Iris Lopez: [unclear] essentially [unclear] [unclear] [unclear] [unclear]. Hi. Did you get lost getting up here? [unclear] [oh] [unclear]. I'm going to start now. So as to not waste anymore time and just to begin by telling you that as you know I will be discussing the issue of sterilization and Puerto Rican women. In New York City as well as in Puerto Rico, and I think that in order to understand sterilization, we have to be able to understand population control. And that's what this conference is about, population control. And different [people] here have taken different focuses. And one of the things that I think is important and I would like to start the talk with is the relationship between sterilization and population control or the issue of overpopulation and it's necessary in a sense that when I get into the kind of a preview of an overview of the history of Puerto Rico, the issue of overpopulation comes up and in order to know why it comes up at the time that it does within the context of Puerto Rican history, how it develops and how the arguments used and why they are even used to begin with and [you have] populations grow, how they decline and so I'm just going to begin with a brief introduction into that and then move on to the issue of sterilization, the history of sterilization on the island and then bring sterilization back to New York City and talk about Puerto Rican women and other woman who are getting sterilized and what's happening in that area. 


Now one of the classical argument that have been used to justify sterilization is the [unclear] argument of overpopulation and Thomas Malthus is a very important person in history how this argument because he said that people outpaced resources and they outpace jobs, essentially people [with] poverty and the only solution to that is to control to control population growth, you have to stop people from reproducing so quickly and the kind of people that he was talking about were [really] low-income people in England right before the Industrial Revolution in the United States. His argument is related to Social Darwinism and the whole concept of natural selection or survival of the fittest and to go even a little further the whole idea of the superior race in the United States and this is all been used as part of the Eugenics movement which developed in the United States during the thirties, I'm going to pay [you] to this and give you very specific examples as I talk, I wanted to introduce this to you first so that when I bring it up you'll know why I'm incorporating into the argument. 

Okay now I think that the most important thing to keep in mind when talking about overpopulation and population growth is that population growth does not exist in a vacuum, people are born into a specific society with a specific mode of production and by the mode of production I mean the way production is organized, what people do, where they work, what choices they have, the kind of work they let their mom do, even the money that they make, if they work just for [necessary] labor or if they are actually working for surface labor for profit for the industry of the living room now if you can understand population growth you have to understand its internal dynamics in relationship to a specific context historical context in [unclear] production and there's another very important point and that is that their qualitative differences in population movement for migration and population growth depending upon the stage mode of production that it's given society has is in so that it were told me about capitalism which I need to discuss them today as I discussed the history of Puerto Rico and the United States briefly at least in relationship to Puerto Rico then we have to understand that population grows at a certain rhythm within a certain time in history depending upon the way the production is being organized, what people are doing and that capitalism goes through different phases. You have intensive capitalism, you have phases where everything is mechanized and/or automated in people you need less people to work and you have more production.

Now as I just said depending upon the evolution of the system it may be argued that overpopulation may exist in one area of the country and not in another. A specific example of that is Puerto Rico during between 1899 and 1910 when sugar was the main crop on the island that was being exported. There were people that argued that there was overpopulation in certain areas and not in others. There was overpopulation in areas where people were working in the sugar field but there was overpopulation in the center of the island where coffee was food perhaps and so that when we talk about overpopulation people tend to talk about it in very general terms overpopulation of a country, and this is universal. I'm talking about theory that's used to justify processes like migration, like sterilization, black population control etcetera and what I'm saying is that population growth changes historically and it doesn't happen at random but it happens in relationship to the type of context that people find themselves in, to the kind of work that they're doing, to the kind of system that they live in etcetera.

Okay now just one example of this to demonstrate the relationship between population growth and social production. I'll be citing a couple of statistics of population growth {in a sector} of the sector of the Puerto Rican population which lived in the largest sugar mill on the island between 1899 and 1910 and I'm going to read this, this is a quote, "Between 1899 and 1910, the population on this side of Boneca", Boneca is the name of the sugar mill, "increased 121.4% as compared to an increase of 17.3% of the entire country", which simply means the population is growing a lot faster in this particular geographical area than in the rest of the island. More generally, 17 major sugar areas grew for an average of 45.4% as compared to a 4.2 decline in population in the main centers of coffee cultivation. 

Now, as many of you already know, Puerto Rico has the highest rate of sterilization in the world and if you examine the statistics of the Department of Health [here], you'll find that it's Hispanics who had the highest rate of sterilization in New York City and in order to understand why this has occurred, I think we have to approach the topic from a couple of different level. And I feel at this point that the most important ones in order to understand the nearest factors are the national level, the types of things that have historically in Puerto Rico, the relationship of Puerto Rico to the United States, policy, how policies developed. And the second level is the individual level, the actual woman, the kinds of decisions that she makes and why she makes them. The broader context in which she makes that decision which is her socioeconomic status or her lifestyle, the income whether she's employed or her husband's employed, the number of children that she has. All those things have to be taken into consideration and understanding what women have to say on an individual level but individuals make groups and groups make populations and I think that if something's happening to a particular group at a specific time in history that it takes on a water level, a more international flavor and you have to understand something like why Puerto Rico has the highest rate of sterilization in the world. 

I think on both levels but particularly on a national level where policy is made because I'm talking about surgical sterilization, not voluntary, not natural sterilization in order for a woman to get the operation, she has to go to the hospital. She has to go through certain procedures and there has to be doctors who are trained to perform this operation. So a woman cannot perform sterilization on another woman even if she wishes to do so. 

Now in order to understand and I think this is one thing is connected to the other and we just have to keep following it, adding to its most logical conclusion. Why Puerto Rican women or Spanish women have the highest rate of sterilization in New York City, we need to take a historical approach to this, we have to understand the development of sterilization on the island and what I'm going to do right now is give you a very brief overview of the highlights of the changes in Puerto Rican history in relationship to sterilization and {I'm doing it in} I'm relating these two things because as I said previously, the mode of production or the way they were organized is intimately connected with population growth. Okay and population growth at one point or another turns into overpopulation or does it? I mean that's the question that I'm asking, is there a such thing as overpopulation and can we talk about it in very general terms? Okay, now maybe before I go on, just pause very briefly and if there any questions at this point. Mhm 

Speaker 2: I just want to be clear [unclear], are you saying that sterilization [unclear]? 

Iris Lopez: That's what I'm looking into, I'm doing my dissertation on this right now collecting the data and that's really what I think is so controversial about sterilization, is it voluntary or is it coercive and that's really the focus of my research. And I'm going to talk about that later but in order before we get into the whole issue of is sterilization voluntary or coercive, we have to know something about what sterilization is and how it developed and how it developed in Puerto Rico specifically in 1937 and how it grew there and then how it was exported to other parts of the world. 

Speaker 2: Yeah this is a basic [ethnological] question, do you know in your data from New York City do you know is there any way to filter out Puerto Rican [Americans] [unclear]?

Iris Lopez: No there really isn't. I've looked at the statistics that the Department of Health has and they have three broad categories: white, Black, and Hispanic, and you don't really know from those statistics who's white, who's black, and who's hispanic because that's very arbitrary I think that the person who is marking off the group is doing it just typically, the way the person looks or what their ideas of what the person, a hispanics should look like or what their ideas of what a Black should look like or what a white should look like for that matter and so that there's nowhere really separating who's who there and that's why I say that we do know that it's Hispanics women who has the highest rate of sterilization in New York City and I'm assuming that because Puerto Rican women have the longest history of sterilization, that is is predominantly Puerto Rican women who are sterilized, although many other ethnic groups are sterilized as well. That whole yeah [unclear] and [unclear]. 

Speaker 3: Yeah I was wondering if we're going to be able to [unclear] in your dissertation, talking about [unclear] [unclear] or it's almost as common [unclear]? 

Iris Lopez: Okay it's common but I don't think it's it's probably it's similar in some ways and different in others and maybe towards the end, if you're interested what we can do is talk about the methodology and how you go about doing a study like this, etcetera. And or if there aren't any other questions at this moment just on that I'm going to start with the history of Puerto Rico and how this developed on the island. Okay, I'll begin with 1898 because that is the time period when Puerto Rico became a colony of the United States. Prior to that, Puerto Rico had been a colony of Spain for 400 years but it was really in 1998 that the economy of Puerto Rico which was characterized by a subsistence economy, self-sufficient. [People who owned land], they could grow their own food; they were self-sufficient and began to change so in 1898, the motor production was a subsistence economy. That's the way that labor was organized, that's the way that people organize themselves which leads to a whole series of things of social interactions etcetera. All the way into the cultural realm. During the 20s, the 1920s, the mode of production in Puerto Rico began to change from sugar, coffee, and tobacco to just Sugar. Sugar became a monocrop so you have a transition during the 1920s from 1898 to the 1920s from a subsistence economy to a monocrop economy. There are lots of reasons why that happened; to begin with, Puerto Rico is in the domain of the United States it's the United States at that point, [which is] deciding what kinds of crops should be grown, the kind the development in fact the United States is determined the development of Puerto Rico almost 100% because as soon as they took possession of the island in 1898, the first thing that happened was that North American corporations moved in and started to buy the land and the land was the only thing that people had at that point so that once you begin to change their mode of production from being self-sufficient to a monocrop economy, you reduce the possessions of people to just one thing: their labor. All that people have to exchange was these society changes from subsistence to a monocrop is their own work, what they could do to earn their living, in any way that they could [unclear] their wages and that was determined from on the level of government. 

Now that doesn't mean that coffee and tobacco became non-existent, there were still smaller fractions of the island that have this. But sugar became the monocrop until let's say the 1930s, 1935 to be more specific, when sugar begins to decline in the World Market it's no longer as profitable to get sugar from Puerto Rico as it is maybe Brazil and other third world countries so you have a declining of sugar and the beginning of the development of an industrial society, you have the introduction of the new work industry, and the introduction of the new work industry in Puerto Rico incorporates in the first time women that weren't already working into the labor market, into the labor force. Women and children begin to work. 

Now, a program is developed in the 40s and this is called, this program is called Operation Bootstrap and this is Operation Bootstrap. At that point, it starts in 1935 begins to get some intensity in the early forties and by the 1950s, Puerto Rico has already made another transition from an agricultural society to industrial society. You have the mechanization of the agricultural sector that starts a movement of people from rural areas to the urban areas so you begin the first migration that you have on the island is internal migration, people have to move from rural to urban areas in search of jobs. Okay, now that's I think a pretty good example of how mode of production which was agriculture, is a monocrop society into industry which is another kind of mode of production, makes people begin to move. They're not moving because they necessarily want to, but they're moving because there are no jobs in agriculture sector anymore. Everything had become [automated] so people have no choice but to go into the urban areas. What they find in the urban areas is inadequate housing, the government, the Puerto Rican government in the United States government which work hand-in-hand, have not really set up in a facility, in terms of housing, in terms of healthcare and all these other things to accommodate so many people moving from one part of the island to the other so that at that point, you begin to see people like almost living one on top of the other, little houses all over the place, heavy congestion, what appears to be very very high-density, land density with people living very close together but if you look into the rural areas I mean it's practically empty so that in the urban areas you do have overpopulation and we have overpopulation in relationship to jobs, overpopulation in relationship to housing, overpopulation in relationship to health. 

Now, you overpopulation begins to take on a certain meaning because a relationship to something else and that is the kinds of things that are available to the Puerto Rican people in the society during that time. Now, at this point from the 30s to the 40s, the major argument becomes that overpopulation is the cause of the problems, it's the cause of poverty, is the cause of unemployment, it's the cause of inadequate housing, overpopulation people are the ones that are causing misery that you find on the island during this period. The solution of sterilization, the solution [of] migration. Now we're in the 40s and I just want to take you to 1937, a few years back just to say that it was in 1937 that Laws 116 and 137 were passed in Puerto Rico and these laws, this legislation I should say, was the first of its kind to allow Puerto Rican women to be sterilized on the island. So sterilization becomes enacted in Puerto Rico in 1937 through Laws 116 and 137. Ok now, when you have a law or legislation of that type, you could wonder where it came from and I think that just like anything else, studies that are being done or laws that are being passed, everything has its roots, is foundation someplace and as I looked into this legislation, what I found was that this kind of movement that developed on the island during this period was related to another movement that was occurring in the United States during the 30s during the Depression and that's the Eugenics movement. Now does anybody know, is anybody familiar with the Eugenics movement here? Okay well just for the benefit of those who aren't, I'm going to just talk about the Eugenics movement a little bit. Now okay, this movement was developed to sterilize anyone in the United States that was considered socially or mentally unfit. Okay now we're the wider context is the depression, very high in the United States. European migration to the United States has been going on since earlier years at this point [has] culminated more people coming into this country, there less jobs, things are very very bad for the people here already so you have a movement which develops, that's the Eugenics movement which is based on, as I mentioned before, social Darwinism, a superior race, very racist theories that there is one race, the Anglo race, the Protestant race that's superior, more intelligent than other people who are coming here and at that time, it was as i said European migrants and the only way to handle unemployment and even social unrest was to start sterilizing people and I didn't really bring statistics with me just to give you an idea of how many people were sterilized but I believe that this movement started here in the early thirties and by forties more than 50,000 or more people had been sterilized through this movement and the only justification for that was too many people. Everyone ranging from prostitutes to epileptic were sterilized in Puerto Rico uh in the United States during this period. And it was very movement in the United States that was exported to Puerto Rico in 1937 and that movement became Laws 116 and 137 so you see the relationship between the United States and Puerto Rico to one movement that develops here and a movement that develops on the island and where it came from. 

Speaker 4: Now did this movement in the United States concentrate [unclear] or was it just more--

Iris Lopez: It concentrated mostly on lower-income people which are the ones that aren't that usually uh that become victims of programs like this. It was focused in a way at Southern European migrants and but it was too kind of take care of any social unrest or any [unclear] about revolution here in this country during that period. In fact, it spread to 24 states in the United States and two provinces in Canada and to different parts of Europe as well. This was something that really or but branched out into different parts of the world and during the Nazi movement it was a form of also taking care of enclose the Jewish problem in German, sterilizing people. 

Speaker 5: How is this done? Voluntarily, involuntarily?

Iris Lopez: At that time, it was definitely involuntary, it wasn't --

Speaker 5: How was it done for example [were women in hospitals]? 

Iris Lopez: All right people who were institutionalized, people who were in jail too frequently, women who were put into jail because of prostitution during the Depression, people in who are considered mentally incompetent in hospitals and other institutions were the people who were being sterilized and anyone who cause trouble essentially but the target population weret he people that I just mentioned right now. Now this program was was exported to Puerto Rico and it developed there in a lot of different ways. 150 clinics were set up on the island by the 1950s specifically just to sterilize women. Studies the government began to fund studies to do this. The first study that was done to find out what doctors' attitudes were what ideology was in relationship to sterilization was the survey that was done in the 19th as early as the 1930s. 80% of the doctors who responded to that survey said that they felt that sterilization was the best solution malnourishment at the poverty on Island so that most doctors have been sold on this, although they were others who were very resistant and felt because of religious reasons that it was totally unacceptable and they would not perform sterilization. This continued through word-of-mouth, the kind of propaganda that was used to spread this program was the radio, counselors and nurses going into the rural areas to talk to women in urban areas in clinics and outside of clinics anyway that they could. And I think that they also used a lot of signs where they drew pictures and most people were illiterate during the time of modernization, modernizations is the family with the private house and a car in the back and maybe a little dog, all right two or three people in the family and right next to it they showed you a picture of a lot of children and this poor woman in this dress that's falling apart with maybe a clothesline in the back with clothing hanging and that was and it said something to the effect of means to reflect [before you have] more children or if you want modernization. The way to modernization [curbs] your family and there's nothing wrong with curbing your family; I'm not against birth control but the way that it was developed in Puerto Rico was so that women felt that this was a form of birth control whereas sterilization in fact is really fertility control once you have this operation and once this operation is performed, it's almost totally irreversible. But the way it was presented on the island was as a form of birth control that if you did get sterilized at some point, maybe five years later you would be able to undo this sterilization for another operation and have children. 

Speaker 6: Because they used this [way] of tying tubes-- 

Iris Lopez: Okay, they use the phrase of the the distinction that most women make even today is the tying or cutting of the tubes and at one point I understand in the United States during the early 60s, there was such an operation as a tubal ligation, strictly tubal ligation where are the fallopian tubes could be tied. It was no suturing, there was no cutting or slicing so there was more of a chance but depending on how much of the fallopian tubes was cut, a woman actually being able to reverse this operation but this was a very unsuccessful procedure and a lot of women got pregnant during this time until that they stop and developed more sophisticated ways of sterilizing women [in operation for together]. Yet to this day, women continue to talk about the time and the tying of the tubes. I think that the question that we need to raise is why is [this not clear] or why women aren't being warned about this in the hospitals where they go in talking like this about this operation in this [church]. Iris Lopez: Are you all right? 

Speaker 7: Yeah that is coming in with a bang. 

Iris Lopez: So, just to finish with the history of Puerto Rico and just to tie, make a relationship between sterilization and migration during the fifties, you have the mass Exodus of Puerto Ricans to the United States. Now because migration was not some, because so many of the people who actually migrated throughout the history of Puerto Rico kept returning to the island, sterilization programs were intensified. The logic was that if people don't stay away once they leave, then the only way to solve the problem once again is just to make sure that they don't continue to reproduce. That was the logic of the Puerto Rican women instead of really examining the development of industry on the island, why there was such high unemployment, why there weren't enough jobs for the native population, and why people actually have to leave in spite of all the money that had been invested. And I think that the answer to that is really that certain types of industries were developed, certain changes occurred very quickly on the island and most of the profits of the things that were developed there were being exported quickly as they were being produced so that the island was not really developing internally but it was geared towards certain kind of products that would be very profitable for the United States with which then exported them to other places. And stop, that's the end of that point that I want to make. 

The next one is the kinds of studies that were developed on the island. I started to tell you about the survey which took place during the 30s to find out the ideology of the doctors [with] lack of that other social scientists [mostly demonologists] and sociologists [unclear]. And what they did there was a focus on fertility and they their focus was really on the individual, the individual as the person who needed to be educated about birth control, the person who had to learn to control his or her sexuality, who had to learn about contraceptives, etcetera rather than on the kinds of programs that already exist in Puerto Rico and that were being developed so the kinds of arguments that you have coming or resulting out of the studies that took place in Puerto Rico during the fifties and these are people like [Sticos who in fact] on population control and Puerto Rican population [unclear] in the 60s [overseas]. People like that were, the kinds of arguments were cultural, culturally based on the individual looking at the family, family disorganization. The emphasis was on inadequate spousal communication on female psychology which is never really defined what that means. They say that these females, that they were getting sterilized some reason and they have to [unclear] psychology but no one really gets into it or defines it. And it's also blamed on the me, I mean these people are rationalizing why so many people have gotten sterilized on the [other side] [550 with these arguments.] And these kinds of arguments unfortunately still being used today in areas like migration, in areas like anthropology where culture is seen as the total entity and things are sort of culturally-based, of course there are lots of anthropologists and sociologists who've gone beyond that but there are lots who haven't. 

The kind of people who have gone beyond that and this is the second kind of argument that has been developed in the literature on sterilization in relationship to overpopulation in Puerto Rico is that it's not culture or it's not really the individual's fault or inadequate communication between men and women that's causing people to get sterilized but it's really more problems of unemployment before the employment status of women and men, things like not having access to quality healthcare because up until the 50s, the health care on the island is very very bad; there were all sorts of diseases. In fact, I don't want to forget to mention that it was during the 50s that contraceptives like the pill and the IUD and phones like info were tested out in Puerto Rico so that then they could be brought to the United States and into other parts of the world but and this kind of left a lot of negative repercussions and a lot of negative attitudes towards birth control as well. 

Now, the kind of focus that I'm taking in my study to try and bring it, we've already talked about the migration in from the mass Exodus of of Puerto Ricans from Puerto Rico to the United States. I've already mentioned that it's according to the statistics of the Department of Health, Hispanic women who have the highest rates of sterilization in New York City. In order to understand what's going on and to really have a to be able to develop a theory and just more comprehension about what happened to Puerto Rican women in the United States, I think we have to look at the situation of Puerto Ricans in general and we have to kind of trace back all the things that have happened from beyond why people came here to begin with, the number of people going back. The fact that sterilization has been available on the island since 1937 and I think it was in the early 60s that sterilization became an operation that could be performed in the United States. 

Now, because arguments that have been developed about sterilization in the United States as well as in Puerto Rico is that it's genocide, that it's a massacre of people, that women are being sterilized without really being fully informed about what sterilization is, in fact being misinformed and I have met women who have gotten sterilized on the island and told me that they really thought when they did this in the 50s or earlier that at one point they would be able to have children again and because other forms of contraceptives were not available on the island during the 50s, they were just being tested out in fact being developed right here in New York City and in other parts of the United States. Sterilization was the last resort to not having so many children. 

Now the situation of Puerto Ricans in the United States when we talk about Puerto Ricans in the United States, I'm talking about the general population, of course, there are many exceptions and different classes. I think even among Puerto Ricans are 2nd generation now in this country but more specifically, my study is aimed at an intergenerational approach where I interview and I work with women who came here in the 50s and their daughters are their offspring and the family that have been living here since that time or afterwards. And I am not, my major focus is on the healthcare system, people's experiences in the healthcare system, the economic incentives behind this operation in terms of who's paying for this? Are people paying out of their own pocket? Is medicaid taking care of this? What are the types of operations being performed? Legislation on abortion, what's available, what isn't in New York City etcetera. Language is still a factor I think for many people, especially from my mother's generation who came here, in terms of expressing what kind of operation they want and what is actually performed and the kinds of consent forms that are developed, the language that they're in advanced [unclear] and etcetera. I'm also looking at women's employment status. I'm interested in seeing whether there are more working women get sterilized than non-working women. I'm examining women's decision within a socioeconomic status [depending] on what their income is, the family composition, whether it's female [headed] household as opposed to male and female headed household. 

And I'm also looking at cultural attitudes and developed since this is such a popular operation, it has been going on for so long, many, many women are familiar with it. It's something that's been passed on through word of mouth. And it's talk to women and it's almost, it's their natural conversation about the type of operation that can be performed not to have anymore children. And this is on the individual level now for the national level of course all of the factors that I just mentioned everything from history to population policy to the bureaucracy in the Healthcare System, the monies that are available, the cutbacks right now, how that's affecting the kinds of operations that will be [put] forward. [Alright] the things that I'm taking into consideration and there has been, I've come across many, many cases of abuse where women actually feel that they've been victimized or they feel that they've been misinformed. This is not just a tubal ligation but hysterectomies are another really explosive issue that I'm incorporating into sterilization because that's what they are, women who have had hysterectomies performed without their knowledge or women who have had hysterectomies performed without their knowledge or women who have had hysterectomies performed when some other operation maybe [tubal ligation]. And the kinds of changes that they go through [in trouble] because of that. 

Now I can go on talking about this and but I don't want to just make this a monologue. I would like you to ask me questions if you have any and then I can we can make the rest of the points as we discuss it. Are there any questions at this point?

Speaker 8: In terms of [unclear] in Puerto Rico, what was the [unclear] government [unclear]? 

Iris Lopez: It was mostly government. Individual women did pay for it privately and their the hospitals are divided into public and private sectors and say that women who could afford it [to pay it] and you couldn't just [go to few] small clinics that were developed just for this type of operation. And a very interesting dissertation has been written on this, in fact the only [women] [unclear Puerto Rico and the name's Peta Henderson, P-E-T-A Henderson and it was published in, it isn't actually published but it was, she completed her dissertation in 1976 and her focus was on healthcare and doctors' ideology in relationship to the broader historical context of what's going on, in terms of sterilization and how it developed on the island so that might be. 

Speaker 9: Ok I have two questions. The first one is what about the Catholic church [unclear] [totally opposed] or [was the sterilization more acceptable] [unclear]? 

Iris Lopez: That trend has changed throughout the years. In the beginning, the Catholic Church [unclear] and sterilization is also [unclear]. Then if you get sterilized, you are only sitting once and it can be solved but if you take birth control, you're doing this every single day or taking the pill or whatever it is that you used and you're sitting there every single day so it's better and in fact, the church's favorite this position, it's better to get sterilized than all right to to use birth control. Although religion, I think that people adhere to religion to a certain point and then make very [illogical] kinds of decisions on their own depending on what their situation is.

 Speaker 9: I think it would be very important to get some documentation

Iris Lopez: I am. Yeah I didn't mention it as I was talking because I wanted to mention a lot of other things but that is one of the things that I'm looking at and I'm looking at religion and I am also exploring the whole idea, the whole myth that it's men that women get sterilized because of their mates or women get sterilized because [we're] kind of [unclear] problems that you're having, even though I'm still in the preliminary stages of my research, what I have found is that a lot of Puerto Rican men are against their wives or girlfriends getting sterilized. And there are many reasons for that. Now, I'm including some men in the study although, one of the problems of doing research like this when you're working by yourself is that there is only so much you can do. You have to limit your study to certain things at least the fact is that you consider most important, but the idea that for example, one of the most common questions that I hear is that well maybe contraception or birth control wasn't available in the 50s but birth control is available now. Why don't women use birth control now or why do they get sterilized? And I find that a lot of the women who have gotten sterilized have gone through a whole series of contraceptive methods that have not worked out for them, for one reason or another, their body has rejected it or they misused it or a series of other things and then have gotten sterilized after they had maybe one or two [unclear] children. Now mhm 

Speaker 10: Well it seems to me that except for the racist overtones [unclear] determine, it seems to me it's no different than anything else, it's like abortion, [it's about choice. I mean unless you can prove [unclear] [that system is] unclear [the language used] [unclear], unless that's really true, it seems to me ot's just like abortion. [The woman can choose but she doesn't want to hassle with this anymore]. 

Iris Lopez: Uhuh, yeah that's one aspect of it and I think an important one but it's a little different than abortions although it's because one of the things that I feel is really important to examine in terms of what's happening with sterilization is woman's experience in hospital. Who actually initiates or suggests that a woman get this operation? What are the economic incentives for a hospital to actually perform this operation? Who's getting sterilized? Okay, what part, what sector of the population is getting sterilized and that's not to confuse it. I think it's very important to try and maintain a part, the fact that sterilization in the United States has become a very popular form of fertility control among white middle-class people. Oh and some have vasectomies and more than a million sterilizations are being performed annually. That I feel is different from what's happening too many lower-income people of all different ethnic groups, who really feel that they don't have any other alternative or that their life situation kind of pushes them in this direction because of unemployment, because cutbacks hit them first and they feel the pressures of this because of single mothers who have to raise children, because and one of the things that I didn't mention before but I think is important to look at now, when I was in Puerto Rico I was even very surprised to see that in some factories, they gave a woman on a monthly basis an hour off to go to their health care unit and get birth control but that the doctor is the kind of birth control that they were suggesting was sterilization because and for women who cannot afford to be out of a job or feel threatened because of unemployment, they might feel pressure to get sterilized rather than be demoted or lose their jobs. 

And I think one example of this even though it's not Puerto Rican women is the case of the six women in California, who were it's it's very similar although not exactly the same, who were demoted, who got sterilized because they did not want to be demoted in their jobs and they were working in the chemical firm. Studies found that these chemicals were harmful to the fetus so instead of losing their jobs, they decided to get sterilized. And I think of the important thing to examine is, is that voluntary sterilization? What is voluntary sterilization and that's exactly, I feel probably the most important thing for me to look at right now: the whole concept of what voluntary sterilization is, even when someone says that this is what they want to do, are they doing it because they have other, they perceive that they have other alternatives? Is this the only alternative that they perceive? What are their life circumstances? What's the broader context in which people are making these decisions? How many people within that life situation is this happening to?

And the fact that it's mostly, at least for New York City Hispanic women have a rate of sterilization four times higher than white women and two times higher than Black women. I think it's significant, the number of hysterectomies that are performed on all women but especially Black and Hispanic who because of the kind of healthcare that they have available to them when they go in with Medicaid, are more vulnerable to that type of operation than someone regardless of us thinking who goes in with money to a private hospital with good physicians and they're able to discuss what the alternates are, they're able to discuss whether or not this is the right operation. Many of the hospital that performs these operations are voluntary hospitals and they are hospitals where that are associated with medical schools and which means that a lot of insurance for medical schools that they're practicing, they're training in these hospitals and the only people to practice on are people who really cannot afford to say or really because of the interaction or their ideas of doctors and professionals are going to object immediately, are lowering people. And these are the hospitals where most, if you look at your statistics for most of these operations have been performed. That's not to say that some women whether they are lower income women or any other group don't make these, there are some women who make these decisions by choice and they are well informed but the majority of the women that I've come across, excuse me, and the cases that have been documented already, been used are lower-income women, predominantly services- 

Speaker 11: Are these operations, are these operations being performed in conjunction with other hospital [unclear] suffering from [unclear] [billing cycle] are they then persuaded to have an operation on [unclear]-

Iris Lopez: Ok well, there are, in terms of abortions, some of the literature on that points to races that issue that, many women are recommended this operation when you're under stress or at a more vulnerable period, when they're pregnant or right after giving birth, during postpartum. And it's been recommended to many women in fact, before 1976 and I think that this is a good indicator that if this was not an abusive practice, the regulations that were developed by HEW in 1976 would never have been enacted or instituted. These guidelines were developed in 1976 because so much abuse was going on that health, the Health and Hospital Corporation had to find a way to control it and had to make sure that women knew what the kind of operation that they were going to have performed before they have actually had it or that they didn't feel pressured or threatened by loss of welfare or Medicaid or any other healthcare services, that if they didn't get this operation, they would lose whatever services like they had already and part of the guidelines in fact, I brought them, clearly state what sterilization of abuse is.

Now, just very briefly, for those of you who are interested,I'm just going to go through them. The guidelines for New York City are slightly different than for other states but they're more or less the same. And they're there to try and monitor sterilization abuse or just [surgery recommended] or women being pressured by social workers or by doctors or nurses or counselors to accept accept this operation. Now, these guidelines require the voluntary informed consent the obtained using a mandatory standardized consent form provided in the patient's preferred language. There's a reason that that regulation was developed was because so many of the consent forms and at one time they weren't even consent forms were written in a language that the woman or a man coming into [sign] really didn't understand so they just signed it and they didn't really know what they were signing. Okay, these regulations also prohibit any overt or implicit threat of loss of welfare or Medicaid benefits as a consequence of non-consent.

Iris Lopez: Okay now, obviously this guideline was instituted and in fact one of the thing that is written at the bottom of consent form is that no one should feel threatened that they're going to lose their wealth [unclear] and Medicaid, Medicare whatever healthcare services, if they don't get this operation, that it should be purely voluntary. It also, these guidelines prohibit obtaining the consent during labor, before or after an abortion, or while the person is under the influence of drugs or alcohol. There were many cases where women were asked if they wanted to get a sterilization when they were under anesthesia and giving birth in a hospital. It sounds pretty outrageous in fact, it sounds almost unbelievable but the fact is that it was happening and if it weren't happening, these guidelines would not have been enacted. These regulations also abolish a quote for the abolition of the distinction between contraceptive and non contraceptive for therapeutic sterilization for purposes of Federal Regulation. That means that a lot of women were getting sterilized and what documents or other medical personnel were writing was that this was being done for therapeutic reasons without really elaborating on that, what kind of therapy and whether or not women in fact really needed this operation or they could have some other type of treatment to take care of whatever symptoms that they had. It also prohibits hysterectomies for sterilizations purposes in federally funded programs.

Now, of course a hysterectomy is a is a more serious and more costly, maybe not more serious but it's certainly more costly than a sterilization and instead of performing sterilizations on women, a lot of hysterectomies were being performed in hospitals for purely economic reasons for these hospital. I don't know about hysterectomies but I can tell you that a hospital that performs a sterilization that's covered by Medicaid is reimbursed 90%. [All hospital] of course and the guidelines also state that a 30-day waiting period must be recognized between the time a woman sign consent to the time she's operated, so 30 days have to pass after a woman actually makes the decision and signs the consent form to try and control for this abuse because sometimes and in many cases, doctors were asking women the day before or a week before and if a woman was under stress and if she made this decision under stress or accepted this operation because of that, she didn't really have enough time to think about it. Now, a lot of doctors have been very angry about this, a lot of people within the healthcare have been very upset that there is a 30-day waiting period. But because this is not an emergency operation in operation that I think a 30-day waiting period is not such a terrible thing since it's such a serious kind of decision that once you do get operated, you can't have any more children and I think people should think about it very carefully. 

Iris Lopez: Okay and then the the last guideline requires that the complete information be provided also in patient's language, orally as well as in writing regarding the irreversibility sterilization, all risking side effects and alternative methods of contraception. What other things that I'm looking at in my research is whether or not this is being done. Now, in spite of these guidelines and because of hospital cutbacks and so many other reasons, these guidelines are not being monitored very carefully in hospitals and clinics where women are getting sterilized. And I've spoken to different people in hospitals and they say that the reason is that they really don't have enough personnel to go around but sometimes it's because well if sterilization does continue to happen, women do get sterilized without signing consent forms, they do get sterilized before 30 days. All someone has to do for each sterilization, the doctor has to fill out a form and send it to the Health and Hospital Corporation and that's how they started to collect these statistics in 1976. Although, in these forms, one of the things the only thing that they include is the person's ethnic group. They don't indicate income or number of children necessarily etcetera. And I think that a lot more people, men as well as women, are trying to monitor this but it's not as effective as as we would think right now since this continues to happen. Are there any other questions?

Speaker 12: I guess one, I just like to sort of add something to what you said about the the regulations that when they they one of the provisions in there was that they audit the ten states that perform the most sterilizations and this audit has just come back except for New York because it got screwed up in the computer but the nine other states, there's widespread abuse as Iris has pointed out. One of, one of the frightening things I guess about the [unclear] is that there was no enforcement built into it, there was no money set aside to actually enforce these things and the other thing is that they're coming up for review in 1982 and given Reagan's whole thing towards deregulating everything, people are real nervous that this little bit which as you pointed out there's all kinds of problems with to begin with but this little bit of protection that we've managed to you no have because of this whole movement could be wiped out in 1982, just so scary to. 

Speaker 13: Are the guidelines similar in Puerto Rico and was Puerto Rico included in this audit? 

Iris Lopez: I don't, I'm not even sure that they have guidelines in Puerto Rico, I don't think that they do.

Speaker 13: My hunch is that they need guidelines too. 

Iris Lopez: [Apply], you think that they'd be extended, I haven't seen them if they do. That's not to say that they don't exist and that's something that I really should look into but I imagine if they're developed here, they might have some of these provisions might apply but sterilization is still increasing on the island. The last time that a survey was done was in 1968 and that's how they found out that 35.5% of the women in Puerto Rico had been sterilized between the ages of 15 to 45 which are their most reproductive years. But since then, no one has actually done the survey to see what's happening or in fact, very little research in this area has been done and that's one of the reasons, it's not highly publicized. I think that it's misunderstood by a lot of people because maybe their approach to it, you cannot take the approach; for example, a study that was done here in the United States by Susan Schrimsher who wrote an article called "The Demand for Female Sterilization among Puerto Rican Women in Spanish Harlem" doesn't take a whole series of things into consideration like socioeconomic status, like whether or not, like unemployment. It doesn't talk about the healthcare system at all. It talks about it in fact, as the people who do who did in the 50s who stress culture, who stress the individual, who stress the differences between men and women and keep it on that level. It's almost like looking at sterilization in the vacuum.

And I supposed that as you said [Stella] before, this is something, it's a lack of alternatives on a national level. It could be, it's definitely population control which can be called genocide or can be called population control is essentially the same thing in a sense, if the number of women who have gone into this operation and then later say that this is not really what they want to do, that they didn't really, that this, this was what it's about and if you come across so many women saying the same thing over and over again and these are separated cases of different families ,then you begin to wonder what's really going on and you begin to compare Puerto Rican women to North American women, lower-income women or Indian women of Black American women, in the California and Chicagoan women and you see that the same thing is happening, it's not just Puerto Rican women but this is something that's taken place I think among all lower income people and not just lower income, that's not the only in in Virginia, just I think a couple of months ago maybe a little longer than that, there was an article in the newspaper that said that five thousand people who were considered mentally incompetent who had been institutionalized had been sterilized and they didn't really give any more information than that. And this is something that's been going on and that's when when something like that happens, it doesn't get a lot of publicity. I was looking for it that information on the news, you would think that something like that would begin publicity and I was just really amazed to see that, I think it was on channel 7 someone did mention it but before that, they talked about, it was during Christmas I think and they were talking about the Christmas tree at Rockefeller Center and right after that they flashed something else onto kind of really, so that you don't get the full impact of what you just seen and it's, I think the way the media has worked with this although, it's I'm sure that's just a lot of people are not aware of what's really going on is really incredible too. 

Speaker 14: Have there been any studies on the [unclear]? 

Iris Lopez: There have been some studies on vasectomies but it's happens, vasectomies have been performed but at a much smaller rate than sterilizations and that has something to do with culture in terms of who get sterilized, I know also with policy and the way it was developed on the island itself. It was doctors, male doctors who were sterilizing and it was women, even though vasectomy is an easier operation although, I believe it's also irreversible, maybe they have more sophisticated procedures for vasectomies now but at least during that time, it was irreversible and so that a small proportion of men, of Puerto Rican men actually have the kind of operation performed. 

Speaker 15: What are the, what did you say the percentages of Puerto Ricans who are

Iris Lopez: 35.5%

Speaker 15 And what, do you know, percentage of that are women who had hysterectomies versus sterilization? 

Iris Lopez: No. [unclear] There are statistics for that in New York City but I don't know about, there are probably statistics on already Puerto Rican women on the island but I haven't seen

Speaker 16: [unclear] do you know the ratio for New York City?

 Iris Lopez: Not on hand, I do but I have those statistics if you [want see I can give them to you.]

Speaker 16: The other question I have is in the 1950s when the sterilization clinics opened, where women still breastfeeding back then or had they gone over to formula food [unclear].

Iris Lopez: I don't know about the population in general, maybe someone else can answer some of these questions. I'm not sure what percentage of the women on the island were breastfeeding as opposed to bottle feeding at the time. Is anyone else familiar with this? No, so then my conclusion for now is that and I think the thing to keep in mind just to give a kind of quick summary of what we talked about, I know that it's a lot of information and that is that the kinds of arguments that have been used to justify sterilization as well as migration in Puerto Rico, any kind of population movement or population control has been the concept of overpopulation has played a major role in that and that sterilization was developed on the island since 1937; by 1968, 1/3 of the female population was sterilized and that the real controversy of this topic is whether or not it's voluntary or whether it's coercive and then I think that the important thing to remember is that coercion exist in many different forms. It's not just physical coercion where someone is strapped down to a table and sterilized against their will but there are other forces and pressures that leave people to make certain kinds or at least accept certain kinds of operations that are more psychological and that that psychology and is not to be seen in the vacuum but is embedded in the kind of, the class and the social conditions of a group of people within a given society you have certain kinds of relationships to the mode of production which is the way production is organized and that the important thing also to consider at least to think about is what is voluntary sterilization, the different facets of it, the types of things that are going on right now on a national level in terms of the economic incentives behind this, the policy, the regulations to counteract this, and on the individual level, the woman herself and her life conditions. Thank you very much for coming and if there are any other questions or anyone wis h e s t o dis c u s s t his f u r t h e r a t s o m e o t h e r tim e o r w o uld lik e s o m e r e f e r e n c e s, I'll b e h a p p y t o t o t alk t o y o u in divid u ally.T h a n k y o u.