social burden," was the philosophical basis for the 1937 birth control legislation enacted in Puerto Rico. A Puerto Rican Eugenics Board, modeled after a similar board in the United States, was created as part of the bill, and officially ordered ninety-seven involuntary sterilizations. The legalization of sterilization was followed by a steady increase in the popularity of the procedure, both among the Puerto Rican population and among physicians working in Puerto Rico. Though sterilization could be performed on men and women, women were most likely to undergo the procedure. Sterilization was most frequently recommended by physicians because of a pervasive belief that Puerto Ricans and the poor were not intelligent enough to use other forms of contraception. Physicians and hospitals alike also implemented hospital policy to encourage sterilization, with some hospitals refusing to admit healthy pregnant women for delivery unless they consented to be sterilized. This has been best documented at Presbyterian Hospital, where the unofficial policy for a time was to refuse admittance for delivery to women who already had three living children unless she consented to sterilization. There is additional evidence that true informed consent was not obtained from patients before they underwent sterilization, if consent was solicited at all. By 1949 a survey of Puerto Rican women found that 21% of women interviewed had been sterilized, with sterilizations being performed in 18% of all hospital births statewide as a routine post-partum procedure, with the sterilization operation performed before women left the hospitals after giving birth. As for the birth control clinics founded by Sunnen, the Puerto Rican Family Planning Association reported that around 8,000 women and 3,000 men had been sterilized in Sunnen's privately funded clinics. At one point, the levels of sterilization in Puerto Rico were so high that they alarmed the Joint Committee for Hospital Accreditation, who then demanded that Puerto Rican hospitals limit sterilizations to ten percent of all hospital deliveries in order to receive accreditation. The high popularity of sterilization continued into the 60s and 70s, during which the Puerto Rican government made the procedures available for free and reduced fees. The effects of the sterilization and contraception campaigns of the 1900s in Puerto Rico are still felt in Puerto Rican cultural history today. Controversy and opposing viewpoints There has been much debate and scholarly analysis concerning the legitimacy of choice given to Puerto Rican women with regards to sterilization, reproduction, and birth