Margaret Sanger, "Sterilization: A Modern Medical Program for Human Health and Welfare," 5 Jun 1951.

Typed Draft Article. Source: Records of PPFA, Sophia Smith Collection , Margaret Sanger Microfilm S72:0637 .

This may have been drafted for Sanger by a PPFA Staff Member. For a draft version see MSM S72:0636. No published version found. Handwritten corrections made by an unknown author have not been included.


(A Modern Medical Program for Health and Human Welfare)

By Margaret Sanger

It happened in an American city. A blind couple were the object of much sympathy, some little charity and a great deal of relief. They had six children, all born blind, and the community commiserated as Americans always do with profound misfortune. The idea that six young lives had been born into the world doomed never to see sunlight or trees or other human beings is profoundly shocking. Everyone in town felt sorry for the couple and for their children.

But the couple did not feel sorry for themselves. They had had their six children deliberately, and planned to have more. They found that their relief checks and allowances for disability increased with each child, and only as a large family could they be comfortable. They and two or three blind children would just subsist.

This is an extreme but not isolated case of what happens in this country, a country where for generations there has been a great deal of talk about improving the quality of our population. It is true that there has been a lack of sound factual knowledge behind much of the talk. Even the experts----one is tempted sometimes to say especially the experts----do not know just what hereditary factors make for improved quality. But one does not need to be a scientist to know that there are some factors which degrade the quality of population.

Not all of these are hereditary by any means. We do not know that mentally retarded parents will have mentally retarded children. But we do know that mentally retarded parents cannot bring up their children in the way that will produce valuable citizens, not without a great deal more help than is often available. We do know that when a couple have produced several blind children, or several deformed children, or several mentally deficient children, they should not in the interest of themselves and in the interest of society produce any more.

It is time that we as communities with a sense of responsibility for our citizens, which means ourselves, should do something about a situation. The answer to much of the problem is a program of sterilization.

The word has acquired some unpleasant connotations which it does not deserve. The Nazi idea of sterilizing whole groups of the population or individuals with whom the authorities did not agree or whom the authorities did not like has made Americans properly cautious as to trusting anyone with a sterilization program. Misunderstanding of what the word implies has left many with fears that are not justified. Therefore it is well to define first the word and the program we are discussing.

Sterilization, in either man or woman, is a simple, safe and almost painless operation which does not disable the individual for more than a few hours. It does not impair sexual vigor. It does permanently and irrevocably bar reproduction. In women, the usual operation consists of tying off the Fallopian tubes so that male sperm cannot reach the ovum to fertilize it. In men, the usual operation consists of tying off a tiny duct called the vas deferens so that the male sperm does not join the rest of the ejaculate and therefore does not enter the female genital tract. Insert next in 25 and of the 25 state having sterilization laws *add

The program in this country at least, does not involve compulsory features. No one here proposes that some official be endowed with the authority to order anyone to be sterilized. What we do contend for is the right of the individual to know what sterilization would mean to him or her, to have the facilities for: the operation if desired and to be protected in life afterwards.

At present, sterilization programs under State laws are carried out chiefly in institutions. Most of those who are sterilized are mentally deficient or are suffering from some incurable transmissible diseases which leads them and their medical advisers to recommend the operation. How many similar individuals are sterilized under private auspices by their private physicians is unknown. Even the physicians are unable to estimate it. Even the number of sterilizations performed in institutions is not known.

In large part, the institutional sterilizations are a medical problem. Most of the debate on sterilization as a method for improving the quality of peoples, the eugenic debate, has been on the level of prejudice and preconceived opinions. But there are facts upon which to base a more sober judgement.

The best experience is that of Sweden. For just ten years, since July 1, 1941, the sterilization program has been combined with general measures for improvement of family life and population quality. Birth control, maternal care, aid to families where desirable and sterilization are all employed. The result has been an increased birth rate for wanted, healthy babies and a decrease in accidental, undesired and dangerous births.

The results have recently been appraised by Dr. Philip Weintraub of the United States. On the sterilization part, He finds that there is a steady increase in the number of operations each year. In the first six and a half years (for which complete statistics were compiled) there had been 12,500 operations, of which 7,000 had been performed on the mentally deficient with a view to decreasing the number of children born with mental defects. For the rest, sterilizations have been performed largely for the blind, deaf mutes and others whose misfortunes are transmissible.

Dr. Weintraub quotes with approval Swedish scientists who have reported such a program over a period of ten generations would reduce the number of such tragic births to one-fourt of the present volume. However, as he notes, sterilization for this purpose has long been recognized in Sweden as the most effective solution of the problem of the mentally inadequate.

In our own country, a program for the prevention of such unnecessary tragedies is long overdue. It can be achieved not only by the action of the individual and the institution, but by the active support of the government. Sterilization is a health measure, a preventive health measure which can avert many of the tragedies of our families. Few people would deliberately encourage the reproduction of such unfortunates as now fill our hospitals and institutions. Yet it is as bad to permit their reproduction by our indifference or neglect of positive preventive measures.

It should be the duty of government not only to supply the facilities which will enable these unfortunates to be sterilized, but to protect them afterwards. There should be provision for a pension of subsidy for those couples whose procreation would be dangerous to the community. If they are denied the normal family, not only for their own benefit but for that of society and above all of their children, society could well afford to see that they are well protected. If anyone thinks that is a bribe to encourage sterilization of the merely poor, he mistakes human nature.

However, the sterilization program should not be confined to the physically or mentally inadequate. The program has wider implications and a broader application.

In my own work, I have seen throughout the world the tragedies of parents overburdened by larger numbers of children than they can rear in decency. The birth control movement sprang from need of mothers and babies. When we opened our first birth control clinics, the majority of our patients were women who were already struggling with the problems of too frequent and too rapid pregnancies. There are still far too many of them, even in our favored country. But the mark of our success has been that more and more young couples are coming to our birth control clinics and to their private physicians to get advice on the spacing of their children before they are overwhelmed with the arrival of babies they cannot support. Those of us who have struggled all these years to give birth control its proper place in our medical and public health picture are proud and grateful that so much has been done.

Birth control, however, is not the answer to all our problems. No one knows better than those who have worked in the birth control movement that this is so. We have never presented it as a panacea for the world’s ills. Birth control is just what the words imply----control, not abolition. It is one of the cornerstones of family life for couples who want children and can bring into the world healthy babies with a chance in life. Conception control measures are adopted by those couples who wish to space the arrival of their children.

Birth control, then, is for the great majority. But there is an important minority of our population, and of every country’s population, who for reasons which they are valid in society or for the individual need a more decisive limitation of their child-bearing. These are by no means always the mentally and physically inadequate.

In birth control work, we find that there are always a certain proportion of women who for one reason or another cannot manage conception control methods, as we know them now, with assurances of success. There are women with insurmountable blocks, stemming in part at least from their early sex education or lack of it, against using birth control measures. A rather common example is the woman who as a girl was taught so sternly that any touching of the genital organs is wicked that she never overcomes her aversion. Sometimes physicians or counsellors can overcome these blocks; not always. Then there are the incorrigibly careless. There are also the couples who have as many children as they believe they can rear. This may be any number, and the only people who can decide what that number should be is the couple themselves.

For all these people, sterilization is the common sense procedure. They are entitled to it as surely as any person who is mentally or physically inadequate. For their individual happiness, their arguments are inescapable. They and their children are condemned to a species of slavery, of forced labor under oppressive conditions, which inability to control their fecundity imposes upon them.

The value of a sterilization program to the community is even more apparent. Science as yet has made few strides toward determining just which undesirable or unfortunate physical and mental traits are inherited and how. A purely eugenic pattern for sterilization, therefore, is opposed by some on the grounds that we do not know enough about eugenics to make it work. There is no such argument against the sterilization of those groups I have mentioned.

If there is one thing that our studies of the family have proved, it is that the healthy emotional and physical development of a child draws its greatest strength from the home environment. Innumerable studies have proved that an overwhelming proportion of our criminals, our maladjusted individuals, our mental cases where no hereditary factor can be determined come from families where the children were either not wanted or came in such profusion that they overwhelmed the abilities of the parents to care for them.

It is not enough to say that society should be so organized that the parents could care for them. Improvement in the standard of living would take care of only a few of these cases. The underprivileged child is more than an economic symbol. Food, clothing and shelter are basic, of course, but they are not enough. The affection and attention of parents is equally essential. Not every parent can bestow these gifts upon the same number of children. One couple may very well be good parents for eight or ten. Another couple with equal economic resources may be incapable of doing their duty by more than one or two----may even be poor parents altogether, resentful and demanding.

Every child is so much the product of his environment, and the home is so much the most important element in his environment, that the quality of our citizens depends upon the family. We hardly need the new sciences of psychiatry and sociology to tell us that. But if we have any doubts from our own observation of the world, those sciences resolve them.

It is one of the world’s tragedies that knowledge seems always to be far ahead of the application of the knowledge. In the matter of sterilization, science has developed harmless, safe, virtually painless techniques. Yet few people know of them, and millions still believe that sterilization is a form of mutilation from which everyone shrinks.

As in every other health program, therefore, the first step to be taken is a broad educational campaign. An informed people is a healthy people.

We in this country have developed splendid techniques for health education. We have only to consider how greatly we have expanded general knowledge of such scourges as cancer and heart disease and tuberculosis, how we have virtually wiped out dread plagues, how we have improved maternal and child care. We have done wonders in teaching people the facts about these medical and health problems.

When it comes to teaching them the facts about the even more basic problem of their own reproduction, we grow timid. Such a course is hardly worthy of our intelligence or our abilities. It only needs the will and the interest to place sterilization in its proper place among our basic health programs. The methods which have ben proved elsewhere will then become effective.

There is the nucleus of the necessary organization in the Human Betterment Association of America. There is a growing awareness of the problem among educators, doctors and publicists----as is indicated by the fact that a leading national magazine prints such an article as this. There is a background of success in breaking with hidebound tradition as is shown by the progress of the birth control movement and the current spread of sounder sex education. These are real educational forces. If they are liberated, expanded and supported, the progress which science has made in providing us with modern sterilization techniques can make its great contribution to human happiness and welfare.

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