Between 1930 and 1970, around one third of all women in Puerto Rico were sterilized to address concerns of 'surplus population'

• When Puerto Rico became a colony of the US in 1898, much of its population was living in poverty.
• The US government and Puerto Rico's appointed government instituted an economic development strategy for the island called "Operation Bootstrap."

In 1898, the United States government acquired Puerto Rico through the Treaty of Paris, which ended the Spanish-American War. This was only one year after Spain had granted the island the power to self-govern. But after Spain lost the war, they ceded control of Puerto Rico.

At the time, Puerto Rico's population was just under 1 million. Most were living in poverty. It wasn't uncommon for families to spend the majority of their income on food. Many people worked for only cents per day harvesting sugarcane. Others owned farms or worked inland on coffee and tobacco fields.

"Imagine that about 90% of your income is spent on food, and you're still malnourished. There's no money for clothes. Shoes were basically non-existent among the peasantry. And that was before the Great Depression," Dr. Harry Franqui-Rivera, a Latin American History Professor with a focus on Puerto Rico at Bloomfield College told Business Insider.

In tandem with the appointed Puerto Rican government, the US government drew up a plan to develop the island. In 1947, US Congress passed the Industrial Incentives Act, which became a part of "Operation Bootstrap," the name given to a number of projects that aimed to industrialize Puerto Rico's agrarian economy.

US corporations were lured to the island through tax exemptions and a cheap labor pool, which pushed agricultural workers into urban areas where newly formed factories were. However, that also led to fewer jobs and higher unemployment, creating what was described as a "surplus population" on the island.

To address this issue, the government came up with a two-pronged approach. In the short term, they would encourage Puerto Ricans to migrate to the mainland and surrounding islands in the Caribbean. In the long term, they would encourage sterilization and birth control, which bolstered the burgeoning eugenics movement in the US.

Sterilization was the only form of contraception accessible to many Puerto Rican women

Beginning in the 1910s through the 1920s, the economy in Puerto Rico was industrialized by pushing rural workers to urban areas where there were new factories. Some families were able to get the newly-formed factory jobs, while others weren't so lucky. Following the landfall of Hurricane San Felipe and the Great Depression, by the 1940s the unemployment rate on the island was around 37%. Many residents were forced into poverty.

In 1937, contraception and sterilization was made legal in Puerto Rico. When signing the bill, Acting Governor Rafael Menendez Ramos made a statement in support of the legalization of sterilization, citing the problem of "surplus population," writing that "the inevitable consequence is increasing unemployment, growing poverty and mounting misery."

Some women chose to undergo sterilization because it was the only option for contraception available to them. Others were coerced into doing so by their doctors.

"In Puerto Rico, it was a class-based society," Franqui-Rivera said. "So imagine a doctor in Puerto Rico in the 1930s telling a woman from the peasantry that she should have or recommend that she get sterilized. There is no way for them to say no."

Sterilization or "La Operación" as it was called, was one of the only options for birth control women had available to them in the early 20th century. Birth control trials began on the island in the 1950s — well after contraception and sterilization became legal.

One survey from the 1982 Puerto Rico Fertility and Family Planning Assessment found that, of the women interviewed who were sterilized between 1954-1982, 21% said they felt some regret and 11% felt definite regret for having been sterilized.

Sterilization and birth control efforts were effective in reducing fertility rates on the island. In 1950, the average Puerto Rican woman had given birth to an average of 5.2 children by the age of 50. By 1977, that average had dropped to 2.7 births per woman.

Some Puerto Rican nationalists feared the US had plans of a physical and cultural genocide

Puerto Rico's birth control movement had strong opponents and supporters. On one side were the Catholic Church and Puerto Rican nationalists, who opposed sterilization. The Catholic Church took their position on birth control based on religious grounds. The nationalists feared that the US as a colonial power had plans of physical and cultural genocide of Puerto Rico.

On the other side of the sterilization debate was the US federal government, the Puerto Rican government, public health officials, and private elite, who held the belief that the underdevelopment of the island was due to poverty and in order to develop the island, the population had to shrink.

Even within the ranks of those who supported sterilization or birth control, there were progressive and conservative factions. Progressive factions supported some amount of birth control and sterilization for those living in poverty, but they didn't agree with the genetic inferiority argument that many conservative eugenicists believed. Progressive groups wanted to institute birth control, but they also wanted to strengthen education, combat crime, and develop welfare benefits for poorer families, Dr. Laura Briggs, Professor at the University of Massachusetts Amherst, wrote in "Reproducing Empire."

Dr. Iris López, a sociology professor and director of Latin American Studies at City College of New York and author of the book "Matters of Choice: Puerto Rican Women's Struggle for Reproductive Freedom," said most people who were a part of the birth control movement held a progressive ideology.

"The sterilization in Puerto Rico had to do more with the whole overpopulation ideology versus the general view of eugenics that people are targeted, genetically inferior, or unfit to reproduce," López said. "It was largely driven by the Puerto Rican government and the Puerto Rican people themselves wanting to help 'our people,' the poor people on the island."

Many women did not know the sterilization procedure would be permanent

The process of sterilization involves a woman's fallopian tubes being tied or cut through a procedure called tubal ligation. While today it may be possible for women to undergo surgical reversal to try to become pregnant, the reversal process was not pioneered until the 1970s. For most Puerto Rican women, sterilization was permanent.

Because of the colloquial language physicians used telling women they needed to get their "tubes tied," some women were under the misconception that the procedure would be reversible.

As López writes in her book, while sterilization in many cases was not forced onto Puerto Rican women, many women felt they did not have an alternative because of government policy and the social conditions they were subjected to. Some factories may have also encouraged their employees to be sterilized to reduce turnover.

While projected rates of sterilization on the island between 1930 and 1970 vary somewhere between 30-40%, López said there were higher rates of sterilization amongst married women. A 1982 survey found that 42% of married women interviewed said they had been sterilized.

The sterilization law and eugenics board were repealed in Puerto Rico in 1960, but high rates of sterilization continued on the island until the late 1980s, according to a Family Planning Perspectives study released in 1992.

Today, the effects of the economic development plan that led to the birth control movement reverberate on the island. Puerto Rico's population is aging rapidly, and people have continued to move away from the island in recent years in the wake of Hurricane Maria and as the economic situation worsens. The average number of births per woman was 0.9 in 2021.

"The Puerto Rican age, on average, is a huge problem," Franqui-Rivera said. "Even when the labor market was so good, incredibly good, it was a tough labor market."