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  • The Sterilization Movement and Global Fertility in the Twentieth Century
  • Philip R. Reilly
Ian Dowbiggin . The Sterilization Movement and Global Fertility in the Twentieth Century. Oxford: Oxford University Press, 2008. 262 pp. Ill. $49.95 (978-0-19-518858-5).

Throughout the developed world, surgical sterilization (tubal ligation and vasectomy) is now the preferred contraceptive option for individuals who have completed their families. It was not always so. Indeed, although both forms of surgery were introduced about a century ago, until about 1950 they were rarely used to control family size.

Dowbiggin's thesis is that a small group of social progressives, many of whom were connected with an organization founded by Marian Olden in 1937 as the Sterilization League of New Jersey (which morphed through several instars into a New York City–based nonprofit named EngenderHealth that is active today), played a key role in ending "one of modern history's most powerful taboos" (p. 4). The argument is based on his studies of the organization's records, which reside in the Social Welfare History Archives at the University of Minnesota (and which I have also studied).

Although Dowbiggin has written a well-paced book that accurately traces the organization's history and that is populated with interesting vignettes about prominent citizens who were in their time major advocates for voluntary sterilization, he failed to convince me that the ancestors of EngenderHealth played the key role in making sterilization the preferred choice in birth control.

Although Dowbiggin accurately reports that during the 1960s and 1970s the Association for Voluntary Sterilization (AVS), as it was then called, funded several [End Page 230] small sterilization programs for poor folks in places such as Appalachia, he does not demonstrate that it played a more important role than Planned Parenthood, the American Medical Association, or Zero Population Growth in fostering a massive increase in use of these procedures. For most of its history, AVS was a small, poorly funded organization that bent to the whims of its wealthiest donors and to which it is difficult to attribute specific victories.

Dowbiggin devotes little attention to a crucial event in the rise of voluntary sterilizations—Operation Lawsuit. From 1971–73, the American Civil Liberties Union, supported by other organizations (including AVS), filed and won or settled a series of lawsuits against community hospitals that (often under the influence of the Catholic Church) had long refused to permit elective sterilization for family planning. The initiative succeeded, and most non-Catholic hospitals quietly and quickly changed their positions.

Given the book's title, I find it odd that the author devotes comparatively little attention to what is among the most notable social programs in history—China's decision in 1976 to enforce a rule of one child per family. His discussion of the rise of family planning in India is more comprehensive.

Dowbiggin correctly ascribes to AVS an important role as a propagandist for voluntary sterilization in the 1950s and 1960s. But he fails to give adequate weight to the roles played by other groups, such as physicians, in the 1970s and 1980s. When obstetricians and urologists realized that there was demand for surgical sterilization, they quickly opened the operating rooms to their patients. In 1965 Time magazine estimated that about 100,000 Americans would choose to be sterilized that year. In 1991, an academic study estimated that about 500,000 men would undergo vasectomy that year. As about the same number of women had tubal ligations, there appears to have been, roughly, a tenfold increase in the annual number of sterilizations in a generation.

The reach of Dowbiggin's book exceeds its grasp. It offers a competent history of the role one organization played in helping make elective sterilization widely available. It falls short of offering a full history of the "sterilization movement," and it overstates the impact of AVS.

Philip R. Reilly
Cornell University
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