The Sterilization Movement and Global Fertility in the Twentieth Century (review)

After publishing important works on eugenics and euthanasia, Ian Dowbiggin has tackled yet another controversial issue in this new book exploring the organized movement to promote sterilization. Most of his book focuses on the organization founded in 1937 as the Sterilization League of New Jersey (but currently named Engender Health), which played a leading role in advocating sterilization as a means of contraception. He provides useful vignettes of key leaders and funders of this organization, including its founder Marion Olden, wealthy physician Clarence Gamble, the gynecologist Robert Latou Dickinson, Alan Guttmacher, and others. Dowbiggin masterfully provides context for the organization, discussing various fellow-travelers and opponents along the way. He also includes some material on other countries, especially India, but even these discussions generally link back to their impact on or relationship to the United States.

In many respects Engender Health (under various names throughout its history) was fabulously successful, since by the last quarter of the twentieth century sterilization became the most widely used form of contraception, both in the U.S. and worldwide. At the dawn of the twentieth century, however, sterilization was generally considered immoral and thus was illegal in all states.

What caused this reversal in attitudes toward sterilization? While Dowbiggin’s book contains many important insights about the sterilization movement, I was not completely satisfied by his handling of this important question. His focus on one organization helps him to track the changes occurring within the ranks of those pushing most forcefully for sterilization, and here Dowbiggin shines. However, it does not allow him to explain why multitudes of Americans altered their perceptions about sterilization. Dowbiggin also provides little information about legislation relating to voluntary sterilization. Why did most states legalize it before 1961? You will not find an answer here.

Nonetheless, Dowbiggin’s important book does shed light on many significant issues. He shows that the shift in attitudes toward (and practice of) sterilization occurred largely in the 1960s and 1970s. Before the 1940s, advocates of sterilization generally pressed for compulsory sterilization of the disabled as a eugenics measure to foster biological improvement. Many states passed compulsory sterilization laws, though other states rejected such legislation. As biological determinism lost ground and eugenics declined in popularity in the mid-twentieth century, sterilization advocates generally argued for sterilization as a way to deal with poverty. However, in the 1950s the medical establishment was conservative, Catholic bioethics was influential, and sterilizations were generally difficult to obtain.

In the 1960s the sterilization movement in the U.S. increasingly turned its attention to combating global population growth, though it also continued to try to make sterilization more easily available in the United States, too. It scored a key victory in a 1973 Supreme Court decision that forced hospitals to lift bans on sterilization. It also supported Indira Gandhi’s campaign in the 1970s to sterilize millions of Indians, which was financed in part by American tax-payers. Despite opposition that arose from the right-to-life movement in the 1970s–1980s, sterilization continued to increase in frequency, partly because of health problems associated with other forms of contraception.

Dowbiggin highlights a number of problems with the sterilization movement. First, he argues that even though the movement altered its goals from eugenic sterilizations to fighting poverty to combating global population growth, there was largely continuity within the movement. Despite their asseverations after the 1940s that they were promoting only voluntary sterilizations and thus promoting individual autonomy, this did not fit easily with their crusading zeal to end population growth. The methods used to entice poor, often illiterate, people in developing countries to undergo sterilization did not really show much concern for their personal autonomy or judgment. The government officials or social planners in the NGOs knew best and often rode roughshod over individuals in their quest to meet their quotas.

Dowbiggin opens and closes his book discussing another problem: maybe the sterilization movement has been too successful. Many countries of...