Iris Lopez, "Sterilization and the Ethics of Reproductive Technology: An Integral Approach"
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Conclusion

An integral model of reproductive freedom challenges and expands common thinking about reproductive technology. Sterilization is neither good nor bad; its outcome depends on how it is used. For example, the integral model of reproductive freedom and social justice shows that although most Puerto Rican women make decisions and are not victims of sterilization abuse in the classic sense, this does not mean that they are or were not oppressed, or that they are exercising full reproductive freedom. High rates of sterilization are driven by the marginalized and impoverished social conditions of Puerto Ricans on the island and in the United States. The circular migration of Puerto Ricans to and from the United States, the unofficial population policy that promoted sterilization, and the impoverished social conditions in both places reflect their dependent position in a transnational global economy based on colonialism and inequality.[24] Yet an integral model of reproductive freedom and social justice shows that even though poor women are targets of population control they do not follow population policy blindly; most women exercise a certain degree of agency.

Undoubtedly, sterilization was unethically implemented in Puerto Rico as a form of population control to ameliorate a problem that was created not by overpopulation but by Puerto Rico's dependence on the United States.[25] However, an examination of the personal, cultural, and social realms shows how Puerto Rican women themselves use sterilization to cope with poverty, lack of access to quality health care, and experiences with sexism, and to negotiate their own reproduction. An integral analysis elucidates how the State's goal to lower the rate of population growth intersected with Puerto Rican women's needs to control their fertility, thus increasing the rate of sterilization among Puerto Rican women on the island and in the United States.

In summary, Puerto Rican women make reproductive decisions; however, choosing between sterilization and continuing to have children under adverse conditions, or getting sterilized as a last resort after having more children than they desire, does not constitute full reproductive freedom. What's more, although all women's reproductive choices are constrained, poor women's reproductive freedom is even more limited because of their poverty and lack of access to quality health care, which limits their knowledge about contraceptives and reinforces their misinformation about the permanent nature of tubal ligation. My study shows that low-income Puerto Rican women do not have complete access to the full range of birth control methods on the market today and available to other women. This reproductive disparity is an ethical issue.

An integral model of reproductive freedom and social justice also builds in a notion of optimal reproductive freedom as an ethical goal. Reproductive freedom consists of the personal/gender consciousness and political capability to decide if, when, how, and with whom a person may want to have children, free of coercion or violence. It also entails having social conditions that enable an individual to have children, for example having: viable birth control options, quality health care, prenatal care, and childcare, the right to a legal abortion, and a support system that allows women and men to raise children in a healthy environment.

As long as sterilization continues to be used as population control in the Third World, justified by representations of Puerto Rican and other poor racialized women in the U.S. as burdens on the State, and as long as these women do not have access to adequate living conditions and access to quality health care services, Puerto Rican women and other poor, marginalized women will not exercise true reproductive freedom. But this breach of freedom cannot be ethically answered by painting Puerto Rican or other women as mere victims or dupes of racist, classist, sexist, and colonialist policies. Solidarity and change requires that we see—and help others to see—how women have resisted, too, and have found some space to exert their own will as they make their way and build their families under oppressive circumstances.

Podcast

Listen using the player above or visit BCRW on iTunes to download or subscribe to BCRW's podcasts.

Global Dimensions of ART - Podcast Description
Iris Lopez introduces and moderates this panel discussion on "Global Dimensions" of ART practices which features speakers Dana-Ain Davis, Laura Briggs and Claudia Castañeda. Increased demand for assisted reproductive technology (ART) and transnational adoption has been propelled by a number of factors, including the development of new technologies and changes in familial form - such as childrearing in second or third marriages; lesbian, gay, and transgendered families; and delays in childbearing and subsequent difficulties in conception - that make ART helpful. Other relevant factors include environmental changes that have negatively affected fertility levels, new levels of transnational migration and interaction that have fueled awareness of babies available for and in need of adoption, and concerns about genetic diseases and disabilities. Effectively, the various imperatives and the desires, both cultural and personal, that the use of ART fosters and responds to, have created a "baby business" that is largely unregulated and that raises a number of important social and ethical questions. Do these new technologies place women and children at risk? How should we respond ethically to the ability of these technologies to test for genetic illnesses? And how can we ensure that marginalized individuals, for example, people with disabilities, women of color, and low-income women, have equal access to these new technologies and adoption practices? And, similarly, how do we ensure that transnational surrogacy and adoption practices are not exploitative? These questions and many others on the global social, economic and political repercussions of these new forms of reproduction were the focus of this year's Scholar and Feminist Conference, "The Politics of Reproduction: New Technologies of Life," which took place on February 28, 2009 at Barnard College.

Endnotes

1. D. Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Pantheon Books, 1997). [Return to text]

2. I. Lopez, Matters of Choice: Puerto Rican Women's Struggle for Reproductive Freedom (New Brunswick: NJ: Rutgers University Press, 2008); L. Mullings, "Resistance and Resilience: The Sojourner Syndrome and the Social Context of Reproduction in Central Harlem," in Gender, Race, Class, and Health: Intersectional Approaches, Amy J. Schulz and Leith Mullings, eds. (San Francisco, CA: Jossey-Bass, 2008): 345-370; and Roberts, 1997. [Return to text]

3. R.P. Petchesky, Global Prescriptions: Gendering Health and Human Rights (New York: Zed Books, 2003). R. Petchesky and K. Judd, eds, Negotiating Reproductive Rights: Women's Perspectives Across Countries and Cultures (London and New York: Zed Books, 1998). [Return to text]

4. Lopez, 2008; I. Lopez (1983), "Extended Views: Social Coercion and Sterilization Among Puerto Rican Women," in Sage Relations 8 (3): 27-40. I. Lopez (1998), "An Ethnography of the Medicalization of Puerto Rican Women's Reproduction," in Pragmatic Women and Body Politics, ed. M. Lock and P.A. Kaufert, 240-259 (Cambridge, UK: Cambridge University Press). I. Lopez (1993), "Agency and Constraint: Sterilization and Reproductive Freedom Among Puerto Rican Women in New York City," in Urban Anthropology and Studies of Cultural Systems 22 (3-4): 299-343. [Return to text]

5. H.B. Presser, H.B, Sterilization and Fertility Decline in Puerto Rico (Westport, CT: Greenwood Press, 1973); and J.M. Stycos, R. Hill, and K. Back, The Family and Population Control: A Puerto Rican Experiment in Social Change (Chapel Hill: University of North Carolina Press, 1959). [Return to text]

6. B. Mass, "Emigration and Sterilization in Puerto Rico in Population Target: The Political Economy of Population in Latin America," Toronto: Latin American Working Group, 1976: 66-95; and CESA, "Workshop on Sterilization Abuse," Bronxville, NY: Sarah Lawrence College, 1976; and A.M. García, 1982. La Operación. Directed and produced by Ana María García with Latin America Film Project. New York: Cinema Guild [Return to text]

7. Lopez, 2008. [Return to text]

8. A. Chandra, "Surgical Sterilization in the U.S.: Prevalence and Characteristics, 1965-95," Department of Health: Vital Statistics 23.20 (1998): 1-33. [Return to text]

9. L. Briggs, Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico (Berkeley: University of California Press, 2002); and García, 1982. [Return to text]

10. I included a small control group of 32 non-sterilized women in order to explore their perceptions of tubal ligation. Of the sterilized women 78 had tubal ligations, 11 only had hysterectomies, and 7 had a combination of tubal ligations and hysterectomies. After spending approximately two months in the field doing participant observation, I developed an in-depth questionnaire that contained 150 open-ended and closed questions. I divided the questionnaire into four sections, which helped me to ask women specific questions about their particular fertility experiences. [Return to text]

11. Lopez, 2008. [Return to text]

12. Ibid. Colon-Warren, A., and E.P. Larrinaga, eds. Silencios, Presencias, y Debates Sobre El Aborto en Puerto Rico y el Caribe Hispaño (San Juan: Universidad de Puerto Rico, 2001). Cólon Alice, Ana Luisa Dávila, Maria Dolores, Fernós, y Esther Vicente. Póliticas, Visiones Y Voces En Torno Al Aborto en Puerto Rico (San Juan: Universidad de Puerto Rico, Centro de Investigaciones Sociales, 1999). Crespo-Kebler, E. "Ciudadanía y nación: Debates sobre los derechos reproductivos en Puerto Rico," Revista de Ciencias Sociales 10: 57-84 (2001). [Return to text]

13. J.L. Vasquez-Calzada and Z. Morales del Valle, La Esterilización Feminina y su Efectividad Demográfica: El de Puerto Rico (Escuela de Salud Pública, Recinto de Ciencias Medícas, San Juan: Universidad de Puerto Rico, 1981); and J.L. Vasquez-Calzada and J. Carnivalli, 1982. El uso de métodos anticonceptivos en Puerto Rico: Tendencias recientes. Centro de Investigaciones Demograficás Escuela de Salud Pública, Recinto de Ciencias Médicas, Monografia número III. San Juan: Universidad de Puerto Rico. [Return to text]

14. Lopez, 2008, and García, 1982. [Return to text]

15. A. Arellano and C. Seipp, Colonialism, Catholicism, and Contraception: A History of Birth Control in Puerto Rico (Raleigh, NC: The University of North Carolina Press, 1983). J. Schoen, "Taking Foam Powder and Jellies to the Natives: Family Planning Goes Abroad," in Choice and Coercion: Birth control, Sterilization, and Abortion in Public Health and Welfare (Raleigh, NC: The University of North Carolina Press, 2005). [Return to text]

16. Lopez, 2008. [Return to text]

17. Briggs, 2002. [Return to text]

18. See: F. Laraque, G. Graham, and E. and K. Roussillon, "Sterilization in New York City 1995," New York: Bureau of Maternity Services, New York City Department of Health, 1995. Also, the rate of sterilization for Hispanic women may be higher than 50% because they were counted in both the black and white categories. Because Puerto Rican women still constitute a large number of Hispanics in New York City and have such a long history of sterilization, it is reasonable to assume that a large percentage of these sterilized women are Puerto Rican. [Return to text]

19. Lopez, 2008. [Return to text]

20. S. L. Schensul, M. Borrero, V. Barrera, J. Backstrand and P. Guarnaccia, "A Model of Fertility Control in a Puerto Rican Community," in Urban Anthropology 11.1: 81-99. [Return to text]

21. To read the stories of these women in their own voices please see Lopez, 2008. [Return to text]

22. I. Lopez, 1983. "Extended Views: Social Coercion and Sterilization Among Puerto Rican Women," in Sage Relations 8 (3): 27-40. I. Lopez, 1998. "An Ethnography of the Medicalization of Puerto Rican Women's Reproduction," in Pragmatic Women and Body Politics, M. Lock and P.A. Kaufert, eds., 240-259. Cambridge, UK: Cambridge University Press. I. Lopez, 1993. "Agency and Constraint: Sterilization and Reproductive Freedom Among Puerto Rican Women in New York City," in Urban Anthropology and Studies of Cultural Systems 22 (3-4): 299-343. [Return to text]

23. J. Carlson and G. Vickers, 1982. "Voluntary Sterilization and Informed Consent: Are Guidelines Needed?" Manuscript available from United Methodist Church, 475 Riverside Drive, New York, NY 10115. [Return to text]

24. Lopez, 2008. [Return to text]

25. For a detailed analysis, see Lopez, 2008. [Return to text]

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