This project was made for demography class in Paris Saclay University (Level M2).
In January 2024, French President Emmanuel Macron called for "demographic rearmament" because INSEE revealed that the total fertility indicator (1.68 children per woman) was one of the lowest since World War II. It means that the government wants a higher birth rate in the country. However, during the same period, in 2023, The Regional Health Authority of Mayotte (the poorest French department and also an overseas territory) encouraged sterilization for women. Then, this phenomenon shows a larger tendency: a differential towards sterilization policy between Homeland and overseas territories in France.
Sterilization is an important tool of control of population growth. For example, a program involving the forced sterilization of Indian men with several children had a clear impact on population growth. In the case of abortion, it is necessary to use it in order to control the population size. This tool is used variously by era and some variables. Women's sterilization increased in the 70s and 80s but decreased after in the USA. Moreover, less educated women who had more sterilization than other highly educated partners underwent more often vasectomy, due to the difference in value about gender equality has influence. Female sterilization is negatively linked with income, and it's the opposite for male. Furthermore, they have children later and use more reversible contraceptives. In the 1970s, the lack of reversible methods explained that sterilization was more frequent.
Unfortunately, sterilization is not only a free choice but has a particular story. It can be encouraged for some populations and rejected for others. We will focus on the story of the United States in this part. Firstly, sterilization was just a consequence of a global policy: men were castrated in the 1800s years to diminish masturbation frequency. In the 20th century, in the USA, race-ethnic minorities and the mentally disabled underwent forced sterilization whereas well-educated white women were discouraged by doctors from pursuing sterilization. It's coherent with an ideology of eugenics: the idea that defaults were hereditary so, by controlling the population, it's possible to make the human population better. Before World II, the idea of "feeble-minded" is constructed as a target of sterilization policies: in the 1920s, sterilization isn't from this point for criminals but these "feeble-minded". After World War Two, there was less sterilization, but it remains realized in psychiatric institutions. However, the label "feeble-minded" was really wide. Let's think about the Nial Cox's case. In 1973, this Black woman was labeled as "feeble-minded" and sterilized because she had a non-marital pregnancy and her mother was dependent on Welfare. The link between mental deficiency and sexual immorality seemed especially close in the case of African American welfare recipients. For Native American women, we observed again misinformation about women who were sterilized without consent. 42 \% of Native American Women were sterilized between 1968 and 1982, and from 1970 to 1980, the birth rate for Indian women fell at a rate seven times greater than that of white women. The author considers that the aim was to commit a "genocide" to have fewer Native offspring who could reclaim their territories. They had the objective to exploit the Native resources, and they needed them to give up their way of life. Moreover, this article highlights higher sterilization rates for Afro-American and Puerto Rican women than white ones. Even if forced sterilization became rare, there was a lot of pressure on minorities. Indeed, racist and classist biases lead doctors to provide operations on minorities without their clear consent, taking advantage of the lack of education of these patients.
To see it in detail, we can see the Californian case. California was an active state in eugenics policies: the aim was to protect "public health" and also limit criminality. The idea was to eliminate deficient genes to limit criminality, violence, and disabilities. Strangers were over-represented in the sterilized population. It started from the beginning of the 20th century until 1952 (when the law put limits on sterilization). However, it continued after for Mexican women: when well-educated feminists campaigned for birth control, women from minorities fought for the opposite because they were seen as "destructive procreators". Indeed, a lot of Mexican women were misinformed and pushed to be sterilized, even without consent. Today, some of these trends keep existing, not by forced sterilization but by difficulty in communicating with geneticists who predict some disabilities for children. Clearly, in the USA, forced sterilization was used as a tool of racial and ableist selection. Even if forced sterilization became almost nonexistent, they were a clear effect on demographic trends, and some phenomena were still effective in other forms.
However, these phenomena aren't specific to the USA. In Europe, there's also a Eugenics and forced sterilization History, and it was not only the case of National-Socialist Germany. Of course, there was the influence of the USA. Danish were inspired by American psychiatry at the beginning of the 20th century: it gave them the idea to sterilize the "mentally retarded". The United States gave financial support to help the Nazis in their Eugenics Program, "Aktion T4". In general, we find some similar patterns. The analysis of Scandinavian countries shows this. In Denmark, a sterilization law against the disabled appeared in the 1920s and stopped in 1964. The temporal trends seem similar to the US. However, we can see an important difference with the USA: Danish eugenics was not motivated by racial preoccupations. On the other hand, in Sweden, Lundborg, one of the Swedish eugenicists, showcased the superiority of the Nordic Values. Even if social deviants and the mentally disabled were the main target, the racial preoccupation was here, by the doctors linking race and physical integrity. Nevertheless, the most striking case is that of Nazi Germany. It was surprising because Germany was a latecomer in Eugenics policies: there were "only" regional tries in three German regions. Eugenicists saw the Nazis as an opportunity to implement their utopia. It went further than all the other policies because they not only sterilized the disabled but gassed those who lived in the annexed Poland. It was the pilot of the Holocaust.
In this work, we will focus on France. In the European context, France was not the most eugenicist country. Doctors created a French Eugenics Society. However, they didn't manage to make policy like in the countries we talked about above. One of the reasons is the following: French were preoccupied with the idea of "depopulation". In the 19th century, the fall of the birth rate in France versus the increase in German one gave rise to some anxieties, and the losses after World War I made this topic a priority for French eugenicists. Therefore, it wasn't a period to sterilize the disabled. Furthermore, Catholic Church disapproved of Eugenics: it took away some doctors to this ideology. By the way, eugenics had less political success in Catholic countries. Notwithstanding, France was influenced by eugenics and especially its racial part. Indeed, in the 1960s, the French government was pursuing a pronatalist policy, banning contraception in mainland France while these methods were available in the French overseas departments. These parts of French territories were seen as a risk of "overpopulation". We see the same opposition in feminist fights: some of them were seeing the law of birth control as an emancipation opportunity whereas the women from la Réunion, for example, were terrified by the control of their bodies by sterilization. Indeed, in La Réunion, in the 1970s, women were forced to get sterilized and aborted in Saint-Benoit's hospital.
Therefore, we can try to analyze the impact on DOM of the differential contraceptive policy. Indeed, if we saw some results of sterilization policies in India or the USA, we wouldn't have an estimation of the effect of forced sterilization in France. It was not organized by law, but there were differences in contraceptive practices between the Homeland and the DOMs. In particular, we will analyze the effect of the Saint-Benoit hospital methods. What was the effect of the forced sterilization policy on the demography of Reunion?
We will use INSEE census data from 1876 until 2022 in all the French towns. We don't have the birth rate or mortality data, so we must use the number of people by town through the years as a proxy. Likewise, we will merge it with geographical data to have the GPS coordinates of French cities. This work aims to test the following hypothesis:
Hypothesis 1 : The trend in population growth is different to the homeland due to differences in public policies. It means that the increase in Homeland should be higher than in overseas territories
Hypothesis 2 : There's a larger decrease trend for the population that depended on Saint-Benoit Hospital that can explain a variation in population growth.
To test the first hypothesis, we will compare the difference in population growth between the homeland and the DOM. We will compare the difference between 1936 and 1954 (comparison of trends), 1954–1975 (difference in the contraceptive policy), and finally 1954–2022 to estimate long-term effects.
This first step isn't specific to Reunion, but it seems relevant to consider Reunion as a member of this group in order to understand social dynamics in this region.
To test Hypothesis 2, we will compare overseas territories in general and towns near Saint-Benoit. If Saint-Benoit's scandal is an exception, the rest of the island can be seen as a counterfactual. Therefore, we will link each town of Reunion with the nearest hospital as the crow flies. It means that we associate a hospital with each city, and we will consider that people go to this hospital if they need care. In this way, we can see if the cities near Saint-Benoit had a lower population growth. Of course, this geographical way to proxy has limits: La Réunion is a very mountainous region with some impracticable roads. Therefore, the nearest hospital isn't necessarily the one we find with our method.
Every French town can have specific variations in time. Moreover, it can influence the fact that being concerned about sterilization is linked to living overseas. Therefore, there would be a cofounder because economic conditions are different between overseas territories and the mainland. Indeed, poverty remains overrepresented in DOM. Then, we will control this variable in our model by adding for each town the median income. The default is that it doesn't represent the income with the year we treat so it can bias the control, but it's better than not control at all. To test it, we will use the difference-in-difference framework. We will do an equation for each hypothesis.
The idea is to identify a causal effect. For the first hypothesis, we consider two groups (Homeland versus overseas territories) and two periods (after the sterilization policy (1975) and before (1954)). The idea is to check the difference in trajectory between the two groups between the two periods to estimate an effect. To be sure that we correctly identify, we have to suppose that the trend of population growth would be the same without the difference in contraceptive policies. To check that, we will check the trends between 1936 and 1954 in both groups. Also, to see the long-term effect, we will compare 1954 and 2022. We suppose that by controlling by income of the city, we can make the trends parallel.
The second equation allows us to test if being near the hospital Saint-Benoit (where the scandal took place), has effects. Therefore, we use the Difference-and-difference-and-difference model. It's the same reasoning as DiD but with three levels: the period, being in the homeland, and being near Saint-Benoit hospital. It allows estimating if the case of the hospital is exceptional by eliminating the effect of income, period, and being in an overseas territory.
If hypothesis 1 seems true, it means that the difference between policies can explain different population growth rate. Else, it means that the policies aren't efficient, even if it would be surprising looking to literature review. If hypothesis 2 is true, it means that Saint-Benoit hospital can be an exception. However, it would be surprising by seeing the racial and colonial history of forced sterilization.
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