Compulsory sterilization

Based on Wikipedia: Compulsory sterilization

In 1982, the military dictator of Bangladesh launched what one expert called "the largest sterilization program in the world." The government trained 25,000 field workers and dispatched them to 65,000 villages with a simple quota: perform two tubal ligations and two vasectomies each month, or don't get paid. Women who showed up for unrelated gastrointestinal surgery sometimes left the operating table unable to have children—without ever being told what had been done to them.

This is what compulsory sterilization looks like in practice. It's a phrase that sounds clinical, almost bureaucratic. But behind it lies one of the most intimate violations a government can commit against its citizens: permanently removing their ability to have children, often without meaningful consent, sometimes without any consent at all.

The Mechanics of Taking Away Reproduction

Sterilization itself is straightforward. For women, it typically means tubal ligation—cutting, tying, or blocking the fallopian tubes so eggs can't travel from the ovaries to the uterus. For men, it's vasectomy: severing the tubes that carry sperm. Both procedures are permanent, or at least intended to be. Reversal surgeries exist but are expensive, often unsuccessful, and rarely accessible to the populations targeted by these programs.

Chemical sterilization is less common but exists. Some governments have explored adding sterilizing agents to drinking water or food supplies, though no such agent has ever been developed that works reliably without causing other harm.

The word "compulsory" is doing heavy lifting here. It doesn't always mean soldiers holding someone down on an operating table—though that has happened. More often, it means creating conditions where saying no becomes effectively impossible.

The Space Between Force and Choice

Consider Bangladesh again. The government offers 2,000 taka—about eighteen US dollars—to anyone who agrees to be sterilized. They throw in a sari for women or a kurta for men. The person who convinces you to undergo the procedure gets paid too: 300 taka, roughly three dollars. In a country where millions live on less than two dollars a day, these amounts aren't incentives. They're coercion dressed up as compensation.

A 1977 study found that between 40 and 60 percent of Bangladeshi men who got vasectomies did so primarily because of the payment. They didn't particularly want the procedure. They needed the money.

The follow-up data is grim. Nearly half of the men surveyed a year later were dissatisfied with their vasectomies. More than half reported their ability to work had decreased. Almost a third experienced severe pain during the procedure itself. Many said they never received all the payments they'd been promised.

This is the pattern that repeats across countries and decades: target the poor, offer something they desperately need, get their "consent," and call it voluntary.

The Eugenics Connection

The word eugenics comes from the Greek for "well-born." The idea emerged in the late 1800s, championed by Francis Galton, a cousin of Charles Darwin. Galton proposed that humanity could be improved through selective breeding—encouraging the "fit" to have more children while preventing the "unfit" from reproducing at all.

It's important to understand that eugenics wasn't fringe science. It was mainstream. It was taught in universities, promoted by respected physicians, and embraced by progressives and conservatives alike. The American eugenics movement influenced Nazi Germany's racial hygiene programs, which eventually sterilized over 400,000 people deemed mentally or physically "defective."

But the Nazis didn't invent forced sterilization. They learned from us.

By the time Germany's sterilization program began in 1934, more than thirty American states had already passed compulsory sterilization laws. California alone sterilized more than 20,000 people by 1964, mostly inmates of state psychiatric hospitals. The targets were labeled "feebleminded," "insane," or simply "unfit." Many were poor. Many were immigrants. Many were people of color.

From Racial Purity to Population Control

After World War Two, explicit talk of racial improvement became politically toxic. The Holocaust had revealed where such thinking could lead. But the underlying logic didn't disappear. It repackaged itself.

The new concern was overpopulation. In 1968, Paul and Anne Ehrlich published "The Population Bomb," predicting imminent global catastrophe from too many humans consuming too few resources. The book became a bestseller. Its influence was enormous.

The Ehrlichs' concern was genuine, but the solutions that followed were often brutal. If the problem was too many people, the answer was fewer births. And if people in developing countries wouldn't voluntarily limit their families, well, perhaps they needed encouragement.

This is where neo-Malthusian thinking intersected with Cold War politics. Thomas Malthus, writing in 1798, had argued that population growth would always outstrip food production, leading to famine, disease, and war. His modern followers added a twist: overpopulation in the "Third World" would breed poverty, instability, and—crucially—susceptibility to communism.

Population control became foreign policy.

The Global Campaign

The United States Agency for International Development, known as USAID, began funding family planning programs in developing countries. The World Bank tied development loans to population reduction targets. International organizations pushed contraception, sterilization, and abortion services to countries that might otherwise have focused their limited healthcare resources elsewhere.

Some of these programs were genuinely helpful. Access to contraception can be liberating for women who want to control their fertility. But many programs crossed the line from offering options to demanding compliance.

India's sterilization campaign in the 1970s became notorious. Under Indira Gandhi's government, state employees were given sterilization quotas. In some areas, men who refused vasectomies lost their ration cards, their access to irrigation water, their government jobs. Police conducted "vasectomy raids," rounding up men from villages and sterilizing them by the hundreds. The backlash was so severe that it contributed to Gandhi's electoral defeat in 1977—and to lasting distrust of family planning programs across the country.

China's one-child policy, implemented in 1980, included mandatory IUD insertion after a first birth and mandatory sterilization after a second. Women who became pregnant without permission faced intense pressure to abort. The policy was officially relaxed in 2015, but its effects—including a dramatic gender imbalance from sex-selective abortion—persist.

Who Gets Sterilized

The populations targeted for sterilization follow predictable patterns. They are poor. They are marginalized. They are people whose reproduction, for whatever reason, the powerful find inconvenient.

Indigenous women have faced particularly brutal treatment. In Peru during the 1990s, under President Alberto Fujimori, a sterilization campaign resulted in the forced tubal ligation of an estimated 300,000 women, most of them indigenous and poor. Healthcare workers were given quotas. Women were sterilized without consent, sometimes while unconscious for other procedures, sometimes under threats that their families would lose food assistance.

In Canada, indigenous women were sterilized without consent well into the 1970s, and credible reports suggest the practice continued in some form until at least 2018. Women have described being pressured to sign consent forms while in active labor, or having the procedure performed without any consent at all.

The United States has its own ongoing history. As recently as 2020, a whistleblower alleged that a gynecologist at an Immigration and Customs Enforcement detention center had performed hysterectomies on detained women, many of whom say they didn't understand or consent to the procedures.

Disability and the Right to Reproduce

People with disabilities, particularly intellectual disabilities, have been sterilized in enormous numbers. The justification has shifted over time—from preventing the transmission of "defective genes" to claims that disabled people can't care for children to arguments that sterilization makes life "easier" for caregivers.

But the result is the same: removing someone's reproductive capacity because others have decided they shouldn't reproduce.

Catalina Devandas Aguilar, who served as the United Nations Special Rapporteur on the rights of persons with disabilities, has heard all the excuses. "So many times, you hear it's in the best interest of the woman," she said. "But often, it's because it's more convenient for the family or the institution that takes care of them."

The assumption underlying these decisions is that disabled people can't make their own choices about sex, reproduction, and family. It's a profound denial of autonomy—the right to make decisions about your own body and your own life.

Transgender People and Legal Recognition

For decades, many countries required transgender people to be sterilized before they could change their legal gender marker. The logic was circular and cruel: to be legally recognized as something other than your birth sex, you had to prove you could never reproduce as your birth sex.

As of 2013, twenty-four European countries still required sterilization for legal gender recognition. Sixteen more didn't allow any legal gender change at all. This meant transgender people faced an impossible choice: accept permanent sterility or live with identity documents that didn't match who they were.

The consequences rippled through every aspect of life. Try getting a job when your appearance doesn't match your ID photo. Try boarding a plane. Try opening a bank account. For many transgender people, the price of participating in normal society was surrendering their fertility.

International human rights bodies have increasingly recognized this as a violation. The United Nations Special Rapporteur on Torture explicitly identified forced sterilization of transgender people as a human rights abuse. Courts in several countries have struck down sterilization requirements. But in much of the world, the requirement persists.

Intersex People and Infant Surgery

Intersex people—those born with sex characteristics that don't fit typical definitions of male or female—face a different but related form of reproductive violation. Intersex conditions are relatively common, occurring in roughly 1 to 2 percent of births depending on how you count.

For decades, the medical standard was to surgically "normalize" intersex infants as early as possible. Doctors would decide whether a baby should be raised as male or female, then perform surgery to make the child's body conform to that decision. These surgeries often included removing reproductive organs—ovaries, testes, or both—eliminating the child's future fertility before they could ever have a say.

The rationale was that children needed "clear" gender identity to develop normally. But no evidence supported this claim. What we do know is that many intersex adults who underwent childhood surgeries experience chronic pain, loss of sexual sensation, and profound psychological harm from having irreversible decisions made about their bodies without their consent.

International organizations including the World Health Organization, the United Nations, and numerous human rights bodies have called for an end to non-consensual surgeries on intersex children. Change has been slow. Many hospitals continue the practice, often presenting it to parents as necessary or routine.

The International Legal Framework

On paper, the world has condemned forced sterilization. The Rome Statute of the International Criminal Court, which established the court's jurisdiction in 2002, recognizes widespread or systematic forced sterilization as a crime against humanity.

There's a catch, of course. The International Criminal Court doesn't have universal jurisdiction. Countries can choose not to participate. The United States hasn't ratified the Rome Statute. Neither has Russia or China. The court can only prosecute crimes committed in or by nationals of countries that have accepted its authority—unless the United Nations Security Council refers a case, which any of the five permanent members can veto.

The Istanbul Convention, a European treaty on preventing violence against women, explicitly prohibits forced sterilization. But again, not all countries have signed or ratified it.

Regional courts have issued important rulings. The European Court of Human Rights has found against countries that forced sterilization on Roma women. National courts in some countries have ordered compensation for sterilization victims. But enforcement is patchy, and many survivors have never received acknowledgment, let alone justice.

What Consent Actually Means

In 2014, a coalition of major international organizations—the World Health Organization, UN Women, UNICEF, and others—issued a joint statement on eliminating forced, coercive, and otherwise involuntary sterilization. The document is worth reading carefully because it distinguishes between different forms of pressure.

Forced sterilization is what it sounds like: performing the procedure without any pretense of consent.

Coerced sterilization is more insidious. It's when consent is obtained, but under conditions that make refusal practically impossible. When a woman in labor is told she can't receive pain relief unless she signs a sterilization consent form. When a man is told he'll lose his job or his ration card if he doesn't get a vasectomy. When a family is told their welfare benefits depend on the mother being sterilized.

Involuntary sterilization is broader still. It includes situations where someone nominally consents but doesn't understand what they're agreeing to—because the procedure wasn't explained, because they don't speak the language, because they're under the influence of medication, because they have a cognitive disability that affects comprehension, because they're a minor whose parents consented for them.

True informed consent requires understanding what the procedure involves, what the alternatives are, what the consequences will be, and having the genuine freedom to say no without penalty. By this standard, much of what has been called "voluntary" sterilization was nothing of the kind.

The Long Shadow

The effects of coercive sterilization programs extend far beyond the individuals directly harmed. They poison the well for legitimate public health efforts.

In communities that experienced forced sterilization, distrust of family planning programs—and of healthcare systems generally—can persist for generations. When health workers show up offering contraception, people remember the last time their government "helped" with reproductive health. This distrust has consequences: higher rates of unintended pregnancy, worse maternal health outcomes, reduced uptake of other preventive care.

The reproductive justice movement emerged partly in response to the failures of mainstream reproductive rights advocacy to address these abuses. Traditional reproductive rights focused narrowly on the right to not have children—access to contraception and abortion. Reproductive justice expands the frame to include the right to have children, the right to parent the children you have in safe and supportive environments, and freedom from reproductive coercion in all its forms.

This framework, developed primarily by women of color in the 1990s, recognizes that reproductive freedom means different things for people in different circumstances. For a middle-class white woman, the barrier might be abortion restrictions. For a poor woman of color, it might be pressure to be sterilized or have her children removed. Both are violations of reproductive autonomy, but they require different responses.

The Present Tense

It would be comforting to treat compulsory sterilization as historical—a shameful chapter we've moved past. The evidence doesn't support that comfort.

Reports continue to emerge from immigration detention facilities, from prisons, from psychiatric institutions, from hospitals serving poor and marginalized communities. The methods have sometimes become subtler—less crude coercion, more exploitation of power imbalances—but the fundamental violation remains.

Bangladesh's sterilization program, described at the beginning of this essay, is ongoing. The government's website still lists the payments offered. Field workers still have quotas. Women and men who can't afford food are still being offered money to give up their fertility.

Disabled people are still being sterilized without meaningful consent, often at the request of parents or guardians who find caring for a potentially fertile disabled person inconvenient.

Transgender people in many countries still face sterilization requirements for legal recognition.

Intersex infants are still undergoing surgeries that will affect their fertility and bodily integrity for life, before they can possibly consent.

The question isn't whether compulsory sterilization still happens. It's whether we'll recognize it when it does—and whether we'll do anything about it.

A Note on Language

Throughout this essay, I've used terms like "forced," "coerced," and "compulsory" somewhat interchangeably, though they have distinct meanings. This reflects both the reality that these categories blur in practice and the difficulty of drawing clean lines around violations of reproductive autonomy.

What matters most isn't whether a particular case meets some technical definition of "force." It's whether people have genuine freedom to make decisions about their own bodies—and whether we, as societies, are willing to protect that freedom even when it's inconvenient, even when the people involved are poor or marginalized or different from us.

The history of compulsory sterilization is, at its core, a story about power: who has it, who doesn't, and what happens when those with power decide that certain people shouldn't reproduce. It's a story that isn't over. And how it continues depends, in part, on whether we're paying attention.