Compulsory sterilization is the practice of permanently removing a person’s ability to reproduce without their free and informed consent. It has been carried out through surgical procedures, most commonly tubal ligation in women and vasectomy in men, and has been imposed by governments, institutions, and individual healthcare workers on people deemed “unfit” to have children. Under international law, widespread or systematic enforced sterilization is classified as a crime against humanity.
How It Is Defined Under International Law
The Rome Statute of the International Criminal Court, which established the framework for prosecuting the world’s most serious crimes, explicitly names enforced sterilization in Article 7. It is listed alongside rape, sexual slavery, and forced pregnancy as a form of sexual violence that constitutes a crime against humanity when carried out as part of a widespread or systematic attack against a civilian population. Cornell Law School’s Legal Information Institute defines enforced sterilization as forcibly sterilizing members of an ethnic group as part of a systematic campaign against that group.
The distinction between compulsory and voluntary sterilization comes down to consent. Voluntary sterilization is a personal reproductive choice. Compulsory sterilization removes that choice entirely, whether through legal mandate, physical force, deception, or coercion such as pressuring someone into agreeing during a vulnerable moment like active labor.
The Eugenics Movement in the United States
The modern history of compulsory sterilization begins in the early twentieth century with the eugenics movement, which promoted the idea that society could be improved by preventing certain people from having children. Eugenicists held a simplistic view of human genetics fused with discriminatory beliefs about who deserved to reproduce. People with psychiatric diagnoses, physical and intellectual disabilities, incarcerated individuals, and those labeled “sexually deviant” were all targeted as supposed threats to society’s economic and moral health.
Indiana became the first U.S. state to pass a eugenic sterilization law in 1907. The practice expanded dramatically after the U.S. Supreme Court’s 1927 ruling in Buck v. Bell, which upheld the constitutionality of these laws. In that case, the court approved the forced sterilization of a young Virginia woman, with Justice Oliver Wendell Holmes writing the now-infamous opinion. Over the following decades, 32 states passed similar laws. By World War II, state programs had sterilized roughly 60,000 people across the country.
These programs did not affect everyone equally. Racial and ethnic minorities, poor communities, and institutionalized populations bore the heaviest burden. The programs provided direct inspiration for Nazi Germany’s own sterilization laws, which were enacted in 1933 and eventually sterilized hundreds of thousands of people.
Indigenous Women and Ongoing Coercion
Indigenous communities around the world have been disproportionately targeted by sterilization campaigns, a pattern that has persisted well into the twenty-first century. In Canada, the province of Alberta enforced its Sexual Sterilization Act from 1928 to 1972. During that period, Indigenous people made up about 2.5 percent of the population but accounted for 25 percent of those sterilized.
These practices did not end with the repeal of eugenics laws. A 2017 report documented that Indigenous women in Saskatoon, Canada, were being coerced into tubal ligations while in labor at local hospitals. Health care workers pressured women to consent to permanent sterilization during one of the most physically and emotionally intense moments of their lives. After the initial findings, more women from Alberta, Manitoba, and southern Saskatchewan came forward with similar accounts. One woman, Melika Popp, said no one should be asked to make “such a drastic, life-altering decision” in the middle of childbirth. The Saskatoon Health Region acknowledged that racism exists within its health care system and issued formal apologies.
Globally, the scale has sometimes been staggering. In Peru during the 1990s, an estimated 200,000 to 350,000 women, predominantly Indigenous, were forcibly sterilized under former president Alberto Fujimori’s government. The stated goal was to control population growth and promote economic development. Many survivors are still seeking justice through the courts. In Indonesia during the same decade, women were forcibly injected with long-acting contraceptives, and migrant workers today can still face deportation if they become pregnant while working abroad.
Other Targeted Groups
Beyond Indigenous populations, compulsory sterilization has been imposed on several other marginalized groups. Incarcerated people have been a recurring target. In California, forced or coerced sterilizations were performed on people in state prisons even after the state’s eugenics laws were repealed in 1979. Transgender individuals in multiple countries have also been required to undergo sterilization as a legal prerequisite for changing their gender on official documents. As of recent assessments, sterilization remains a requirement for legal gender recognition in at least 12 countries and territories, including Czechia, Turkey, Romania, Slovakia, and Serbia.
People living with HIV have faced coerced sterilization as well. Research in Namibia and South Africa has documented cases in which women living with HIV were sterilized without proper consent, often during other medical procedures.
Psychological and Emotional Impact
The effects of compulsory sterilization extend far beyond the loss of fertility. Research on women living with HIV who were forcibly sterilized in Namibia found that every participant experienced anxiety and stress-related symptoms. The broader range of psychological harm included depression, feelings of helplessness, hopelessness, worthlessness, self-blame, shame, isolation, sleep disturbances, weight changes, and loss of interest in daily life.
What makes these findings particularly striking is their duration. In the Namibian study, the average time since sterilization was eleven years, yet participants still struggled to cope. Research in South Africa echoed these results: most respondents reported ongoing and significant emotional distress, with some experiencing clinical depression requiring medication. The loss of reproductive capacity carries profound personal and cultural meaning. For many women, the inability to bear children affected their relationships, their standing in their communities, and their sense of identity. These are not wounds that heal on their own timeline.
Reparations and Legal Accountability
Efforts to compensate survivors have been slow and limited. North Carolina became the first U.S. state to establish a compensation program for eugenics victims, and California followed in 2022. California allocated $4.5 million to be divided among eligible applicants, with an estimated 600 survivors of the state’s eugenics program still alive. The program also covered people who were sterilized in California prisons after the eugenics laws were formally repealed. An additional $1 million was set aside for markers or plaques at sites where sterilizations took place.
These amounts, split among hundreds of applicants, are largely symbolic. For a program that sterilized thousands of people in California alone between 1909 and 1979, the compensation represents acknowledgment more than restitution. In countries like Peru, where the numbers of victims reached into the hundreds of thousands, legal accountability has been even harder to achieve. Courts continue to process claims decades after the sterilizations occurred, and many survivors have died without ever receiving recognition or compensation.
Why It Persists
Compulsory sterilization thrives where power imbalances are greatest: in hospitals where patients are vulnerable, in prisons where consent is inherently compromised, and in legal systems that condition basic rights on surrendering reproductive capacity. The formal eugenics laws of the early twentieth century have largely been repealed, but the underlying dynamics that enabled them, including racism, ableism, and the devaluation of marginalized people’s reproductive autonomy, have not disappeared. Coerced sterilization in Canadian hospitals, California prisons, and gender recognition laws in over a dozen countries demonstrates that the practice continues to adapt to new institutional settings even as its historical forms are condemned.