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PUERTO RICO: A CASE STUDY OF POPULATION CONTROL

by Bonnie Mass *

The U.S. invasion and conquest of Puerto Rico in 1898 was motivated by economic as well as military considerations. Militarily, American political leaders viewed Puerto Rico as essential for expanding and enforcing U.S. domination throughout the Americas. Economically, the war against the crumbling Spanish empire was motivated by the desire to cash in on the rich resources of the Caribbean. Through the development of a dependent trade relationship, the United States rapidly established full integration with the island economy, principally with an exploitive mercantile tariff policy which forced Puerto Rico to buy and sell in the U.S. market. For example, the U.S. sugar cartel moved into Puerto Rico early in the twentieth century (Lewis, 1963: 85-103) to establish a monoculture system, thereby decimating the coffee- growing economy and dislodging other agricultural crops such as tobacco and citrus. One consequence of the ensuing intensive cultivation of a single export crop was the disruption of land settlement patterns and the uprooting of thousands of jibaros (Deasants) from their land. In the light of these changes, this paper examinescthe demographic formulations which were developed by American scientific organizations and foundations in response to the need of American corporations to protect capital earnings and holdings in the island colony beginning with the depression of the thirties, (see Silen, 1971: 54; Weinberg, 1935:60-67; Milbank Memorial Fund, 1948: 77).

Eugenic and Fertility Theories

By the turn of the century the ideological groundwork from population control concepts of eugenic thought were established (Gordon, 1974; Allen, 1974; Haller, 1963). As early as 1900, a growing nativist Anglo-Saxon current had arisen among powerful financeers and industrialists. Influenced by the Social Darwinists, significant members of the American ruling class developed theories of heredity which often concluded that the fittest in society be

*Bonnie Mass is a writer and lecturer on population control, sterilization and women's rights. She is National Board Member of the Puerto Rican Solidarity Committee. Part of this article is from her Population Target: The Political Economy of Population Control in Latin America, Toronto: Latin America Working Group, 1977.

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encouraged to breed selectively and that the "dysgenic," or less than fit, be weeded out so that the entire "human stock" be improved to the extent that the "aristogenic" individuals with perfect genes would abound (Gordon, 1974; Chase, 1977: 66-137).

These theories reached the highest level of legitimization in 1913 when, on the eve of the First World War, the Kellogg family of Battle Creek, Michigan, founded the well-known Race Betterment Foundation to lobby for "a policy of national eugenics" (Haller, 1963: 170-174; Progressive Labor, 1973; Allen 1974: 32-37). In 1928 at the meeting of the International Federation of Eugenic Organizations, C.B. Davenport of the Station for Experimental Evolution led a discussion on "cross-breeding," based on his work, Race-Crossing in Jamaica, published by the Carnegie Institute in 1929. About the same time prestigious journals published on eugenics topics; these journals included the Scientific Monthly as well as the publications of the American Sociological Society and the American Philosophical Society (Gini, 1929: 116-117).

By 1930 laws against miscegenation had been enacted in 24 states, while 30 states as well as two Canadian provinces had laws calling for sterilization of "criminals," the "feeble-minded," and the "insane" (Gordon, 1974: 74-75; Progressive Labor, 1973). During this period private foundations and birth control organizations began experimental population campaigns in the colon- ies of Puerto Rico, Jamaica, and Barbados, although fertility rates there were comparatively low, even by standards of developed industrialized countries. In Puerto Rico, the annual population growth rate was close to 1.5 percent in the early thirties, whereas elsewhere in the Caribbean population growth was nearer 2.7 percent (Roberts 1958:129).

Although eugenic concepts lost their original racial categorizations after the Second World War, the new population planners maintained much in common with the old-line eugenicist. Remnants of eugenic theory persisted throughout the late thirties and into the forties even though many scientists repudiated their validity. One British periodical, hailed Hitler's Germany in 1936 as a vast laboratory which was the scene of a "gigantic eugenics experiment." "It would be quite wrong and quite unscientific to decry every- thing that is going on in that country" (Eugenics Review, 1936:33). In 1939, the respected International Union of the Scientific Study of Population (IUSSP) met in Nazi-ruled Berlin, and racist population control theories were used to justify anti-semitic policies and demands for "lebansraum" or "breathing room" (Carder and Symonds 1973: 15). For the most part, however, U.S. demographic programs internationally were studied in terms of emigration, redistribution of population, and reduction of numerical birth rate. The same year that the IUSSP met in Berlin, a special League of Nations committee was set up to study international demographic problems.

In America the League's work was complemented by the prestigious Princeton Office of Population Research (OPR), founded in 1936 as a subdivi- sion of Princeton's School of Public Affairs, a melting pot for former eugeni- cists (Gordon 1974:83). The OPR was sustained by grants from the Rockefeller Foundation and from the Milbank Memorial Fund, the largest private doner at that time to subsidize research on world population trends (see Milbank Memorial Fund, 1948). The Scripps Memorial Foundation for Population Research was directed by eugenicist Warren Thompson from 1922 until he was Latin American Perspectives: Issue 15, Fall 1977, Vol. IV, No. 4

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succeeded in 1953 by Pascal Whelpton, another prominent eugenicst of the 1920s (Piotrow 1973; 8). All these developments undoubtedly influenced a law regulating "eugenic sterilization" which was enacted in Puerto Rico (Act number 116 of May 13, 1937), not to be repealed until June 8, 1960 (World Health Organization, 1973).

Unemployment, Migration, Sterilization

It hardly appears coincidental that during the 1930s with eugenic concepts in their intellectual prime and with international demographic data-gathering well underway, "a major break-through" towards limiting fertility in Puerto Rico took place under the administration of William Moran, Director of the U.S.-Puerto Rican Reconstruction Administration.' Testifying about his earlier experience in Puerto Rico, Moran explained to the U.S. Senate Population Crisis Hearings in 1965 that unemployment had resulted in the introduction of birth control programs in the colonial government's maternal child-health services.

We found in 1935, a tremendous unemployment and depression with several hundred thousand people out of work and we went to work and initiated projects that greatly diminished unemployment, but we were confronted with the fact that while we were putting people to work, the population growth was out-stripping all our efforts (Moran, 1966:206).

Although a birth control league similar to the eugenic-oriented American Birth Control League was founded in Ponce in 1925 and in San Juan in 1932, it was soon closed because of popular opposition and the lack of support by private physicians. Official support was gained, however, in 1937 when the Puerto Rican legislature passed birth control legislation (which included sterili- zation for "health reasons" rather than for clearly economic reasons of unemployment). It was clearly the poor health of Puerto Ricans caused by social and economic hardship which promoted doctors to support sterilization: "The great prevalence of dietary deficiences, hookworm, malaria and other chronic ailments among the poor of Puerto Rico has enabled the medical profession to carry out the provision in a liberal spirit" (Tietze and de Alvarado, 1947: 15-17).

The Puerto Rican government's understanding of birth control legislation, however, was also directly expressed as a concern for a growing "surplus population" manifested by large numbers of poor and unemployed. The 1937 birth control bill was signed with an accompanying statement which included the overpopulation theme of the day:

Maldistribution of Puerto Rican lands and its growing absentee ownership must realize that these problems are growing more and more serious through our existing surplus population and its constant growth. The inevitable consequence is increasing unemploy- ment, growing poverty . . . (cited in Presser 1973, 123)

Supporting the bill's contention that birth control was a major means to

Moran was a former Dean of the School of Foreign Service in Washington, Chief of the Mutual Security Administration, President of the Catholic Association for International Peace, an agent of the Federal Bureau of Investigation, Consultant to the National Planning Association of African and Latin American Studies, member of the Council on Foreign Relations, author of Population Growth: Threat to Peace?, and a leading member of the military-heavy Population Crisis Committee (see Population Crisis Committee, 1970).

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MASS: POPULATION CONTROL IN PUERTO RICO 69

better health were the results of a survey taken on sterilization by Puerto Rican physicians in the thirties - a time when 80 percent of those who responded favored sterilization as a medical solution to malnourishment and poor health (cited in Stycos 1954:3). One highly personal motive attributed to the apparent choice of post-partum sterilization as opposed to other means of birth control is noted by Tietze: "Since the baby furnishes an obvious reason for the hospital visit, no further explanation need be supplied to curious neighbors and the privacy is greater than for those visiting a birth control clinic" (Tietze and de Alvarado 1947: 25).

Additional empirical evidence used to support large-scale birth control programs in the absence of adequate health-care services was based on the high birth rate of 39.6 per thousand, whereas the death rate was declining proportionally at a much greater rate. Clearly omitted from defense of an official birth reduction policy was the economic situation of a colonized economy based on the extraction of resources which increasingly turned Puerto Rico's working population into a marginal and surplus labor force.

During the late 1930s, fifty-three clinics opened, and sterilization, labelled "la operacion," was used as the major means of controlling Puerto Rico's population growth. Although official legitimization was bestowed upon these clinics by the legislature and Puerto Rico's physicians, Senator Ernest Gruen- ing, then Director of the Division of Territories and Island Possessions of the Department of the Interior, abandoned these initial official efforts after strong opposition arose from the Catholic church2 as well as from popular nationalist sentiment antagonistic to the obvious attempt of the colonizing power to relieve the Puerto Rican unemployment problem by means of population control (Stycos, 1955: 109).

Depression conditions during the 1930s, had stimulated a huge emigration from Puerto Rico to the U.S. mainland, and natural population increase was offset in the process. In order to seek living wages during the 1930s approxi- mately 3,700 Puerto Ricans left yearly as compared to an annual exodus of about 500 between 1900 and 1920 (Roberts, 1958: 132). Emigration was also stimulated by massive repression against popular movements, as evidenced by the Ponce Massacre of 1937 where many were killed and imprisoned.

By the early forties, the Puerto Rican economy had been devastated by the sugar cartel's development of a single-crop export economy and crippling mercantile tariffs which prevented broader trade agreements with other Latin American nations (Lewis, 1963: 103-120). More incentive was needed to attract U.S. private capital, more than was offered in Western Europe where better technology and markets were available. Accordingly, a special tax arrange- ment was set up by the United States. Outside capital was offered in a package deal soon labeled "Operation Bootstrap" which encouraged the influx of capital into industrial production with the purpose of siphoning off superprof- its for the mainland. In spite of the "boom" caused by this transition, not enough jobs were created, and as a result, emigration to the United States between 1950 and 1955 increased, drawing off 83 percent of the natural 2Ernest Gruening won the approval of the Catholic bishops in Puerto Rico for birth control clinics, but the highly sensitive presidential election campaign of F.D. Roosevelt was affected by the intervention of Cardinal Spellman of New York who indirectly forced Gruening to cancel official U.S. support. However, in 1937, birth control clinics were legalized by the Puerto Rican legislature. They were again downgraded in 1946 (Piotrow, 1973:32).

Latin American Perspectives: Issue 15, Fall 1977, Vol. IV, No. 4

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population increase of the island (Roberts, 1958: 132). This emigration benefit- ed the United States by forcing Puerto Rican labor to accept migrant work or non-unionized jobs throughout the United States.

A Geo-Political Strategy

During the early fifties, American leaders and industrial magnates became increasingly conscious that propserity in North America and Western Europe was largely determined by a continuous flow of raw materials from the underdeveloped nations. The President's International Development Advisory Board (1951:46) estimated that nearly three quarters of the raw materials used in the United States originated in Asia, Africa, and Latin America. An earlier note of alarm relative to population growth and the need for resources had been sounded by Julian Huxley, Director General of the United Nations Economic and Social Council, in his annual report of 1948: "Somehow or other, population must be balanced against resources or civilization will perish. War is a less inevitable threat to civilization than is population increase" (Carder and Symond, 1973:54). American foundations and academic bodies represented by political demographers had been engaged in building a firmer justification for U.S. foreign policy since the mid-forties. Warren Thompson, while Director of the Scripps Foundation and Professor of Social Science at Miami Universi- ty, wrote Danger Spots in World Population (1929) in which he argued that Japan's defeat was caused by population pressure in the Pacific. After the war, in 1946, he wrote Population and Peace in the Pacific. These former eugeni- cists adopted Malthus' "Permanent Laws" of nature based on the assumption of the inevitability of overpopulation growth. They claimed as did Reverend Malthus that this phenomenon of nature produced discontent among the "lower members" of society, and they feared that social discontent would increase the scope of "communist propaganda" (Thompson, 1929: 201-207; 1947, 68,69). In Population: Roads to Peace and War, former Eugenics Society member, Guy Irving Burch, explained in 1945 that the introduction of modern medicine had served merely to worsen the situation by accelerating the rate of population growth. Death control, the eugenicists argued, must be balanced by birth control. No matter the amount of foreign aid, it would fail to achieve its goals unless accompanied by strenuous measures to limit population growth (Carder and Symonds, 1973: 93).

U.S. geo-political strategy in the Caribbean, as elsewhere, remained one of insuring raw material sources, stability for foreign investment, and accessible pools of cheap labor. Puerto Rico was becoming increasingly important as a military base for defending this role in the western hemisphere. "The Gibraltar of the Caribbean" allowed the United States to support military offensives against Guatemala in 1954, against Cuba in 1961, and against Santo Domingo in 1965. U.S. military and economic strategy in the Caribbean could not be implemented without social stability, and this required, among other things, demographic control, including migration, sterilization, and data collection.

In the fifties Paul Hatt of Princeton's Office of Population Research collaborated with the Social Science Research Department of the University of Puerto Rico, compiling interviews of married couples in their mid-twenties in order to show sterilization preference by gathering data on attitudes towards

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MASS: POPULATION CONTROL IN PUERTO RICO 71

birth control and sterilization (see Table 1). As a result of information which presented U.S. social scientists with a "demand" in Puerto Rico for permanent birth control, and with the support of the U.S. government, Puerto Rico's governor and commissioner of health had temporarily opened 160 private birth clinics, and many small hospitals were established primarily if not solely for the purposes of performing sterilization (cited in Presser 1973: 29).

Table 1

Attitude of Married Sterilized Puerto Rican Women Toward Sterilization

Date of First Marital Union Attitudes Toward Sterilization 1920-1929 1930-1939 1940-1949 Average

Would do again 79.2% 70.6% 77.2% 73.4% Would not do again 23.8% 29.4% 22.8% 26.6% No information 3.1% 2.0% 3.0% 3.0%

Total interviewed 65 146 60 271

Source: Hatt, 1952: 450

In 1949, a survey taken in Puerto Rico revealed that 21 percent of all women interviewed had been sterilized and that sterilizations were currently being performed in 18 percent of all private and government hospital child deliveries on the island (Stycos, 1954:3). Other estimates concerning steriliza- tion during the same period were lower (Vasquez Calzada 1973:284). Steriliza- tion campaigns corresponded to the huge immigration of Puerto Ricans into the United States. It was at this time that the Independence Party specifically accused the government of supporting a mass sterilization program (New York Times, November 11, 1951). This opposition resulted in the closing of many clinics (Parrilla-Bonilla, 1974: 75-108). With a high level of sterilization achieved by 1955 (16.5 percent of women of child-bearing age) and an 83 percent loss of natural population growth through emigration, Puerto Rico's birth rate had dropped from one of the highest Caribbean rates of 40.7 per thousand in 1940 to one of the lowest of 30.8 per thousand in 1961 (Kelly, 1971: 44).

The Planned Parenthood Federation (PPF) also participated in Puerto Rico to lessen the "demographic pressure." Modernizing developments were held responsible by population control enthusiasts for creating sharp declines in death rates, thus upsetting the "natural" population balance (between nature and its environment). While colonialism helped establish systems of transpor- tation and communication and improved food distribution (particularly impor- tant in times of famine), the infrastructure building was largely for the purposes of supplying the colonial metropole with raw materials and transport and not for guaranteeing the prolongation of life. With the effective implemen- tation of preventive medicines, death rates often fell substantially, but the fall itself was not a new development. At the turn of the century, for example, before the malaria and small pox eradication campaigns of the 1920s reached the Third World, death rates in 18 underdeveloped countries fell by 35 percent (cited in Marshall, 1974:683). In addition, population growth in Africa, Asia, Latin American Perspectives: Issue 15, FaIl 1977, Vol. IV, No. 4

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and Latin America in 1850 was three times slower than in 1950, indicating once again that population growth cannot be absolutely correlated with medical advancement or industrialization (Marshall, 1974: 682).

American concern for Puerto Rico's "demographic pressures" increased in the fifties, and new private birth control clinics were set up under the title "La Associaci6n Puertorriquefia el Bienestar de la Familia" with the support of the Sunnen Foundation (Kelly 1971: 50). As a prosperious American corporate investor, Sunnen devoted much of his life to the study of reproduction control. "He spent hundreds of thousands on a pilot control project in Puerto Rico to learn if an operational formula could be found that might be applied in other larger areas" (Lader, 1970: 11). Later Sunnen became a millionnaire with his product Emko, the contraceptive foam which was one of the major forms of contraception used in Puerto Rico during the fifties other than the sterilization procedure. During this period, free contraception was brought to field, factory, and home. According to the Puerto Rican Family Planning Association, 100,000 persons received generous contraceptive supplies subsidized by Sunnen; addi- tionally, about 8,000 women and 3,000 men were sterilized in these private clinics (Presser, 1973: 31). Gynecologist Adaline Satterthwaite, a member of the American sterilization team, explained the "preference" for a rapid "bootstrap- style" means to population control rather than other forms of birth control:

At an eighty-five bed mission hospital in Humacao, a municipality of 30,000 in the southeastern part of Puerto Rico about thirty-five miles from San Juan, between 1951-1961, we attended approximately 4,800 deliveries and performed 2,000 female sterilizations, most of them postpartum. It was a surprise for me when I first arrived in Puerto Rico to find that most of the women who came for prenatal care for the second or third child wanted post-partum sterilization. Since 1937, when sterilization was made legal for socio-economic as well as medical reasons, the "operation" was generally known and accepted as the means of family limitation (Satterthwaite 1965: 474).

One-Third Sterilized

By 1965, approximately 34 percent of women of child-bearing age had been sterilized, two thirds of whom were still in their early twenties (see Table 2, and Presser 1973: table 6,7).

Table 2

Trends in Female Sterilization in Puerto Rico

Year Author of Study Age Percent Sterilized

1947-48 Hatt 15 years or more 6.6 1948 Cofresi N.A. 6.9 1953-54 Hill, et.al. 20 years or more 16.5 1965 Presser 20-49 years 34.0 1968 Vasquez 20-49 years 35.3

Source: Vdsquez Calzada, 1973: 288

As a result of eliminating the reproduction potential of many Puerto Rican women, Presser speculated that an average of about "two births per month may have been averted" (1973: 92). A common rationale given for sterilization between 1955 and 1965 by demographers was a "real demand" for the

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MASS: POPULATION CONTROL IN PUERTO RICO 73

procedure. Demographers rationalized that poor Puerto Rican women with few positive economic options wanted domestic conditions which would allow them to take advantage of employment in the new service sector, and they wanted white-collar jobs which promised to come with the rapid foreign investment under Operation Bootstrap. Demographers also admitted that sterilization was a response to the inadequate promotion by the government of adequate and safe contraceptive services available at the birth control clinics. Physicians also supported sterilization:

A good many physicians on the Island were already aware of the problems of population, the prestige of the private hospital was great, and a number of physicians came informally to learn more about operative techniques. Many physicians thought and still think that contraception methods are too difficult for lower class Puerto Ricans and they regarded post-partum sterilization as the most feasible solution to the problems (Stycos, 1954:3).

The overtly indiscriminate use of sterilization in Puerto Rico even caught the attention of the Joint Committee for Hospital Accreditation which refused recognition to Puerto Rico's hospitals unless a ten percent limit of sterilization (in proportion to all hospital deliveries) was agreed upon (Presser, 1973:38). With sterilization legitimized by Puerto Rico's physicians and encouraged by U.S. population agencies, it is not surprising that liberal testing of new birth control products by American pharmaceutical firms also took place in Puerto Rico on a broad scale. Testing at Ryder Memorial Hospital of six different varieties of the pill and the IUD was carried out on 1,700 women; in the first four years of the 1960s over 1,000 women were used for testing spirals, coils, loops, and IUD's (Satterthwaite, 1967:475). In addition to hospital testing, the poorest Puerto Rican women at the San Juan Hospital had to submit to lengthy interviews as part of the Population Council's International Population Pro- gram to have complete marital and fertility histories recorded on a clinic card to be sent to the clinic nearest the patient's home to insure a follow-up visit. After 1966, the Population Council expanded its program to-include all health districts in Puerto Rico (Presser, 1973: 35)

In 1965, a Population Office was formally established as part of the Alliance for Progress and regarded as a major innovation in foreign assistance (Piotrow, 1973:84-85). Teodoro Moscoso, Alliance Director, had been deeply involved in Puerto Rico's population planning in the fifties. He appointed Edgar Berman to head the new Population Office and to develop strategies for convincing other Latin American governments to adopt population control policies. Berman presented a mathematical formula to the 1966 Population Crisis Hearings showing that population growth divided by economic and social development equals political instability. Population Growth (PG)/Economic and Social Development (E+SD) = Political Instability (PI) (Berman, 1966:1060). Because of Moscoso's experience and the "success" of the Puerto Rican experiment, he was able to persuade the U.S. Senate Foreign Relations Committee to sanction the first State Department-financed efforts (grants) in Latin America, to the Pan American Health Organization and to CELADE (the United Nations-sponsored demographic research center based in Chile), with funds from the Rockefeller and Ford Foundations as well as the Agency for International- Development (Piotrow, 1973:84-85). In 1964, AID and the IPPF jointly sponsored a population conference in Puerto Rico with Latn American Perspectives: Issue 1 5, Foil 1 977, VolI IV, No. 4

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representation from each Latin American nation except Cuba. Governor Luis A. Ferre of the Progressive Party made birth control a major

issue in his 1968 campaign. In 1971 he called for an expansion of the existing birth control services in his State of the Commonwealth Message by offering the existing health centers as birth control centers (Presser, 1973:37). With the approval of the Archbishop of San Juan and the assurance of federal monies for these programs taken from Maternal Infant Care funds, the programs extended to all five health regions in Puerto Rico (New York Times, February 1971).

Maximizing Management and Efficiency

Studying the effectiveness of Puerto Rican population control programs in the seventies, a Defense Department researcher recognized the value in intensifying the demographic policies of the last half century. William Kelly explains why the system of imperialism has no use for a surplus population in Puerto Rico.

Direct private investment in Puerto Rico is a function of the profitableness of manufac- turing in Puerto Rico - which in turn, is a function of product prices on the U.S. mainland (the major market for Puerto Rican manufacturers), labor costs in Puerto Rico and transportation costs between Puerto Rico and the U.S. mainland. Loans to the Commonwealth government are a function of the credit rating of that government which in turn is related to the government's ability to repay these loans as indicated by its present and anticipated tax revenues. Capital investment from local resources is a function of individual business, and government saving rates and the profitableness of investment in Puerto Rico is oriented toward export to the mainland and hence would not be influenced by the size of the Puerto Rican market. Individual saving is more likely to decrease than increase with a higher birth rate. Finally, government revenues and hence the government ability to borrow outside of Puerto Rico may be harmed by a higher birth rate if more dependents mean more tax exemptions for income earners. (Kelly, 1971:47).

Although Kelly's suggested conclusions - population reduction by elimi- nation of tax exemptions for dependents - are as absurd as they are insidious, his argument's major premises have some basis. Capital investment has from the start goals of superprofits and reinvestment and priority spending which pertains to export rather than upgrading the living standard of the Puerto Rican people. Even Kelly admits that while gross production measured in current dollars increased from $750 million to $4,606.7 million from 1950 to 1970, Puerto Rico's per capita personal income was only 36 percent of the U.S. average of $3,921 and only about 55 percent of that for Mississippi, the poorest state in the United States (Kelly, 1971:46). Studies such as Kelly's calculate the effectiveness of birth control on the basis of studies similar to those done at the General Electric Tempo Research Center by Stephen Enke (1969: 798), which explains that expenditures devoted to retarding population growth can be 100 times more effective in raising per capita income in "less developed countries" than expenditures in accelerating conventional economic growth. The General Electric study also served as the basis of Lyndon Johnson's 1965 speech at the U.N. anniversary meeting in San Francisco where he stated that $5 worth of birth control was worth $100 of economic development (Mass, 1974:663). The defense study by Kelly, however, was based on real data, not hypothetical data such as Enke's. In attempting to maximize the prevention of births, the study

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MASS: POPULATION CONTROL IN PUERTO RICO 75

posed the question to cost-conscious demographers as to whether one should estimate expenses according to raw-cost data of services dispensed or accord- ing to the "production function." The results from the "cost-effectiveness" study demonstrated that "If a birth prevented is worth 2.6 times per capita output, then values of births prevented in Puerto Rico in 1968, based on the population and current GNP data, should have been about $3,600 per birth" (Kelly, 1971:84). The study suggested that total benefits to improved manage- ment efficiency and more permanent birth control might result in over $12.5 million for Puerto Rico. The above calculations were based on intensive study and data collected in the towns of Bayamon and Toa Baja. Other conclusions showed that through mass use of the IUD, sterilization, and vasectomy, minimal costs would acrue. The Depro-Provera hormone was recommended as a 6-month and 12-month injection and carefully charted as another means of inexpensively averting birth. This drug has been withdrawn from the U.S. market many times because of carcenogenic effects and permanent steriliza- tion (Population Reports, 1975).

In response to national and international pressure, the United Nations established a Special Committee for Decolonization which argued that the United States was violating the inalienable right of the Puerto Rican people to self-determination and independence. Invited before the special committee, Juan Mari-Bras, Secretary General of the Puerto Rican Socialist Party, called on the committee to implement its resolution that "immediate passage of all powers to the peoples who have not yet obtained their independence must be implemented without reservations or conditions" and to demand that the United States refrain from taking measures which would obstruct this process.

In his testimony Juan Mari-Bras revealed the shocking economic realities which the Puerto Rican people are forced to accept and the rate of exploitation they suffer compared to other regions of the world. He explained that U.S. foreign investments for 1974 in Puerto Rico reached $6,112 million or 5.5 percent of total U.S. foreign investment in the underdeveloped world, and 40.3 percent of U.S. investment throughout Latin America. U.S. investments in Puerto Rico were greater, he explained, than in any other country in the world except Canada and West Germany. New investments increased eightfold from $226.2 million in 1960 to $1,722.4 million in 1974. Profits obtained from investment were more astounding because they indicated the rate of exploita- tion of Puerto Rican resources and labor force. Profits repatriated to the United States alone - that is excluding the stockholders' returns and reinvestment jumped twelve times from $115.7 million in 1960 to $1,345 million in 1974. The growing dependency of Puerto Rico on U.S. imports was marked by the fact that Puerto Rico is the fifth largest market for U.S. goods and services throughout the world, the second market in the western hemisphere and the first in the world in per capita terms (for fuller discussion, see Campos and Bonilla, 1976: 68-71). Mari-Bras explained that federal funds from the United States in 1974, which subsidized the extractive economic structure, represent- ed 11.1 percent of the royalties and credits granted by the United States to all foreign countries. These federal funds also paid for expenses related to maintaining the U.S. armed forces, as well as health funds channeled into sterilization programs. In overall terms, these federal funds aided the Puerto Rican government to create an infrastructure which insured the flow of capital Latin American Perspectives Issue 15, Fall 1977, Vol. IV, No. 4

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76 LATIN AMERICAN PERSPECTIVES

and profits. Among the many other capitalist profiteers, the interests which best manage and profit from this infrastructure are the powerful North American financial groups represented by the Rockefeller Investment Group, the First National City Bank, and groups connected with the Morgan Guaran- tee Trust Company (see Puerto Rican Socialist Party, 1976: 55-65).

American Team Confirms Mass Sterilization

On a visit to Puerto Rico in August of 1975, an American doctor, working as a hospital administrator, together with an investigation team were able to corroborate directly the previously well-documented fact that close to one third of Puerto Rican women of child-bearing age had, in fact, been sterilized (Raka, 1975). The evidence also showed that in 1975 there had been a visible intensification of the mass sterilization program underway in large private hospitals - such as Ryder and Presbyterian - as well as an expansion of clinical services in numerous smaller clinics scattered throughout the rural, impoverished regions, including San Martin, San Hermon, Byamon, Caiz, and others (Presser, 1973:37, Raka, 1975). Information which corroborated the genocidal campaign was obtained through visits to the clinics themselves as well as a lengthy interview with Antonio Silva, Secretary of the Population and Family Planning Department (Committee for Puerto Rican Decolonization, 1974).

Responsibility for the formation of the new national population depart- ment in the Health Ministry, explained Antonio Silva, falls on the shoulders of several American agencies such as the Population Crisis Committee, a lobby in Washington which is composed of high-ranking army and navy officers, ruling-class industrialists, and congressional leaders (Population Crisis Com- mittee, 1970). He also identified the Rockefeller-created Population Council with aiding in the creation of his new department as well as the initiatives of individuals such as Teodoro Moscoso.

Future planning and implementation of population control blueprints is based to a large extent on a commonwealth report of November 1973, entitled "Opportunities for Employment, Education and Training." This report was endorsed by Governor Rafael Hernaindez Col6n (Committee for Puerto Rican Decolonization, 1974). Official colonial policy is further reflected in the com- position of the subcommittee which drew up the report: Luis Silva Recio, head of the Labor Department; Teodoro Moscoso, Administrator of Fomento; Dr. Ramon Cruz, Secretary of Education; and Amador Cobas, then president of the University of Puerto Rico.

In the plans is a "target population" which is openly identified as "those who suffer most from a condition of excess population . . . the groups with the least income and smallest amount of education" (Committee for Puerto Rican Decolonziation, 1974). Completely in line with this outlook is the programatic outreach of Puerto Rico's birth-control campaigns into welfare programs, social service agencies, factories, affiliated unions, and large-scale participa- tion by middle-class women's clubs (Stycos, 1955). The report officially recom- mends what had already been taking place at a slower pace. The number of births "to be averted" by 1985 should now be targeted at one million, which would mean cutting the fertility by nearly two-thirds (Committee for Puerto Rican Decolonization, 1974). Under the Puerto Rican report heading "Organ-

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MASS: POPULATION CONTROL IN PUERTO RICO 77

ization and Focuses of Family Planning," the mathematical fertility calcula- tion, involving the entire population of Puerto Rican women, is based upon the acceptance of sterilization as the major means of accomplishing this fertility goal by 1985. This despite the fact that in 1973 Puerto Rico had one of the lowest natural population increases in Latin America, 19.1 per thousand (Nortman, 1973:19-30) as compared to 29 per thousand for all of Latin America. For similar but slightly higher figures for the Puerto Rican natural population increase, see Chaplin (1973:2).

The Question of Choice

In order to rationalize former Governor Colon's "zero population" policy aimed at reducing unemployment, the Ministry of Health was forced to camouflage its massive sterilization program with a humanitarian face which projects a concern for "women's rights." Demographer Harriet Presser, former- ly attached to the Population Council, has become well known in demographic circles for her field work in Puerto Rico documenting the "progress" of sterilization growth. Presser legitimizes the campaigns and supports the pro- gram's expansion. Referring to sterilization, she explains, "Its widespread practice represents grass-roots response among women who sought an effec- tive means of limiting family size" (1973:1). In one isolated respect, Presser has correctly observed that Puerto Rican women have chosen sterilization on a mass scale without government use of direct sanctions against those who reject this procedure. Attitude surveys confirming this "positive" choice were con- ducted by Princeton's OPR in 1937, Cornell's International Population Program in 1968, and.by the Population Council in 1974. More recently, these choices have been confirmed by the management consultant firm of Clapp and Mayne (Clapp and Mayne, 1973). These surveys indicate that Puerto Rican women desire sterilization as a means of birth control. Questionnaires were, however, given at random and were obviously geared to illicit anti-natalist sentiments, often because of the interviewee's lack of other socio-economic options for obtaining family support or absence of accessible birth control other than sterilization. As a result, the surveys portray a poor population which desires few or no children. The questions eliminate the possibility of positive choices in the realm of choosing improved living conditions - a natural basis for planning a family. Sterilization consent forms which were examined by the investigation team must be signed when required by both husband and wife. Each form lists socio-economic motivation as a basis for consent (interview with Raymond Raka, 1975).

Specific reasons for having no other choice than sterilization as a means of birth control are not difficult to ascertain if one is aware of the specific conditions which exist in the fields of health and social services for Puerto Rican women and their families. Through an extensive interview with the sterilization investigation committee and using Puerto Rican Health Service data, I determined several reasons for the choice of sterilization as opposed to other means of birth control: (1) Puerto Rican health-care services have greatly deteriorated. In particular, post-natal care, child-health care, and maternal care are costly and the wait is long (Puerto Rican Health Department, 1971). (2) Abortion is difficult to obtain, with high fees and eligibility restrictions. For example, stringent laws since 1913 state that illegal abortion carries no less Latin American Perspectives Issue 15, FaIl 1977, Vol. IV, No. 4

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78 LATIN AMERICAN PERSPECTIVES

than a two-year prison term (Presser, 1973:86). (3) The pill has been under- mined in the past through its non-prescription status, resulting in side-effects from misuse or non-effectiveness (Raka, 1975). (4) There has been difficulty and expense in obtaining safe IUD's with follow-up attention (Puerto Rican Health Department, 1971). (5) Mass propaganda has noted that sterilization is free. Campaign propaganda reaches factories and affiliated unions, schools, and social services (Raka, 1975; Presser 1973:54). (6) Sterilization guidelines for acceptance by women and their families have not been enforced and in some rural clinics not used at all (Presser, 1973: 54-55). (7) Physicians are reimbursed around $50 for each procedure, and approximately 90 percent of hospital costs for "la operacion" are reimbursed by HEW (Presser, 1973: 58-59). (8) Steriliza- tion is carried out post-partum most often to insure compliance by those who have not chosen this method. Consent is obtained during labor when patient is in a weakened state (Stycos, 1955: 34-40; Hatt, 1952; Presser, 1973:163-167). (9) General instability of the nuclear family because of unemployment and the resulting grave uncertainty about the future increases the attractiveness of permanent birth control (Raka, 1975; Presser, 1973:91).

Conclusion

U.S. investment in Puerto Rico's heavy industry such as mining and petrochemicals, as well as in the insurance and banking sectors, has resulted today in even fewer laborers than during the last two decades. However, because of severe recessionary conditions in the United States, continued emigration from Puerto Rico to the United States is presently considered undesirable by certain economic analysts. Anti-immigrant sentiments were even voiced by members of Rafael Hernaindez Colon's government. In 1973 a special consultant to the Governor remarked: "It is obviously not in the interest of Massachusetts, New York, and New Jersey to receive increased immigration into urban areas already glutted with the poor" (cited in Unger, 1974:7).

Capitalist-minded planners today have offered only one option for solving Puerto Rico's "population problem" or more accurately identified as an unem- ployment problem - further depopulation - so that increased exploitation of the island in the seventies can proceed full steam ahead, according to the blue prints of the multinational corporations. These recommendations continue despite the recognized fact that Puerto Rico has the highest proportion of its reproductive population sterilized of any country in the world - male or female (Nortman, 1970: table 15).

With greater consciousness of social and economic contradictions in Puerto Rico taking place between "haves" and "have nots" as a result of increasing unemployment and decline in living standards, these planners have encountered formidable popular opposition to implementing their blueprints for development. In opposition to the systematic plunder, the island's national- ist and more recently expanding socialist movement has attracted growing sympathy from around the world. Persistent struggle in Puerto Rico and the United States against exploitation of the island is seen by U.S. strategists as a mounting threat to American economic and miltary interests, not unlike that which Cuba posed in the late fifties.

There are some conclusions which we might attempt to draw in regard to imperialist social control via sharply increasing sterilization measures. Cer-

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MASS: POPULATION CONTROL IN PUERTO RICO 79

tainly, they are socially far-fetched, but mathematically logical. If the rate of sterilization of 19,000 monthly (mostly women in their twenties and thirties) was accurately projected (New York Times, November 4, 1974; Intercom, 1974), then the island's population of workers and peasants could be eliminat- ed within the next 10 to 20 years. Although in feudal and tribal periods, large populations in the world disappeared because of plagues, starvation, and warfare, the twentieth century could conceivably establish for the first time in world history, a systematic use of birth genocide which if continued into the next decade, would eliminate an entire generation of people.

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MASS: POPULATION CONTROL IN PUERTO RICO 81

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* POPULATION CONTROL IN LATIN AMERICA * ~~~~Bonnie Mass "Population Target is a well dlocumented analysis of the American population movement, its ideol- ogy and the social interests it serves.. .This is clearly one of the most useful studies in the area and should aid in demolishing the latest myths of imperialism." -Jarme.s Petras, Latin American analvst

Co-published by the Women's Educational Press

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