Compulsory sterilization (or sterilisation), also known as forced sterilization (or sterilisation), programs are government policies which attempt to force people to undergo surgical sterilization. In the first half of the 20th 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. Widespread or systematic forced sterilization has been recognized as a crime against humanity by the Rome Statute in the Explanatory Memorandum. This memorandum also defines the jurisdiction of the International Criminal Court. Despite international agreement concerning the inhumanity and illegality of forced sterilization, it has been suggested that Government of Uzbekistan continues to pursue such programs.
In countries providing for a procedure to legally recognize sex change, surgical sterilization usually is a pre-condition for such recognition. The procedure consist of surgical removal of reproductive organs (orchiectomy, oophorectomy, hysterectomy, bilateral adnexectomy) leading to irreversible loss of reproductive functions. This should be recognized as compulsory sterilization too because people going through the process do not usually have freedom of choice to undergo the procedure or not.
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. However, one notable difference is in the treatment of non-insane criminals. Canadian legislation never allowed for punitive sterilization of inmates.
Czechoslovakia and the Czech Republic
Czechoslovakia carried out a policy to sterilize 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.
"We do not stand alone": Nazi poster from 1936 with flags of other countries with compulsory sterilization legislation
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 Verh tung 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.
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's state of emergency between 1975 and 1977 included a family planning initiative that began in April 1976 through which the government hoped to lower India s ever increasing population. This program used propaganda and monetary incentives to convince citizens to get sterilized. People who agreed to get sterilized would receive land, housing, and money or loans. Because of this program, thousands of men received vasectomies and even more women received tubal ligations. However, the program focused more on sterilizing women than men. An article in The New York Times entitled For Sterilization, Target Is Women states, There were 114,426 vasectomies in India in 2002-03, and 4.6 million tubal ligations, the analogous operation on women, though ligation is a more complicated operation.  Despite the fact that sterilizing men is a more simple procedure, the government still chose to focus on sterilizing women instead.   Son of the Prime Minister at the time 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.
Puning city china river bank housesIn 1978, Chinese authorities became concerned with the possibility of a baby boom that the country could not handle, and they initialized the one-child policy. In order to effectively deal with the complex issues surrounding childbirth, the Chinese government placed great emphasis on family planning. Because this was such an important matter, the government felt it needed to be standardized and so to this end laws were introduced in 2002.  These laws uphold the basic tenets of what was previously put into practice, outlining the rights of the individuals and outlining what the Chinese government can and cannot do to enforce policy.
However, recently accusations have been raised from groups such as Amnesty International, who have claimed that practices of compulsory sterilization have been occurring for people who have already reached their one child quota. These practices run contrary to the stated principles of the law, and seem to differ on a local level. An especially egregious example, according to Amnesty International, has been occurring in Puning City, Guangdong Province. The stated goal of the sterilization drive in this city in China was to meet with family planning targets that were outlined by the government in the Population and Family Planning Law of 2002. This drive, also known as the Iron Fist Campaign, also is said to have used coercive methods in order to ensure that close to 10,000 women were sterilized, including detaining elderly family members. 
The Chinese Government does not seem to be unaware of these discrepancies in policy implementation on a local level. For example, The National Population and Family Planning Commission put forth in a statement that, Some persons concerned in a few counties and townships of Linyi did commit practices that violated law and infringed upon legitimate rights and interests of citizens while conducting family planning work. This statement comes in reference to some charges of forced sterilization and abortions in Linyi city of Shandong Province. However, it remains unclear to what extent the government has prosecuted or disciplined the officials in charge of family planning in the country.
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 indigenous 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 N ez D vila 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 j venes (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 Jos 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.
Jan Guillou brought up eugenics in the TV-program Rekordmagazinet in the 1980's, at which time this was still a topic largely unknown to the people, but it wasn't until 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.
In Sweden, sterilization is only compulsory before sex change. This last compulsory sterilization has been criticized by several political parties in Sweden and since 2011 the Parliament of Sweden is expected to change the law since no party is formally supporting it.
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:
Switzerland refused, however, to vote a reparations Act.
A poster from a 1921 eugenics conference displays the U.S. states that had implemented sterilization legislation by then
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.
According to reports, as of 2012 forced and coerced sterilization are current Government policy in Uzbekistan for women with two or three children, as a means of imposing population control and to improve maternal mortality rates. In November 2007 a report by the United Nations Committee Against Torture reported that "the large number of cases of forced sterilization and removal of reproductive organs of women at reproductive age after their first or second pregnancy indicate that the Uzbek government is trying to control the birth rate in the country" and noted that such actions were not against the national Criminal Code, in response to which the Uzbek delegation to the associated conference was "puzzled by the suggestion of forced sterilization, and could not see how this could be forced."
Reports of forced sterilizations, hysterectomies and IUD insertions first emerged in 2005, although it is reported that the practice originated in the late 1990s, with reports of a secret degree dating from 2000. The current policy was allegedly instituted by Islam Karimov under Presidential Decree PP-1096, On additional measures to protect the health of the mother and child, the formation of a healthy generation which came into force in 2009. In 2005 Deputy Health Minister Assomidin Ismoilov confirmed that doctors in Uzbekistan were being held responsible for increased birth rates.
The United States, the Puerto Rican government, and the medical community began a program for the mass sterilization of women in Puerto Rico. Puerto Rico was first Claimed by Christopher Columbus in 1493 for Spain. Puerto Rico remained under spanish control for the next 400 years although the Netherlands, France, and England made various attempts to control the island. Under the Treaty of Paris (1898) during the Spanish-American War , Spain gave the island to the United States. In 1917, Puerto Ricans became United States citizens and the United States Congress began controlling a large amount of life in Puerto Rico. 
The Puerto Rican government and population was suffering from economic problems, high unemployment rate, and poverty during the 1920's. The United States blamed overpopulation for these problems.  Contraception was illegal in the Puerto Rican colony which was largely due to the main religion of Puerto Rico: Catholocism. The Catholic Church teachings state that contraception and sterilization are sins against nature. Therefore, any form of contraception was illegal in Puerto Rico before the late 1930's.  In 1937, the United States made contraceptives legal, initiating their plan for population control. 
By 1965, one-third of the female population had been sterilized and Puerto Rican women continued to use female sterilization as a form of birth control due to a lack of knowledge of the irreversible effects.  Sterilization was so common that Puerto Rican women labeled it "la operacion", or the operation.  The government continued with their plan as stated in a report dated November 1973. The report, entitled "Opportunities for Education, Employment, and Training", was written by an economic policy group backed by the governor of Puerto Rico. This report explains alternatives for decreasing the Puerto Rican working class and a high unemployment rate was noted in the report as Puerto Rico's main problem. 
A private organization opened twenty-three birth control clinics in 1937 and a bill was signed eliminating the laws making the advertisement of contraceptives and pregnancy prevention services a felony. Another 160 private and public birth control clinics were opened after another bill was signed authorizing the "Commissioner of Health in Puerto Rico to regulate the teaching and dissemination of eugenic principles, including contraception, to health centers and maternal hospitals". Soon after, the United States government passed Law #136 which made sterilization legal for other than strictly medical reasons and advocated picking out the "unfit".
The United States began governing Puerto Rico in 1898 and began their efforts for population control. A demographer from Puerto Rico reported in 1968 at women in the United States were ten time less likely to be sterilized than women from Puerto Rico. The U.S. began to worry about overpopulation of the small island that could potentially lead to a major decline socially and economically. Therefore, the U.S. began to enforce public policies in order to control the rapidly increasing population. Many Puerto Rican women began having "la operacion" due to healthcare workers visits whom advocate sterilization and already sterilized women receiving favoritism in the work industry. 
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.
- "B.C. faces forced sterilization lawsuit". CBC News. February 7, 2003. Canadian Broadcasting Corporation. Accessed April 13, 2006.
- Clarke, Nic. "Sacred Daemons: Exploring British Columbian Society's Perceptions of 'Mentally Deficient' Children, 1870-1930." BC Studies 144 (2004/2005): 61-89.
- Dowbiggin, Ian Robert. Keeping America Sane: Psychiatry and Eugenics in the United States and Canada 1880-1940. Ithaca: Cornell University Press, 2003.
- Grekul, Jana., Krahn, H., Odynak, D.. "Sterilizing the 'Feeble-minded': Eugenics in Alberta, Canada, 1929-1972." J. Hist. Sociol. 17:4 (2004): 358-384.
- Manitoba Law Reform Commission. Discussion Paper on Sterilization of Minors and Mentally Incompetent Adults. Winnipeg: 1990.
- Manitoba Law Reform Commission. Report on Sterilization and Legal Incompetence. Winnipeg: 1993.
- McLaren, Angus. Our Own Master Race: Eugenics in Canada, 1885-1945. Toronto: McClelland & Stewart, 1990.
- Rosen, Christine. Preaching Eugenics: Religious Leaders and the American Eugenics Movement. Oxford [England]; New York: Oxford University Press, 2004.
- Wahlsten, Douglas. "Leilani Muir versus the Philosopher Kings: Eugenics on trial in Alberta." Genetica 99 (1997): 195-198.
- "Nine women sterilized in B.C. have lawsuits settled for $450,000". The Vancouver Sun. December 21, 2005.
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