In this ninth post for the State Violence Research Network blog, Ximena Osorio Garate, PhD candidate at the Graduate Institute, Geneva, builds on the paper she delivered at the ‘From the State to the Streets’ conference, discussing the Peruvian state’s use of forced sterilization against (particularly indigenous) women under President Fujimori in the mid-to-late 1990s. If you are interested in submitting a blog yourself, please see the information at the end of this post.
Female sterilization is one of the most used birth control methods in the world. It provides a permanent, effective, and even subversive method of contraception for millions of women. Although it has a troubled history with the eugenics movement, today most of us think that surely the days of coercive contraception are over: we are ‘civilized’ now. However, as recently witnessed in places as diverse as Canada, Israel, the United States, Peru, and beyond, coercive reproductive practices are very much part of this world, and they can occur anywhere, regardless of ‘development’, political system, or geography.
In my research, I focus on the case of Peru to map the conditions of possibility that enabled the forced sterilization of hundreds of thousands of, mostly indigenous, Quechua-speaking women. These conditions range from the socio-political environment to the bureaucratic apparatus, as well as the material and technological instruments of violence. Here, I focus on one single enabling element: surgical sterilization. Let us look back at its career to see how it came about, how it developed, how it travelled to Peru, and how it was eventually translated into a violent state-led campaign with dramatic consequences.
A Sterilization Programme and a Hierarchy of Violence
In 1995, the then-president of Peru Alberto Fujimori presented the National Plan of Reproductive Health and Family Planning, a programme that would run four years, from 1996 to 2000. The programme was promoted internationally by Fujimori as a modern, progressive, feminist project for the empowerment of women, and it was readily embraced by the international community and local feminist groups. However, as it turned out, the program targeted mostly indigenous, Quechua-speaking women living in poverty in the rural areas of Peru. Since the beginning of the programme, women spoke out about experiences of coercion, intimidation, manipulation, and force, reporting forced sterilizations on a massive scale.
Many women were forcibly taken in vans or ambulances to hospitals, sometimes by soldiers or the police; some women reported being locked up inside clinics; others went to hospitals to give birth and were sterilized without them knowing so. At other times health professionals would bribe or threaten women to get them to sign consent forms. Some women were even tied to hospital beds. From 1996 to 2000, almost 300,000 women were sterilized, thousands of them without their consent (CLADEM 1999).
In contemporary Peru, many argue that indigenous women deserve to be sterilized because they ‘reproduce like pigs and rabbits’, and that sterilizing them is for their own benefit since they don’t have the resources to take care of their children. The question of violence is completely absent. The clinical, sanitized character of sterilizations excludes them from the repertoire of what counts as recognizable violence.
How could this happen? Looking at the conditions of possibility for forced sterilizations in Peru, it is clear that many elements played an enabling role, from racial, ethnic, and gender dynamics and discrimination in Peru to the civil conflict between state forces and the maoist group Sendero Luminoso. But beside these elements, one also needs to think about the production of biomedical knowledges and practices, techno-medical objects, scalpels, white robes, doctors, nurses, consent forms, and hospital beds. These medical, technical aspects also play a crucial part, and bring with them a politics of what is thinkable.
A Story of Sterilization(s)
Tracking down the politics of female surgical sterilization as a medical technology, we go back to the late 19th century in the United States and then Europe. As surgical technologies improved, more women could survive caesarean sections. However, women undergoing this operation multiple times were at risk of life-endangering pregnancies. Given this situation, doctors started developing techniques to make women sterile, which included removing their ovaries or uterus (EngenderHealth 2003). This is how tubal ligation came about. At its inception, it wasn’t meant to be a form of birth control in the same way as we think about it today. It was instead a medical solution to prevent potentially lethal pregnancies.
Shortly after, as is well known, sterilization became one of the chosen tools of eugenicists. It became a technical solution for biomedical problems: pathologized subjects such as people with mental illnesses, women with ‘heightened sexual desire’, queer populations, and racialized subjects/bodies, as well as a more ‘merciful’ form of punishment for ‘the criminal’, resulting in the sterilization of many inmates (Ladd-Taylor 2017). So we see surgical sterilization as a disempowering tool to prevent ‘undesirable’ populations from reproducing, as their bodies and desires become despised.
It wasn’t until the 1960s and the sex revolution that we get a different type of surgical sterilization. The technology quickly becomes very popular as a form of modern contraceptive, alongside the pill, the IUD, Depo Provera, and others. It was, in short, framed as reproductive tool to empower women and advance their right to choose over their own bodies and reproduction.
Now while sterilization in these three eras seems to be the same technology, I would rather think about them as quite different. The medical procedure to achieve a sterile body may be the same, but if we consider them as one part of a wider social context they are entirely distinct matters. We have, first, a medical technology to prevent potentially complicated pregnancies; second, a biomedical technology to prevent the reproduction of pathologized, undesirable subjects/bodies; and third a contraceptive technology for the empowerment of women.
This technology, in short, is multi-faceted, and not only because of its diverse purposes, but in that its three instantiations co-exist and function in their different ways simultaneously. For instance, while white, middle-class women in the United States were seeking sterilizations as a way of exercising their right to decide over their own reproduction, women of colour were being sterilized against their will.
A Violent (Mis)Translation
By the time female surgical sterilization reaches Peru it is the early 90s. President Fujimori is in power and, turning away from the Catholic Church, he legalizes sterilization. This decade was also a time of conflict, which was waged mostly in the Andes; of Fujimori’s modernization program and war against poverty; and of population control
Fujimori’s National Plan of Reproductive Health and Family Planning (1996) is interesting in this last regard. If we take a look inside, we see that it is not just the benign reproductive health programme it claimed to be. The document itself is filled with techspeak, graphs, charts, statistics, predictions, scores, and indicators. The story told is that rural, backwards, uncivilized Peru is holding urban, modern, civilized Peru back. And this, of course, is mostly the responsibility of the mujeres en edad fertil, the women of childbearing age, and more specifically, of rural women of childbearing age. They are considered excess, surplus bodies. Their ‘myths, ‘false beliefs’ and ‘traditional methods’ of birth control, which are irrational and ineffective, are cast as oppositional to ‘modern’ contraceptive methods, which must be promoted nation wide.
The irreparable division between these two spaces and their corresponding subjects also splits the reproductive health programme in two, encompassing a project of population control for economic development. When referring to the urban subject, what must be done, according to the program, is to promote safer sexual behaviours to prevent STDs. When referring to the rural subject, however, a population control and development logic creeps in, where over-reproducing bodies must be controlled and supressed for the sake of progress and modernization.
At this point, let us recall the three sterilizations mentioned above and think about which one was, in the eyes of the state, the most compatible with ‘rural women of childbearing age’. At the same time, let’s think about what type of subject/body is needed if modern contraceptives more generally are to be empowering, rather than disempowering. Who is deemed responsible enough and can be trusted to remember to take a pill every day? Whose body and reproduction is despised, criminalized, racialized, and pathologized? Which bodies are made intervenable, by any means necessary, for the common good?
In Peru and elsewhere, different subjects/bodies come to be paired with different types of contraceptive technologies, and even different types of sterilization. In the case of Peru, it was indigenous, Quechua-speaking women living in poverty that the state deemed unfit to reproduce or choose for themselves – sterilisable subjects. And although many things came together to make such large scale sterilization campaign possible, inscribed in the very materiality of biomedical technologies, the politics of fit and unfit reproducing subjects was already there.
CLADEM. 1999. “Nada Personal: Reporte de Derechos Humanos Sobre la Aplicación de la Anticoncepción Quirúrgica en el Peru 1996-1998.” Lima, Peru.
EngenderHealth. 2003. Contraceptive sterilization: global issues and trends. EngenderHealth, New York.
Ladd-Taylor, Molly. 2017. Fixing the Poor: Eugenic Sterilization and Child Welfare in the Twentieth Century. JHU Press.
Briggs, Laura. 2002. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. University of California Press.
Browner, Carole H, and Carolyn F Sargent. 2011. Reproduction, Globalization, and the State: New Theoretical and Ethnographic Perspectives. Duke University Press.
Dugdale, Anni. 2000. “Intrauterine Contraceptive Devices, Situated Knowledges, and the Making of Women’s Bodies.” Australian Feminist Studies 15 (32): 165–76.
Ginsburg, Faye D, and Rayna Rapp, eds. 1995. Conceiving the New World Order: The Global Politics of Reproduction. Univ of California Press.
Mol, Annemarie. 2002. The Body Multiple: Ontology in Medical Practice. Duke University Press.
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