A (brief) history of female sterilisation
During Women’s History Month, Charlie Elizabeth Culverhouse takes a look at the long and controversial history of the most common form of contraception in the world; female sterilisation
You’re spoilt for choice when it comes to contraception methods; the pill, the implant, IUDs, condoms. Each offers the promise of protection, albeit with side effects and varying degrees of success. But what if you never want to be pregnant, again or at all?
Considered the ‘gold standard’ for its ease-of-use and unrivalled effectiveness, female sterilisation has become the most common form of contraception worldwide. In 2024, Statista found sterilisation to be the contraceptive method of choice for 25% of women worldwide, compared to 16% using the pill, which has been mirrored by regional research including that of the CDC in the US and the International Institute for Population Sciences found cases of voluntary sterilisation in India to be even higher at 37%.
If it’s such a popular choice of contraceptive, why do we hear so little about it? The mainstream media and, more personally, medical professionals whom we go to seeking contraception, both seem tight-lipped about the procedure. And as frustrating as it is for those seeking to be sterilised, it’s understandable. The long and disturbing history – and largely present – of forced and coercive sterilisations has marred what could be a freeing, empowering contraceptive for thousands of people. So, while acknowledging the dark past, unpacking the positives is also vital.
What is female sterilisation and how does it work?
There is one factor drawing people towards sterilisation more so than any other contraceptive; its effectiveness. According to the NHS, the procedure is over 99% effective at preventing pregnancy and, as it doesn’t affect hormones like other contraceptive methods, and it largely comes without any side effects.
During the procedure, the fallopian tubes are simply tied, blocked, or cut to stop sperm meeting and fertilizing an egg (eggs are fertilised in the fallopian tube, if you need that quick science lesson). It is a routine surgery today, carried out by nearly every gynaecologist in the world, and has been developed to become safer and easier to complete since its first successful use in 1880, when Samuel Smith Lungren performed the first sterilisation by tying his patient’s fallopian tubes with silk (okay chic).
Involuntary, coercive, and forced sterilisation
That historic surgery should have changed the contraceptive field forever, giving women unprecedented control over their own bodies – and it did, says gynaecologist Dr Hrishikesh Pai, but not before it was grossly misused.
“Female sterilisation was not always about choice,” he says, explaining that the surgery designed to help women, particularly those with life-threatening health conditions for whom pregnancy could be dangerous, quickly became used to further marginalise already struggling populations.
“By the mid-20th century, sterilisation became a tool for population control, often targeting marginalised women,” he explains. “Many underwent sterilisation without full consent, believing they were receiving routine medical care, only to discover years later that their ability to have children had been taken away.”
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This hit certain populations harder than others; immigrants, indigenous peoples, people of colour, lower class people, unmarried mothers, disabled people, and those suffering from mental illness. It was by design, of course, with governments including those of the USA, Japan, Canada, Sweden, Australia, Norway, Finland, Estonia, Slovakia, Switzerland, and Iceland all enacting laws that allowed the coerced or forced sterilisation of women.
These laws, many of which were first introduced in the 1930s, and weren’t abolished until the late 1980s, were put in place specifically to reduce the economic and social ‘strain’ these people were perceived to be putting on the nation.
Writing in his book, Eugenic Nation: Faults and Frontiers of Better Breeding in America, author and researcher Alex Stern explains how legislators believed they were cutting ‘heredity’ traits such as ‘criminality, feeblemindedness, and sexual deviance’ off at the source by stopping certain people from having children.
“Many sterilisation advocates viewed reproductive surgery as a necessary public health intervention that would protect society from deleterious genes and the social and economic costs of managing ‘degenerate stock’,” Stern writes.
How forced sterilisation became a tool of oppression and eugenics in America
As Stern’s book explains, forced sterilisation was particularly popular in America, where in 1909 they rolled out a federally-funded mass sterilisation project across the country. Approximately 70,000 forced or coerced sterilisations took place in the 70 years the project ran, with Pai explaining: “They were often sterilised without even being asked, because someone else decided they shouldn't have kids.”
It’s something Nazi Germany took note of, with Hitler praising the country’s approach before enacting his own eugenics programme, which started with forcibly sterilising Jewish women, and ended with the horrors of the Holocaust.
America’s dark history with eugenics didn’t end with WWII, and coercive sterilisations have continued even into modern day. Most recently, the California State Auditor found that the state had conducted a number of forced sterilisations on female prison inmates between 2003 and 2013 without their ‘lawful consent’.
“It was like my life wasn’t worth anything,” Kelli Dillon, who was 24 when she was told she needed cyst-removal surgery while serving her sentence in Central California women’s facility, told The Guardian. She woke up and found her ability to have children had been taken away from her.
“Somebody felt I had nothing to contribute to the point where they had to find this sneaky and diabolical way to take my ability to have children.”
A doctor from the prison, trying to justify his actions, accidentally backed up Dillon’s claims when in 2013, telling the Center for Investigative Reporting that he viewed sterilisation as a way to prevent prisoners from having “unwanted children” that could cost the state money.
An even more shocking case comes out of South America, where in Peru an estimated 300,000 people were sterilised against their will between 1996 and 2000 due to then-president Alberto Fujimori’s so-called ‘anti-poverty drive’
Rudecinda Quilla was 24 when she was ‘forced onto a hospital bed’ and ‘her hands and feet tied while she was injected with an anaesthetic,’ BBC News reports.
She says that when she woke up, staff told her she was sterilised and would, "Never breed like an animal again".
While the United Nations urged Peru to compensate the people affected in 2024, calling the sterilisations a ‘crime against humanity,’ no apology or money has yet been awarded to the victims.
Female sterilisation in the 21st century
All this history has understandably and rightly had a massive impact on how we see female sterilisation today, with the forced and coercive procedures hindering those who want to voluntarily have the surgery.
“Today, female sterilisation remains one of the most widely used methods of permanent contraception, giving millions of women control over their reproductive future,” Pai says. “But, all that history with forced sterilisation still makes a lot of women nervous about it, even when they're making the choice themselves.”
And there’s the new societal view too, with the 21st century marking a huge switch from a state standpoint. Those who once forced many to be sterilised without consent now are apprehensive about letting those who are desperate for the procedure undergo it at all.
“Younger women and those without children are often denied sterilisation due to medical gatekeeping and outdated assumptions about future regret,” Pai says, pointing to a gendered double standard. “But men seeking vasectomy rarely encounter the same resistance.”
Read more: Male contraception: Where are we at?
It’s something I have experienced myself. I’ve been taking the contraceptive pill for near-on ten years, knowing not only that I don’t want children now, but that I never want them. There are a host of reasons for this, including those documented in 2023 by the Pew Research Centre, who found that 18% of Americans say they never want children; it’s expensive, I want to focus on other things like my career and not cleaning up sick, and, of course, there’s the dismal state of the world and its environment to consider too. But the reason cited above all else is the easiest to understand; I simply don’t want to.
Yet when I went to speak to my GP about voluntary sterilisation – which I’d researched heavily and wanted to explore as the hormones from the pill had been affecting my mood and giving me painful spots, while the occasional spotting had also left some of my favourite underwear ruined – I was simply told no.
“Younger women and those without children are often denied sterilisation due to medical gatekeeping and outdated assumptions about future regret”
I was ‘too young’ to make a big decision like that. Did I know it was irreversible? I would ‘regret it’ when – not if – I changed my mind later on. How could I possibly know what I want at 25, was the general gist I picked up. Though I’d be free enough to know I wanted a baby at the same age, which is hardly the same kind of life-altering decision, is it…?
The future of female sterilisation
As the medical field moves forward, with reversals for female sterilisation now being available from private practitioners across the globe, Pai believes it is vital not to forget the past – and present – when talking about contraception.
“The main thing is, women need to know all the facts,” he says. “They need to be asked properly, and we need to understand where they're coming from. Every woman should be able to decide what happens to her body, without feeling like she's being judged because of what happened in the past."