Sterilization and the Ethics of Reproductive Technology: An Integral Approach

A Case Study: The Robles Family

The Robles family provides a good example of a family in which the women’s sterilization experiences range from agency to abuse. Doña Rosario is the matriarch of the Robles family. She grew up in an agricultural society where it was the norm for peasants to have large families. Her family was so poor there were times when she could barely feed her children. In doña Rosario’s era, temporary methods of birth control were not readily available. Therefore, she was sterilized after she had ten children, a larger family than she desired. Doña Rosario was sterilized in Puerto Rico before she migrated to New York City. She waited until her husband migrated so that she could get sterilized without his knowledge. This occurred in the context of an unethical practice that took place in Puerto Rico during the election period for the mayor of a small town: women would exchange a vote for free tubal ligation.

Carmen, doña Rosario’s eldest daughter, wanted to have her tubes “cut” in New York but because her English was limited she told the doctor she wanted an operation so that she would not have any more children. Instead of performing a tubal ligation the doctor removed her uterus. Carmen was outraged that the doctor would perform an unnecessary hysterectomy on her and felt violated. According to Carmen she never fully recovered from the trauma. Ironically, Carmen actively sought to be surgically sterilized, but since she was given unnecessarily invasive surgery she ended up being a classic victim of sterilization abuse.

Doña Rosario’s youngest daughter, Nancy, dropped out of high school at 17 when she became accidentally pregnant. Her ideal family size was three but she had four children because her third pregnancy resulted in twins. Nancy was unhappy in her marriage. She worked around the clock and her husband did not help her with the children or housework since he felt that was her responsibility. Nancy was sterilized because of economic reasons but also as a way to resist her sexist husband and gain some control over her life.

Sonia, Carmen’s daughter and doña Rosario’s granddaughter, graduated from high school and wanted to do other things in life in addition to raising children. Sonia only wanted one child. When we met she was pregnant with her second. Her grandmother warned her to get sterilized before “se llenará de hijos,” which literally translates as “being filled with children.” The implication of this parable is that Sonia would ruin her life if she continued to have so many children. After she gave birth in the hospital, Sonia decided to get sterilized there because she felt it was the only way she could gain control of her life. However, she delayed getting sterilized because her son was born prematurely and she wanted to make sure he was safe and healthy before she had her tubes “cut.” Despite her decision to wait to get sterilized, after she gave birth Sonia claimed that numerous nurses and doctors stopped by her room to ask her if she wanted a tubal ligation.

With the exception of Carmen, all the women in the Robles family exemplify how women exert agency within constraints. Even though Nancy and Sonia were aware of temporary methods of birth control, neither of them was well-educated about them. In Sonia’s case her second unplanned pregnancy precipitated her decision to get sterilized. Even Carmen, who was a victim of sterilization abuse, wanted to have la operación ever since she had her second child but her husband was against it until she had her sixth.

The Robles women and their families lived below the poverty level in New York and worked hard to improve their lives. They discussed and recommended sterilization to one another. For example, doña Rosario encouraged her daughters and granddaughter to get sterilized because she felt if they were not careful they would end up having more children than they desired. The Robles women had a keen sense of gender consciousness and they resisted women’s gender subordination. Their stories show the powerful influence culture and social conditions played in shaping and limiting their fertility decisions. ¹

The Robles family reveals how important it is to use an integral model of reproductive freedom and social justice because it provides us with a broader scope to see the myriad forces that influence and limit Puerto Rican women’s fertility experiences. In the case of the Robles family, their reproductive experiences ranged from agency within constraints to sterilization abuse. Their stories are similar to those of the many women I interviewed, leading me to conclude that Puerto Rican women make the best fertility decisions they can within the parameters of their difficult lives.

Beyond Victimization and Toward an Integral Approach

I am always struck by the continued high level of misinformation among Puerto Ricans, Dominicans, and other Latinos on this important topic. These misconceptions are reflected in the attitudes of the women in my study ² as well as among white, black, and Latina populations citywide. ³ I also see these misconceptions among the students I teach at City College/CUNY. When I teach about sterilization, at the beginning of my lecture I ask my students to raise their hands if they believe that a woman can still have children after she has been sterilized. In my predominantly Latino class of thirty to thirty-five students, almost all but one or two raise their hands.

To avoid making the sterilized students in my class feel like victims, I prepare them with a more nuanced analysis. I distinguish between victims of sterilization abuse and women who are proactive in their fertility decisions (i.e., those who make the best fertility decisions they can under difficult conditions). I educate my students from an integral perspective (e.g. personal, cultural, social, and historical) and show them Ana María García’s popular film, La Operación, to discuss its strengths and weaknesses. The strength of this film is García’s powerful rendition of the history of sterilization in Puerto Rico and her presentation of Puerto Rican women’s stories. But because none of the women in her film clearly states that she was sterilized because she wanted fewer children, this lends itself to a pronatalist interpretation, that it is natural and good for all women to have children. The only exception is an older Puerto Rican woman who excitedly inquires in the street about how she can get sterilized when she finds out that other woman in her town have had la operación [see Excerpt 5 from La Operación in this issue]. Based on my research among Puerto Rican women in New York City, this woman’s experience is more representative of the majority of sterilized Puerto Rican women.

García represents most Puerto Rican women as victims of sterilization abuse. Even though one woman in the film explicitly states that no one forced her to get sterilized, all these women are cast as helpless victims. When my students watch this film they walk away in a rage, or, if they are sterilized, feeling like victims themselves. Consider this example in the film where García might have shown the nuances of women’s sterilization experiences: a young woman holds up two plastic tubes in her hands; she tells the audience that the doctor inserted these tubes in her uterus, that she had a tubal pregnancy, and that everything exploded and fell apart. What this young woman does not share with the audience is that she had an operation to try to reverse sterilization. We learn about this from her distraught mother or grandmother, an older woman to whom the director pans; she starts to cry and says that she does not understand why (her daughter or granddaughter) had to have another operation since she already has children. She ends by saying that the young woman could have died from this operation. It is clear from the older woman’s statement that she disapproves of this young woman’s decision to have a reversal operation.

A film with an integral perspective would have shown the role the young woman herself played in having this reversal operation rather than portraying her solely as a victim. It is quite possible for example that she wanted to have another child to solidify her relationship with the father of the child, a common reason among women who sought a reversal operation, something I found often in my study. A film with an integral perspective also would have translated the mother or grandmother’s disapproval of her decision. My point is that an integral perspective enables us to see the co-existence of agency and constraints and does not reduce anyone to a helpless victim. It also recognizes that just because Puerto Rican women make decisions about their own fertility, that does not mean they are exercising complete reproductive freedom.

1. To read the stories of these women in their own voices please see Lopez, 2008.[↑]
2. 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. [↑]
3. 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.[↑]