How to Hide an Empire

by Daniel Immerwahr

  Under the appointed mainland officials served elected Puerto Rican ones, less powerful but much cannier about local affairs. Chief among these was Luis Muñoz Marín, the leader of the island’s dominant party, who towered over the political scene from the 1940s through the 1960s. John Gunther deemed him “the most important living Puerto Rican.”9

  Born just three days after the USS Maine exploded in Havana Bay in 1898, Muñoz Marín grew up in the shadow of U.S. rule. His father had been Puerto Rico’s nonvoting representative in Congress, so he’d been shuttled back and forth between the mainland and the island. As a young man, Muñoz Marín joined the bohemian demimonde of Greenwich Village and worked as a journalist, writing occasionally for The Nation under Ernest Gruening’s editorship. He spoke, one governor remembered, a “full, flexible,10 meaty English without indication of origin, except, perhaps, a trace of New Yorkese in expression”—Muñoz Marín joked that his English was better than his Spanish.

  Yet for all his cultural ties to the mainland, Luis Muñoz Marín was a sharp critic of colonial rule. As a young man he had concluded, just as Pedro Albizu Campos had, that Puerto Rico needed independence. It was the only way the island could escape poverty.

  One evening in the late 1920s, while dining at the Hotel Palace in San Juan, Muñoz Marín noticed Albizu sitting alone. Muñoz Marín invited Albizu to join him.11 The two had much in common. They were young, charismatic leaders who spoke English fluently and held law degrees from prestigious mainland universities (Georgetown for Muñoz Marín, Harvard for Albizu). As they talked, they found that their political visions matched. Still, Muñoz Marín noticed a difference in their motives. Whereas Albizu was obsessed with “getting rid of the Americans,” Muñoz Marín’s chief concern was “getting rid of hunger.”

  Were those two goals the same? Given the hardships Puerto Rico faced because Washington controlled its trade, it was easy to suppose they were. Muñoz Marín met with Albizu often and told a newspaper in 1931 that he would vote for Albizu.12 But as the turbulent decade wore on, Muñoz Marín started to wonder if the relationship between colonialism and poverty wasn’t more complicated.

  He had cause to rethink his commitment to independence in 1936, when two of Albizu’s followers assassinated the chief of police and Ernest Gruening drafted an independence bill in retaliation. The bill was a “weapon of imperial vengeance,”13 wrote Muñoz Marín, one that would subject Puerto Rico to a steep and immediate tariff. He saw, to his horror, that the island had become so dependent on sales to the mainland that any interruption of trade would trigger an economic collapse, destroying “all hope of life and civilization.”14 He felt “emotional confusion” at “wanting independence but not wanting economic upheaval.”15

  In 1938 he launched the Partido Popular Democrático, the party he would lead until the end of his career. It campaigned on a slogan of “Bread, Land, and Liberty,” though that last term, liberty, was kept ambiguous. It resonated with the widespread resentment of colonial rule in Puerto Rico, yet it was vague enough to encompass many possibilities. Muñoz Marín instructed PPD leaders to studiously avoid the status question. It was, he believed, a political trap.

  That wasn’t a bad call. In 1940 Muñoz Marín’s party received 38 percent of the vote.16 In 1944 it won 65 percent, establishing itself as the island’s dominant party.

  In 1946, the year the Philippines gained its liberty, Muñoz Marín came out publicly against independence and purged his party of members who favored it. The PPD would instead champion a middle solution—not independence, not statehood, but something in between. The hope was to gain autonomy for Puerto Rico without losing access to the U.S. market (“the biggest and most prosperous in the world,”17 Muñoz Marín noted).

  It was the right time to push. In an age of rapid decolonization, when the Philippines got its independence, Guamanians got citizenship, and Alaska and Hawai‘i were on the road to statehood, Washington was ready to resolve the Puerto Rican conundrum. “Two million people cannot permanently be kept in the twilight zone of colonialism,”18 insisted the New Dealer Rexford Tugwell, then serving as this island’s governor.

  Tugwell agreed with Muñoz Marín’s autonomy-plus-development vision, expecting that it would ease the palpable unrest among Puerto Ricans. State Department officials supported the plan, too, hoping that it would relieve the United States of the embarrassment of having to submit a yearly report to the United Nations on the “non-self-governing territory” of Puerto Rico—a report that gave Soviet diplomats an annual opportunity to mock the United States for its hypocrisy.

  In 1946 the Truman administration appointed a Puerto Rican as governor, Muñoz Marín’s colleague Jesús T. Piñero. In 1948, Congress allowed Puerto Ricans to elect their own governor. Muñoz Marín won easily, and he would keep the position until 1964. Now, holding the highest political office in the colony, he could move Puerto Rico down the new political path. He could also address the island’s social issues.

  He’d have to, in fact. In gaining local power, Muñoz Marín had also gained responsibility for local affairs. Poverty, resentment, political violence—these were his problems now.

  *

  Puerto Rico suffered from many maladies, but, in the near-unanimous view of mainlanders, they all stemmed from a single root. The island’s women, as one official put it, “kept shooting children like cannon balls at the rigid walls of their economy.”19 Mainlanders lamented the overcrowding on the small island, which by 1950 had nearly 650 inhabitants per square mile. Today, that’s not impressive—Bangladesh has nearly 3,000 inhabitants per square mile and the city-state of Singapore has close to 20,000. Yet at the time it was one of the highest population densities on the planet.

  “If the United States were as crowded as Puerto Rico,”20 wrote the sociologist C. Wright Mills, “it would contain almost all the people of the world.”

  Muñoz Marín shared this concern. He’d been talking publicly about overpopulation since the 1920s. As he’d put it then, the problem of hunger in Puerto Rico could be solved in two ways: more food or fewer mouths. Getting more food was a lifelong obsession of his, and he would superintend Puerto Rico’s gradual rise from poverty by promoting economic development. Yet he was also drawn to the second solution. Of the two approaches, he wrote, “I believe that reducing the population is the most important,21 the most practical, and the cheapest.” He identified as a “Malthusian,” meaning that he supported birth control.

  Muñoz Marín wasn’t alone in this. Although the men who controlled Puerto Rico held a variety of opinions on the matter, a good many—including Presidents Herbert Hoover and Franklin Delano Roosevelt—were troubled enough by the island’s growing population to deem birth control a necessity.22 The practice remained deeply controversial on the mainland,23 but it was, in Ernest Gruening’s judgment, Puerto Rico’s “only hope.”24

  Still, as Gruening well knew, in an overwhelmingly Catholic society this was a delicate matter. The church attacked Muñoz Marín frequently for his position—at one point, the local bishops declared voting for him to be a sin.

  Birth control also stoked the ire of the nationalists, who had learned from the Rhoads affair to view doctors and diagnoses of “overpopulation” with deep suspicion. Albizu regarded Puerto Rico as underpopulated and saw birth control as an insidious attempt to “invade the very insides of nationality,”25 to carry the war against Puerto Rican freedom to the womb.26

  To avoid controversy, officials—both Puerto Rican and mainlander—soft-pedaled their support for family planning. Government-run clinics provided contraceptives but didn’t aggressively foist them onto their patients. Instead, officials fostered birth control quietly through a series of philanthropic initiatives, corporate partnerships, and university pilot projects, starting in the late thirties and gaining speed under Muñoz Marín’s governorship. Publicly, the government was agnostic about birth control. Privately, it encouraged doctors, researchers, and pharmaceutical companies to try their best.


  That was all it took. The island was, in many ways, the perfect site to test new medical techniques. It was close to the mainland, with doctors and nurses who spoke English and were trained in U.S. methods. Whereas most states had laws outlawing contraception as well as aggressive “blue-nose brigades” to enforce them,27 Puerto Rico had legal birth control and an obliging government. And, of course, Puerto Ricans had a history of serving as subjects for experimental medical research, from anemia to mustard gas. Their poverty and marginal position in U.S. society made them all-too-convenient fodder.

  It is perhaps not a surprise, then, that Puerto Rico became the proving ground for one of the twentieth century’s most transformative inventions: the birth control pill.

  *

  Like many key figures in Puerto Rico’s history, Gregory Pincus,28 known as the father of the pill, was a Harvard man. In fact, while there he’d shared a mentor with Cornelius Rhoads: the geneticist William Castle. Castle had directed the Rockefeller Anemia Commission in Puerto Rico and had brought Rhoads to the island. He had also trained Pincus.

  But Pincus, a Jew, had struggled to gain the official support Rhoads had always been able to count on. After some sensational research involving the in vitro fertilization of rabbits (headline: rabbit without parents amazes men of science),29 Pincus found himself portrayed in the press as a Frankenstein. His bid for tenure at Harvard failed.

  Pincus left Harvard and founded his own research center, in Worcester, Massachusetts. His concern about the world “population explosion” led him to propose a study of contraception.30 Might there be a pill or a shot that could reliably suppress ovulation? It was a fine question, but Pincus couldn’t get funding to answer it, either from pharmaceutical companies or from Planned Parenthood.

  Pincus’s research would quite likely have gone nowhere had the activist Margaret Sanger (who founded Planned Parenthood and popularized the phrase birth control) and the heiress Katharine Dexter McCormick not intervened. Recognizing the value of his work, they gave him virtually limitless funding—privately—to research synthetic hormones.

  Pincus first tested nearly two hundred compounds on animals. His colleague John Rock meanwhile administered hormone injections to “eighty frustrated,31 but valiantly adventuresome” infertile women in Massachusetts who were hoping to conceive (the hormones that inhibit ovulation could also, Rock believed, be used to strengthen the reproductive system). But Rock’s tests were burdensome, the side effects were serious, and the whole thing depended on the desperation of childless women.

  McCormick was impatient for large-scale field trials. “How can we get a ‘cage’ of ovulating women to experiment with?” she asked Sanger.32

  The team considered tests in Jamaica,33 Japan, India, Mexico, and Hawai‘i. In 1954 Pincus visited Puerto Rico and was suitably impressed. Here was a place where they could undertake, as Pincus expressed it to McCormick, “certain experiments which would be very difficult in this country.”34

  The first experiment used medical students at the University of Puerto Rico.35 Despite having their grades held hostage to their participation in the study, nearly half dropped out—they left the university, were wary of the experiment, or found it too onerous. The researchers then tried female prisoners, but that plan fizzled too. In 1956 they began a large-scale clinical trial in a public housing project in Río Piedras.

  The pill that Pincus’s team administered had a far higher dosage than the pill does today. Many women complained of dizziness, nausea, headaches, and stomach pains. The lead local researcher concluded that the pill caused “too many side reactions to be acceptable generally.”36 Pincus, however, was undaunted. He blamed the complaints on the “emotional super-activity of Puerto Rican women” and tried giving some the pill without warning them of its side effects—a clear violation of the principle of informed consent.37

  The next year, a team of researchers allied with Pincus began another large-scale trial of the pill in Puerto Rico. Yet again, the side effects were hard to ignore. One researcher noted that the women appeared to be suffering from cervical erosion (“whatever you call it,38 the cervix looks ‘angry’”), but the tests continued. Stopping them would mean delaying approval from the Food and Drug Administration, which the researchers were eager to get.

  They got it. In 1960, basing its decision largely on the Puerto Rican trials, the FDA approved the birth control pill for commercial sale.

  Nor was it just the pill. With a supportive government and a network of clinics, Puerto Rico became a laboratory for all sorts of experimental contraceptives: diaphragms,39 spermicidal jellies, spirals, loops, intrauterine devices, hormone shots, and an “aerosol vaginal foam” known as “Emko” distributed to tens of thousands of women. Searle, Youngs Rubber, Johnson & Johnson, Hoffman-La Roche, Eaton Labs, Lanteen Medical Laboratories, and Durex all sponsored research there in the forties and fifties.

  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,”40 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.

  The practice began in Puerto Rican hospitals in the early 1940s, just as Luis Muñoz Marín was rising to power. It quietly spread, typically administered after the birth of a child. By 1949, a survey revealed that 18 percent of all hospital deliveries were followed by “la operación.”41

  No governmental program championed sterilization.42 The advocates were doctors themselves, both mainlanders and locals. Worried that Puerto Ricans lacked the education to use other methods of birth control, they steered their patients toward the surgical procedure. Sometimes, hospitals offered it free.

  Did doctors go beyond mere steering? At times, yes. One hospital refused to admit women for their fourth delivery unless they agreed to be sterilized after.43 And most sterilizations were performed within hours of childbirth—hardly ideal conditions for informed consent.44

  Still, documented cases of outright compulsion are hard to find. And given Puerto Rico’s strict laws against abortion, taboos against contraception, and patriarchal culture, women had their own reasons to want the operation. “The only way to avoid having children was getting sterilized—free,”45 one remembered. “I just got my husband’s signature, went in and got operated on.”

  Whether because doctors pushed or women pulled, female sterilization in Puerto Rico grew to staggering proportions. In 1965 a governmental survey found that more than a third of Puerto Rican mothers between the ages of twenty and forty-nine had been sterilized, at the median age of twenty-six. Of the mothers born in the latter part of the 1920s, nearly half had been sterilized.46

  Such numbers, stunning on their own, become even more so in comparative context. This was a time when India’s rate—one of the world’s highest—was six sterilizations for every hundred married women. Puerto Rico had more women sterilized, by far, than anywhere else in the world.47

  *

  Puerto Rico’s adventures in reproductive health happened out of view of the mainland. Life reported in depth on the field trials for the pill (“a brilliantly successful example of scientific insight and collaboration”) but mentioned their colonial location only glancingly.48

  Yet mainlanders were all too aware of another maneuver in the demography game. Cheap and regular aviation had made it possible for Puerto Ricans—who were, after all, U.S. citizens—to simply leave the island.49 A trip between San Juan and New York, which took days in the thirties, was by the fifties a matt
er of hours. And so, just as African Americans made their way in the mid-twentieth century out of the impoverished rural South toward Northern cities—the “Great Migration”—Puerto Ricans made a similar trip. Most landed in New York City.

  The difference was that Puerto Ricans had a government prodding them along. In 1947 Muñoz Marín’s party created a migration bureau, a rare case of a state agency dedicated to getting people to leave an area. The government distributed millions of pamphlets to help people adjust to life on the mainland. Muñoz Marín’s colleagues set up a three-month training program for women seeking to enter mainland domestic service.50 They practiced talking in English, washing dishes, polishing silver, answering the phone, and doing laundry.

  When economic forces carry sojourners from a poorer area to a richer one, the fortune seekers are usually men. But the Puerto Rican Great Migration was strikingly female—in the half decade after World War II it was 59 percent so.51 That was partly because foreign women had a harder time crossing U.S. borders, which left an opening for Puerto Rican women, often in domestic service. But it also owed to the encouragement of the island government, which was eager to see the departure of women of child-bearing age.

  Many did leave. In 1950 about one in seven Puerto Ricans lived not on the island,52 but on the mainland. By 1955, it was closer to one in four.53

  For Luis Muñoz Marín, this all hung together. Turning Puerto Rico from an “unsolvable problem” into a viable economy meant doing a lot of things at once: tamping down birthrates, ushering the surplus population off the island, and channeling profits from tariff-free trade into economic development. More food, fewer mouths.