro
strua
al
stud y done on the men
tended just before her norm
em all and I had no trou b le con r
th
g
eithe
doin
zed
l1
sterr
and
been
l
had
usua
who
than
whic h was again heavier
said wo men
one
No
rt.
do
to
them
of
one
ing
vinc
od
by laparoscopy o; by the older meth
still has not stopped entirely .
hing abou t any long term eftec ts of
anyt
pian
fallo
ic
the
pelv
a
off
had
tying
she
and
.
ring
now
of seve
Alarmed by
the
the sterilization .
tubes -cal led either lapa roto my or
a
exam and later a minibiopsy of
is
rn
patte
l
strua
men
al
norm
My
"
d
pare
com
ine
y
uter
meth od . The stud
uter us- diagnosis: irregu lar
every two mon ths, no Pomeroy
d
perio
light
of
p
grou
prorol
one
cont
a
cells. She was given the horm
cont rol I have both groups with
its matt er wha t form of birth
ands had vasechusb
se
who
en
wom
gesterone to help the uterus shed
opy
rasc
. The pattern after the lapa
used
But
e.
on proc edur e.
sens
a
lizat1
in
C
sten
&
D
tomy . the male
linin g- a chemical
th
changed to heavy bleeding every mon
y"
ctom
t Linda and
tere
wha
"hys
out
ing
bear
hear
lts
n
The resu
she also bega
t
for the first few mon ths and then wen
ing
-nine perty
treat
Thir
.
was
ribed
who
desc
gist
colo
have
e
gyne
Elain
from the
mon ths - pret ty muc h
two
y
ever
to
back
wom en
con257
be
the Lanc et sample of
her . If the bleeding coul d not
rn . Last mon th, the heavy cent of
patte
old
my
ased
erincre
hyst
had
C.
&
D
opy
lized by laparosc
trolled by hormones or by
started again - and by heavy I steri
ding
blee
21 %
said.
her
he
anot
tion,
and
solu
menstrual blood loss
ectomy was the only
n a sanitary pad every half hou r to
mea
year
A
.
take
to
pain
t
l
abou
strua
isn't
men
She
Linda is gutsy.
and . had increased
one hour . That wen t on for a week
she
until
er
answ
an
as
hysterectomy
and a half, I
the after stop ping for a day
understands wha t rs going on. wha t
y - started again .
options are and is satisfied that ever
" I have called the gyne colo gist but
.
done
be
d
coul
thing has been done that
wha t is
r have not been examined. I know
She started checking around with othe
ones
horm
,n store. D & C after D & C,
women who had been sterilized .
that
know
I
.
and eventual hyst erec tomy
Linda says, "1 never had problems
with
nd
arou
king
chec
I because I've been
with periods before the laparoscopy so
rn
othe r wom en . It seems like it is a patte
ecconn
a
was convinced that there was
gyne
the
to
it
tion
men
I
n
but whe
tion even if the doct ors' weren' t . It turns
not
.
is cologists. they don 't wan t to know
out that other wom en think that there
."
even tne one who did the operation
a connection, too ."
Linda found fifteen wom en who had
been sterilized, ranging in age from
abdo mina l wall in flate d
nineteen to fifty, all of who m had lapa
last
the
with carbon diox ide
in
with
ion
roscopic sterilizat
y
heav
rted
repo
n
Eleve
.
s
three year
&
bleeding, all but one of those had a D
e
ther
C - some as many as four . And
nunco
for
es
were four hysterectomi
trolled bleeding .
. :,,I • ·t "\,
I '
'I
One of the wom en Linda talked to
·-1<1' t ' .../ r,:~)i )j°i)- ,
_:-•'
was Elaine : "I had a laparoscopy two
dy
years ago when I was 21 . I had alrea
LA PAR OSC OPY
on
was
iage
had two children, my marr
'-{l'l:j
,,
_,
,
__
I
and
Pill
the
take
the rocks, I coul dn't
::,ource: Obstetrics & Gynecology.
,t::.. '
lar
regu
My
.
y
nanc
preg
November 1973
was terrified of
J
I
gynecologist was against it. He said
--
"°""
..,,
/~\
""~--~f-~
, _T ¾,,/·.
I
If you have been sterilized ...
Co ntac t the phys ician who drd the
hponse. check out the staff of a teac
• Please write me c/ o SISTER , 250
procedure and desc ri be wha t rs hap
area . They should
your
in
ital
hosp
rng
19.
065
CT
to
,
n
or
Have
doct
Howard Ave .. New
pen ing, or ask your curr ent
t
have a reoroducttve endo crino logis
't
telling me wha t procedure you had,
do so , even :f he or she "doesn
staff , or ask to see an endo
t
their
on
wha
,
rt
did
until
who
ies
stud
and
n
be
't
whe
where ,
know ." There won
rtcrinolog,st in the gyne colo gy depa
be
methods of birth cont rol you were
there 1s awareness that there migh t
who
to
d
talke
ment . Wom en I have
you
le
peop
ical
med
the
Ask
.
using before the procedure, your age
a problem
were cons ultin g endo crino logis ts were
t
now . wha t changes, if any , you have
are dealing with how they feel abou
time
more
.
1ons
anat
expl
r
bette
ing
gett
not
will
I
a
.
e
just
edur
as
it
proc
noticed since the
the uterus . If they regard
and atten ti on. and more respect tor
quote you with out per:-n rss,on . Please
mp of musc!e and you wan t to fight
lu
en
wom
g the uterus than
ervin
I
pres
.
ber
num
e
phon
or
ess
addr
enclose
to keep rt, there rs at leas t philosoph ical
- dealing with gyne colo gists . (Gynecol
am particularly interested rn out-of
con flic t .
og1sts. rt shou ld be said , are trained
state women .
• If you are thinking about getting
or
sly
ciou
cons
and
ery
surg
,n
a·rrly
prrm
are
and
.
s
W. _.
K. _
ultie
;..n._ _ _-_
agai
irik_
• If you are having diffic
_. ti'_
__
_lized
steri
_. _ _
dies
_......,
_reme
ical
__
to surg
__
_
ump
1
_
to
_
tend
_
res_
not
's
_
tor
_
_
doc
_
your
_
_
with
_
satis
___
_fied
__
8_not
. late(, 7. 4% had hysterectomies (compared with 5.4 % of those with the old
tube typing method and 1.4% of the
control group whose husbands had
been sterilized . l The hospital where the
study was done has since stopped doing
laparoscopic sterilization . Says one of
the study's authors . Dr . A . 0 . Noble , "I
have come to doubt the ethics of using .
A second factor may be the differen t
rates of hystere ctomy in Britain and in
the United States. With allowances for
every possible factor that physicians can
think of. tw!ce as many hysterectomies
are done In the United States as in
Britain . It may be that the British gynecologists are simply more alarmed at the
hystere ctomy-t or-any-reason than their
colleagues in the United States.
STERILlZA TION
Traditionally, sterilization was performed through a large abdominal
incision called laparoto my . Today,
so-called Band-A id or "belly-b utton ..
surgery - developed experimentally in
the 1930s and 40s - is very much
in vogue.
Laparoscopic sterilization is the
It "
formal name for these new proThe study has several defects as other
OF FALLOPIAN TUBE
LIGATION
. The laparoscope is a lighted ,
cedures
Ea (owum)
British physicians rushed to point out . It
instrum ent through which
farther.
10
pipelike
cannot
eg.
reach
cannot
Sperm
Is a retrospective study . meanir.g that
the surgeon can peer into the abmuch of the 1niorma11on comes from
cavity and operate , making
dominal
what women remember about their
or two small incisions . Orione
only
periods be forP the procedure . It asks
opy was a diagnos tic
laparosc
ginally
questions :ibout sub1ect1ve facts like
still widely employe d
is
and
re
procedu
" more or less pain " or " more or less
copic sterilization
Laparos
.
such
as
blood flow. " and. according to another •
res. laparosprocedu
two
s
combine
group of critics . fails to account for
(so that
tubes
the
of
closing
and
copy
different forms of birth control and their
the
reaching
from
barred
are
sperm
long term effects after women have
Traditional tubal ligation : ends of
ed .
perform
is
tion
steriliza
When
.)
egg
stopped using them . A Lancet editorial
rubes are actually folded back inco
the tubes are. as a rule. blocked with
calls for a better study. with a larger pool
surroun ding (Issue . Tubes cauterized
electric current -a process called
of women surveyed prospectively - that
lbumed l dunng laf)aroscopic sterilizacoagulation .
Is. a study started before the procedure
(!On look differen t from those ,n this
Before her laparoscopy. the patient
Is done and then followed up after- Our Bodies. Our Selves
drawing .
either a local or general anesgiven
is
that
w ards . Other commen tators agree
thetic, then about two auarts of
there ,s something urn,xpected going
dioxide are pumped into her
carbon
on. but suggest that bad surgical techal cavity . The gas helps to
abdomin
nique of 1ndiv1dual surgeons Is to blame
And in the United States . . .
push away the intestines, giving the
or that cauterization Is the culprit and
Judy Nors1gian of the Our Bodies.
better access to her tubes .
surgeon
that plastic clips to close the tubes are
Ourselves group, has seen the British
are surprised to learn
people
Most
the answer . Not unexpectedly, there is a
literature and she has heard some horror
has a failure rate .
tion
steriliza
that
exists.
It
f
group which says that. 1
stories . "I think it was a mistake to play
Subsequent pregnancies occur in 1 to
ahnormal bleeding Is the result oi
down laparoscopic sterilization as
2 percent of the patients . These pregpsychological reaction to ster iliza tIon .
'band-aid surgery ' as we did in the
nancies are often ectopic and are
Why should the discussion occur in
book. " she says. "The morbidi ty rates
medical emergencies , which some?
States
United
Britain and not in the
!rates of complic ation of a procedure.
times result in death .
One intriguing thought is that the British
includin g pregnancy) are pretty high,
Deaths also occur at the time of the
medical system Is better set up to notice
especially where people are not very
re . For convent ional tubal liprocedu
there
long term patterns . Gynecologists
experienced in doing the procedure.
estimated mortalit y rate is
the
gation.
.
s
hospital
to
assigned
.
nts
are consulta
Like nicking an intestine . for instance
. With laparoscopy , the
100,CXXJ
per
25
All patients who see gynecologists go
And I think that women should consider
20 to 30 per 100,CXX).
from
ranges
rate
th rough the hospital records system. not
the risks of general anesthesia itself .
sterilization cannot
id
Band-A
Thus.
subany
for
but
re
only for the procedu
aside from the procedure . But as to this
a "safe" operacalled
truthfull y be
sequent problems . Linda's doctor in
particular question, I think that statis.
tion
New Haven . In contrast . has no idea
tically at least . there is a link between
Serious physical complic ations
that she Is having trouble. She has
sterilization and eventual hysterec to- .
of death occur in obout 5
short
she
where
plan
health
Joined a prepaid
my .
percent of female sterilizat ion . The
sees entirely differen t people. none of
It is difficult to find physicians who
of these. varying with the pronature
ves.
themsel
re
whom do the procedu
agree with Nors1gian's conclusion . Dr.
includes cardiac arrest . hem,
cedure
Marcia Storch. New York endocri noloorrhage . infection . perforat ion or
gist . Is frankly puzzled by the bleeding .
burning o f the uterus, or intestines .
She has seen cases of premature menopulmona ry embolis m. smphysema or
pause probably caused by damage to
respiratory difficulti es . W ith laparothe blood supply of the ovaries at the
scopic steriiizat1on, occasional emertime of the operation , she told Linda .
gencies or even deaths, also occur
But this does not result in abnormal
from carbon d1ox1de embolism ...
bleeding . It does. however . suggest hor- Barbara Seaman
monal or chemical imbalances. another
Seaman , M .D.
Gideon
&
explanation offered by British physi" Women & rhe Crisis
cians . 9
__
__
3 bum modifica tion used by
"
es-.111!
Hormor.
in Sex
. __ _ _ _ _ _
continued on next page
Wheeless laf)aroscopy
I
Dr. Gerson Weiss, reproductive endo-
slower and more expensive, but only so
in the short run .
University Medicrinoligist at New York _
cal Center, says it is pretty difficult to
Procedures and Public Policies
separate mechanical damage from
For some years now. sterilization has
chemical damage. Damage to the
been a conscious policy of the United
ovary 's blood supply, a mechanical inStates government, independent of
jury. will affect hormone production .
which party held the White House
This is true of the entire endocrine
When the Carter administration cut off
system which operates on feed-back
Medicaid funds for abortions this
and triggering interrelationships. "Howmonth, Medicaid sterilization was not
ever, one of the things to keep in mind
even mentioned. One way to make
about the longterm effects of sterilizasense of the apparent contradict ion is to
tion," he says, "is that the effects end
think of the Medicaid cutoff as increawith menopause. Maybe, that is, meno- 'sing pressure on poor women to
pause in two years or in ten years, but
" choose" sterilization to control fertility,
it's nothing like the longterm effects of
that is, as a pro-sterilization policy rather
the Pill where you wonder what it's
than as an anti-abortion policy. In the
going to do to your veins when you're week following the Medicaid cutoff. the
seventy ."
Carter administration announced an
Barbara Seaman whose warnings increase in funding for sterilization
resulted in an FDA package insert for abroad .
oatients about the dangers of the pill,
It is not so far in the interest of the
has this to say in her new book, Women federal governme nt to question the
in che Crisis of Sex Hormones : "After safety of a policy it enthusiastically prosterilization, women suffer a threefold motes for some sections of the populaincrease in menstrual complaints. Five tion, here and abroad . To do so at this
percent of nonsterilized women have point would be extremely embarrassing
severe menstruation in contrast to six- since its official positron has stressed
teen percent of the sterilzed . (The only the ease and convenience of the
reasons for this have never been fully procedur e- a procedure developea by
.
clarified.)"
federal funding. Normally, research
Brenda Penner, nurse-mid wife at
funds to investigate adverse reactions
Yale-New Haven Hospital. points out
would come from the same source. The
that women with medical problems
governme nt, like Elaine's gynecolog ist.
which result in high-risk pregnancies has ample reason to not want to know.
are often advised to choose sterilization
The effect of national policies on the
rather than take a chance. And Penner decisions of individuals is always dehas seen some cases of irregular batable . But it_is haraly surprising that
bleeding after sterilization of high-risk
middleclass women and their gynecolowomen . "It is possible that sterilization gists should have picked up on the prohas longterm effects that we don ' t know sterilization propaganda aimed at other
about yet or that don' t seem to make population groups. To say that in such
much sense at this point. All I have
learned in medicine is that anything can
happen and often does . even if it
The Women 's lnternation Network
doesn 't mc1ke much logical sense."
women
healthy
that
reports that the mutilation of feout
(WINI
points
Penner
male children and especially young
who choose sterilization because they
orris Is still widespread throughou t
cannot take hormones are in a real
most of the African continent.
dilemma if irregular bleeding occurs .
WIN says a lengthy study of the case
" Hormonal therapy 1s usually indicated
explained.
she
histories of mutilation s of women and
to control the bleeding,"
do?
to
supposed
women
their medical results indicates that at
these
are
"What
least 30 million children and women are
They are really boxed in ."
mutilated as a result of infibulatron , a
Like all other birth control methods
process commonly referred to as
available today, sterilization has liabilifamale circumc ision .
ties, some still unsuspected. If back-up
WIN says one study publ:sr,n,d 1n the
abortion is available, a healthy woman
British Iournal Trocical Doccor indishould exhaust all other forms of birth
cated that out of 4,024 women coming
control before turning to eittier the pill or
:o a Sudan hospital over several years.
to sterilization . If sterilization is neces3,820 were subjected to infibulatron .
sary , the safer procedure is the old
lnfibu lation involves the removal of
Pomeroy tube- tvmg procedure . doAe by
the who le clitoris and the closing of the
a skilled and experienced surgeon . It 1s
10
climate an informed decision can be
made about sterilization by even ideal
patients like Linda, is questionable . It is
also questionable what the federal policy
makers will do when they discover that
their barely disguised eugenics movement has affected the very groups
D
regarded as ideal for reproduction .
CONTACTS:
Boston Women ' s Health Book Collec tive
(Our Bodies, Ourselves)
Box 192
West Somerville , Mass 02144
Healthright Good files .
175 Fittr, Avenue
New York, 10010 (212-674-36€01
Committee to End Sterilizatron Abuse
(CESA) tnternatronal files.
Box A 244
Cooper Station , New York 10003
(212-924-1593)
The British Studies :
Neil . J . A. et al " Late Complicat ions of
Sterilization by Laparoscopy and Tu bal Ligation " Lancet. October 11,
1975, p. 699
Noble, A .O. "Sterilizat ion : Laparoscopy
or Laparotomy J" British Medical
Journal. October 25, 1975. p 227 .
Anonymou s . " Late Effects of steri l1zatIon teared : Hysterecomties needed
months after tubal electrocoagula tion ." Medical World News. May 31 .
1976 . p 30. Popularized account of
the British dialogues.
John
and
Geoffrey
Chamberlain.
Foulkes, "Long -term Effects of Laparoscoprc Sterilization on Menstruation ." Southern Medical Journal,
November. 1976, p. 1474.
Customary torture
vagina except for a small opening posteriorly to allow passage of urine and
menstrual blood . WIN says 1nfibulat1on
1s often accompfished with tt'lorns or
catgut , and that the child 's legs are
ued together for several weeks until
tt'le wound Is healed .
W omen w ho are subIec ted to inf1bu iat1on reportedly have to be cu t open to
have intercourse and to permit deilvery
of any ch ildren . The network says tha t
oft en . after the birth of their fi rst child.
wo men are subIected once again to me
same process ii heir husband wishes .
W IN reoorts that all efforts to have
tne Uni ted Nations look into th e
problem of the genital mutilation of
cn1i dren has been unsuccessful.
-Her Say
Sterilization of Salvadorans
pr O m ot ed by U.S. ag en cy
By CHRI S HEDGES
provid es supp ort in more circµi tous route s.
The
agenc y donat es contr acept ives which are
sold '
San Salvador, El Salvador 1I 11 <;s 3
throu gh appro ximat ely 800 pharm acies .
Sales
ROSA RIO GUAD ALUP E de Gonz alez, a moth
proce eds supp ort ADS AID dona ted 47 jeeps
er
in
of two childr en , is nervo us. In a few minut es
1981 for ADS teams to travel in the count ryside
she
will becom e one of. some 30,000 poor wome
and prom ote family plann ing. The rema inder
n
of
who have been surgically sterilized here this
ADS
funds come s from the Intern ationa l Plann ed
year.
Her opera tion and the bomb ardm ent of
Paren thood Feder ation (IPPF), a world wide family
radio
and television propa ganda that direc ted her
plann
ing organ izatio n based in New York.
to
this clinic have been paid for by the U.S. Agen
The ADS, found ed in 1962, prom otes family
cy
for Intern ation al Deve lopm ent (AID) .
plann ing as a way to deal with what it sees
as
seriou
s overc rowd ing and pover ty in El Salva dor.
In a " Briefi ng Book " publis hed earlier this year,
AID stated that one of its four major objectives
ADS has 900 contr acept ive distri butio n cente
in
rs
El Salva dor was to "expa nd popu lation and family
natio nwide and four clinic s that provi de
free
plann ing services."
surgic al sterili zation .
The _ distri butio n cente rs are run by local
The prima ry recip ient of AID suppo rt for
this
wome n out of their own home s. The cente
proje ct is the Salvadoran Demo graph ic Assoc
rs
iaprovi de temp orary contr acept ives to wome
tion (ADS) .
n at a
minim al cost and refer wome n for surgic al
sterilThis assoc i ation has receiv ed more than
izatio ns. The ADS provid es contr acept ive servic
$4
es
millio n from AID in the past five years. AID
als
maint enanc e, such as IUDs and Depo is becom ing the prefe rred metho d of contracep tion in El Salvador. "
Provera. Depo- Prove ra, ari inject ible contra ~
to appro ximat ely eight per cent of the nation 's
ceptiv e, is •g ood for three month s. The drug is
Relief worke rs charg e that food has been
935,000 fertile age women. They sterilize 7,000
banne d in the Unite d States because of posoffere d to poor wome n in Santiago de Maria
peopl e a year.
sible side effects. Its side effects includ e the
if they will have surgical sterili zation . They
risk of sterili ty, mens trual proble ms and child
The progr am has been critici zed by the
also charg e that poor wome n who give birth
deform ities if the inject ion is given while the
Roma n Catho lic churc h and some health
in the hospit al in San Francisco Goter a are
workers here.
patien t is pregn ant. More than 10 per cent of
surgic ally sterili zed after the birth witho ut
the wome n in this camp receiv e Depo prior
consu
"The progr am ," said a memb er of the
ltation .
Provera inject ions.
archb ishop ' s office staff, " is anoth er attem pt
Centers for displaced persons have becom e
The family plann ing progr am has been
to silenc e the poor, in this case before they
special targets for both ADS and the family
are born ."
successful , accor ding to ADS and AID officia ls
plann ing services of the Minis try of Health .
here. AID estimates that appro ximat ely 30
Local health workers and physicians argue
The Minis try of Health provid es contra that family plann ing is not the most pressing
ceptives for appro ximat ely 20 per cent of the
health need.
"We expect each nurse in the
popul ation and surgic ally sterilizes about
23 ,000 peopl e a year.
"We focus our progr am ," said Dr. Enriqu e
field to sign up one woman for
•
Enriques, ADS direct or, " in the count ryside
The Minis try of Health receives indire ct
sterilization a day . . . and if a
and amon g the displa ced persons. These
AID suppo rt throu gh PL-480 Title I. This pronurse doesn't find 300 wom en a
impov erishe d familie s habitu ally have large
gram has loane d the Salvadoran gover nmen t
numb ers of childr en ."
year for sterilization, she falls
$30 millio n worth of basic food comm oditie s
The tempo rary contra ceptiv es promo ted
such as whea t, soybean and yellow flour. The
belo w what we consider aver at the distrib ution centers, accor ding to
,,
Salvadoran gover nmen t sells these comm odage.
Enriques, are prima rily pills and IUDs. Surgical
ities in El Salvador. The reven ues gener ated
sterili zation s , which Enriqu e said are always
are used to suppo rt gover nmen t progra ms.
volun tary, are offere d as alternatives by travelThe Salvadoran gover nmen t has spent an
ing ADS teams . These teams make house calls
per cent of the nation 's fertile age wome n
estima ted $400,000 of these gener ated funds
on the wome n enroll ed in the local family
use some type of contra ceptio n .
to help finance contra ceptiv e distrib ution and
plann ing progra m. Most teams , Enriques said,
surgical sterili zation s at 291 health centers.
" What this count ry needs is basic pharm ainclud e a nurse .
ceutic al suppli es and funda menta l clinica l
In Santa Tecla , ADS has two clinics . One ,
"We expec t each nurse in the field to sign
equip ment ," said Jose Rodo lfo lr~bet_a, the
which only makes referr als for surgical sterilup one woma n for sterili zation a day," said
admin istrato r of the Rosales Hospi tal in San
ization s, is in a cente r of a camp for some
Martin Cabal lero Reyes , the direct or of infor1,000 displa ced persons. The clinic , which
Salvador.
matio n and educa tion at ADS, " and if a nurse
only provides contra ceptiv es, is the only
AID recen tly initiat ed a $25 millio n progra m
doesn ' t find 300 wome n a year for sterili zamedic al assistance offere d to the displa ced
which will help rectify the shortage of supplies
tion , she falls below what we consi der
peopl e here.
and replace some medic al equip ment. In
average."
,ts
Rosales, this equip ment is often 30 or 40 years
The nurse at the clinic , Maria Elizabeth
"The nurse ," Enriques said , "expla ins what I
old.
Argue ta, has made 80 referrals for surgical
,l
the sterili zation is about and what its benef its
sterili zation since April , a figure Cabal lero
" The proble m with this progr am, like all
are. You would be surpri sed, but sterili zation
considers "very low, especially since she visits '
\
AID progra ms here, " said Irahet a, " is that
what is sent to us passes throu gh many hands.
I other camps in the area.'
We wond er how many of these suppli es will
In displa ced centers, ADS often promo tes ;
ever make their way to our hospit al.'.' ~-\1:-~
contra ceptiv es that do not requir e daily
J
Special to the Nation I Cathol ic Re orter
t
:r- .
: :- lu.'3 d.e clix mille femmes sont annuel lement st er ili zfes a New Yor k Ci
ty.
-.!rre s:te:ril i zg.t ion est perman ente.
Les tubes lies ne .,. ., euvent plus
et re denoue s.
Il existe de moyens plus simples de preven ir une gross esse.
Une propor tion d'une sur trois femmes ster il i zees regr ette plus tard
l eu.r decisio n .
Beaucou p de ces femmes ont ete contrai ntes de signer des formes durant
les docl.eu rs de l'en.fan teme nt, ou durant une abortio n. Recemme nt, une
pri s onniere noire de Rikers Island agee de dix neuf ans , etait s t erilize
e
a Kings County Hospit al sans son consent ement. Beauc oup ~lus de femme
s ont
ete sterili z~es a leur insu parce qutelle s ne parlaie nt p&s l 1 anglais
. Une
parmi qua.rtre femmes noires mari~es dan le pays a et e de ja sterili zee.
A Porto-R ico J4% de femmes en age d'enfan ter ont e te sterili z~es sous
les
auspice s de program mes du gouvern ement des ttats Uni s .
Un outrage nat ional aux sterili zation s forc ee s des s eurs Relf en
Alabam a a oblig~ le gouvern ment federal a adopter des reglemc nt cont
re de
futurs abus, incluan t une periode d'att ente de 3 j ours entre le moment
de
signer un consent ement et c-~d e l ' operati on. Mai s le departe ment
de la
Sante , de l 'fflucat ion et du Bien- Etre Social n' a f ai t a ucune tentati
ve de
demanda de conf'orm ance a de tel s regleme nt s .
A Nev York City environ 80% de; sterili zations sont fa i tes dans les
hospita ux: prives , souven t payees par Medicai d. De t els operati ons seraien
t
protege es par l es regleme nts f ederaux non enforce s. Pour ' les nombre
uses
sterili zation s non couvert par le Medicaid faites dans les h~pitau x
prives,
elles echapp ent a tou s standar ds. Le reste des 20% des sterili zation
s est
f ait dans les Wpitau x municip aux ou un long combat a conduit al' adopt
ion
de severes mesure s , y compris une periode d ' attente de 30 j ours et
beaucou p
de co11.Q.ei l s dans la langue de leur choix , et da~§_ une lihert; san_s __const:ra
in~
Le Health tmd H.ospi tal s Corpora tion cependa nt n' a pas remis en
vi geur ces regl.ements , et b eaucoup de m~decin s en f ont peu de cas ouverte
mente .
En !"ait;, six profess eurs d'Obste trique et de Gynecol ogi P, _ai..9ce5- par
le
. de l'Educa tion et •
.~..
Departe ment de la Sante,
du Bien-E tr e Soc ial ont ete"
en appel pour renvers er ces reglem ents.
~
La situati on est clairem ent dangere use . Les droits de Liberte d' Informati ons ~ de Libert ; de Cho ix d I enfante r sont en trai n. d I etre viol
ee s
journe llemen t . La Coaliti on contre l'Abus de Sterili zation presse tou
indi vidus e"t; Organiz ations a se joindre a elle pour d,emande r:
APPLIQUEZ LES REGLEJ.'1ENTS A TOUSLES PATIENTS
CESSEZ L'!J3US DE SrE5~~IZATION
El Abuso de Esterili7.aci6n
- los Hechos
Sterilization Ab ~
- the Facts
L'Abus de la
Sterilization - ,Jes Faits
-,
Coalition Against Sterilization Abuse
C/OTWW A
2«--48 West 27th Street
N.Y , N.Y . 10001 .
For informati on
(212) 243-2310 .
--~
'
iFIN AL ABUSO
.,
r:
DE ESTERILIZACION EN NUEVA YORK!
•
STOP STERILIZATION ABUSE IN NEW YORK CITY!
Mas de diez miles mujeres estan esterilizadas cada a·no en la ciudad de
Nueva York. ?Cuantas de ellas saben las hechos fundamentales?
- la esterilizaci6n es permanente, las tubas no se pueden ester
deshecho mas tarde.
- hasta una de tres mujeres esterilizadas se arrepenten mas tarde.
Over ten thousand women are sterilized yearly in New York City. How
many of these women know the basic facts?
- sterilization is permanent; the tubes cannot be "untied" later.
- there are safer ways to prevent pregnancy.
- up to one in three women sterilized later regrets the decision.
Muchas de estas mujeres han estado forzadas de afirmar un
consentimiento durante el dolor de parto o de aborto. Recientemente una
presa negra de 19 arias de edad de Rikers Island fue esterilizada sin su
corisentimiento en Kings County Hospital. Muchas mµjeres ademas han
estado esterilizadas sin el saber porque no hablan ingl~s. En las hospitales
que sirven a comunidades predominantelmente boricuas las esteriliz~~iones aumentaron en un 180 por ciento en 1973, y si vale Lina tendencia
11acional, siguen aumentando. Una de cada cuatro esposas negras en el
pais ya esta estirilizada. En Puerto Rico el 35 por ciento de las mujeres en
edad reproductlva estan estlrillzadas, resultado de un programa del
gobierno de EEUU.
Many of these women have been coerced into signing forms during
painful childbirth or abortion. Recently a 19-year-old black woman prisoner
from Rikers Island was sterilized without her consent at Kings County
Hospital. Many more women have been sterilized without their knowledge
because they did not speak English. In the municipal hospitals serving
predominantly Puerto Rican neighborhoods, sterilizations increased 180%
in 1972-73, and if nationwide trends prevail, that rate is rising steadily.
One in four married black women in the country has already been
sterilized. In Puerto Rico, 34% of women of childbearing age have been
sterilized under U.S. governmental programs.
La ira de todo el pa(s a las esterilizaciones forzadas de las hermanas Relf
de ,12 y 14 anos de edad en Alabama oblige al gobierno federal a promulgar
unas normas contra m~s abusos, incluyendo un perfodo de 3 dfas entrc el
tiempo de firmar el consentimiento y el tiempo de la operac ion. Estas
normas sirven solamente a las operaciones hechas con las fondos federales.
Una encuesta por el departimiento de Salud, Educacion y Bienestar (HEW)
revellflas violaciones escandalosas de estas normes debiles, pero el HEW
no hace nada para poner en vigor la ley.
National outrage at the forced sterilizations of the 12- and 14- year old
Flelf sisters in Alabama obliged the federal government to draw up
guidelines against further abuses, including a three-day waiting period
between the time of signing the consent and the time of surgery. These
standards apply only to operations done with federal funds. A survey by
the Dept. of Health, Education and Welfare shows flagrant widescale
violation of weak guidelines, yet HEW is making no attempt to demand
adherence.
En la ciudad de Nueva York casi el 80 por ciento de las esterilizaciones
estan hecahs en los hospitales privados, muchas veces pagados por
Medicaid. Estas operaciones de Medicaid deben estar protegidas por las
normas federales; para las muchas operaciones no pagadas por el Medicaid
no hay ningunas normas. El 20 por ciento ademas de las esterilizaciones se
hacen en los hospitales municipales, donde una lucha larga llego a la
adopcion de unas normas fuertes, incluyendo una espera de 30 dfas, los
consejos completos en la lingua escogida por la mujer, y la libertad de la
compulsion. La Corporacion de la Salud y los Hospitals, sin embargo no
esta poniendo en vigor las normas y muches doctores las violan
apiertamiente. De hecho seis profesores de obstetrica y ginecologia han
radicado un pleito, con la ayuda de HEW, para declarar todas normas
illegales.
Claro esta que la situacion esta peligrosa, por los derechos preciosos de
la libertad de informacion y la libertad de escoger tener los ninos estan
diariamente violados. La Coa!icion contra el Abuso de Estirilizaci6n pide a
todos individuos y organizaciones que se unen con nosotros para
demandar:
!Que sirven las normas fuertes para todos pacientes!
!Fin al abuso de estirilizacion!
In New York City about 80% of the sterilizations are done in private
hospitals, often paid for by Medicaid. These Medicaid operations should be
protected by the unenforced federal guidelines; for the many non-Medicaid
sterilizations done in private hospitals there are no standards at all. The
remaining 20% of sterilizations are done in municipal hospitals, where a
long struggle led to the adoption of strong guidelines, including a 30-day
waiting period, full counselling in the language of choice, and freedom
from coercion. The Health and Hospitals Corporation, however, is not
enforcing the guidelines, and many doctors are publicly flaunting them. In
fact six professors of obstetrics and gynecology, aided by HEW, have gone
to court to have all guidelines overthrown.
Clearly the situation is dangerous. The precious rights of freedom of
information and freedom to choose to bear children are daily being
violated. The Coalition Against Sterilization Abuse urges all individuals
and organizations to join us in demanding:
Apply the guidelines to all patients! Stop sterilization abuse!
/
O,irn rr,1i ... i~, \\
HcAlil; Ctrsirn
ChoiC£ Cli"
WOM(N';
My name is Shauna r,., Hecs.e rt frorn the Chico F E!t':'.: inist. Wome n's
H8aJ. th Ce ntE'.! r..
I am spe .,tking on !)ehalf of t he F -.derc.i t ion of
F;:::rn.inist Wonen ' s R"<::!<"-.:1th Centers f which. is a g:rvup of wo1r:sn
con t r oll ed c-:J.ir,i - s t.hat c,ffc,t· s·,.yn e colo9 ic~1. l a:rd b:i.rtr. c. 1:;nt::.-0:1.
scrvic2 s . ~3 crs in ½~s lc ~gre em01 t wJth tn e l~C~ p ~op o ~~1
-'""""· ·1, ..-~. -"
r-,- .• ,!
- '
(-·.·,,-,:iu,· .~--'-'"-'--
::.;; -,
...-.. •.. ~ .•'l
.1...c:e<~ •,',
tf,. -"·,
~--,-.p,
c·:\ ,.,,
1~_,:i. ·r f• ,nA ,.. t
,.l .. -~ ••
v .e., _
•.,..~
1-,,•
-
..,. A,.'\.--,l .... -- • ~
,.
- .1 1.. r.,:,;,
d ,-=,.\ r r.,. 'l-VJ..J
A:", -::. rd·
,
A. ~
-
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~.
C4
"' g
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1' '1rJ.'
, J ..,_.
J~-.tz.
documen t that: n e eds c.oD5U rnE"·r impu t o So1;. e of t ho strc.ngpoints
of the document are: the c'i.efini ti ou of .steril:i. ~:at ion tha t incor porates both i;thc1:-apeutic.1' and 11 non.-the ::apeu'tic'1 sterilizations, not including hysterect omy as n ~e thod of family
planningp and the pr opos ed waiting period upon consent to
steri.li zation o
These provisions cnn potencially allow morr:!
prot e cti on tc consumers, a.s cor;i.m on incid _nts of abuse and ex-~
pe.1;-imentati.on h ave h a pp·2 ned with unnece s s a ry surgery, both
hystere-ctomies and 1;t.herapeutic 11 st erili zation and wh e n informed
consent h as not beAn obta ined. Th. issues tha t we feel need
cl.2.r.ifi c a tion or am.mending- a.re : l" the cons ent proced:,1re , 2c
provision for an ~udi.tor/witness, 3,. ster-Llization procedure s
f.or institutionalized indiviclu· 1 ~, 4., methods of enforcement
and r e porting violc1.tion of the r cqul a t:tons .
We urge that the following be added to the procedure to obtain
con e nt: In_reHenting the oral informa tion, the person ~10
obta ins c on.sent: shou ld :be bound to d e scribe all other metho.fils
of birth control, i1~luding risks and advantages~ Oral i nfor-
mation should include the d escript:i.cn of all other surgical
sterili zation procedur es, including· risks and ad 'antages. For
the- a c tual procedure of choice: the regulations should define.-. •
more specifically, those items that need to b e discussed in
obtaining consent., The regulations should define the kinds of;
risks that may be encoumtered. This list. should include both :·
surgical ~nd long-.ran9t1 complications from sterili z.o.tion. A
revi ew of current statistics on complications and effectiveness
needs to }'.)e added to the requi:r.:-ements. If the procedure i.s new
or cxp.arimental, it im.,. st be mand'3tory 'chat the client be mad,a
awar e of this fact4 In addition to the oral presentation, written.
material shouid be required and given to the cl.i. nt, in the clien~s
primary ln.nguage. The provision for a translc:..tor should be stated ·
as the responsibility of the facility to provide, as it is not •
c le?.r in the proposed guidelines. as stated, who is to provide
the translator. The regulatiori's should also add that a video
of the actual procedure be shm,m, if the client ·s o de sires.
HO Flt.M( 51RHI
ruco. C,l~oo,-iA 9'1926
Tclcpl,oNr (916l 89H9il
• ,v
..., ......
(.
Bec aus e of the hi sto ry o f abu
b ee n a ske d to con sen t to st se tha t occ urs 'wh en women h a v e ·
e
gu ide lin es mu st h ave a str on ril iza tio n du rin g de liv ery , the
wh en con se nt mu st b e ob tai ne ge r st a tem e nt a nd r equ ire me nt on
d. Ho re pro t e cti ve and app
pr i at e r eq i reme nts can be mod
roe led aft er the Ca li f orn i a ste
liz a tio n gu ide lin es , wh ich
ri set f i ve pre co nd itio ns for
con s e nt:
1. pa tie nt' s jud gement is no
c a tio n, 2. p at i ent no t in l t si gn ifi ca ntl y alt ere d by med iabo r, 3. pa t i ent no t wi t hin
po st - p a.r tum or p os t-o pe rat ive
24 ho urs
p a t ien ts na tiv e l ang uag e or. , 4. inf orma tio n commu nic a ted in
one in wh i c h ( s )h e is flt e
au dit or/ wi tne s s av ail ab le (un
nt, s.
• sh one
p res e nt) . The p r epo s ed H.EW les s p a·ti e nt d o es no t
tl1 i s 1- st ond iti n~ Un les reg ula tio ns do no t pro vid e fo r
s the d ~p ar t me nt do e s ma nda
a n au di ··or / ~- i tn es s be pre sen
te
t, t he cli en t I s rig ht to h ave t hat
one p res e nt can po t e nc ial ly
.some L , sue of: pri va c y, th.~s req be r e f use d. Wi ~h res pa ct to he
uir
h e au ·to r/ 1it nes s she ld be em e nt can be wa ive d by the cli en t.
o f t h e cli en t's cho os i n
fo ll ri i.g the Ca l · for ni a s
t eri liz ati on -re gu lat i ns , the• Ag a in,
wi tne ss sho .ld b e n ad ult ,
ud i tor / •
the p.y s ic i n , ass oc iat e
of th e ph ysi cia n , o r ho spi t oth er th
sign i n of the c on sen t f orm l e .p oye e , a nd oul d ove rse e th e
, and be p res en t dur i ng t he
.,,e si n.
con sen t
The p rop os e d r egu l · tio ns now
to ob ~in c on s e nt e Th is pro al low f or the att en din g p ys ici an
d9e no· in s re t ha t the cli vis ion s hou ~d be om itte d ,
a thi s
en
i nfo rm ati on · ~i ch c an ote nc t is obt ain ing an oth er sou rce o f
nd ers tan din g abo ut t he r oceial ly a dd inc re a s ed -cc ura cy and
th e "nf on .at ion ha red wi th dur e o To in .. 1re the qu lit . of
t
per son ot4 e r tha n
the ph J ic ic:n sho uld ob~:: ain he cli en t ,
the
c
on
sen
t,
i
., e e c mmun:i.ty h a lth
, ork e r, rai ne d sta ff p ers on
, or n urs e .
g ~te r ili za ti n in
qu e sti o I b eca u se of t e po i ns tit tti o. a l se tti ng is a s e r : ous
ten
'he rov ioi o n fo r cre ati ng a cia l for ex pe rie1 :1t ati <)n a.n d abu se ., .
i n ap r ori ate me tho d t o P' ot ste riz a tio n rev 4 e com mi tte e is a n
c t per son <· in 1 ns ti tu ti ons
ste ril iz.a t i n abu se o The
rol e of the st er ili za ti on rev :,;;ro m
i s to cva lua te i nc! i v • du alreq ue st s for s~i:er iliZ c.-i. tio .. , .ie ccnuni tte e
.
•
.
. o f ac .t ing
t.
ins·l:e ad.
.
_ . a mon~ o 1ng com . -, 'i
-1-'
,.
• .. •
~ '
Li; ~ enma y be c o nd1 c tin ~· e:xp.a:: -im ent nic t.Pe :o ~no se ra~ i~~
~
al
pro
j
ec
t
s
or studie,:;,., 'l he
compo s i tio n of the s te ril iza
tio n rev i e1 comrn.i tt -e , b e ing
f ess ion :a_l s and no t of the
pro cli en t I s cho ice , is no t a
gua ran t -•e
th at th ose c o mm i tte e ra nlbers
of the cli en t .. Al th gh the are a c tin g in t e h e st in ter es t
for -le ga l cou ris el, it is no d e:pa rtm e nt h as ma de p ov · sio n ..
b e an adv oca te for the cli ent cle ar tha t thi s cou nse l wo uld
may b e c ou rt ap po int ed or a t , e sp ec ial l y giv en tha t thi s cou nse l
cho os ing@ Su btl e inc en tiv e pu bl ic def e nd e r ,no t o f th e cli en t 's
s or coe rsi on wo uld be ex tre
h ard f or thi .s commi t:te e to
de t e ct, and c an po ssi bly go eml y
to the:;: r eq ue st for s ter ili
o n pr ior
zat
bir th co ntr ol may n o t be mad i on.Q 'l 'he fac t th at oth er me tho ds of
ste ril iza tio n wo 1 ld no t be e av ail ab le , inf orm ed co nse nt to
or cho ice s. I t i.s dif f icu lt bas ed on ~11 ~ o ssi bl e a l ter na t ive s
in pri son , for exa mp le, tha to de fin e the numJ:,e r of pe r s ons
t wo uld ind eed cho ose to be
ste ril ize d
wh ile in• pri so n.
..
:·- ,
1
Unfor tun a te l y, a 1.igh in c ide nce of steri li za tion may be a
me asur e of a bu.e o r expe riLle ntatio n, r at h er ·tha n choice ~
In s 'c ca d of a ste r ili za ti on re v i ew co;nm i ttee to r vi2w e a ch
cli e nt ;:\ppli .a t i o n , the ~e pa ~ t 1~c; n'c sh o ld t a k e s teps to
t he in s tituti onal
i i s u i: e th a t "· u s e \•;ill n o t t c i·e pl a ce in
be p r e f o r "e d _
tion
a
. e t t i ng, by n ct11 d a ti ng t ha t no s t -riliz
for those
lly,
i n a n in s ti t uti o n or i ts a ff il i 2te . Id e
p e r s ons who do \ Yi s h t o nde!" go ster ili z a ti n , p:covi sio ns
s h ould b e 1,3d e :c a r a c -·1.c::e n t ses r- i on a nd st e r il i za t ion
proce d u re -c o be p "ei:o:i~;~c d o-..1 t si de th a t i ns ti t uti on . Thi s
would inch d e 1, a k ing ob .e r f or:..s of bir th con·tro l ava il• bl e . In thi s li ght , the n e th od of obt a ini ng cons e nt
would b e s ubj e ct t o t h e s aae requi r eme nt s th a t fa cil i ties
not in i n ti tu t io ns . Howev e r , b a sed
r~~1s t rr, e e t for clie n t
on th e h "s t o r y of ~~u £e , t h e v -r y nature of th e tns tituti onal
s e tting , a nd t h e t cs t i ~o. y give n by wi t nes s e s today , erecom1 e nd a . morato rium , ste r ilizat ions fo r p r s o ns who a re
i mp r i s on ed ..
Steri l iza tion medic a l r e cor ds s h ould b e tr e a t e d a s al l other
medic a l rec ord s and b e k e p t for sev e n y ear s i11stea d of the
.
p r opose d thr ee ~
ly 0 1itt e d a ny requi r ement s or
e
t
e
l
p
co11
The d e p a · t . en t ha s
r e gul ati ons ~ This is a serthe
of
me tho d fo r e n f orcef e nt
e t a il ed co nse n t for m i s ,
d
d
i ou s -i ·sue, a s a l engt ~Y -- n
u se wi l l n ot t ake place or
b
a
t
in it se lf , no s s ur ·1n c e t h a
auide lin es will be f: ol lm· e d .. In f a ct , Pi t h ou t o ngoing
enfor ceme nt , a si g, .8d con .:. 2nt fo r m could c ov e r abu se . Re quir eh, e nts should b e .ade t o mon itor s ter il i zation f a c i liti es , wh e th e r by c ommit t e e or a ge ncy. Wi t hou t spe cific
me cha ni sms for on go i ng enforc e1 e nt, qu a li t y contr ol,
guid e line effec tive n e ss, a nd compl i a nce will not b e insured . Anoth er i mport a 1t s ystem, is o ne d e s ign e d for
c onsume r repor •ing. Again , wh e n no means have b e en pro-vid e d for, a clien t o r s e cond party can not effec tively
issue a compl aint or sight a viola tion. Those p er sons
wh o ar e subje ct to a b us e , in the absenc e of a repor ting
syste fu , must resor t t6 the court s yst em, whi ch i s c ostly ,
l engthy , and ma ny times inacc esible . • 'rhis pla ces a n undo
h a -d ship on those p e rsons whos e righ t s have been viola ted.
The depart ment n eeds t o seriou sly consi der the ramif ications from the lack of mecha nisms for enforc ement . Appro priat e mecha nisms could includ e commu nity adviso ry board s
to monito r facil ities and . to take action on guide line violation s.
Lastl y, steril izatio n abuse is not an isola t ed issue . Informed cons e nt to any form of b ir th contr ol can only b e
met when all other alturn atives in family pl a nning a re
In light of the HEW fundin g cuts for a bortio n,
availa ble.
this altur native for perso ns pa r ticip ating in fed eral pro-
gr am s is also cut.
Steri liz at ion has become an accep table
metho d of f am ily plann ing by HEW, while a bo rti on has Le e n
exclud ed f rom this catag ory. The basis for women to make a
tru e inform ed conse nt is seriou sly abridg ed by this fac t .
Sh aun~ L. He ckert
Chico F2cin ist Women 's Health Ce nter
3 3 0 F 1 u '" 2 St •
C~j~o ,
C~lifo rnia
WOMEN BEWARE!
Do not let yourself be sterilized
without making the choice yourself.
Sterilization is on the rise. In the last five years the number of women sterilized has tripled . Approximately
one million female sterilizations are performed in one year.
Because it is permanent and not reversible, sterilization ends a woman's control over her ability to have children. It is an important decision. It is not something we should be pressured or forced into without knowing
all the facts, or because we don't know what else to do.
Many doctors in hospitals and clinics are pushing surgical sterilizations on women without giving the facts
about the risks and consequences. Teaching hospitals are pushing sterilizations, especially hysterectomy, as training
for new doctors.
Sterilization can be a good form of birth control for some women who choose it. However, many women are
pressured to make the choice without being informed that it is a permanent (irreversible) operation, or that there
are other forms of birth control. Some women are forced to sign consent forms for the operation without knowing
all the facts, while they are in labor of childbirth, before a Caesarian section, or at the time of abortion. Many
women agree to sterilizations because they are threatened or are afraid they will lose their welfare, or the right to
medical services.
For the U.S. government, sterilization is part of the population control program. It is a cheap and effective
way to control births. Most sterilizations are performed on Black, Puerto Rican, Native American (American
Indian) and poor women. Puerto Rico has the highest number of sterilizations in the world with 35% of Puerto
Rican women of childbearing age having been sterilized.
We must protect ourselves from sterilization abuse.
In order to protect yourself from becoming a victim of sterilization abuse you must know the facts.
What is sterilization?
Sterilization is a procedure after which the person cannot bear children. For women, sterilization can take
several forms. Tubal ligation - or "getting your tubes tied" - is the tying, cutting, or blockage of the Fallopian
tubes. Hysterectomy (removal of the uterus or womb) is also being used to sterilize.
Is it reversible?
Sterilization is a permanent operation. It is not reversible . It does not matter if you have been told your tubes
are cut or tied. After having this operation you can never plan to get pregnant again. You cannot plan on the
operation coming undone after a certain period of time . There is an operation which attempts to reconnect the
tubes, but pregnancy after the operation is very rare, and having a baby is very unlikely.
Is sterilization 10096 effective?
Doctors say that if you have a tubal ligation you will never have to worry about getting pregnant again. Even
though the operation is not surgically reversible, many women are surprised to find themselves pregnant. Out
of a million women who get tubal ligations, 10,000 to 20,000 will become pregnant. This is a higher failure rate
than women taking the pill. In addition, a higher number of pregnancies after tubal ligation are ectopic pregnancies
(pregnancies in the tube) . This is a very serious medical emergency, from which women have died .
What are the complications?
Many doctors refer to a certain type of tubal ligation as a "band-aid" operation. This is very misleading, because it makes us think there are no risks or side effects. Sterilization is not a problem-free method of birth control.
It is not any safer than the long-term use of birth-control pills. It is much more dangerous than the IUD (coil,
loop) or diaphragm. Out of 100,000 women, 25 will die from a tubal ligation . Side effects after the operation may
include: Bleeding, infection, perforation of the uterus, accidental burning or bowel trauma, abdominal pain or
pain during menstruation, an increase in menstrual bleeding, ectopic pregnancy, and psychological complications.
What are the alternatives?
As women, our health is given low priority. Little research is being done on developing better birth control
methods. We are unable to get safe, effective, convenient birth control. Many women settle for sterilization because they have had such bad luck with other contraceptives, or are afraid of their side effects.
Besides birth control pills (oral contraceptives) and the IUD (coil, loop), the diaphragm and spermicidal cream
or jelly is another form of birth control. The diaphragm is a rubber cup which is covered with spermicidal cream
(used to kill sperm) and is inserted into the vagina before having sex . A diaphragm must be fitted by a doctor or
other health practitioner. After that, it is controlled by you, the woman . A diaphragm can be used by almost
any woman, unlike birth control pills or the IUD, with no side effects or danger. Even though it is very effective in
preventing pregnancy when used properly, many doctors do not tell their patients about it. Another method of
birth control is condoms (rubbers) and spermicidal foam .
What can ~ou do?
IF YOU ARE PLANNING TO BE STERILIZED,
take your time to make the decision . Remember : You can never plan to get pregnant again.
LEARN ABOUT THE ALTERNATIVES
Make sure that no other birth control method is suitable for you .
MAKE SURE THAT THE DECISION TO BE STERILIZED IS YOURS, and not something you are being pushed
into. Do not make the decision at the time of childbirth, at the time of abortion or if you are depressed or having
emotional problems. These are some of the questions you should ask yourself before choosing to be sterilized :
1. What if st some point in the future I marry a new man and want to have children with him?
2. What if one or more of my present children sb_ould die?
If you have any doubts at all: you can refuse the operation ; you can even get up and leave the hospita l.
It is your right to change your mind, no matter what you have signed, even up to the time of the operation.
You can always have it done at another time, if you should decidP to . Do not agree to any medical procedure
or sign any consent forms without having it fully explained to you, so that you understand it completely. If your
doctor tells you that you need a hysterectomy , it is your right to get another opinion . Hysterectomy is a serious
major operation. Complications after a hysterectomy are 10-20 times more likely than for tubal ligations. Many
unnecessary hysterectomies are performed each year. You should not have a hysterectomy just so you won't
get pregnant.
Tell your friends, family and neighbors about sterilization abuse. The only way to protect ourselves is to learn
the facts, and demand our right as women to control our bodies.
If you would like to distribute this leaflet contact: 3619 Baring Street, Phi/a., PA 19104. This leaflet was prepared and distributed by
Women Against Sterilization Abuse.
~,
'~-
lEs la esterilizaci6n efectiva en un 10096?
Los medicos dicen que despu~s de "la operacion" usted no tiene que preocuparse de estar embarazada otra vez.
Sin embargo, a pesar de que la operaci6n no es revers_ible, muchas mujeres se sorprenden al encontrarse embara zadas de nuevo. De 1 mill6n de rnujeres que se han amarrados los tubos, de 10,000 a 20,000 salen embarazadas.
Este es un porcentaje de riesgo mas alto que cuando la mujer toma la pastilla. Ademas, un gran numero de embarazos ocurridos despues hacerse "la operacion" ocurren en la pequena parte de los tubos que quedan. Esta es una situ aci6n muy peligrosa, que puede dar por resultado la muerte de la mujer.
lCuales son las complicaciones?
Muchos medicos hablan de esta operaci6n como si fuera sencilla. Esto no es cierto, porque nos hace creer que
no existen riesgos o efectos secundarios. "La operacion" no es metodo de control de la natalidad libre de problemas. No es mas seguro que el uso continuado de la pastilla. Es mucho mas peligroso que el coil
o el diafragma.
De 100,000 mujeres, 25 mueren de "la operacion." Los efectos secundarios de "la operacion" pueden incluir:
Sangrar, infeccion, perforacion del utero, quemar o lesionar los intestinos, dolor en el estomago, dolores durante la
regla, hemorragia durante la regla, embarazo fuera la lugar, y complicaciones emocionales.
( Cuales son las alternativas?
La salud de la mujer no es, ciertamente, una prioridad. Muy pocas investigaciones se han hecho para desarollar un metodo mejor de contracepci6n. Nosotras no podemos tener un sistema contraceptivo coveniente, seguro, y
efectivo. Muchas mujeres usan "la operacion" porque han tenido mala suerte con otros metodos, o tienen miedo
de sus efectos secondarios.
, el diafragma y la crema o gelatina son otras formas contraceptivas. El diaAdemas de la pastilla y el coil
fragma es un tipo de copa de goma que estfi' cubierto con un crema espermicida (usada para matar los espermatozoides) que se inserta en la vagina antes del acto sexual. El diafragma debe de ser recetado por un medico o otro
trabajador de salud . Despues, es controlado por usted. El diafragma puede ser usado por casi todas las mujeres yes
diferente de la pastilla o el coil porque no produce efectos secundarios, y no es peligroso. A pesar de que es muy
efectivo en prevenir el embarazo cuando es usado debidamente, muchos medicos no informan a sus pacientes
de estos beneficios.
Otros metodos son la espuma espermicida o los condones (o gomas) para el hombre ,
iQue se pueden hacer?
SI USTED ESTA PENSANDO HACERSE "LA OPERACION"
Piense bien su decisi6n. Recuerde: Usted no puede esperar estar encinta otra vez.
CONOZCA LAS ALTERNATIVAS
Este segura de que no hay otro m~todo que sea mejor para usted.
ESTE SEGURA DE QUE LA DECISION ES SUVA
y no algo que la han forzado a hacer. No tome la decisio'n durante el parto, immediatamente antes o despues
de un aborto, o si usted esta deprimida o si tiene problemas emocionales. Estas son algunas de las preguntas
que usted debe de hacerse antes de "la operacion":
1. lOue sucede si en el futuro deseo tener un hijo/a con un padre diferente?
2. lOue si uno/a o mas de mis hijos/as mueren?
Si usted tiene una duda: usted puede negarse a "la operacion"; usted puede levantarse de la mesa de operaciones
o irse del hospital. Usted tiene el derecho de cambiar su decisi6n, sin importar lo que usted haya firmado, hasta el
momento immediatamente anterior a la operaci6n. Usted siempre puede operarse mas adelante, si asf lo desea.
No de su consentimiento ni firme nada si usted no entiende bien de que se trata. Si su medico le dice que usted
necesita una historectomfa, usted tiene el derecho de ofr la opini6n de otro medico. La histerectomfa es una
operacion muy seria. Las complicaciones despues de la histerectom1a ocurren 10 o 20 veces con mas frequencia
que despues de "la operacion." Muchas histerectomfas no son necesarias. Usted no debe hacerse una historectom(a
para evitar estar encinta.
Hable con sus amigas/os, familiares, y vecinos acerca de los abusos de "la operaci6n." La mejor manera de protejernos es conocer los detalles y exigir los derechos que las mujeres tenemos a controlar nuestros destinos.
Si usted desea mas informacion , escr(banos a: 3619 Baring Street, Phi la. PA 19104.
Este panfleto ha sido escrito por "Women Against Sterilization Abuse -WASA" (Mujeres en Contra del Abuso
de la Esterilizacion)
MUJERES
No se dejen hacer «1a operacion» si usted no esta segura.
La esterilizacion de las mujeres esrn en aumento. En las ~ltimos cinco anos al numero de mujeres esterilizidas se ha triplicada. Aproximadamente un millon de esterilizaciones de mujeres ocurren en un ano.
La esterilizaci6n es permanente y no permite que la mujer controle su capacidad de tener hijos/as. Es una decision muy importante. No es alga a ·que debamos ser empujadas o forzadas sin tener la informacion adecuada,
o porque no sabemos de otra soluci6n.
En las hospitales y las clfnicas, muchos me'dicos estan forzando a las mujeres a ser esterilizadas sin ofrecerles
suficiente informaci6n acerca de las riesgos ode las consecuencias . Los hospitales universitarios estan hacienda
esterilizaciones, especialmente histerectom1as, para ensenar a otros me'dic~s y estudiantes de medicina .
La esterilizaci1ln puede ser una forma aceptable de contracepci6n para algunas mujeres que asf lo deseen . Sin
embargo, muchas mujeres son forzadas a escorjerla sin antes haber sid.o informadas de que la operacion es permanente, ode que existen otras formas para el control de la natalidad. Algunas mujeres son obligadas a firmar
su consentimiento a "la operacion" sin conocer todos las detalles de la misma, mientras tienen las dolores del
parto, antes de una cesaria, o al momenta de un aborto. Mucha_s mujeres no protestan de estos procedimientos
porque tienen miedo de perder las beneficios de la asistencia p6blica o el derecho a recibir atenci6n medica.
Para el gobierno norteamericano, la esterilizaci6n es una parte de un programa para controlar la poblaci6n del
mundo. Es una forma barata y efectiva de contolar la natalidad, siendo las mas parjudicadas las negras, las puertorriquenas, las chicanas, las indias americanas, y las mujeres pobres. Puerto Rico tiene el mas alto porcentaje de
esterilizaciones en el mundo, 35% de mujeres entre las edades se 15 y 45 anos han sido esterilizadas.
Oebemos protejernos de los abusos de la esterilizaci6n.
Para protejernos de las abusos de la esterilizacion debemos de conocer todos las detalles.
~Que es la esterilizaci6n?
La esterilizaci6n es un proceso par el cual la persona no puede tener mas hijos/as. Para la mujer la esterilizacion puede tener formas diferentes. La operaci6n significa amarrar y cortar las tubas del t'.itero. La histerectom1a (remover el utero) es usada tambien para esterilizar.
~ Es reversible?
La operacion es permanente. No es reversible. No importa si a usted le han dicho que sus tubas, son cortados
o amarrados. Despues de operada usted no puede estar embarazada otra vez. El resultado de la operaci6n no es
reversible despues de cierto tiempo . Hay una operaci6n que trata de conectar de nuevo las tubas, pero el embarazo
despues de la operacion es muy raro, y tener un nino/a es casi imposible.
WOMEN BEWARE!
Do not let yourself be sterilized
without making the choice yourCielf.
Sterilization is on the rise. In the last five years the number of women sterilized has tripled . Approximately
one million female sterilizations are performed in one year.
Because it is permanent and not reversible, sterilization ends a woman's control over her ability to have children. It is an important decision. It is not something we should be pressured or forced into without knowing
all the facts, or because we don't know what else to do.
Many doctors in hospitals and clinics are pushing surgical sterilizations on women without giving the facts
about the risks and consequences. Teaching hospitals are pushing sterilizations, especially hysterectomy, as training
for new doctors.
Sterilization can be a good form of birth control for some women who choose it. However, many women are
pressured to make the choice without being informed that it is a permanent (irreversible) operation, or that there
are other forms of birth control. Some women are forced to sign consent forms for the operation without knowing
all the facts, while they are in labor of childbirth, before a Caesarian section, or at the time of abortion. Many
women agree to sterilizations because they are threatened or are afraid they will lose their welfare, or the right to
medical services.
For the U.S. government, sterilization is part of the population control program . It is a cheap and effective
way to control births. Most sterilizations are performed on Black, Puerto Rican, Native American (American
Indian) and poor women. Puerto Rico has the highest number of sterilizations in the world with 35% of Puerto
Rican women of childbearing age having been sterilized.
We must protect ourselves from sterilization abuse.
In order to protect yourself from becoming a victim of sterilization abuse you must know the facts.
What is sterilization?
Sterilization is a procedure after which the person cannot bear children. For women, sterilization can take
several forms. Tubal ligation - or "getting your tubes tied" - is the tying, cutting, or blockage of the Fallopian
tubes. Hysterectomy (removal of the uterus or womb) is also being used to sterilize.
Is it reversible?
Sterilization is a permanent operation . It is not reversible . It does not matter if you have been told your tubes
are cut or tied. After having this operation you can never plan to get pregnant again. You cannot plan on the
operation coming undone after a certain period of time. There is an operati on which attempts to reconnect the
tubes, but pregnancy after the operation is very rare, and having a baby is very unlikely.
Is sterilization 100% effective?
Doctors say that if you have a tubal ligation you will never have to worry about getting pregnant again . Even
though the operation is not surgically reversible, many women are surprised to find themselves pregnant. Out
of a million women who get tubal ligations, 10,000 to 20,000 will become pregnant. This is a higher failure rate
than women taking the pill. In addition, a higher number of pregnancies after tubal ligation are ectopic pregnancies
(pregnancies in the tube) . This is a ve ry serious medical emergency, from which wom en have d ied .
What are the complications?
Many doctors refer to a certain type of tubal ligation as a "band -aid" operation. Th is is very misleading, because it makes us think there are no risks or side effects. Sterilization is not a problem-free method of birth control.
It is not any safer than the long-term use of birth-control pills. It is much more dangerous than the IUD (coil,
loop) or diaphragm. Out of 100,000 women, 25 will die from a tuba l ligation . Side effects after the operation may
include: Bleeding, infection, perforation of the uterus, accidental burning or bowel trauma , abdominal pain or
pain during menstruation, an increase in menstrual bleeding, ectopic pregnancy, and psychological complications.
What are the alternatives?
As women, our health is given low priority. Little research is being done on developing better birth control
methods. We are unable to get safe, effective, convenient birth control. Many women settle for sterilization because they have had such bad luck with other contraceptives, or are afraid of their side effects.
Besides birth control pills (oral contraceptives) and the IUD (coil, loop), the diaphragm and spermicidal cream
or jelly is another form of birth control. The diaphragm is a rubber cup which is covered with spermicidal cream
(used to kill sperm) and is inserted into the vagina before having sex. A diaphragm must be fitted by a doctor or
other health practitioner. After that, it is controlled by you, the woman. A diaphragm can be used by almost
any woman, unlike birth control pills or the IUD, with no side effects or danger. Even though it is very effective in
preventing pregnancy when used properly, many doctors do not tell their patients about it . Another method of
birth control is condoms (rubbers) and spermicidal foam .
What can you do?
IF YOU ARE PLANNING TO BE STERILIZED,
take your time to make the decision. Remember: You can never plan to get pregnant again.
LEARN ABOUT THE ALTERNATIVES
Make sure that no other birth control method is suitable for you.
MAKE SURE THAT THE DECISION TO BE STERILIZED IS YOURS, and not something you are being pushed
into. Do not make the decision at the time of childbirth, at the time of abortion or if you are depressed or having
emotional problems. These are some of the questions you should ask yourself before choosing to be sterilized:
1. What if st some point in the future I marry a new man and want to have children with him?
2. What if one or more of my present children sb_ould die?
If you have any doubts at all : you can refuse the operation; y ou can even get up and leave t he hospital.
It is your right to change your mind, no matter what you have signed, even up to the time of t he operation.
You can always have it done at anoth er time, if you should decide to . Do not agree to any medical procedure
or sign any consent forms without having it fully ex pl ained to you, so that you underst and it complete ly. If your
doctor tells you that you need a hysterectomy, it is your right t o get anot her opinion . Hysterectomy is a serious
major operation. Complications after a hysterectomy are 10-20 t imes more like ly than for tubal ligations. Many
unnecessary hysterectomies are performed each year. You should not have a hysterect omy just so you won't
get pregnant.
Tell your friends, family and neighbors about sterilization abuse. The only way to protect ourselves is to learn
the facts, and demand our right as women to control our bodies.
If you would like to distribute this leaflet contact: 3619 _
Baring Street, Phi/a., PA 19104. Th is leafle t was prepared and distributed by
Women Against Sterilization Abuse.
®'-
lEs la esterilizaci6n efectiva en un 10096?
Los medicos dicen que despues de "la operacion" usted no tiene que preocuparse de estar embarazada otra vez.
Si n embargo, a pesar de que la operacion no es revers.ible, muchas mujeres se sorprenden al encontrarse embara zadas de nuevo. De 1 milI6n de mujeres que se han amarrados los tubos, de 10,000 a 20,000 salen embarazadas.
Este es un porcentaje de riesgo mas alto que cuando la mujer toma la pastilla . Ademas, un gran numero de embarazos ocurridos despues hacerse "la operacion" ocurren en la pequena parte de los tubos que quedan. Esta es una situ aci6n muy peligrosa, que puede dar por resultado la muerte de la mujer.
lCuales son las complicaciones?
Muchos medicos hablan de esta operaci6n como si fuera sencilla. Esto no es cierto, porque nos hace creer que
no existen riesgos o efectos secundarios . "La operacion" no es metodo de control de la natalidad libre de problemas. No es mas seguro que el uso continuado de la pastilla. Es mucho mas peligroso que el coil
o el diafragma.
De 100,000 mujeres, 25 mueren de "la operacion." Los efectos secundarios de "la operacion" pueden incluir:
Sangrar, infecci6n, perforacion del Gtero, quemar o lesionar los intestines, dolor en el estomago, dolores durante la
regla, hemorragia durante la regla, embarazo fuera la lugar, y complicaciones emocionales.
~ Cuales son las alternatives?
La salud de la mujer no es, ciertamente, una prioridad. Muy pocas investigaciones se han hecho para desarollar un metodo mejor de contracepci6n. Nosotras no podemos tener un sistema contraceptive coveniente, seguro, y
efectivo. Muchas mujeres usan "la operacion" porque han tenido mala suerte con otros metodos, o tienen miedo
de sus efectos secondaries.
, el diafragma y la crema o gelatina son otras formas contraceptivas. El diaAdemas de la pastilla y el coil
fragma es un tipo de copa de goma que esta cubierto con un crema espermicida (usada para matar las espermatozoides) que se inserta en la vagina antes del acto sexual. El diafragma debe de ser recetado por un medico o otro
trabajador de salud. Despues, es controlado por usted. El diafragma puede ser usado por casi todas las mujeres yes
diferente de la pastilla o el coil porque no produce efectos secundarios, y no es peligroso. A pesar de que es muy
efectivo en preven ir el embarazo cuando es usado debidamente, muchos medicos no informan a sus pacientes
de estos beneficios.
Otros metodos son la espuma espermicida a los condones (o gomas) para el hombre,
~Que se pueden hacer?
SI USTED ESTA PENSANDO HACERSE "LA OPERACION"
Piense bien su decisi6n. Recuerde: Usted no puede esperar estar encinta otra vez.
CONOZCA LAS ALTER NATIVAS
Est€ segura de que no hay otro m~todo que sea mejor para usted.
,
ESTE SEGURA DE QUE LA DECISION ES SUVA
y no al ga qu e la han forzado a hacer. No tome la decisio'n durante el parto, immediatamente antes o despues
de un aborto, o si usted esta deprimida o si tiene problemas emocionales. Estas son algunas de las preguntas
qu e usted debe de hacerse antes de "la operacion" :
1. lQue sucede si en el futuro deseo tener un hijo/a con un padre diferente?
2. lQue si uno/ a o mas de mis hijos/as mueren?
Si usted tiene una duda : usted puede negarse a "la operacion"; usted puede levantarse de la mesa de operaciones
o irse del hospital. Usted tiene el derecho de cambiar su decisi6n, sin importar lo que usted haya firmado, hasta el
momenta immediatamente anterior a la operaci6n. Usted siempre puede operarse m§s adelante, si asf lo desea.
No de su consentimiento ni firme nada si usted no entiende bien de que se trata. Si su medico le dice que usted
necesita una historectomfa, usted tiene el derecho de ofr la opini6n de otro medico. La histerectomfa es una
operacion muy seria. Las complicaciones despues de la histerectomfa ocurren 10 o 20 veces con mas frequencia
que despues de "la operacion. " Muchas histerectomfas no son necesarias. Usted no debe hacerse una historectom(a
para evitar estar encinta.
Hable con sus amigas/os, familiares, y vecinos acerca de los abusos de "la operaci6n." La mejor manera de protejernos es conocer las detalles y exigir las derechos que las mujeres tenemos a controlar nuestros destines.
Si usted desea mas informacion, escrfoanos a: 3619 Baring Street, Phi la. PA 19104.
Este panfleto ha sido escrito par "Women Against Sterilization Abuse -WASA" (Mujeres en Contra del Abuso
de la Esterilizacion)
MUJEAES
No se dejen hacer «10 operacion» si usted no esta segura.
La esterilizaci6n de las mujeres estti' en aumento. En los ultimas cinco afios al nGmero de mujeres esterilizi das se ha triplicada. Aproximadamente un millon de esterilizaciones de mujeres ocurren en un ano.
La esterilizacion es permanente y no permite que la mujer controle su capacidad de tener hijos/as. Es una decision muy importante. No es alga a que debamos ser empujadas o forzadas sin tener la informacion adecuada,
o porque no sabemos de otra solucion.
En los hospitales y las clfnicas, muchos medicos estan forzando a las mujeres a ser esterilizadas sin ofrecerles
suficiente informaci6n acerca de los riesgos ode las consecuencias. Los ~ospitales universitarios estan hacienda
esterilizaciones, especialmente histerectom,as, para ensenar a otros medicos y estudiantes de medicina.
La esterilizacibn puede ser una forma aceptable de contracepci6n para algunas mujeres que as1 lo deseen . Sin
embargo, muchas mujeres son forzadas a escorjerla sin antes haber sido informadas de que la operaci6n es permanente, ode que existen otras formas para el control de la natalidad. Algunas mujeres son obligadas a firmar
su consentimiento a "la operacion" sin conocer todos las detalles de la misma, mientras tienen los dolores del
parto, antes de una cesaria, o al momenta de un aborto. Mucha.s mujeres no protestan de estos procedimientos
porque tienen miedo de perder los beneficios de la asistencia p6blica o el derecho a recibir atenci6n m~dica.
Para el gobierno norteamericano, la esterilizaci6n es una parte de un programa para controlar la poblacion del
mundo. Es una forma barata y efectiva de contolar la natalidad, siendo las mas parjudicadas las negras, las puertorriquenas, las chicanas, las indias americana$, y las mujeres pobres. Puerto Rico tiene el mas alto porcentaje de
esterilizaciones en el mundo, 35% de mujeres entre las edades se 15 y 45 anos han sido esterilizadas.
Debemos protejernos de los abusos de la esterilizaci6n.
Para protejernos de los abusos de la esterilizacion debemos de conocer todos los detalles.
~Que es la esterilizaci6n?
La esterilizaci6n es un proceso por el cual la persona no puede tener mas hijos/as. Para la mujer la esterilizaci6n puede tener formas diferentes. La operaci6n significa amarrar y cortar los tubas del utero. La histerectom,a (remover el utero) es usada tambien para esterilizar.
~Es reversible?
La operacion es permanente. No es reversible. No importa si a usted le han dicho que sus tubas, son cortados
o amarrados. Despues de operada usted no puede estar embarazada otra vez. El resultado de la operaci6n no es
reversible despues de cierto tiempo. Hay una operacion que trata de conectar de nuevo los tubas, pero el embarazo
despues de la operacion es muy raro, y tener un nino/a es casi imposible.
-~ -
: -1-u::: d.e dix mille
femme s sont annuellement ster ilizees a New Yo r k Ci ty.
Une sterilization est J?ermanente,
e-cre
"'
- los Hechos
Les tubes lies ne peuvent plu s
a' enoues.
Il existe de ~oyens plus simples de prevenir une gross esse .
Une proportion d ''une sur trois femmes sterilizees regrette plus tard
leur dec::.sion.
•
El Ahuso de Esteriliz.aci6n
Beaucoup de ces femmes ont ete contraintes de signer des formes durant.
les douleurs de l'enfant ement, ou durant une ab ortion. Recemment, une
prisonniere noire de Rikers Island agee de dix neuf ans , etait s terilizee
a Kings County Hospital sans son consentement. Beauc oup rlus de femme s ont
ete steriliz~es a leur insu parce qu 1 elles ne parlaient pas l 1 angl ai s. Une
parmi quartre femmes noires mari~es dan le pays a et e de ja sterilizee.
A Porto-Rico 34% de femmes en age ·d'enfanter ont ete sterilizfes sous les
auspices de programmes du gouvernement de s ~tats Uni s .
Un outrage r..at ional aux sterilizations for c ee s des S.) eurs Relf en
Alabama a oblig~ le gouvernment feder al a adopter de s reglement cont re de
futur s abus, incluant une periode d'attente de 3 jours entre le moment de
signer un consentement et c-e:l::ui-de 1 1 operation. Mai s le departement de la
Sante , de l'fflucation et du Bien- Etre Social n' a f ait aucune tentative de
demand.a de conformance a de tels reglement s .
A Nev York City environ 80% de; sterilizations son+ faites dans les
hospitaux: prives, souvent payees par Medicai d . De tels operations seraient
prot ege·es par les regJ.ements f ederaux non enforces. Pour ' les nombreus es
st erilizat1ons non couvert par le Medicaid faites dans l~s h~pitaux prives,
elles echappent a t ous standards . Le res te des 20% de s sterilizations est
f ait daru. l es ~ pita:ux municipaux ou un long combat a conduit a 1 1 adopt ion
de severes mesures , y compr is une periode d ' attente de 30 jours et beaucoup
de co:q&ei~s dans la langue de leur choix , et da~~ une l i bert~ san~_ con~~~ ain~
Le Health tmd Hospi tals Corporation cependant n'a pas remis en
vi geur ces r egl.ement s, et beaucoup de m€decins en font peu de cas ouvert emente .
En 1·a1 t;, s i x pro:fesseurs d ' Obstetrique et de Gynecol ogi e- , ~9'!=§. par le
Depa rt ement de la Sante, de l' Education et du Bien-Etre Social ont ~t ~
en appel pour renverser ces reglements.
La situation est clairement dangereuse . Les droits de Lib erte d ' Inf ormations, de Libert~ de Chaix d'enfanter sont en train d 'etre violees
journel lem.ent . La Coalition contre l' Abus de Sterilization presse taus
i ndi vidus et Organizations a se joindre a elle pour d,emander:
APPLIQUEZ LES REGLE1'1ENTS A TOUSLES PATIENTS
CESSEZ L I J;BUS ~E S1'ER-;::rJIZATION
Sterilization Abuse
- the Facts
L'Abus de la
Sterilization
- Jes Faits
·,
Coalition Against Sterilization Abuse
c/oTWWA
244-48 West 27th Street
N.Y , N.Y . 10001 .
For information
(212) 243-2310.
.,·.
' :. ·,~ '..!·:-
~01?
-~
; .
iFIN AL ABUSO
DE ESTERILIZACION EN NUEVA YORK!
STOP STERILIZATION ABUSE IN NEW YORK CITY!
Mas de diez miles mujeres estan esterilizadas cada a·no en la ciuaad de
Nueva York. ?Cuantas de ellas saben los hechos fundamentales?
- la esterilizaci6n es permanente, los tubos no se pueden ester
deshecho mas tarde.
- hasta una de tres mujeres esterilizadas se arrepenten mas tarde.
Over ten thousand women are sterilized yearly in New York City. How
many of these women know the basic facts?
- sterilization is permanent; the tubes cannot be "untied" later.
- there are safer ways to prevent pregnancy.
- up to one in three women sterilized later regrets the decision.
Muchas de estas mujeres han estado forzadas de afirmar un
consentimiento durante el dolor de parto o de aborto. Recientemente una
presa negra de 19 anos de edad de Rikers Island fue esterilizada sin su
consentimiento en Kings County Hospital. Muchas mujeres ademas han
estado esterilizadas sin el saber porque no hablan ingles. En los hospitales
que sirven a comunidades predominantelmente boricuas las esterilizaciones aumentaron en un 180 por ciento en 1973, y si vale una tendencia
nacional, siguen aumentando. Una de cada cuatro esposas negras en el
pais ya esta estirilizada. En Puerto Rico el 35 por ciento de las mujeres en
edad reproductiva estan estirilizadas, resultado de un programa del
gobierno de EEUU .
Many of these women have been coerced into signing forms during
black woman prisoner
painful childbirth or abortion. Recently a 19-year-old _
from Rikers Island was sterilized without her consent at Kings County
Hospital. Many more women have been sterilized without their knowledge
because they did not speak English. In the municipal hospitals serving
predominantly Puerto Rican neighborhoods, sterilizations increased 180%
in 1972-73, and if nationwide trends prevail, that rate is rising steadily.
One in four married black women in the country has already been
sterilized. In Puerto Rico, 34% of women of childbearing age have been
sterilized under U.S. governmental programs.
La ira de todo el pa(s a las esterilizaciones forzadas de las hermanas Relf
de 12 y 14 anos de edad en Alabama obligo al gobierno federal a promulgar
unas normas contra mas abusos, incluyendo un perfodo de 3 dfas entre el
tiempo de firmar el consentimiento y el tiempo de la operacion. Estas
normas sirven solamente a las operaciones hechas con los fondos federales .
Una encuesta por el departimiento de Salud, Educacion y Bienestar (HEW)
revela las violaciones escandalosas de estas normes debiles, pero el HEW
no hace nada para poner en vigor la ley.
National outrage at the forced sterilizations of the 12- and 14- year old
Flelf sisters in Alabama obliged the federal government to draw up
guidelines against further abuses, including a three-day waiting period
between the time of signing the consent and the time of surgery. These
standards apply only to operations done with federal funds. A survey by
the Dept. of Health, Education and Welfare shows flagrant widescale
violation of weak guidelines, yet HEW is making no attempt to demand
adherence.
En la ciudad de Nueva York casi el 80 por ciento de las esterilizaciones
estan hecahs en los hospitales privados, muchas veces pagados por
Medicaid. Estas operaciones de Medicaid deben estar protegidas por las
normas federales; para las muchas oper'aciones no pagadas por el Medicaid
no hay ningunas normas. El 20 por ciento ademas de las esterilizaciones se
hacen en los hospitales municipales, donde una lucha larga llego a la
adopcion de unas normas fuertes, incluyendo una espera de 30 dfas, los
consejos completos en la lingua escogida por la mujer, y la libertad de la
compulsion. La Corporacion de la Salud y los Hospitals, sin embargo no
esta poniendo en vigor las normas y muchos doctores las violan
apiertamiente. De hecho seis profesores de obstetrica y ginecologia han
radicado un pleito, con la ayuda de HEW, para declarar todas normas
.
illegales.
de
preciosos
derechos
los
por
Claro esta que la situacion esta peligrosa,
estan
nines
los
tener
escoger
de
libertad
la
y
la libertad de informacion
diariamente violados. La Coalicion contra el Abuse de Estirilizaci6n pide a
todos individuos y organizaciones que se unen con nosotros para
demandar:
!Que sirven las normas fuertes para todos pacientes!
IFin al abuso de estirilizacion !
In New York City about 80% of the sterilizations are done in private
hospitals, often paid for by Medicaid. These Medicaid operations should be
protected by the unenforced federal guidelines; for the many non-Medicaid
sterilizations done in private hospitals there are no standards at all. The
remaining 20% of sterilizations are done in municipal hospitals, where a
long struggle led to the adoption of strong gu·idelines, including a 30-day
waiting period, full counselling in the language of choice, and freedom
from coercion. The Health and Hospitals Corporation , however, is not
enforcing the guidelines, and many doctors are publicly flaunting them. In
fact six professors of obstetrics and gynecology, aided by HEW, have gone
to court to have all guidelines overthrown.
Clearly the situation is dangerous. The precious rights of freedom of
information and freedom to choose to bear children are daily being
violated . The Coalition Against Sterilization Abuse urges all individuals
and organizations to join us in demanding:
Apply the guidelines to all patients! Stop sterilization abuse!
Th facts
WHAT IS STERILIZATION?
Surgical sterilizati on is a procedure which permanently ends your ability to have children . It is
also cal led "bandaid surgery , " "la operacio n,"
"a stitch," "tying the tubes," and "belly button
surgery. " These names are misleadin g and make
the operation sound safe and easy, when in fact ;•
for women this is major surgery.
•
FEMALE REPRODUC1 IVE
MALE REPRODUCTIVE ORGANS
~rinary bladder
vas deferens
(s~minal duct)
seminal _
vesicle
urinary
opening
corpus
cavornosum
epididym is
(Barbara Caress . " Womb Boom ," Health I PAC
Bulletin #77 , July / Aug. 1977) Although the
Departme nt of Health, Education and Welfare
promotes hysterect omy as a method of sterilizatestis
_
~
•
·, tion, many others disagree, and Dr . Charles
Mclaugh lin , for-mer President of the American
scrotum
glans penis
I
College
of Surgeons , has said that to perform a
urethra
hysterect omy solely to ster ilize a woman is "like
For men, sterilizati on is called a vasectomy . It killing a mouse w ith a cannon.''
involves cutting the vas deferns (the sperm carryNew methods of steril ization are being devel oping tube) ; and can be performe d in a doctor's ed . Some of these include squirt ing acids
, plast ics
office under a local anestheti c . For women, the an d other chemicals through the vagina
into the
procedure is more complica ted and varied. The . uterus in order to scar or plug the tubes
closed
.
two most common types of tubal sterilizati ons are
abdomina l tubal ligation (laparoto my) and laparoscopic tubal sterilizati on . Laparoto my consists of LIGATION OF FALLOPIAN TUBE
Egg (ovum)
cutting through the abdomina l v.:all in order to cut Sperm cannot reach egg .
t
f rth
canno go a er.
and tie off the Fallopian tubes (which carry the egg
from ·the ovaries to the uter·us). This procedur e
requires a two or three day hospital st~y .
Laparoscopy involves a special instrume nt which
is inserted through a tiny incision into the
abdomen . The tubes are then burned (cauterizad)
or clipped closed.
Hysterec tomy, removing the uterus (womb) is
also used to sterilize . This operation is performe d
TRADIT10N AL TU BA L LIGATION . Ends of tu bes are
at a higher rate than any other operation : 10 per
actually fold ed back int o surrou nding ti ssu e. Tubes
every 1 ;ooo •women in 1976, and if it continues ,
cauterized (burne d) dur ing laparoscop ic ster ilizat ion
more than half of all women in the United States
look differ ent fr om thos e in th is drawi ng.
will have had a hysterect omy before they reach 65.
prepuce
(foresk in)
t
---
1975
Earlier yura
3t.3
16 .3w1te
15.0 husband
t6 (1970). 8 .8 (1 965)
: Cou ples married 5-9 years . one partner sterilized
22
8 (1 970 )
\ Couples marri ed 20-24 year, . one partner ster ilized
55 7
37 (1973)
( Marr ied couples using pil l\
34
; (P"lr ~ent age dist ribu t ion )
!
' Marri ed co uples. one partner sterilized
Married co uples using IUD
8.7
9.5 (1973) , 1.1 (1965)
Married couples using diaphragm
3.9
5.7 (1973). 10 .5 (1965:
M arried couples using s0ndom
10.9
22 (1965)
----···-· - -·-· ,··-·- -- - ··... --.,~--··- ·---- --·--·- ~-- - - -·-
WHAT ARE THE COMPLICATI ONS?
Sterilization is neither problem-free nor a
method of birth control. It is the termination of the
ability to reproduce. It is more dangerous than
birth control, because it is a major operation,
. which requires the use of an anesthetic .
The death rate fpr tubaf sterilization is 25 per
100,000 women . Side effects after this operation
include: bleeding, uterine perforation, accidental
burning or bowel trauma (between 1 to 2% of
cases), abdominal pain or pain during menstruation (20 to 30% ); and increase in menstrual bleeding (10to40%).
The comp I ication rate tor a hysterectomy is 10 to
' 20 times higher than for tubal sterilization, with
between 300 to 500 deaths per 100,000 operations.
Recovery from a hysterectomy usually requires at
least 6 weeks.
Psychological complications after sterilization
operations are common . According to a 1973
study , one fourth of the women who have been
sterilized regret their decision, and in certain instances, a regret rate of 32% has been documented (by the Health Research Group Study on Surgical Sterilization, Oct. 1973).
IS STERILIZATI ON 100% EFFECTIVE?
As can be seen from the chart below, hysterectomy is 100 % effective . However , more women
become pregnant after tubal sterilizations than
those who use the pill.
Tub.al
ectomy
Ster il i.zauon
Pill
IUO
10,000
5 .000
30,000
3,000-5,000
250
31
9
150,000
15,000
600
400
Hyster-
Pregnancy Rate
per m, 11 ,on wctmen
Deaths
p er mli l1 on women
Senous Complicat,ons
p er m.Jloon wo m en
These figu r es ~re takenirom the Health Research Group Scudy
on Surg,c.al Scer,lizac,an . Oct . 1973.
So urce : New York Times July 22. 1917, fro m 011 \ce
of Pop ulati on Research (Princeton Un iver s;t y)
surv ey .
Total number of married couples,
one partner sterilized= 7 .9 million
Total number of: married cou_ples
using the pill= 7.1 million
In about 1 % of reported cases, pregnancies resulted after tubal sterilization operations because
of surgical failure and recanalization (the tubes
grew back together).
IS STERILIZATI ON REVERSIBLE?
Sterilization is NOT reversible . The few times
that the operat ion fails are accidental , and for all
intents and purposes, sterilizat ion means a permanent end to your ability to have children .
In men, the procedure to reconnect the vas
deferns is successful 50-80% of the time depending upon the skill of the physi~ian . However, conception rates are much lower (20-25% of the successful reconnections ) . (Advances in Surgical
Sterilizations, Marilyn E. Schima, et. al., 1973.)
People think that for women sterilization is
reversible because they've heard of the operation
which attempts to reconnect the tubes. However,
this operation fails approximately 75% of the time .
In thos~ 25% of the cases where the tubes are successfully reconnected, there is very little chance
that pregnancy can be achieved .
WHAT IS STERILIZATI ON ASUSE?
Sterilization abuse occurs every time a person is
sterilized: •
• without giving informed consent ;
• without knowing that the operation is permanent;
• without any knowledge of the risks , benefits,
or alternatives to the operation; •
• without having the opportunity to make a
carefully thought out decision , with the chance to
learn the social facts and to understand their implications. (Many women change their m inds after
consulting with friends);
• because he / she has been threat ened with the
denial of other medical services or termination of
welfare payments ;
• by court order or parental consent , because
they are "feeble minded" or " socially inade•
quate' ' (eugenic sterilization).
Sterilization abuse also occurs whenever a
woman is sterilized because abortion is unavail-
able, or birth control methods too costl y. Or whe1
a woman is forced to accept steril izatio r as a con dition for obtaining an abort ion. Or wh ':!n an /o ri •~
chooses to be sterilized but is discouraa ed or even
prevented from undergoing the operation .
•
Sterilization abuse is another wa '/ to den y ~eople the right to plan when and how man y ch il dren
. to have , and the right to choose the best met ho'd of
birth control.
JbF(ED
te • a-uonis a
n1cenaJlle
forc9enoc:ide.
WHO ARE THE TARGETS OF STERILIZATiON
ABUSE?
The overwhelming majority of people who are
victims of sterilization abuse in the U .S. are Native
American, Black, Mexican-American and Puerto
Rican women.
More than a million sterilizations were performed annually in the U .S. in five of the last six
years. According to the New York Times , the total
new is about seven million people between the
ages of 15 and 44. (The AVS reports that the total
is closer to nine million .) The ·balance between
male and female sterilization has shifted. In 1970.
only 20% of the924,000 sterilizations were of women. By 1975, of the estimated 1,313 .000 stE ril izations, 51 % were for women, and estimates for
1976 indicate that this proportion may be nigher .
One of the partners in every ten couples or childbearing age in the world has been sterilized : a
total of ab.out 75 million. This repres ents a trip ling
between 1970 and 1976 . Estimates from the Ass ociation for Voluntary Sterilization pred ict that 200
million people will be steril ized by 1985 . (All data
in the preceding two paragraphs , except as noted.
from the New York Times, May 22 , 1977. )
There rs also a definite trend towards ster iliz ing
younger women. In 1973, the median age of
women sterilized in federa lly financed famil y
planning programs was 28. Less than half of these
women were over 30 , and fnur of every 100 were
under 25 years.
Teaching hospitals are pushing sterilizat ions .
especially hysterectomies, to train residents. ,;.\imost every major teaching hospital in the U.S. has
doubled the number of elective tubal sterilizations
since 1971.
The acting director of OBIGYN at a munici~al
hospital in New York City reported that it is common practice to use elective hysterect omies to
train residents: "At least 10% of gynecological
surgery in New York City is done on this bas is. an d
99% of this is done on Black and Pu erto Rican
women. '· In a survey reported in the January 1972
issue of Family Planning Digest 94 % of the phy ::; icians responding favored compulsory sterilization
of welfare mothers with three illegitimate
children.
International
By far, the highest incidence of steri :ization
abuse is found in Third World countries and in the
T'lird World communities of the U.S. For exam-
pie , 40 ,000 women were steril ized in Colombic, between 1963-65 by Rockefeller funded programs .
Th es e women were coaxed by gifts of lipstic k or
artifi cia l pear ls , by small payments of money , and
by prom ises of free medical care . (Population
Targ et. Bonnie Maas , 1976): In Bol ivia, a U.S .imposed populat ion control program administered
by the Peace Corps sterilized Quechua Indian
women without their knowledge or consent . In
India . men were being given transistor radios if
they agreed to a vasectomy . When this failed to
attract sufficient numbers the state governments
initiated compulsory sterilizateon programs with
penalties of imprisonment , fines, and deprivation
of social services . Within one year (1976) over
seven million people were sterilized . This program
was one of the major causes of the Gandhi government ' s ouster in the last elections . (New York'
Times , April 3, 1977.)
Puerto Rico
Puerto Rico has the highest incidence of sterilizations in the world : 35 .3 % of Puerto Rican women of childbearing age have been sterilized , and
according to a study by Columb ia University
demographer Harriet Presser, 92 % of them were
under 35 years of age . The key agency carrying out
sterilizations in Puerto Rico is the Family Planning
Association of Puerto Rico, which receives 80% of
its budget from the U .S. Department of Health ,
Education and Welfare .
There was a 180 % rise in the number of sterilizations·perfor med between -1972-1973 in New York
Cit y municipal hospitals which serve predominately Puerto Rican neighborhood s.
Afro-America n
A 1970 Nationa! Fertilit y Study by the Office of
Population Research of Pr inceton Uni versity found
that 43 % of the women steril ized in federal ly financed family planoing programs were . E}lack.
wh ile Blac k women represent only one third of the
patient population . Twenty percent of married
Black women in the United States have been sterilized.
Mexican-Ame rican
In the same study , 21.7 % ·of Mexican-Ame rican
women under the age of 45 who are or have ever
been married have been sterilized .
Native Americans
Representativ es of the Mohawk Nation are
chargjng that the U .S. Public Health Service has
been conducting numerous sterilizations on young
Indian mothers withput informing them. of the
exact natu re of the surgeries . The In di an Health
Service Hospita l in Claremont , Oklahoma surgically sterilized 132 Indian women in 1973 . One hundred of these operations were for t he sole pur pos e
of making the women incapable of havi ng
children . It has recently been estimated -by Dr.
Connie Uri (New York Times , May 24 , 1977) that
more than 25 % of Native American wo m en nave
been steri I ized.
All data, except where noted , is from Health/PAC
Bulletin , No. 62, January/ Feb ruary 1975.
THE COMMITTEE TO END STERILIZATI ON
ABUSE
Th is is the first in a series of fac t sheets produced by CESA , the Committee to End Steri li zation Abuse. For more information or if you would
like to help in our fight against sterilization abuse,
fill out and return the ~oupon below.
CREDITS
p .1- Our Bodies, Ourselves (first edition)
p .3-Peg Averill/ LNS-
STERILIZATION RIGHTS, ABUSES, REMEDIES
"
Rahemah Amur
Laura Rodriguez
Karen Stanvn
Nancy Stearns
Sterilization is a time-honored procedure in the United States. The first of the laws empowering
the State to sterilize unwilling and/or unwitting people was passed in Indiana in 1907 . Based on
the pseudo-scientific belief that heredity determines wealth , intelligence , criminality, etc.,
this Eugenics Law was applicable only to those in State institutions, although its framers would
hav e applied it to the entire "dysgenic" population had they been able. A model Fede ral Eugenics
Law published in 1922 by H. H. Laughlin of the Eugencis Record Office, set out explicitly whose
procreation was to be prevented. The "socially inadequate" targets included : the feeble-minded,
insane, criminalistic, epileptic, inebriate , drug addicted , diseased, blind, deaf, deformed, and
'
economically dependent or destitute.
By 1964 , some 65,000 people were for c ibly sterilized under such laws in over thirty states and the
colony of Puerto Rico . The most common indication was "feeble-mindedness." The popularity and influence of the Eugenics movement began to de c line in the 1940's as Americans saw a Eugenics program
carried to it•s logical extreme by Hitler's policy of Race Hygiene. Scientific advances also demonstrated that most of the conditions that the Eugenicists sought to eliminate by surgery were , in
fact, not he reditary, but socially or environmentally caused.
Although both the frequency of use and total number of Eugenics Laws has been reduced since World
Was II, they continue to remain on the books in some 20 states, due in part to the 1927 Supreme
Court decision written by Justice Holmes in Duck v. Dell, upholding the constitutionality of the
While the reasoning that led the Court to declare that "three generations of
Virginia Eugenics Law.
imbeciles are enough," probably would not be used today, the precedent still stands.
During this time, sterilizatiod for contraceptive purposes was sometimes outlawed by the Eugenics
statutes in keeping with the policy that encouraged breeding among the educated and we ll-to-do.
In any case, it was not generally available.
During the late 1950's and all through the 1960's there were numberous attempts to pass laws that
would impose sterilization on unwed welfare mothers with two or three children, and courts sometimes
The rationale for such statutes
offered sterilization to criminal offenders in lieu of jail terms.
was couched in the language of "f itness to parent" while the racial overtones were broadly hinted
at as legislatures looked at statistics on out-of-wedlock births, and complained about welfare cos ts.
None of these . attempts to pass such legislation was successful, and so, instead, various states enacted voluntary sterilization laws as much to shield physicians from liability for what they were
already doing as to accomplish with a soft-sell approach that which would be looked upon unfavorably
the less than freely consented-to sterilizaif it were done in a compulsory and punitive manner:
tion of poor and minority women.
Two major events in 1969-1970 changed greatly the access to sterilization and led to increasing
abuse. These were the abandonment of the arbitrary and arbitrarily applied "Rule of 120" by the
American College of Obstetricians and Gynecologists which required a woman's age times the number
of her children to equal 120 before she could be considered for a sterilization, and the Federal
government's decision, reached in response to concern about "overpopulation" to fund sterilization
Sterilization was funded at 90% of cost before abortion was available
as a family planning method.
in Federal programs and continues to be so, now that abortion funding is almost totally restricted .
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While domestic policies have been ambiguous or ambivalent, U. S. foreign policy has been clear in
its stated aim of sterilizing one quarter of the world's fertile women to preserve U.S . commercial
and political dominance. The State Department's population control budget has grown from $1.9 to
The
$200 million per year since 1965 when most population monies came from private foundations.
U.S . government is the largest 'supporter of population control programs in the world , contributing
have
Loans and food aid to developing nations
through both bi and multi-lateral organizations.
In any given year the
been conditional upon the donee nation"s acceptance of population programs.
greater than that appropriated for all health50%
is
control
population
for
amount appropriated
•·
, .,,,,
related aid ,
Given the above conditions, abuse may occur in a variety of ways.
Sterilization abuse occurs whenever someone is sterilized:
· without knowledge of ~he risks, benefits, and alternatives;
· without knowing the operation is permanent;
without knowing the operation will be performed;
without the opportunity to make a decision slowly and thoughtfully;
under threat of denial of other medical services or welfare benefits;
when abortion is unavailable; as a precondition to obtaining an abortion, or when methods of
birth control are too costly or unavailable;
by hyst e rectomy instead of tubal litigation;
after "consenting" when consciousness is impaired due to drugs, alchohol, or other stress,
_..
e.g., during labor or abortion; '~
~
as punishment;
convenience;
for institutional or parental
for eugenic reasons.
Abuse also takes place when -a person has freely chosen to be sterilized but is discouraged or prevented.
Abuse also occurs
Abus e is not only the result of overt coercion or a lack of informed consent.
whenever an individual chooses sterilization because of his or her social and economic conditions.
The history and prevalence of sterilization make it clear that the social problems which affect
the poor have influenced many people, particularly Black, Hispanic, and Native American women to
The lack of employment opportunities, e ducation, daycare, decent housing, adequate
be sterilized.
medical ca re, safe, effective contraception and access to abortion all create an atmosphere of
s ubtle coe rcion .
The colo~y of Pu e rto Rico has lcing been used as a laboratory in which fertility polici es are test-
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, rt . Fa1n1l)· p l an ni11~ 11 1· 0~1· ams th c 1·e . lar ~ely funded by DHE~ . whi c l1 ha ve ne,·e r provi d e d abortion,
:. ·,J ,t1 ·l11v,,,d a rat,· or !ilL' rili ,: ati o n . a s o f 1968. of 3 5 . 3'; of the women of c hildb ea rin g age . ~!an y
•1·,· 1h,t :n~:t1'l' ul
1.ll e i1Tl ' \ 'C 1· s i b 1 l i ty or the pi·ocedu r e a nd OYe r 1/3 e,·i ct e n ce d regr et, 12c; of these
:, ... :1u'.... 1 mu 1· 1• 1·h1 ld1·L•n w0r e dc.--.si r e d.
In 197--l. the e d i t o rs of Family Planning D iges t . an HEW-Pl a nn e d
, 1r• ntln,o d p11Ul icaLiu n. W l' Ot( • :
" As C.S . professio nal attitudes c hange. it is poss ibl e that we may
, l' :--.r1 1·1 11.:::atiun b eco me a s impo rt a nL in th e fifty st at es as i L al r ea dy is in Pu e rt o Rico."
1-
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1-
T1dJf tn the f ilt ~ s tat es 60r; of th e 1. 3 million annual ste rili za ti o ns a re do ne o n women . I n 1970 .
This c h a nge ha s b ee n ac compani e d b>·
u 11l~· :;u'; 01 .0 mi l l i o n pr oce dur es we r e p e r for med f o r wome n.
dt·up ,..\n t he m1..•di:1n a ge ol s t eril ize d women .
DHEW s tati stics s h o\,. that the r ate o f ste r i l iza t ion
i .lL' l'1._~.tH1 ?s ::is .inc ome l c\·C' l s dec r e ase among both illa c k and wh i t e wom e n.
Th e o pposite r ela t i o n is
l l'lli' amung men .
,\t all i n c ome l e Yels. howe\· e r 1 th e rate::::, f o r I3lack women are s ignifi ca ntly hi g h er
lh.rn Ju r \\h.iLt.? ,, ome n. with t h e g r e at e st i n c r ease among l o w in come marri e d wo me n of all g roup s in
tlit · <· llild l.h.•a 1·ing- y t: ars (25 - 34 ).
I n co ntr ast , among high e r in come wo men of all groups the g reatest
111\·1·.:ase ts found among tho~e ove r 33.
A 1972 study r e \·e aled tha t whil e Bla ck wome n compr ise d
J~ ul Lhe patie nL s in federally fund e d family plannin g programs. they compri se d 43~ of th e ster ili La t1,1i1 s .
Fo 1· white wo1n e n t h e re spec tive fi gu res are 5 3~ and 40~ Another study showe d that n o nwl1iLe wom1..• n 1n n o n- p ri\·ate 1·ac i l i t ies are s t e ri l i ze d mor e frequent!)· followin g abo r tion s, at young 1..• 1· ag0s :tnd aftet· l ewe r c h i l dre n than are wi 1i t e wome n o n private medical servic es .I
\lust
of
es
s
cs .
Ly
r1 •ce nl HEW s tatistics r e \·eal that:
l7.8't of white ma rri ed wome n :
lcJ. 7', ot BL1 c k ma r ried wome n :
2D.9'~ ot whit e un marri e d wome n:
:ttl. -11: o f Ul;t ~ k tt nma1· ri c d wom e n
l1a\·~ !iec n s t e r i l i ze d fo r co n tracept i ve and n o n - co ntra ce ptive reas ons as of 1976.
1nd1<:i1tt•d tl1at 21 .7~ u f e \· er - mar1·ied Raza wome n under 45 ha\·e be e n sterilizect. 2
Anot h er s tud y
X~tlj\· ,, .\ml:r 1c ans ha\·t.~ c ha r ged th e U.S . ~o \· er nme nt with ge n oci de 1n the United ~ati ons co nt e ndin g
Lh~ll as many as :!5c-~ o f th e women of ch ildbea rin g age ha \·e b ee n st e r i l i z ed at th e hand s o f th e
tnd 1a 11 ll~ ·attll SP r\· i t' e and it s co 11t1·ac t faci l ities .
l n de rl y in g this prog ram is the dri\·e t o d e feat
th£• resi::;tance to the e xpl o i tatio n o f the va s t mine r al and energy we alth lyin g ben ea th re ser \·ati o n
la nd s by e l 1m111at i ng the people t hemse l\·es .
Pl1~·s l c ia11 al t itudes are a l l - i mportant
i n d e t e rmi11ing h ow sterilization s e r\·ic es will be d e l i\·e r e d
and Lo whum . A SL ud y r epo rt e d i n Fa mily Pla nning Digest showed a distinct bia s among o bs t et ri cia n /
gy necolog isL s to r ecomme nd sterilizati o n more r ea dily Lo their public t han th e ir private patients.
In the same sL udy. 95~ of t he o bsLet r icia n /gy neco logists polled favo r e d compul so ry ste rili z ati on
u f t: 11"cd wome n u 11 public ass i sta11ce witl1 mor e t l1an tw o cl1ildre n, o r tl1 e withd1·awal o f welfa1· e be n e fiLs if th ey refu se d the o µe ra c i o n . Ot h e r st udi es hav e no t e d that such su r ge ry is lu cra ti ve and
is ofte 11 11e 1·J o 1·1ned to ful f i l l trai11ing r e quir· ement s . Sterili z ation is euphemi ze d as ''mini - laµ··.
and ' 'bank-aid" su r ge r y t o hid e i t s se ri o us n at ur e a n d must common s ide e ff ects.
pain and blee din g (33~) a nd r eg r e t (25~ ).
in c r ease d me nstrual
cu n stitne n c ies r es ponded to S tPril ization abus e in a , ·ariety of ways with \·arying d eg re es
SuiLs we r e b 1·ou g l1 t to e l i mi n a t e tl1 e r e maini11g bar1·icrs t o acc e ss. s t1 c l1 ns spousnl
~tJ 11sent. now no l on~e r i1np ose d i n mos t s tat es and most p r oba bly unc o nstitut io11al .
Vi ct im s o f
f\> r ce d ste r i l i~ ati o n ~,1e d fo t· damages, some tim es c lai1ni n g \'iolations o f civil 1·ig l1t s . and for in-
,.\J fl:l' L<.?d
,,r success .
j1 111 c.: L in, reli ef co hal t abusi\·e pt·n c ti ces . To dat e th e re ha,· e bee n few damage award s and fo r ced
s te rj liz aLiun !1as yet co be d eclared a violation of civil rights , but cou 1·ts hav e o rd e r ed g0Y e r111n1 t1tal agencies to p r o mul gate r egula ti o n s co l1alt abu se .
[l1,I t ,· . We inb e r ge r was br o ught o n be half o f two Bla c k, allegedly ,·,•ta rd e d g irls. 12 and 1,1, who
wl• r c ::; t e 1·i lized without t l1ei r k11ow l e d~c o r co n se nt in a F e d e rally fu 11ded program i n Alabama.
Tl1eir
mutht:r, who co u ld n e ith e r r e ad nor wr.it e , s ign e d the conse nt form with a n " X" after clinic work e r s
tu lti llu1· th:..tt she was co n se nting t 'O additional inj ec tion s of De p o -Pro \· e ra. a l o n~ - acti n ~ c ar c ino g0 ni c cu t1Lr3 ce µtj \u.
HEW wa s or d e r e d to put o ut regulutio11s to e n s ur e tl1at t l1e 1 50.000 s t e r i l iza tiu 11ti whi c l1 i t funde d yea rl y wo uld b e c arri e d ou t i n a vo luntar)· ma 11n c r in keeping witl1 s tatut o r>·
1· L• quin.!mt~ nt ::; that Federa l f ami ly plannin g mo nies b e di s bur sed o nl y for v o luntary se r \" i ces .
He n ce .
Lhe r e~ ulaci o ns are a minimum de finiti o n of voluntarin ess. Th e 19 7,! HE\\ reKulati o ns pro vid ed th e
fo l Lowing i n the case of e lecti\· e s t c ri liza ti o n:
A dcscriptio11 of ri s ks, b e n e fits, and alternativ es;
In to n nation o n the pe r ma nenc e o f ste r i l iza tion;
An o ff e r to a n sw~ r q u es t i o n s,
Wr,tLen and o ral notlcc thaL r e fu s al t o be s Le riliz e d would not j eo pardi ze o th e r b e ne fit s:
A 72 hou1· waiting µc r iod b e twee n co 11 se nt and o µ e rati o 11 :
J.lurato ri a o n th e s teri l i za t i o n s o f in compet e nt µ e r so ns a n d th ose und er 21.
Tl!c~sl· rv ~ul at i o n s \ve1·e wi <..l c l y h e ld t o b e .inad e quat e, we r e frequently hon ore d in the b 1· e ach, and \\'E.-' r e
ur u .: 11 unk n ow n Lo p r ov id e r s acco r ding to st udil?S by th e He alth Resea r c h Group, Am e ri c an Ci\·il Lib e rt. ie::;: Un 1_0 11 , a n d O Lh e r s .
In ~ladri.gal \' . Quilli.g-an. brough t b y e l eve n Chi <" anas, some o f wh o m ' ' co n se nt e d" t o ste r i l i zatio n
during L.tlh.J l' , the dt'f e ndant Sta l e He alth Dep artme nt \\'U~ direc t ed to adopt cons e nt f o rm s \\Titt l ' ll by
P l ilJt1L1t f s .
Ori1e 1· cases, e .g . , Cux v. Sta nt o 11. Walk e r v. Pi e r ce . Se r e n a \'. L eeze r, Jol111 so n \'. Ci t~·
u l N.Y. , wl11l c 11 ot so far obtaini n g i· e lief f ur thos e womc 11 f o r c i bly s t e r i l i ze d. l1ave se i·v cd as
~ eduea t iu nal and o rg a ni z ati o nal effo rt s by act ivi. s ts.
Uroad-b:..t.b\'d co :.1lit1ons in NL•W Yo rk City a nd Ca l i for nia so u g h t t o i·eme dy the s h or t com ing s of LIH • r e gu1~1Ltun::; Uy wo rki nµ- l ur o th e r s fa r mo r e s trin ~e nt.
In 1975 th e New Yo rk Ci ty Hea l th and Ho spital~
Cl1rpu ratt ~) n 1mpluncnt e d r egu lat io n s w ri tten by a large n o n - medic:il c i t .i ze n s committ e e in i t s 15
[ac.:1lit1es.
So o n afte r. s. ix professo r s o r obs teLri cs a nd gy neco l ogy c hallen ged the IIHC guidelin es
\\ tth th L• 1r :30 d:.iy w:11ti n g pe ri od, prohibition o n physician cou n belo r s. e x cl u sio n o f the mentally
l11 cun1 11etent. an
l ,,,ns ,iul~L e d Lhe, r Fi r st Amendme nt ri g hts u f fre e sp e e c h , i n terfe r ed with the do c t o r- patie n t
ci•l.1L1on~hiµ. impeded a ccess an d denied e qual p r otec ti o n by t r eati n g sterilization d i f f e r e nt ly than
,ti l o Lh e r m,•d1c al p r ucedures.
The 1974 HEW r eg ulations we re lik e wise ::ittacked. Co nce rn e d groups
:::;o ught :1nd tu.:h1\ •\·ed ~ Latus a.s ctef e ndant-tn te r\' e n o r s .
Plai nt iffs w1thd r e\1r' wi th p r eju di c e after fi\ e
o t tht' :::;iA 1:1.ilt..:d tn :L nsw~r inte rr oga t o r ies put to them b y d e f e ndant - inter\·enors.
f o l l o wing this
ra\·c) r ab l e >U t, ·u111t::!, P.L. 37. e xte nd ing the JJC r e gu l ati o ns to all proced ur es wa s u nani mous ly pa~se d
12 1
Ste rili zat ion - Page Thre e
in 19 77 over t he vocife r o u s obje c tions of physicians , pop ulati o n cont r o l Kro u ps and th e ~Y C
Healt h Depa rtme nt whi ch wa s entrusted with th e law's enfor ceme nt.
Th e 1977 Calif o rni a r e gulatio n s, als o writt e n by laywo me n , p r ohib it e d co n se nt d u rin g ch1l d b1 r th ,
l e n gt he ne d th e waiti ng pe ri o d to fourte e n d ays, but included a wai ver to 72 hou r s. and appJ1cd
Th ey we r e attac k e d in Calif o r nia ~l edica l As soc i ati o n , . La c- kn<'r
some saf eg uards t o h ys t e r ec t om i es .
where physicians co nt e nd e d that th e State He alth De partme nt h ad n o autho rity to i ssu e su c h guid e line s, that th e g uideline s interfered with th e practi ce of me d ici n e, and th e doc t o r - pat, nt r ela tions h ip , that th e y were vag ue, that th ey vio lat e d th e eq ual pro t ec ti o n p r o v isions o f the Four teenth Ame ndme nt of the U . S . Constituion , a nd th at th ey violated th e ri gh t t o p r iva c y o f th ~ ir
g r oups int e rv e ne d o n th e s id e o f the d efe ndant State ll ea lth Depart Ac tivist
female pati e nts.
Th e cou r t found f o r d e fendan t s h o ldin g that do c t o r s h ad no s t andin g t o liti gate the p riment.
va cy i ss ue on b e half of th e ir f em a le patients wher e th e r eco rd docume nt e d nume r ous in sta n ceh of
physi c ians vio l ati n g th e ir patients' ri ght t o bodily aut o nomy (priva c y).
Th ey
After nati o nal h e a ring s, HEW ado pted a final set of r egulatio n s , e ff ec tiv e ~ar c h 8. 1979.
ar e d es ign e d to p r eve nt th e kinds of abuses f o und in Re lf , a s well as ot he r s occur rin R a s a r esu lt
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ul language barri e r s, coe r c i on during labor , e t c ., by r est raining un sc r upulou
pr ese r v in g access to se r vice lur those who freely c hoose s t eril i za ti on . Th ey ve r y c l ose l y l o llow
N\"C's PL 3 7.
Significant provisi o ns ar c as follows:
Co nt i nu at i o n of th e mo r atoria on the imcompe t e nt and th ose und e r 21;
No auth o ri za tion of payme nt f o r th e ste rili za ti on o f in s tit uti onalized per so n s;
Operating physi c ian may co un se l ;
An int e rpr e t e r must b e provide d if th e language of th e co n se nt f o r m is not o n e th e pati e nt
und e r st and s;
No co ns e nt may be elicite d fr om someo n e in labor , c hild bi rth , seeking o r ob taining an ab n rti u n.
o r unde r th e influ e n ce of drugs o r alcohol ;
A thirty da y ma ndat o ry w~iting p e ri o d with e xc e pti o n s for ea rl y d e liv e r y and emergP n cy ab domi nal surg e ry;
Infor mat i on provid e d o rally and in writing about th e pe rman e n ce of s t e rili z ati o n. ri s k b,
b e n ef its, a n d alternatives, and that co nsent ma y be withdrawn at any ti me witho ut J oss o f
benefits; a nd
No r ei mbur seme nt for hyst e r ec tomi es don e for ste riliz a ti o n purpo ses .
The Fede r al r eK ulation s o ft e n v i e we d by t hei r d et ra c tor s a s a mere reimbur seme nt mec hani sm, app l y
o nl y to th ose proce dur es paid f o r by Medicaid, or tho se obta in e d in projec t s fund e d by Publi c
In Ca lif o rnia , wh e r e the s tat e r egulations a r e c urr ent ly unde r g<>i n~ r t·v i s Heal th Servic e gra nt s.
i o n t o come into co nf o rmit y with Federal s tandard s , th e Stat e used it s li ce n si ng auth o rit y tu apply
New Yo rk City's IIII C r egu th e m to all li ce n se d facilities a s we ll as to Stat e -fund e d proce d ures .
lati ons applied o nl y to e l ec tiv e f e mal e pro ce dur ew with i n Co rp o rati o n f a c iliti es . but we r e I nte r
wome n r eg;trdJ ess 11f place\
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PL 37 and 42 U.S.C.A. N300(a) - 8 prov id e a pena l ty f o r ~i o l atio n
perf o rme d o r sou r ce of pa yme nt .
of a Sl,000 fi ne.
Of c ou rs e, if t h ese r eg ul at i o n s and laws are no t ad equa t e l y enfnrced , th ey will ha ve no mo r e pro ~lo nit o rin g e fforts b y wo men's g r oups In California
t ect i ve effec t than any o f the pr ev iou s rul e s.
and x,,w Yo rk City hav e f ound no o n ve r s i g ht in the fir st case and inad eq u ate e ffort s in thr second .
It is no t e~>r thy that no funds were appropriat e d nor c iti ze n participation so ught by th0 Fe de r al
Howeve r, it appear s that f orme r II EW Sec r e gove rnment f o r e nf o r ceme nt o f th e n ew HEW r e gulations .
ta r y Califano did d e n y r ei mbur seme nt for some violative procedures.
On e is that of unn ecessa r y
Th e r e r emai n severa l ot h e r are as whi c h are in ne e d of c l a rifi ca tion.
Hys t e r ec tomy is today th e mos t commo nl y p e rf o rme d op e rati o n in thi s cou ntr y and
h ysterectomi e s.
it ha s bee n es tima te d that as many as 1/3 may not ha ve b ee n do ne for valid medical indi c ation.
An ~t h e r troublesome ar ea i s that of d es igning the prop e r safeguards and s t a nda rd s th a t wo uld
p e r mit th e st e rili z ati o n of minors and imcompetents with o ut allowing a r e p eat of th e g r ossl y a~u s i v, ,
Court s hav e s plit over wh e ther a b sent e n a blinR
s itu a ti o ns o f th e r ece nt and not - so - re ce nt past.
l egis l a ti o n th ey h ave juri s diction to hea r petitions brought by parent s o r guardian s srck in g steriIn an e ffort t o c l a rif y thi s s ituati o n,
lization of their incomp e t e nt and/or minor c hildren .
l eg islatur es hav e looked at att e mpts to e na c t substitute or third party consent statutes with no
r e su lt so far. Th ese bill s u s ually represe nt c aretaker and parental i nt e r ests.
Th e simpl e fa c t that th e Eugenics Laws, whi, :h pr ese ntly give rise t o abo ut 400 coe r ce d steriliza Th e range o f due process prot ec t i,, n s
tions yearly , ar e s till q n the books n ee ds t o b e addressed.
A succes s fu l c ha! l enge
a l l o rd e d b y th ese s tatut es r a ng es from non- ex istent to fairly e labor a t e.
to Co nn eticut's lugenic~ Law o n equal prot ec tion grounds ha s r es ult e d in th e e xt e n s i o n of that
law to a no n-in s titutionalize d group.3 There is growing co nce rn about the l ack o f con s ume r a nd
wcJmc n's input a nd ove rsight in th e developme nt and testing of new s t e ril izatio n mo dalitit cs, wl1ich
Similarly, hea lth planning age nc i es, which
p r e s e ntly rest en tir e l y with the medi cal pr o f essio n.
have th e powe r to mak e services available and to set s tandards, ar c fr e quently pro n e t o e valu ate
1>rojects la r ge l y in t e rms of co nst- e ff cc tiv c ne ss , tu ac ce pt undhall e n ge d provider eslimatrs of
c unsumur nee d , and to pe rmit inad e quat e r e pres e ntation o f s i~nificant con s ume r co ns titu e ncies.
La s tly , th ere co ntinues to b e diffi cu lty in finding attorneys to bring s uit o n behal r o f indig e nt
Eve n a lar~ c
wo me n . Thi s only emphas izes the ne glect e d nee d fora strong pr eve nta tive system.
psyc hic wounds.
mon e tary award c annot r es t o r e Just fertility or hea l
Ste rili z atio n - Page Fo ur
FOOTNOTES
l •·cont ra cep tiv e Utili z atio n Amo ng Current l y Harried Women 15-44 Years of Age : United States','
l 9 73. Mo nthly Vital S tati s ti cs Re po rt, Nat i o n al Su rv ey of Family Growth Data, DHSW, 1976;
Fo rd , Kathl ee n, "Co ntra ce ptive Use in th e Unit e d States, 1973-1976," Family Planning Pers pec ti ves~ Vol. 10 , No. 5 (S e pt./Oc t. 1978);
l-
Lcwit, Sa r ah, "S t e rili z ati o n Assoc iated With Indu ce d Abortion :
Pla nnin b Pe r s p ec ti ves, 5 (3), Summe r, 19 73 ;
JPSA Findings ," Family
Spar e r . Vau g h a n , ''Ethni c Group and We lfar e Stature of Wome n Sterilized in Federally Funded
Family Pla nnin g P r og ra ms, 1972 " Fa mily Pl a nnin g Pe r spectives , 6 (4). Fall 1974.
Jt
w
2 Ad van ce d Data , U.S.D . HEW, Public He alth Service, #36, 8/18/78;
Ad van ce d Data, U.S.D. HEW, Publi c Health Se rv ice, #40 9/22/78;
Pratt , Wil liam , " Sterilization in th e U. S. : Pr elimi nary Findings From the National
S ur vey of Fami ly Growt h : 1973'' , Pap e r prese nted at annual meeting of the Population Association
o f Ameri c a, Ap r i l 19 7 5.
3 Ru by v. hla ssey , Cir c uit Co urt'.1 9 76 , 315 (D. Com . 5/16/78).
io n,
STDHLIZATION BIBLIOGRAPl!"f
ly
ce
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C'ox ,· . S t•ntnn. 52<) F.2d 47 (Hh Cir. 1975)
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(1978)
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Helf v. •einberger, 172 F,Supp. 11Q6 (D.D.C. IQ74), on re-nd, ~01 F. Supp. 12J5 (D.D.C. 1975), appeal di ■ •
miese • •• moot. 565 F.2d 7 ~~ (D.D.C 1'177)
Civ 11-76-115 (D.Conn. , Hay 16, 197R)
Huhv v.
)
So r en■ v . Leozer, Civ , 74 -111 (li.D.Penn.
Stump v, ~oorknaan, 9R S. Ct . 1099 (1978)
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Vo e v, Califano, 414 F. Supp, 105R (D.Conn. 1977)
Wade v. Hetheoda lloopit•I, 157 F. Supp. 671 (D.Ohio, 1971)
Wslker v. Pi•r•e, 560 F. 2d 609 (4th C'ir. 1977)
Wyott v, Aderholt, 16R F. Supp. 11RJ (H.D. Ala. 1974)
~••••Y•
P,l~l'II L~TS A1'D ~n;on:s
Hodri,z:ue7.-Triss, Helen, H.D., "St.erili7.ation Ahu,.e," The Wnfflf'n'• f•nter Rt>id Lectureahip. N"'· York, Bernard
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A'1 llnf' '.·,uaen's S tudies Committee A«ainst S terili7at i nn Ahu ■ e, "'nrkhnnk on St.•rili7ation and St•rj)i7af.ion
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fnmmittf"e for Ahortion Hi1rht,a anci A1;z:,d.nst Ste rilization Abuse, \ri'nafln Undf'r AtUck: Abortion St•r ' lizatiftn
P.O.Bn1 12,, N.Y. 1002'J
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Nationft l La"'yer'e Guild. He rorluc-tive Frpedom: S Pa.ken,' llanrlhonk on Ahnrtion ■ nd Sterili7ation Abu ■ t'.
1"51 D'.,.av, l(.Y. 10001
New York. 19 79
Am.-ric-ftn Civil Libertif"ll L'ninn . Hrprnductive t·r.-erlnm On~k.-t11, 197~, 1Q77, 1q79.
Public Ci tizen ' s Health lieafle11rch Group, Study nn Su rgi<'ftl Stf"riliz11tinn; rr•••nt. Ahuef'a and Prorn ■ ,.tl ,-.,,.
ul11tion8. 1,l11ahingto11 1 Jl.C., tQ71.
St•rilizatinn \idthnut fnn11ent: T .. 1rhin1 Hn1pital Violation• of lltll l•galation ■•
liash•n~ton, D. C.• 19 7 ,.
S t.-rilizat1nn llt>port Su ■ hf"r 1: fn ntinuinc Vinlatinna nr ferl•r•l Sterili7 ■ tinn
GuidrlinPft hv Tr&rh ing lln~pitAI~ i n IQ]O . ~11ehin•tnn, 0.C •• 1Q7Q.
Srv York f 1 t~ IIPR Ith anrl llnsri ta l II rnrpora t 1 on, Annuft I Audit H•pnrt.• nn fnarl ianrfl' -,j th St•ri I i•tiH G.itle1 i neo in Corporation F•dlit.i••• 1'176. 1'177, 1'17!1. (12'5 li•rtb St, Ila. 4211, li.Y.
10011)
fn1m11itlf'P tn f.nd S t40r i IJ7 ation ,\bu&f', Local Monitnrina Prn,i•c-t. ff40pnrt nn fn•pli ■ nc-e -.ith PL i7. May, 1q7tJ
(P . O.Ro x A244, l(.Y. 1001)
123
STATUTE.s A\ D Hf.GlL\TIU\S
,.2 LS.C. I! 3oo(a) - 5. wn(e) -R
42 l.s.c. II h02(a)(t5)
42 LS.C. ~ 70R(a)
,. 2 u.s .c. B \,0 7 .!.!. ll.4·
,.2 c . S.C . IJ tQ fl,
,. 2 LS . C. ~ 19R5
42 t;.S . C. @ 1QR6
'•2 f .f .}I. ~n.'.'nt-'ir.'.'tfl
4'i C. ~.I<. '.'0 'i . "\5
~f'w York r, ,). r.1.. "17 nf 1Q77
fR l. Arlmin. fnde 8 'i t 16, !:.!. !!!!!·
Ca I. Artmin. r nrlf'
700")7.1 s.!. .!!!l·
s
ROOKS
ChAse. Allen.
The Legacv of HA1th,1e; the Socjel ("n@ts of thP ~ew SriPnti fir Hari~m. Sew York, Knopf, JQ77.
GnrrJn n, Linria. \,o:uan '.! Rnrlv 1 \i\·nmAn ' s Hight; A S ncinl
1q 77 _
Littlewood, Thome~.
Mees, Bonnie .
Meek.
n.. ed.
llietnrv nf Hirth fnntrnl
in Am.-rice. Se\i/ York, GrneAmAn,
The PnliticA of Popu leti"n Contro l. Sot.re DamP, lnrl . t: niv. of \"otre DamP Press, 1g77.
Populetinn TRrget; Tht> Political Ecnnnmv of Populnt i nn Con tr ol in LAtin AmPrica. Toronto,
The i.-·omeo'e Press, 1977.
Ma rx and Engels on thf" Population Homh.
BPrkrlPy,
r" .. HampRrte PrPs~, 1<)71.
President's Committee o n MPntal l?etnrrlation. l(epn rt t.n thP l'rP~irlPnt, HPntnl llPAtrrlntinn: Century of n~ciAinn.
~n~hin2ton, 1).C., ~ . S. GovPrnmPnt Print.in~ OffirP, Mnrrh, 1q7h.
llobitscher, J.
FugPnic S t.PrilizAtinn.
Sprint"fiPlrl, 111. , fh1'r}p,- f . Thnmnp;, lQT'i .
S eeman, IL nnd Seeman, G. • M.D. "-'omen and the frisi~ in S ex HormnnPl'I. SPw York, HtH,·eon AsenciatPs . 1Q77.
for ft more cnmplpte hihlin~rRphy, plPn~e rontact. thP wnrk~hnp cnorrlin~tnr.
