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The Little Known History of Forced Sterilization in Puerto Rico

By Elizabeth Santiago, Founder, The Untold Narratives and author of The Moonlit Vine

When I wrote The Moonlit Vine, a young adult novel that interspersed Puerto Rican history with present day occurrences, I wanted to shed light on aspects of history that are often ignored or even suppressed. Puerto Rico’s status as a territory of the United States is nuanced and complex. While the island’s political standing is not the focus of this blog, this dynamic plays into why Puerto Rican women were used for years as unwilling test subjects for birth control and forced to undergo horrific and unethical sterilization procedures.

If you haven’t read The Moonlit Vine, the story starts with a vignette from 1492 where the Taíno leader, Anacaona, is navigating the aftermath of European invaders on her land. She understands the Taíno people are outnumbered and will not win. She hands her daughter a precious object to save and pass along to her future daughters to help keep the Taíno alive. This is an extended metaphor for how Taíno survival was based on the matrilineal line.

Now, imagine, the year is 1950 and you are handed a precious object that has been in the family for almost 500 years. You might feel honored, humbled, awe-inspired and eager to keep the object safe so you can pass it along. You try to have children but discover that you have been sterilized against your knowledge.

When I conceptualized this scene, I put myself in the shoes of the character, feeling her anguish, anger and deep disappointment. I wrote a historical vignette I wanted to include, but it didn’t fit with the overall tone of the book. While not including it was the right decision for the story, I have been haunted ever since by what I developed. I still cannot fathom what it would feel like discovering that the choice of having children had been stolen from you.

I recently re-read the excerpt and decided I would share this more widely to shed light on the barbaric and racist practices Puerto Rican women endured in the name of science and progress. Before you read the vignette, explore some of the context for why and how this was allowed to happen.

The Historical Context

La Operación

In the 1930s, doctors in Puerto Rico falsely pushed women into sterilizations as the only means of contraception. Between 1947-1948, it’s estimated that 7% of Puerto Rican women were sterilized and by 1954, the rate had doubled (see reference 1 below). In many of these cases Puerto Ricans were told their “tubes were being tied”, medically known as a tubal ligation, which was agreed to, but patients were never informed this was an irreversible procedure.

In 1982, La Operación, a documentary directed by Ana María García showed the widespread sterilization operation led by the United States during the 1950s and 60s in Puerto Rico (see reference 2 below). Women and their families were promised security after they underwent “la operación,” or sterilization. The operation was marketed to them as a way out of poverty and many women thought that once their “tubes were tied”, they could be “untied.” This was not the case and they ended up losing their reproductive rights. The filmmaker was quoted as saying, “All the women interviewed could be you, your mother, your wife, your sister, your daughter, and your friend. One way or another this issue touches everyone's life." (See reference 3 below)

Test Subjects for Birth Control

Puerto Rican women were also used as test subjects (unbeknownst to them) for the then considered experimental birth control pill. This started with Margaret Sanger, a birth control advocate who in 1916 opened the nation’s first birth control clinic. Sanger also supported eugenics, a theory that non-white or less desirable populations could be reduced or eliminated by controlling their breeding. While she believed that women weren’t free until they had control of their bodies, she did not believe that all women were of equal value.

She partnered with Gregory Pincus, a biologist who specialized in mammal reproduction, to create a large-scale, modern form of birth control. Pincus had preliminary success in Boston through small trials for the Pill in 1954 and 1955, but without large-scale, human trials, he knew he would never get FDA approval, which was necessary to bring the drug to market. Given the strong opposition to birth control in America in the 1950s, he had to find an alternate place to conduct his experiments.

In the summer of 1955, Gregory Pincus visited Puerto Rico, and decided it would be the perfect location for the research trials he needed. There were no anti-birth control laws and there was already a network of birth control clinics in place. I also learned that Pincus thought that by showing Puerto Rican women could successfully use oral contraceptives, he could quiet his critics' concerns that oral contraceptives would be too complicated for women in developing nations and American inner cities to use. (See reference 4 below)

Dr. Edris Rice-Wray was in charge of the trials. After a year of tests, Dr. Rice-Wray reported that the pill was 100% effective when taken properly. She also informed him that 17% of the women in the study complained of nausea, dizziness, headaches, stomach pain and vomiting. Pincus quickly dismissed the conclusions believing that the benefits outweighed what he considered minor issues. Although three women died while participating in the trials, no investigation was conducted to see if “the Pill” had caused the young women's deaths.

In later years, Pincus's team would rightfully be accused of deceit, colonialism and the exploitation of poor, brown women. The women had only been told that they were taking a drug that prevented pregnancy, not that the pill was experimental or that there was a chance of potentially dangerous side effects. In other words, they were given no choice as to whether they would want to participate in these trials. Pincus and others believed they were following the appropriate ethical standards of the time. In the 1950s, research involving human subjects was much less regulated than what we see today. Would he have gotten away with the same behavior toward middle class white women in the United States? Probably not, which is why the argument that they thought they were following the appropriate ethical standards rings completely false to many. The medical community thought they could easily exploit Puerto Rican women and they did exactly that.

El Yunque Rain Forest, Puerto Rico
El Yunque Rain Forest, Puerto Rico by Elizabeth Santiago

Unused historical vignette from The Moonlit Vine

San Sebastián 1950

Ides gazed toward a vast piece of green land that stretched out into nothingness. The sun was rising, but the beauty of the morning light illuminating the countryside was lost to her. All she could think of was how she could never have children. Hot tears filled with loss, anger, and frustration sat on her face. She held the amulet her mother had given her for safekeeping and for passing on to the daughter she would never have tight against her chest. A sound escaped her mouth and soon she was screaming. Why would they do this to her? What had she done? She had been treated like a nothing, a thing unworthy of a future.

THEY approached her at the hospital where she was being treated for appendicitis.

Do you want children?

No, not now.

We can help!

THEY helped alright. THEY helped themselves to her daughters and sons. Now that Puerto Rico was ruled by the United States government, they wanted to keep the population under control. We are like rats to them, Ides thought. They wanted to control the spread of us and they did this without permission or mercy.

Ides dropped to her knees – the weight of her unborn children pulling her toward the soil. Who might she have given birth to? She thought. Perhaps one of her daughters would have set them all free. She opened her palm and looked at the amulet wondering what would happen if she unlocked it. If she called her ancestors and if they came. What would they do? Could they help? No. Ides thought. No one could help her now.

She would have to give the amulet back to her mother and tell her to give it to Juana or to Isaura. She would have to reveal what she learned at the clinic just yesterday. She had gone there to inquire what she might do to get pregnant since she and her husband had been trying for three years without luck. It was then she learned that she had had “la operación.”

Ides walked back into her home, which consisted of two rooms. Her husband lay asleep in one room while she put all of the items back into the box with a note for her mother. The note simply read, “fallé.“

She left the box in the hiding place her mother had shared knowing her mother would look there first for the items. She then walked off never to return. No one knew what happened to her. One day she was there and the next she was not. Esmerelda, her mother, did find the objects and tried to understand the message, “I failed,” but never figured it out. Three years had passed before Esmerelda passed the items onto Isaura, her youngest daughter.


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The Untold Narratives is a website to help you learn the art and craft of storytelling so you can tell whatever story you want to tell and bring your voice to life. Not seeing oneself or one’s community represented in narratives can make you feel like you don't belong. It can also give an inaccurate representation of history and reality. Visit us to learn more. We look forward to experiencing your amazing stories!

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