The unconscionable and inexcusable treatment of Puerto Ricans after Hurricanes Irma and Maria is nothing new. It is part of a long line of abuses heaped on the U.S. citizens who reside in the colony of Puerto Rico. Their second-class status has had grave results for the island’s residents. As we begin coverage of Women’s History Month, it is important to revisit just how colonial policies permanently affected women on the Island. At one point in time, more than one-third were sterilized without informed consent, and poor Puerto Rican women were also used as guinea pigs to test birth control products.
I became aware of the sterilization of women on the island while a participant in actions to gain comprehensive reproductive and women’s rights for Puerto Rican women (on the mainland and on the island) during the rise of the Young Lords Party (YLP) in the late ‘60s and early 70s. Raquel Reichard wrote about this for Latina in “10 Ways the Young Lords Fought for Women's Rights.”
1. The Young Lords called for an end to the forced sterilization of Puerto Rican women on and off the island. In 1968, a survey revealed that one-third of all Puerto Rican women, ages 20 to 49, had been sterilized, many through coercive strategies that denied them access to informed consent. Viewing this as evidence that Puerto Ricans were targets for mass genocide through population control, the Young Lords protested against the massive sterilization program.
2. Unlike other 1960s and early 1970s nationalist organizations like the Black Panther Party and the Nation of Islam, however, the Young Lords considered abortion a woman’s choice, and they demanded safe and legal access to the procedure. In fact, the group fought fervently for hospital reforms so that poor and minority women who wanted to terminate a pregnancy could do so without risking their own lives with inadequate and dangerous services, which were standard in public facilities in communities of color.
3. The Young Lords also fought for safe and legal contraception. Though they were anti-genocide, resisting coerced sterilizations and their women being treated like Guinea pigs for birth control research, the Young Lords understood the nuances of reproductive justice and developed a reproductive rights agenda that encompassed access to voluntary birth control.
As a member of the YLP Women’s Caucus, I worked in conjunction with hospital workers, doctors, nurses, and community members to change the abysmal health and hospital conditions in mainland Puerto Rican communities. To the best of my knowledge, we were the first revolutionary nationalist organization to address and develop a broad platform of reproductive justice, which included abortion rights (see Jennifer Nelson’s “Abortions under Community Control: Feminism, Nationalism, and the Politics of Reproduction among New York City's Young Lords”). Dr. Helen Rodriguez-Trias was a key figure in the battle to expose sterilization abuses.
From the exhibit titled “Changing the Face of Medicine: Celebrating America's Women Physicians” at the National Library of Medicine:
Helen Rodriguez-Trias
Born in New York in 1929, Helen Rodriguez spent her early years in Puerto Rico, returning with her family to New York when she was 10. Growing up as a Puerto Rican in New York City, she had experienced racism and discrimination first-hand. Rodriguez-Trias graduated from the University of Puerto Rico in 1957 where she became a student activist on issues such as freedom of speech and Puerto Rican independence. Later she re-enrolled at the University of Puerto Rico to study medicine, a field that "combined the things I loved the most, science and people."
(Link to video) From the video transcript:
Dr. Helen Rodriguez-Trias wanted to study medicine because it combined the things she loved the most—science and people. She graduated from the University of Puerto Rico in 1959 and moved to New York,where she married and had three children. After seven years, she returned to the University of Puerto Rico to study medicine. She saw it as a direct way to contribute to society—by helping individuals instead of working through groups or organizations. She received an M.D. with the highest honors in 1960. During her residency, Dr. Rodriguez-Trias established the first center in Puerto Rico for the care of newborn babies. Under her direction, the hospital’s death rate for newborns decreased 50 percent within three years.
In 1970, she returned to New York City to serve the Puerto Rican community in the South Bronx. Working at Lincoln Hospital, she led community campaigns against lead paint, unprotected windows and other health hazards.She also taught at City College, raising students’ awareness of the real conditions in the neighborhoods they served. Dr. Rodriguez-Trias saw the critical links between public health and social and political rights, and expanded her work to a broader international community. She said, “I think my sense of what was happening to people’s health... was that it was really determined by what was happening in society— by the degree of poverty and inequality you had.” Working as an advocate for women’s reproductive rights, she campaigned for change at a policy level. She worked especially for low-income populations in the United States,Central and South America, Africa, Asia, and the Middle East. She fought for reproductive rights, worked with women with HIV, and joined the effort to stop sterilization abuse. Government-sponsored sterilization programs led to hundreds of unwanted sterilizations.
(Dr. Helen Rodriguez-Trias) “Sterilization has been pushed really internationally as a way of population control. And there is a difference between population control and birth control. Birth control exists as an individual right. It’s something that should be built into health programming. It should be part and parcel of choices that people have. And when birth control is really carried out, people are given information, and the facility to use different kinds of modalities of birth control. While population control is really a social policy that’s instituted with the thought in mind that there’s some people who should not have children or should have very few children, if any at all. I was working in Puerto Rico in the medical school in those years, the decade of 1960 to 1970. And one of the things that seemed pretty obvious to us then was that Puerto Rico was being used as a laboratory. And it was being used as a laboratory for the development of birth control technology.”
In 1979, Dr. Rodriguez-Trias testified before the Department of Health, Education and Welfare for the passage of federal sterilization guidelines, which she helped to draft. These require a woman’s consent to sterilization, offered in a language she can understand,and set a waiting period between the consent and the operation. Toward the end of her life, she said, “I hope I’ll see in my lifetime a growing realization that we are one world.And that no one is going to have quality of life unless we support everyone’s quality of life. Not on a basis of do-goodism, but because of a real commitment. It’s our collective and personal health that’s at stake.”In 2001, President Clinton presented her with a Presidential Citizen’s Medal for her work on behalf of women, children, people with HIV and AIDS, and the poor.
Later that year, Helen Rodriguez-Trias died of complications from cancer.
Joyce Wilcox wrote this profile of her for the American Journal of Public Health (AJPH), titled “The Face of Women’s Health: Helen Rodriguez-Trias.”
In the United States, African American, Puerto Rican, Chicano, indigenous, and poor women have been more likely to be sterilized than White women from the same or higher socioeconomic classes. Women with physical disabilities whom physicians judge to be “unfit to reproduce” have also been sterilized since the eugenics movement in the 1920s. By 1968, in a 30-year period, a third of the women of childbearing age had been sterilized in Puerto Rico. Sterilization abuse was so common among African American women in the South that a woman's having her fallopian tubes tied or uterus removed without her knowledge or consent was called the “Mississippi appendectomy.”
Rodriguez-Trias helped create both the Committee to End Sterilization Abuse and the Committee for Abortion Rights and Against Sterilization Abuse, which were among the groups instrumental in bringing about federal sterilization guidelines in 1979. Their struggle was opposed even within the women's movement. She described what happened when this issue came up at a Boston conference in 1974, attended by thousands of women. “We had a panel on sterilization abuse, which had to do with disrespect for women's needs, wishes, and hopes. We brought up the Relf suit, brought on behalf of 2 Black, allegedly retarded girls, Minnie Lee Relf, age 12, and Mary Alice Relf, age 14, who had been sterilized without their knowledge or consent in a federally funded program in Montgomery, Alabama. “The Southern Poverty Law Center found out about the girls, and interviewed the mother, who said she thought she was consenting to the girls' getting a contraceptive. She signed the consent form with an X because she couldn't read and write. The case went to federal court, which said there was incontrovertible evidence that sterilization abuse was taking place, that some sterilization abuse was being subsidized by the government, and enjoined HEW [US Department of Health, Education, and Welfare] to come up with guidelines to prevent sterilization abuse.”
Rodriguez-Trias was among those who brought this and other cases before a panel at the Boston meeting. “We got a lot of flack from White women who had private doctors and wanted to be sterilized,” she said. “They had been denied their request for sterilization because of their status (unmarried), or the number of their children (usually the doctor thought they had too few). They therefore opposed a waiting period or any other regulation that they interpreted as limiting access . . . While young white middle class women were denied their requests for sterilization, low income women of certain ethnicity were misled or coerced into them,” she explained. “I began to understand that we were coming to different conclusions because we were living different realities,” she explained. “The women's movement is heterogeneous; people have different perspectives. The women's movement has been successful only to the extent that it shares experience, finds common ground, and fights for the same thing.
“I am proud that I made my contribution in moving forward that dialogue among many women, a dialogue that took place over many years. We had to listen to each other; we had to find out each other's reality. For example, I had a professional salary. I didn't know what it's like to live on welfare.”
The American Public Health Association (APHA) has an award named in her honor: the Helen Rodriguez-Trias Award.
The Helen Rodriguez-Trias Social Justice Award is awarded to a person who has worked toward social justice for underserved and disadvantaged populations. This individual’s work should focus on improving the health and well being of these populations and should include the activities of leading, advocating and mentoring (any or all three of these activities). This award is named after the late Dr. Helen Rodriguez-Trias, past president of APHA and a pediatrician. Dr. Rodriguez-Trias was an inspiration and role model who strove to meet the needs of underserved and disadvantaged populations, especially women and children. Through her work and activism, she used social justice strategies that affect change for the better.
For the purpose of this award, social justice is intended to be seen in the context of improving the public’s health and well being through works that lead to the elimination of health disparities. These works, which empower disenfranchised communities toward making healthy changes, and influence public policies toward a greater equitable distribution of resources for those with little or none. Specific areas to be considered for this award are those that deal with cross cultural communications, reproductive rights, women’s health issues, and providing access to health care. Priority shall be given to a public health worker whose actions can be viewed as a model for what can be done to address inequities and injustices at national, state, and/or local levels of operations.
Her papers are housed at The Center for Puerto Rican Studies at Hunter College in New York City. In their guide to her papers, they write:
Throughout the 1970s and1980s, Rodríguez-Trías was active in the reproductive rights movement. One of her most significant contributions was expanding the overarching feminist movement’s understanding of reproductive rights to include coerced sterilization and establishing federal guidelines that would protect women at risk of being forced, directly and indirectly, into the procedure. While middle to upper class white women were fighting to gain access to sterilization, a practice often denied to them by a medical establishment that encouraged these women to have more children, many low-income women of color were pressured into the procedure as part of a subtle, but effective eugenics movement.
In fact, as Rodríguez-Trías researched the prevalence of sterilization in Puerto Rico, she unveiled a staggering picture. Between the late 1930s and the late 1960s, approximately one third of Puerto Rican women of childbearing age had been sterilized and, often, without information about the irreversible nature of the procedure. Studies on the practice uncovered that the Puerto Rican government had conducted an intensive sterilization program that included subsidized or free procedures, a sharp contrast to expensive and scarce birth control methods. In 1982, Rodríguez-Trías went on to participate in a documentary film project titled “La Operación” that discussed sterilization abuse in Puerto Rico. The film featured interviews with Rodríguez-Trías as well as with Puerto Rican women who described their experiences with the practice. Moreover, sterilization abuse in Puerto Rico was not an isolated case. Further research revealed that hospitals in the United States were also aggressively pushing sterilization among low-income women of color. By the mid 1970s, over 65 percent of sterilizations in U.S. hospitals were performed on women of color.
Scenes from La Operación (the complete film is here):
La Operación (Directed by Ana María García, 1982) Ana María García created this forty-minute documentary to highlight the social policy of female sterilization in Puerto Rico. This island has the highest rate of sterilization in the world. Over one-third of its women have undergone what is commonly referred to as “La operación” (The Operation). García incorporates interviews with working-class and middle-class women of differing racial and ethnic backgrounds who have undergone this procedure. Rather than rely solely on interviews however, the documentary is intercut with action sequences and historical footage to make this a thought-provoking, yet entertaining work.
The film opens with an interview of an Afro-Puerto Rican woman talking about how many of her siblings had “the operation” and how her children were also undergoing it. The film has some candid and poignant moments: some of the women interviewed are not clear what had happened to them; some regret it; some feel that they didn’t have a choice when it came to birth control. There is a cut to a woman undergoing childbirth; she is crying out of happiness, and there are palpable emotions on the screen. There are also close up shots of women undergoing surgeries. There are experts interviewed as well: there is a cut to a woman doctor explaining the government discourses on “population control” as opposed to a woman’s decision regarding “birth control.”
I have interviewed women who were sterilized in Puerto Rico, and all of them referred to the procedure as having had their “tubes tied,” making gestures with their hands as if they were tying shoe laces. They were not told their tubes were being tied off and cut, and it is clear to me that ethical medical information had been withheld from all of them.
Also covered in the film was the use of Puerto Rican women as guinea pigs to test birth control pills and a spermicide called Emko foam, which was taken off the market.
“Revisiting the Dark History of Birth Control Testing in Puerto Rico,” written by Yara Simón, tells the story:
Nearly fifty years after participating in the experiments, Delia Mestre could still remember the hospital social worker who visited families in her neighborhood and offered them a simple way to avoid pregnancy. “We all jumped on it quickly and didn’t look back,” a 60-year-old Mestre told the Orlando Sentinel in 2004. “Women were told this was medicine that would keep them from having children they couldn’t support.”
What they women didn’t know was that they were serving as guinea pigs, as doctors monitored the effects of the experimental drug. The pill also had three times as much hormones as the modern-day pill, which brought a host of side effects that went unaddressed. From the mid-1950s to about 1964, the poor and uneducated women received free birth control, testing several different versions.
Doctors dismissed complaints about negative reactions, calling them psychosomatic because women in Boston didn’t experience as many side effects. But even after three women died, the doctors did nothing. No one performed an autopsy to determine if the death was drug related. Back then, the pill was three times as potent as the modern-day version. Experiments in other parts of the United States stopped because of the side effects, but they continued for years in Puerto Rico. By 1960, the FDA approved the pills – marketed to white women “as a symbol of independence.”
This video details how poor women in Puerto Rico became unwitting guinea pigs for the birth control pill, from Timeline on Vimeo.
A housing project in Puerto Rico is where the most extensive human trials for the birth control pill were conducted. The women who participated in the trials––about 1,500 over several years––didn’t know about possible side effects. The doctors––John Rock and Gregory Pincus––didn’t either, since the pill had only briefly been tested on humans, in a failed trial in Boston. Doses of hormones in the pill were much higher than they are today, and though the usual side effects were nausea and dizziness, sometimes blood clots could cause death. The FDA approved the pill in 1960, and added warnings for those with high blood pressure in 1962, but three women had died in the Puerto Rico trials, and no autopsy was conducted.
In 2010, Bianca I. Laureano wrote “Why I’m Not Celebrating the Pill.”
All the "celebration" about The 50th Anniversary Of The Pill is a party I can't attend. There are missing pieces that are being ignored in the celebration and these pieces are vital parts of my history. I’ve mentioned before that hippie immigrant Puerto Rican parents raised me in the US. One of the messages that was transmitted to me as a young Puerto Rican woman growing up was that the birth control pill kills Puerto Rican women. And it did.
Excuse me if I do not partake in all of the celebration of The 50th Anniversary of The Pill because from my perspective it is still very much a reminder of the exploitation and violation of human rights among Puerto Ricans (and Haitians, and working class women in general) that continues today. Ignoring this reality is easy. Yet, it is a part of my, our history that I can’t simply forget or overlook. If I choose to ignore this history I also choose to ignore the history of activism by members of my community that has helped to create change at an institutional level. Ignoring this reality and history also perpetuates the ideas that historically oppressed communities are not important in the work we do today
There are some things I’m not ready to ignore or forge and many of those are the power of language. The adjectives used to describe members of my community are horrifying. I don’t care if it was how people spoke “in that time,” they were and remain inappropriate. To describe our homeland as “slums,” “jungles,” and our community as “undesirable,” “genetically inferior,” and “ignorant” is defendable? The ideology “that the poor, uneducated, women of Puerto Rico could follow the Pill regimen, then women anywhere in the world could too” is not condescending to you? Don’t be fooled. There was almost nothing that was “female controlled” or “empowering” about being a part of the trial for many participants, especially after they realized they were taking a medication that they did not know was not approved.
Using women of color—Latinas, African-Americans, and Native Americans—as test subjects and as targets for sterilization is the product of white supremacist thinking and fear. As Donald Trump and his Republican lapdogs ramp up racism and xenophobia and target communities of color, I worry about future policies in their pipeline.
In addition to La Operación, I also show my students No Más Bebés.
No Más Bebés tells the story of a little-known but landmark event in reproductive justice, when a small group of Mexican immigrant women sued county doctors, the state, and the U.S. government after they were sterilized while giving birth at Los Angeles County-USC Medical Center during the late 1960s and early 1970s.
Marginalized and fearful, many of these mothers spoke no English, and charged that they had been coerced into tubal ligation — having their tubes tied — by doctors during the late stages of labor. Often the procedure was performed after asking the mothers under duress.
The mothers’ cause was eventually taken up by a young Chicana lawyer armed with hospital records secretly gathered by a whistle-blowing doctor. In their landmark 1975 civil rights lawsuit, Madrigal v. Quilligan, they argued that a woman’s right to bear a child is guaranteed under the Supreme Court decision in Roe v. Wade.
The filmmakers spent five years tracking down sterilized mothers and witnesses. Most were reluctant at first to come forward, but ultimately agreed to tell their story. Set against a debate over the impact of Latino immigration and overpopulation, and the birth of a movement for Chicana rights and reproductive choice, No Más Bebés revisits a powerful story that still resonates today.
They came to have their babies. They went home sterilized. The story of Mexican immigrant women who were sterilized at LA county hospital during the 1970s. Alongside young Chicana/o lawyers and a whistle-blowing doctor, they stood up to powerful institutions in the name of justice. From the filmmakers Renee Tajima-Peña and Virginia Espino.
Learning about these ugly chapters in our history should make us doubly aware that they can happen again.
We have to fight and vote to make sure that does not happen.
Pa’lante, Puerto Rico.
