Sterilization, Involuntary

Sterilization refers to the permanent interference of the ability of an individual to reproduce, most often through surgical methods. Sterilization is considered involuntary when an individual is either unable to provide consent, has been denied the opportunity to provide consent, or has been deceived or coerced into providing consent. Many countries throughout the world have a history of forced or involuntary sterilization programs. Currently, mentally retarded individuals continue to be legally sterilized without consent.

Modern methods for female sterilization include tubal ligation, hysteroscopic sterilization and hysterectomy. Both tubal ligation and hysteroscopic sterilization methods entail closing off the fallopian tubes to prevent eggs from traveling to the uterus. Though considered permanent sterilization, in some cases, the procedures can be reversed. Hysterectomy refers to the surgical removal of the uterus. It is irreversible and, generally, not used for contraceptive purposes.

For much of the 20th century, interest in involuntary sterilization was for eugenic purposes. Eugenicists believed that physical disabilities, mental defects and social ills such as poverty, promiscuity, criminality, and drug or alcohol abuse were hereditary. Those [Page 1402]with these genetic predispositions were believed unfit to reproduce, and sterilization was touted as a means to humanely eliminate social problems from society. Involuntary sterilization was argued to benefit society as a whole by reducing the economic and social drain caused by undesirable populations.

By the 1930s, eugenics programs were adopted by as many as 30 U.S. states and by countries around the world, including Canada, Sweden, the United Kingdom, Germany, and China. Evidence reveals that, most often, victims of these sterilization programs were poor and women from minority groups. After World War II brought attention to the eugenics practices of Nazi Germany, public support for forced sterilization programs waned. With the exception of China, most countries abandoned wide-scale sterilization programs by the 1970s.

Despite abandonment of formal programs, practices of involuntary sterilization continue. Recent reports highlight the forced sterilization of poor and indigenous women in Peru and Brazil in the late 1990s as well as Roma women in the Czech Republic and human immunodeficiency virus (HIV)-positive women in Namibia.

Much of the concern surrounding involuntary sterilization today focuses on issues of “informed consent.” Generally, there are three requirements for informed consent: the decision for sterilization must be voluntary, the decision for the procedure must be made by a woman who is intellectually competent, and it must be made with complete knowledge and understanding of the facts, including alternative options.

China's one-child policy forbids couples from having more than one child. In 2002, China outlawed the use of physical force to make a woman submit to an abortion or sterilization, but it is not strictly enforced.

Determining if consent is voluntary or coerced is complicated. In some cases, coercion may be blatant (e.g., a physician refusing to deliver a baby or perform an abortion unless the woman consents to sterilization). In other cases, coercion may be more subtle. There is evidence to suggest that healthcare providers [Page 1403]vary the kinds and amount of information they provide, as well as the quality of services offered, based on the social characteristics (e.g., race, class, age, type of insurance, etc.) of their patients. Qualitatively different interactions between healthcare providers and patients may explain why, in the United States, for example, African American women and women with public or no health insurance are more likely to undergo sterilization than white women or women with private insurance.

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