The MacNeil/Lehrer Report; Sterilization

ROBERT MacNEIL: Good evening. Last week the Federal Drug Administration officially changed the labeling on birth control pills to include notice of the dangers of oral contraception. The required wording ended by saying the pill was "the most effective method of birth control outside of sterilization. In a few years sterilization, the small operation on a man or woman to prevent conception, has become the fastest growing method of birth control. More than eight million Americans are reported to have been sterilized. An official study three years ago estimated that a quarter of couples practicing birth control use sterilization, and there are informed guesses that the percentage has doubled since then. But for all the growing enthusiasm there is a darker side to the story -- frequent charges of abuse, of doctors forcing sterilization on women in the racial minorities and lower income groups. Tonight we examine sterilization: its growing popularity and the claimed abuse. Jim?

JIM LEHRER: Robin, first, a personal story from a New York woman who was sterilized last summer. She`s a medical reporter and writer, 35 years old, married and the mother of twin seven-year-old boys. Her name is Jane Brody and she`s in our New York studio. Mrs. Brody, why did you decide to be sterilized?

JANE BRODY: My husband and I felt we had had all the children that we intended to have and that the world needed us to have; and since we weren`t going to have any more we said let`s do it the right way and end our fertility once and for all, instead of fooling with this, that and the other thing that is available today.

LEHRER: All-right, speaking of what was available today, did you weigh that in your decision, the other methods that are available, and decide that they just weren`t effective, from your standpoint?

BRODY: I certainly did. I think I used just about everything that`s in the contraceptive cafeteria. I had been on the pill, and I got migraines from the pill. I had had the IUD for five years and finally developed some ovarian infections which the doctor thought might be related to the IUD. I then went back to the diaphragm, my first contraceptive, and I found that interfered with my sex life, frankly. And foam was irritating and condoms made me nervous, so what was left?

LEHRER: Sterilization.

BRODY: Right.

LEHRER: Okay. What was the procedure itself like?

BRODY: The operation I had, called a laproscopic sterilization, was very simple; it was basically a 15-minute operation. I was in the hospital a total of four hours, I had had an examination the day before in the doctor`s office; I had a local anesthetic; I was awake and talking with the doctor throughout the procedure. And two hours after leaving the hospital I went out and bought three pairs of shoes.

LEHRER: I wonder what the connection is there. Have you thought about that? (Laughing.)

BRODY: (Laughing.) I needed shoes.

LEHRER: Speaking of money, what did the operation itself cost? Was it an expensive thing?

BRODY: The fee for any surgery was about average; it was approximately $450, including the doctor`s fee and the hospital`s charges.

LEHRER: Did medical insurance take care of it?

BRODY: Icy medical insurance covered practically all of the cost, but not everybody`s insurance does cover it, and if you`re going to have this procedure you should check ahead of time to make sure that your coverage is adequate.

LEHRER: Have there been any after-effects? You obviously, in your own mind, made the decision to be sterilized, and you must have had an idea as to what it was going to be like after you had been sterilized. Has the reality met your expectations, or what have the after-effects been?

BRODY: I`ve had no adverse effects to date that I can detect; I`ve been very happy with the feeling of freedom from all the gadgetry of contraception. I`m very relieved to know that for the first time in my adult life I don`t have to worry about an unwanted pregnancy, and my husband and I are really quite satisfied with the effect on our personal lives.

LEHRER: What about any possible psychological hang-ups as a result of the fact that you`ve now done something that is irreversible, and in case something should happen -- God forbid -- to your two children, that you can no longer reproduce; have you had any residual feelings that bother you about that?

BRODY: I haven`t had them, because I considered this very, very carefully before I had the operation. The most important thing was to be sure that if anything happened to my children, to my marriage, to my husband, that I would not want to bear any more children, that I...

LEHRER: No matter what.

BRODY: No matter what, and this is a critically important thing to decide before you decide on sterilization.

LEHRER: One final question. Hasn`t in any way affected your interest or your-ability to enjoy sex? It`s a question many people wonder when sterilization comes up.

BRODY: The operation itself does not get rid of sexual hangups or problems, but it certainly gives you that feeling that you can be totally spontaneous about your sexuality, and I certainly have had that feeling. It`s been all positive, as far as I`m concerned.

LEHRER: All right, thank you. Robin?

MacNEIL: One organization that helps those seeking information about this process is the 40-year-old Association for Voluntary Sterilization. Dr. Joseph Davis has been president of AVS for the last six years; he`s also a professor and chairman of the Department-of Urology at New York Medical College. If Mrs. Brody is typical of one kind of woman who can at choice have sterilization, is there a problem of people who want to have it but cannot get the operation?

Dr. JOSEPH DAVIS: I think there is; we have many files. As a matter of fact, in response to one of the articles that Jane Bordy wrote AVS received about 2,000 requests for information on voluntary sterilization from all over the country from people who just couldn`t get the operation and had been thinking about it for quite a while.,

MacNEIL: Is it a class thing? Is it easy for middle-class people to get it and difficult for poorer people to get it?

DAVIS: I think it certainly is; I think it`s a question of education, and I think it`s a matter of the fact that many of the middle-class and upper- class people who may have more access to information about sterilization are coming for the operation.

MacNEIL: Is it a problem with lack of information in the minds of the people who might like it if they knew, or is it the unwillingness of doctors to perform it, or what?

DAVIS:I think it`s both. I think it`s basically a lack of education, and a lack of dispersion of education, and I think there`s also a matter of some physicians who like to play God and refuse to serve as technicians for reproductive health.

MacNEIL: On moral or religious grounds.

DAVIS: Whatever reasons.

MacNEIL: I see. What are the problems with sterilization of men -- men having vasectomies?

DAVIS: Well, I think it`s a very popular operation, and up until this past year I think there were more men having vasectomies than women having tubal ligations. I find that as people enter the middle classes, black or white, they are looking to male sterilization more and more. I think that, working at city hospitals, I find that there is still lack of education as to what vasectomy is, and I think as education and family planning clinics increase, I think more men in the poorer groups are going to seek male sterilization.

MACNEIL: Why don`t you tell us what vasectomy is; I think we have an illustration we can show. What is vasectomy?

DAVIS: It`s an operation done in a doctor`s office on the male sac, the scrotum, and the vas deferens is interrupted so that although sperm continue to be produced they do not go up the vas; and the ejaculate, which is from the prostate and seminal vescicles, continues and this tiny fraction of the fluid which contains sperm simply doesn`t come up the tube.

MacNEIL: I see. Is sterilization, male or female, in your mind, as a doctor, a satisfactory method of birth control?

DAVIS: Oh, I think it is; I think it`s a very satisfactory one-time motivation type of -- but permanent -- contraception, and I think individuals have to understand that it`s permanent and basically irreversible, and that they should have, as Jane Brody said, reasons for not wanting to have any more children or having no children at all.

MacNEIL: There have been reports of doctors who claim to have achieved procedures to reverse the operation; are they still not reliable as operations?

DAVIS: No, the operations are -- if anything -- becoming more reliable. There is now a technique using micro surgical methods of reversing male sterilization with up to 90 percent success in getting sperm through the duct. There`ll never be a 90 percent success in terms of pregnancy because there may be factors in the female or other factors which go into the equation of making up fertility; but the success rates are much higher in the male, and they`re getting higher in the female, although they`re less than 50 percent.

MacNEIL: Thank you. Jim?

LEHRER: There are other sides to this sterilization story, of course, and one of them in particular is just as personal as Ms. Brody`s, only on the negative side. It involves people, mostly low in come, from racial minorities, who feel sterilization is being thrust on them against their will. The General Accounting Office, Congress` investigating arm, just last month completed a report on sterilization among Indians in three Midwest- Southwest states. The GAO studied more than 3400 sterilization`s performed on Indians from 1973 through last June. While it cited discrepancies in the administration of some consent forms and age limit requirements, it stopped way short of charging that the government was sterilizing Indians against their will. But there are some people who feel strongly that that is the case. There was a strong statement issued this afternoon, for instance, by the social action staffs of three religious organizations, including the National Council of Churches. It condemned the Indian sterilization as a form of genocide, a gross violation of human rights, and called on the government to investigate further. An Indian leader in Oklahoma has already said he plans to file a lawsuit against the Indian Health Service on behalf of the 3400 persons. There are other cases already pending, including one the famed California trial attorney, Melvin Belli, filed against a Los Angeles hospital, alleging the involuntary sterilization of seven Chicano women. Now, on the question concerning Indians, there is no one who feels stronger about it than Marie Sanchez, a northern Cheyenne Indian, who is Chief Tribal Judge for some 2400 people on a reservation in Lame Deer, Montana. Ms. Sanchez, have women on your reservation been sterilized as a result of coercion?

MARIE SANCHEZ: Definitely. The number that I have interviewed personally within just two days was 25, and of all the women that told me their side of the story, these women had large families and they numbered about eight or nine. And the doctor approached them and the doctor said, isn`t it time you quit? And there were other reasons, such as anemia, which I know, anemia can be treated medically with iron pills; but in this case it was sterilization.

LEHRER: As a result of your interviews, did these women understand what was being done to them? Did they understand that they were going to be permanently sterile -- they could no longer have children?

SANCHEZ: The one case -- the one lady with nine children -said that her doctor told her that she could later on have children and her tubes could be untied.

LEHRER: You say the coercion element -- who are these doctors? Are these official government doctors who perform these operations, or are they private doctors, or what?

SANCHEZ: They`re Indian Health Service doctors who serve a period of time of two years, and usually they don`t do the operation, they have a contract with...

LEHRER: I see, somebody who is paid by the government to perform the medical service.

SANCHEZ: Yes.

LEHRER: Did these women feel they had a choice in the matter?

SANCHEZ: I really feel that they did not have a choice, because in a situation such as a reservation, where poor people have to depend on Indian Health facilities, they generally take the word of a white doctor who says, "This is the best thing for you." And I really feel that there is a heavy element of coercion.

LEHRER: Let`s take the case of the woman you cited who`d already had -- what did you say, nine children. Did she, in fact, not want to have any more children, or...?

SANCHEZ: She did not want to use contraceptives -- any Contraceptives, and she said that her husband would throw pills away. And ever since she had the sterilization done she`s been having marital problems. And I think this gets into the idea of the spiritualism that`s involved with childbirth, the male`s idea of reproduction; and the Indian man just doesn`t believe in sterilization.

LEHRER: How do you feel about it? Are you opposed to sterilization under any circumstances, even under the most voluntary of circumstances?

SANCHEZ: Yes, I am opposed to sterilization, because I feel that since the Indians don`t quite number a million, if sterilization such as this continued to take place then our gene pool will be very, very small. And I really feel that in the past we`ve suffered different methods of genocide, such as in one instance where we were offered blankets with smallpox to exterminate us; and in this day and age I feel that it`s done in a more nobler sense...

LEHRER: But the result is the same, from your point of view.

SANCHEZ: Yes. Because now the medical tools are used, such as the scalpel.

LEHRER: Do you feel that this is a result of some kind of -your personal feeling -- do you feel that this a result of some kind of government policy, or do you think it`s a result of overzealous people at the working level in these health clinics, or what?

SANCHEZ: In the first place, I feel that our population -the way the government is after our coal, our resources, our gas and oil, uranium -- I really feel that this has some bearing in their at tempts to control our population, because if we continue to increase in number -- and more Indians are becoming aware of what we have, what we can do to preserve our reproductive potential, chances are we will oppose whatever methods of genocide that the government continues to use.

LEHRER: Thank you. Robin?

MacNEIL: This problem of involuntary sterilization is not isolated to the Indians on the reservation; it`s a problem in the nation`s urban areas, as well. One group concerned with this is the Committee to End Sterilization Abuse. Dr. Helen Rodriguez is a founding member of this organization, and an attending pediatrician at New York`s Lincoln Hospital. She`s also a member of the Department of Social Science at Montefiore Hospital. Dr. Rodriguez, how widespread do you believe this form of abuse is?

Dr. HELEN RODRIGUEZ: We believe it`s extremely widespread, and the evidence we have for that are some of the things that have been mentioned, certainly, very ably by Judge Sanchez; but also the suits that have been brought against the different agencies are really nationwide. For instance, in South Carolina a number of women from Aiken County charged that the doctor who was the only obstetrician there who could give -- or. who would give -- services to Medicare patients would only give his services if they agreed to be sterilized, and...

MacNEIL: What do you understand -- perhaps you can`t generalize about it, but if you would -- what do you understand is the motive of doctors or officials doing this? Is it a political motive, or is it the humane motive that a women might have, who has very little resources, too many children to look after? What do you understand is the motive?

RODRIGUEZ: I think whenever we talk about motives we`re talking about very complex, kind of things, but one recent study showed that a number of doctors who would favor sterilization for welfare patients would not favor it for their private patients.It turned out that actually it was something like five times the number of doctors who favor it for welfare patients when surveyed said that not for their private patients. A very interesting study that was done a couple of years ago on the contraceptive preferences of wives of obstetricians, it was found that the lowest percentage of sterilization occurred among the wives of obstetricians, presumably the best informed group. So I would say that mixed as they may be, there`s a great deal of social judgmental quality to the thinking that certain people ought to be sterilized, that certain people do not have a right to determine how many children they want to have.

MacNEIL: What does your organization want done about it?

RODRIGUEZ: Primarily, what we`re concerned about is that there be preventive guidelines; that is, that there be guidelines throughout the country -- enforceable guidelines, that is -- national legislation to prevent abuse. And we think that the way to bring this about is by informing people of the fact that there is abuse, particularly those who are most vulnerable to be abused, and having people organize around it, getting the kind of information and pressuring -- but very, very mightily - - in terms of avoidance of abuse.

MaCNEIL: And those guidelines would center primarily on making sure that there is voluntary consent to the procedure.

RODRIGUEZ: Exactly. That complete information is there. I`d just like to say a word on that, because it relates to urology and Dr. Davis. A recent survey was done by the Center for Disease Control in Atlanta in looking at how many departments of urology and how many departments of gynecology gave a fair explanation of the procedure when carrying out sterilization. They found that something like 88 percent of the departments of urology did not give a fair explanation of the procedure to the men who were to undergo vasectomy. And I say this smilingly because it`s generally thought that men don`t have a problem, at least in this country.

MacNEIL: Good. Jim?

LEHRER: Dr. Davis, can a system be worked out that would make sterilization more freely available to those who want it, but at the same time prevent involuntary sterilization?

DAVIS: I think there will always be isolated situations as have been discussed tonight, but I think that the issue is one of getting information to all groups of people so that the situation of involuntarism will not arise. I think that it`s just a question of making sure that in the prenatal clinics that women of all groups will understand that they have the opportunity to consider sterilization against the risks; the benefits of sterilization versus other forms of contraception when they`ve had their children -- as many as they want.

LEHRER: Mrs. Brody, in addition to your own personal experience, of course, you`ve been covering sterilization as a professional reporter. Why do you think that sterilization is thought of as a way to control population growth in certain races and classes?

BRODY: Well, it`s obvious that if you cut off someone`s fertility they simply cannot have any more children. The controlling groups have frequently taken advantage of their opportunities, but there is also a tremendous burden on the individuals who are sterilized in that even when they have received an adequate explanation of the procedure they simply do not have the background and the vocabulary to understand the true significance of this. And there have been many cases, even in middle class people, where operations have been explained and the operation was done, and you ask ten days later, "What was this operation all about and what was it supposed to have done for you?" And the patient does not give an accurate answer.

LEHRER- But in that case shouldn`t there be some procedure that would prevent an operation from proceeding unless you were certain the person understood?

BRODY: I should hope so. It is a very difficult thing to do; for vasectomy the operation is most often done in a doctor`s office, and there is no procedure for assuring that the patient had an under standing of the operation before the doctor cut the vas.

LEHRER: Robin wanted to ask one final question of everybody, if you have the time, Robert.

MacNEIL: I`m just curious to know whether 50 years from now doctors and the public won`t be looking back on this as an extremely primitive form of medicine, comparable to 100 years ago having to cut off limbs because when they were wounded they couldn`t be repaired. Isn`t it the failure of medicine to provide another form of birth control?

DAVIS: Let me just say briefly that we`ve been talking about sterilization for a half hour, but basically this is not sterilization; basically we`re talking about occluding the tube or occluding the vas. The function of the ovary in the female and the function of the testicle in the male continue, so we`re talking about developing better techniques, as you say, for simplifying vas occlusion or tubal occlusion to make it more reversible; and we`re almost there.

MacNEIL: I`m awfully sorry, I`d love to go on with this. We`re going to have to end it there. Thank you very much, Judge Sanchez in Washington, and Jim. And thank you all here. Jim Lehrer and I will be back tomorrow night. I`m Robert MacNeil. Good night.