How to Hide an Empire: A History of the Greater United States

by Daniel Immerwahr

Puerto Rico is central to the history of contraceptives. Yet contraceptives are not central to the history of Puerto Rico. By the late 1950s, the island had “one of the most extensive systems of birth control clinics in the world,” a study found. That same study, however, noted that Puerto Ricans had “a fairly low tolerance for modern contraceptive methods” and used them so irregularly, infrequently, and incorrectly that the effect on population growth was “minimal.” Why did contraceptives fare so poorly in Puerto Rico despite the boundless zeal of birth control advocates? Surely, social stigma was part of the story. But another part was the aggressive promotion of a different form of birth control: female sterilization.