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Childbirth
Medical professional policy makers find that induced births and elective cesarean can be harmful to the fetus and neonate as well as harmful or without benefit to the mother, and have established strict guidelines for non-medically indicated induced births and elective cesarean before 39 weeks.

The Puerto Rico birth control experiment
When it was deemed that a large scale human trial on birth control would have been illegal to conduct in the United States following the success of the preliminary oral contraceptive trials in Boston, Massachusetts, American scientists John Rock and Gregory Pincus decided that the United States territory of Puerto Rico was the ideal location for the experimentation to occur.^

Development of an effective combined oral contraceptive
Norethynodrel (and norethindrone) were subsequently discovered to be contaminated with a small percentage of the estrogen mestranol (an intermediate in their synthesis), with the norethynodrel in Rock's 1954–5 study containing 4–7% mestranol. When further purifying norethynodrel to contain less than 1% mestranol led to breakthrough bleeding, it was decided to intentionally incorporate 2.2% mestranol, a percentage that was not associated with breakthrough bleeding, in the first contraceptive trials in women in 1956. The norethynodrel and mestranol combination was given the proprietary name Enovid. The first contraceptive trial of Enovid led by Edris Rice-Wray began in April 1956 in Río Piedras, Puerto Rico. A second contraceptive trial of Enovid (and norethindrone) led by Edward T. Tyler began in June 1956 in Los Angeles.Vaughan, Paul (1970). The Pill on Trial. New York: Coward-McCann. On January 23, 1957, Searle held a symposium reviewing gynecologic and contraceptive research on Enovid through 1956 and concluded Enovid's estrogen content could be reduced by 33% to lower the incidence of estrogenic gastrointestinal side effects without significantly increasing the incidence of breakthrough bleeding.

The Family and Population Control; A Puerto Rican Experiment in Social Change (1959)
The Family and Population Control; A Puerto Rican Experiment in Social Change (1959) is a summary of the Puerto Rico birth control study, addressed by the researchers who directed it externally (from the United States): Kurt W. Back, Reuben Hill, J. Mayone Stycos. In their publication, the authors explain the experimentation exercised on low-income Puerto Rican women during the advent of oral contraception. Their book highlights and describes the formal and informal reasons for choosing to do the birth control study in Puerto Rico.

Puerto Rico was chosen as the site for the trial because of the vastly growing population as well as the perceived social factors contributing to the uncontrolled population growth, a list which includes the involvement of the Roman Catholic Church in Puerto Rican society, the identification of machismo as a Latino cultural phenomenon, the surgical and nonsurgical practices of sterilization already in place in Puerto Rico, and the lack of education among Puerto Rico’s impoverished communities. An excerpt from the final portion of the experiment's justification explains that Puerto Rico provided an example of the difficulty of applying a criterion of acceptability of a birth-control program, and that the forces affecting the constitutional framework of the society, preventing birth control from becoming a positive policy and sometimes even obstructing a permissive policy, are not effective among the majority of the population.

This mindset suggested to researchers of the era that it was the civic duty of American scientists to intervene in Puerto Rico's attempts at population control. American researchers were able to manipulate the ambiguity of Puerto Rico's legal position to introduce programs favoring family limitation in the name of modernization, freedom of choice and family planning, with sustained and controlled use over an extended period of time as the central mantra of those involved. The dangers of these perspectives lay in the language barrier between American scientists and Puerto Rican subjects, as well as the amount of inference about Puerto Rican culture and the inherent population size causes on the part of the researchers.

Doctors provided hundreds of women--descendants of Puerto Rico's jibaro agricultural underclass--with refined versions of the pill for free until 1964, in exchange for testing its safety and effectiveness.

Cultural Climate
United States researchers attempted to introduce contraceptive experimentation to the island of Puerto Rico in the spirit of population control, to influence the vast numbers of Puerto Ricans migrating from the island to urban areas of the United States.

Machismo
Researchers argued that it was the fault of the Latino phenomenon of machismo which heavily contributed to the large-Latino-family model. It was percieved at the time that the male dominated society of Puerto Rico would keep producing until they reached the appropriate number of males in the family, perpetuating the size of the average Puerto Rican household. Although phenomenological data was gathered merely through societal observation and not through statistical evidence, it contributed enough weight to the importance of birth control in Puerto Rico in the 1950's to influence the decision to legitimately experiment.

Religious environment
Back, Hill, and Stycos, among other researchers during the 1950's and 60's, argue that of the obstacles in Puerto Rico's socio-political climate, religious opposition to birth control from the Roman Catholic Church was one of the forerunners. Back and his compatriates stated that"this opposition is probably the main reason for the reluctance on the part of government officials to proceed with an active family-control program." The opinion that Puerto Rico needed assistance not only in contraceptive availability but also in terms of their religious/political sphere enabled researchers from the United States to feel like a necessary source of intervention and innovation.