Compulsory sterilization

Compulsory sterilization (or sterilisation) also known as  forced sterilization  programs are government policies which attempt to force people to undergo surgical sterilization. In the first half of the twentieth century, several such programs were instituted in countries around the world, usually as part of eugenics programs intended to prevent the reproduction and multiplication of members of the population considered to be carriers of defective genetic traits such as those with intellectual disabilities, learning difficulties]] and mental disorders. In the past psychologists and psychiatrists have advocated and actively supported such measures.

Forced sterilization has been recognized as crime against humanity if the action is part of a widespread or systematic practice by the Rome Statute Explanatory Memorandum, which defines the jurisdiction of the International Criminal Court.

Canada
Two Canadian provinces (Alberta and British Columbia) performed compulsory sterilization programs with eugenic aims. Canadian compulsory sterilization operated via the same overall mechanisms of institutionalization, judgement, and surgery as the American system. One notable difference is in the treatment of non-insane criminals. Canadian legislation never allowed for punitive sterilization of inmates.

Czechoslovakia, Czech Republic
Czechoslovakia carried out a policy of sterilization of some Roma women, starting in 1973. In various cases the sterilization was agreed upon, often in exchange for social welfare benefits or was given by the lack of education. The dissidents of the Charter 77 denounced it in 1977-78 as a "genocide", but the practice continued through the Velvet Revolution of 1989. A 2005 report by the Czech government's independent ombudsman, Otakar Motejl, identified dozens of cases of coercive sterilization between 1979 and 2001, and called for criminal investigations and possible prosecution against several health care workers and administrators.

Germany
One of the first acts by Adolf Hitler after achieving total control over the German state was to pass the Law for the Prevention of Hereditarily Diseased Offspring (Gesetz zur Verhütung erbkranken Nachwuchses) in July 1933. The law was signed in by Hitler himself, and over 200 eugenic courts were created specifically as a result of the law. Under the German law, all doctors in the Reich were required to report patients of theirs who were mentally retarded, mentally ill (including schizophrenia and manic depression), epileptic, blind, deaf, or physically deformed, and a steep monetary penalty was imposed for any patients who were not properly reported. Individuals suffering from alcoholism or Huntington's Disease could also be sterilized. The individual's case was then presented in front of a court of Nazi officials and public health officers who would review their medical records, take testimony from friends and colleagues, and eventually decide whether or not to order a sterilization operation performed on the individual, using force if necessary. Though not explicitly covered by the law, 400 mixed-race "Rhineland Bastards" were also sterilized beginning in 1937.

By the end of World War II, over 400,000 individuals were sterilized under the German law and its revisions, most within its first four years of being enacted. When the issue of compulsory sterilization was brought up at the Nuremberg trials after the war, many Nazis defended their actions on the matter by indicating that it was the United States itself from whom they had taken inspiration. The Nazis had many other eugenics-inspired racial policies, including their "euthanasia" program in which around 70,000 people institutionalized or suffering from birth defects were killed.

Japan
In the first part of the Showa era, Japanese governments promoted increasing the number of healthy Japanese, while simultaneously decreasing the number of people suffering mental retardation, disability, genetic disease and other conditions that led to inferiority in the Japanese gene pool.

The Leprosy Prevention laws of 1907, 1931 and 1953, permitted the segregation of patients in sanitariums where forced abortions and sterilization were common and authorized punishment of patients "disturbing peace". Under the colonial Korean Leprosy prevention ordinance, Korean patients were also subjected to hard labor.

The Race Eugenic Protection Law was submitted from 1934 to 1938 to the Diet. After four amendments, this draft was promulgated as a National Eugenic Law in 1940 by the Konoe government. According to Matsubara Yoko, from 1940 to 1945, sterilization was done to 454 Japanese persons under this law.

According to the Eugenic Protection Law (1948), sterilization could be enforced on criminals "with genetic predisposition to commit crime", patients with genetic diseases such as total color-blindness, hemophilia, albinism and ichthyosis, and mental affections such as schizophrenia, manic-depression and epilepsy. The mental sicknesses were added in 1952.

India
India's state of emergency between 1975 and 1977 included an infamous family planning initiative beginning April 1976, which involved the vasectomy of thousands of men and tubal ligation of women, either for payment or under coercive conditions. Son of then Prime Minister Indira Gandhi, Sanjay Gandhi was largely blamed for what turned out to be a failed program. A strong backlash against any initiative associated with family planning followed the highly controversial program, which continues into the 21st century.

China
Coercive sterilization to enforce the one child policy has occurred in China. This is not permitted by the law, and some local officials have been jailed for their actions. In 2010, Amnesty International accused authorities in Puning of compelling people to be sterilized by imprisoning their elderly relatives. See also Iron Fist Campaign

Peru
In Peru, President Alberto Fujimori (in office from 1990-2000) has been accused of genocide and crimes against humanity as a result of a sterilization program put in place by his administration. Peru put in place a program of forced sterilizations against indigeneous people (essentially the Quechuas and the Aymaras), in the name of a "public health plan", presented July 28, 1995. The plan was principally financed using funds from USAID (36 million dollars), the Nippon Foundation, and later, the United Nations Population Fund (UNFPA). On September 9, 1995, Fujimori presented a Bill that would revise the "General Law of Population", in order to allow sterilization. Several contraceptive methods were also legalized, all measures that were strongly opposed by the Roman Catholic Church, as well as the Catholic organization Opus Dei. In February 1996, the World Health Organization (WHO) itself congratulated Fujimori for his plan to control demographic growth.

On February 25, 1998, a representative for USAID testified before the U.S. government's House International Relations Committee, to address controversy surrounding Peru's program. He indicated that the government of Peru was making important changes to the program, in order to:
 * Discontinue their campaigns in tubal ligations and vasectomies.
 * Make clear to health workers that there are no provider targets for voluntary surgical contraception or any other method of contraception.
 * Implement a comprehensive monitoring program to ensure compliance with family planning norms and informed consent procedures.
 * Welcome Ombudsman Office investigations of complaints received and respond to any additional complaints that are submitted as a result of the public request for any additional concerns.
 * Implement a 72 hour "waiting period" for people who choose tubal ligation or vasectomy. This waiting period will occur between the second counseling session and surgery.
 * Require health facilities to be certified as appropriate for performing surgical contraception as a means to ensure that no operations are done in makeshift or substandard facilities.

In September 2001, Minister of Health Luis Solari launched a special commission into the activities of the Voluntary Surgical Contraception, initiating a Parliamentary commission tasked with enquiring into the "irregularities" of the program, and to put it on an acceptable footing. In July 2002, its Final Report ordered by the Minister of Health revealed that between 1995 and 2000, 331,600 women were sterilized, while 25,590 men submitted to vasectomies. The plan, which had the objective of diminishing the number of births in areas of poverty within Peru, was essentially directed at the indigenous people living in deprived areas (areas often involved in internal conflicts with the Peruvian government, as with the Shining Path guerilla group). Deputy Dora Núñez Dávila made the accusation in September 2003 that 400,000 indigenous people were sterilized during the 1990s. Documents proved that President Fujimori was informed, each month, of the number of sterilizations done, by his former Ministers of Health, Eduardo Yong Motta (1994-96), Marino Costa Bauer (1996-1999) and Alejandro Aguinaga (1999-2000). A study by sociologist Giulia Tamayo, Nada Personal (in English: Nothing Personal), showed that doctors were required to meet quotas. According to Le Monde diplomatique, "tubal ligation festivals" were organized through program publicity campaigns, held in the pueblos jóvenes (in English: shantytowns). In 1996 there were, according to official statistics, 81,762 tubal ligations performed on women, with a peak being reached the following year, with 109,689 ligatures, then only 25,995 in 1998.

On October 21, 2011, Peru’s Attorney General José Bardales decided to reopen an investigation into the cases, which had been halted in 2009 under the statute of limitations, after the Inter-American Commission on Human Rights ruled that Peru’s sterilization program involved crimes against humanity, which are not time-limited.

Sweden
In 1997, following the publication of articles by Maciej Zaremba in the Dagens Nyheter daily, widespread attention was given to the fact that Sweden once operated a strong sterilization program, which was active primarily from the mid 1930s until the 1970s. A governmental commission was set up, and finished its inquiry in 2000.

The eugenistic legislation was enacted in 1934 and was formally abolished in 1976. According to the 2000 governmental report, 21,000 were estimated to have been forcibly sterilized, 6,000 were coerced into a 'voluntary' sterilization while the nature of a further 4,000 cases could not be determined. However, the 40 000 or so socio-medical cases are contested, and Zaremba and others argue that they were more in the interest of society than individual women. The Swedish state subsequently paid out damages to victims who contacted the authorities and asked for compensation.

The program included all known criteria for sterilization, including a loosely phrased "social" indiciation. In 1922 the State Institute of Racial Biology was founded in Uppsala and in 1927 Parliament began to deal with the first legal provisions on sterilisation. A new draft was produced in 1932, already taking into account sterilisation for general socio-prophylactic reasons, and even without the consent of the person concerned. The draft was adopted in 1934. Another law, passed in 1941, was more far reaching, included a social indication and did not include any age of consent limit.

From 1950, the number of eugenic sterilisations under the 1941 legal provisions gradually decreased. It is possible but not proven that the Swedish sterilizations targeted travellers. These were sometimes viewed as a separate race or ethnic group. The Swedish Racial Hygiene Society had been founded in Stockholm in 1909, and the 1934 works by Alva and Gunnar Myrdal was very significant in promoting the eugenic tendencies in practical politics. The authors theorized that the best solution for the Swedish welfare state ("folkhem") was to prevent at the outset the hereditary transfer of undesirable characteristics that caused the individual affected to become sooner or later a burden on society. The authors therefore proposed a "corrective social reform” under which sterilisation was to prevent "unviable individuals” from spreading their undesirable traits. .

Switzerland
In October 1999, Margrith von Felten suggested to the National Council of Switzerland in the form of a general proposal to adopt legal regulations that would enable reparation for persons sterilised against their will. According to the proposal, reparation was to be provided to persons who had undergone the intervention without their consent or who had consented to sterilisation under coercion. According to Margrith von Felten: The history of eugenics in Switzerland remains insufficiently explored. Research programmes are in progress. However, individual studies and facts are already available. For example:

The report of the Institute for the History of Medicine and Public Health "Mental Disability and Sexuality. Legal Sterilisation in the Vaud Canton between 1928 and 1985" points out that coercive sterilisations took place until the 1980s. The act on coercive sterilisations of the Vaud Canton was the first law of this kind in the European context.

Hans Wolfgang Maier, head of the Psychiatric Clinic in Zurich pointed out in a report from the beginning of the century that 70% to 80% of terminations were linked to sterilisation by doctors. In the period from 1929 to 1931, 480 women and 15 men were sterilised in Zurich in connection with termination.

Following agreements between doctors and authorities such as the 1934 "Directive For Surgical Sterilisation" of the Medical Association in Basle, eugenic indication to sterilisation was recognised as admissible.

A statistical evaluation of the sterilisations performed in the Basle women's hospital between 1920 and 1934 shows a remarkable increase in sterilisations for a psychiatric indication after 1929 and a steep increase in 1934, when a coercive sterilisation act came into effect in nearby National Socialist Germany.

A study by the Swiss Nursing School in Zurich, published in 1991, documents that 24 mentally-disabled women aged between 17 and 25 years were sterilised between 1980 and 1987. Of these 24 sterilisations, just one took place at the young woman's request.

Having evaluated sources primarily from the 1930s (psychiatric files, official directives, court files, etc.), historians have documented that the requirement for free consent to sterilisation was in most of cases not satisfied. Authorities obtained the "consent" required by the law partly by persuasion, and partly by enforcing it through coercion and threats. Thus the recipients of social benefits were threatened with removal of the benefits, women were exposed to a choice between placement in an institution or sterilisation, and abortions were permitted only when women simultaneously consented to sterilisation.

More than fifty years after ending the National Socialist dictatorship in Germany, in which racial murder, euthanasia and coerced sterilisations belonged to the political programme, it is clear that eugenics, with its idea of "life unworthy of life" and "racial purity" permeated even democratic countries. The idea that a "healthy nation" should be achieved through targeted medical/social measures was designed and politically implemented in many European countries and in the U.S.A in the first half of this century. It is a policy incomparable with the inconceivable horrors of the Nazi rule; yet it is clear that authorities and the medical community were guilty of the methods and measures applied, i.e. coerced sterilisations, prohibitions of marriages and child removals – serious violations of human rights.

Switzerland refused, however, to vote a reparations Act.

United States
The United States was the first country to concertedly undertake compulsory sterilization programs for the purpose of eugenics. The heads of the program were avid believers in eugenics and frequently argued for their program. It was shut down due to ethical problems. The principal targets of the American program were the mentally retarded and the mentally ill, but also targeted under many state laws were the deaf, the blind, people with epilepsy, and the physically deformed. According to the activist Angela Davis, Native Americans, as well as African-American women were sterilized against their will in many states, often without their knowledge while they were in a hospital for other reasons (e.g. childbirth). Some sterilizations took place in prisons and other penal institutions, targeting criminality, but they were in the relative minority. In the end, over 65,000 individuals were sterilized in 33 states under state compulsory sterilization programs in the United States. ]

The first state to introduce a compulsory sterilization bill was Michigan, in 1897 but the proposed law failed to garner enough votes by legislators to be adopted. Eight years later Pennsylvania's state legislators passed a sterilization bill that was vetoed by the governor. Indiana became the first state to enact sterilization legislation in 1907, followed closely by Washington and California in 1909. Sterilization rates across the country were relatively low (California being the sole exception) until the 1927 Supreme Court case Buck v. Bell which legitimized the forced sterilization of patients at a Virginia home for the mentally retarded. The number of sterilizations performed per year increased until another Supreme Court case, Skinner v. Oklahoma, 1942, complicated the legal situation by ruling against sterilization of criminals if the equal protection clause of the constitution was violated. That is, if sterilization was to be performed, then it could not exempt white-collar criminals.

Most sterilization laws could be divided into three main categories of motivations: eugenic (concerned with heredity), therapeutic (part of an even-then obscure medical theory that sterilization would lead to vitality), or punitive (as a punishment for criminals), though of course these motivations could be combined in practice and theory (sterilization of criminals could be both punitive and eugenic, for example). Buck v. Bell asserted only that eugenic sterilization was constitutional, whereas Skinner v. Oklahoma ruled specifically against punitive sterilization. Most operations only worked to prevent reproduction (such as severing the vas deferens in males), though some states (Oregon and North Dakota in particular) had laws which called for the use of castration. In general, most sterilizations were performed under eugenic statutes, in state-run psychiatric hospitals and homes for the mentally disabled. There was never a federal sterilization statute, though eugenicist Harry H. Laughlin, whose state-level "Model Eugenical Sterilization Law" was the basis of the statute affirmed in Buck v. Bell, proposed the structure of one in 1922.

After World War II, public opinion towards eugenics and sterilization programs became more negative in the light of the connection with the genocidal policies of Nazi Germany, though a significant number of sterilizations continued in a few states until the early 1960s. The Oregon Board of Eugenics, later renamed the Board of Social Protection, existed until 1983, with the last forcible sterilization occurring in 1981. The U.S. commonwealth Puerto Rico had a sterilization program as well. Some states continued to have sterilization laws on the books for much longer after that, though they were rarely if ever used. California sterilized more than any other state by a wide margin, and was responsible for over a third of all sterilization operations. Information about the California sterilization program was produced into book form and widely disseminated by eugenicists E.S. Gosney and Paul B. Popenoe, which was said by the government of Adolf Hitler to be of key importance in proving that large-scale compulsory sterilization programs were feasible. In recent years, the governors of many states have made public apologies for their past programs beginning with Virginia and followed by Oregon and California. None have offered to compensate those sterilized, however, citing that few are likely still living (and would of course have no affected offspring) and that inadequate records remain by which to verify them. At least one compensation case, Poe v. Lynchburg Training School & Hospital (1981), was filed in the courts on the grounds that the sterilization law was unconstitutional. It was rejected because the law was no longer in effect at the time of the filing. However, the petitioners were granted some compensation as the stipulations of the law itself, which required informing the patients about their operations, had not been carried out in many cases.

The 27 states where sterilization laws remained on the books (though not all were still in use) in 1956 were: Arizona, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Iowa, Kansas, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Utah, Vermont, Virginia, West Virginia, Wisconsin.

Other countries
Eugenics programs including forced sterilization existed in most Northern European countries, as well as other more or less Protestant countries. Some programs, such as Canada's and Sweden's, lasted well into the 1970s. Other countries that had notably active sterilization programs include Denmark, Norway, Finland, Estonia, Switzerland, Iceland, and some countries in Latin America (including Panama). In the United Kingdom, Home Secretary Winston Churchill introduced a bill that included forced sterilization. Writer G. K. Chesterton led a successful effort to defeat that clause of the 1913 Mental Deficiency Act.

According to some testimonies, the Soviet Union allegedly imposed forced sterilization on female workers deported from Romania to Soviet labor camps. This is said to have occurred after World War II, when Romania was supposed to supply a reconstruction workforce (according to the armistice convention). However, no court decisions or formal investigations of these allegations are known for the moment.

A Dutch Labour Party MP has recently proposed temporary (two year) compulsory contraception, (not sterilization), of women who have a legally proven history of child abuse. The method would be via injection of anti-conception medicinal drugs, every six months. If the woman or parents have shown progress during that time, this would be reversed.