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Sterilization: women fit to be tied.


 Sterilization abuse is both systematic and widespread. Frequently, women are misled about the dangers of surgery, misinformed about its permanence, and coerced while under the stress of labor or abortion. Generally, instances of abuses in the health system are treated as illegitimate, illegal aberations of an otherwise decent health care system. Careful examination of these so called abuses would reveal that each can be causally connected to particular aspects of the care of America's health system. Sterilization abuse stems from a combination of factors inherent in the health system plus 1 critical additional factor. Besides resulting from teaching and research imperatives, profit making, and the fee for service systems, such abuse is the most widespread example of medicine as an instrument of social control. Sterilization is the most extreme form of birth control and birth control is official US government policy. There were about 500,000 sterilizations performed on American women in 1973. None of the sterilization methods is innocuous, and each is associated with some physical and psychological side effects. General agreement exists in the medical literature that some risk is attendant to each procedure. Sterilization is the most dangerous and the fastest growing method of birth control. Since 1970 the figures show an almost 3-fold increase in the incidence of female sterilization, from 192,000 in 1970 to 548,000 in 1974. Much evidence exists to suggest that the increase in the number of sterilizations has fueled a trend toward the sterilization of younger women with fewer children. Official accommodation to liberalization of sterilization practices in the US came in 1969, when the American College of Obstetricians and Gynecologists (ACOG) withdrew its age parity formula. This liberalization of sterilization guidelines opened the floodgates to abuse. Some of the increase in the number of operations performed is due to increased demand, some of it is the result of misinformation and coercion. Training imperatives and political attitudes account for some of the increase in hysterectomies. Many young gynecologists in training have united their professional needs for training and their political ideas. Another reason for an increase in operations is greed. Doctors' attitudes toward sterilization and the misinformation about its impact stem from the same source: a change in government attitude toward population control. Although budget tightening is the byword for most government financed health care at this time, this is not the case for contraceptive services. Between 1967 and 1973 federal support for family planning services increased more than 1300%, from $11 million to $149 million. The growth of US spending for its birth control program abroad has been just as spectacular. Providing birth control services is population control. The line between voluntary and involuntary sterilization becomes thinner all the time.
