Forced Sterilization in Peru
The government of Peru, a Latin American country with a population of 24 million, more than half of which are women, is being held accountable for several cases of forced sterilization since 1995, when the procedure was legalized. During 1997, the Peruvian Ministry of Health registered 100,000 women for the sterilization procedure and 10,000 men for the vasectomy. It now appears that some women have died after undergoing tubal ligations, that many have suffered complications and several have testified that they had been bribed, coerced and misinformed. What went wrong?
In 1995, just before the Fourth UN World Conference on Women, a law was passed that authorized sterilization as a means of family planning. Many thought it was very courageous of President Alberto Fujimori (in power since 1990) to take on the powerful Roman Catholic Church. At the time, the law was applauded by women as a step forward, as a tool that enabled them to decide about their own body. Womens organizations collaborated with the health ministry in setting up health centers and family planning services. Now critics claim that the ministry has been waging a massive sterilization campaign in which women, and particularly poor and indigenous women, have been pressured and bribed or deceived into accepting surgery for tubal ligation. Growing evidence suggests that the sterilization law has been arbitrarily applied to reduce the birth rate as a way to combat poverty rather than as an expression of womens reproductive rights.
The methods of the Program for Reproductive Health and Family Planning are questionable. It encourages sterilization campaigns and sterilization fairs where women are captured to be sterilized. Physicians are forced to comply with a minimum quota of tubal ligations per month. Health workers are trained to capture as many women for sterilization as possible. For each sterilized woman they get about $5-11 and if they fail to produce the minimum number of women, they are likely to get fired. The setting of targets very easily encourages coercive practices. Pilar (not her real name), a health worker in Piura (northern Peru) says: Women are hardly ever informed about alternatives to tubal ligations, nor are they given full information about its implications. In most cases they are not told that the ligations are usually definite and irreversible. And many of the women are very young, some as young as 20.
The circumstances under which such operations are carried out are appalling. Sometimes one doctor can operate on as many as 20 women per day. Accidents and negligence are frequent. Women are given short periods of recovery, sometimes not even four hours. There is no monitoring, nor is there any follow-up. When faced with complications afterwards, many women will not seek a doctor; although the family planning service is free, any follow-up care has to be paid for and the women do not have the money to pay for it. (It is interesting to note that while the family planning service is free, women have to pay when they give birth at the hospital.)
As we have said, the majority of the women targeted are poor women from rural areas and indigenous women. They are the ones with little education and no access to adequate health services. In Peru, it is they who experience the most discrimination. The deep racism embedded in Peruvian society comes into play here as well. Many of the health workers do not respect poor indigenous people and, therefore, do not care about their health. Many indigenous women have testified that they feel persecuted and threatened by the health workers.
The average number of children born per woman in Peru is 3.5 compared with 3.1 for Latin America in general and 2 for the US. The rate is 6.2 children for Peruvian women who have little or no education, and 7.1 children for those who live in rural areas. That compares with a rate of 1.7 children for women who have at least a university or college education and 2.8 for urban residents of all educational levels. It is obvious that any family planning program in Peru today has to connect the discussion on reducing the birth rate with the disussion about social and political inequality, access to education and unequal income distribution.
The race to reduce population growth raises an important issue. Last year international organizations applauded the reduction in the Peruvian population growth rate from 3.2% to 1.17% annually. Peru is complying with the objective of the United Nations Fund for Population Activities (UNFPA) guidelines, which hold that the population in a country should be proportional to the capacity of its territory to generate sufficient food. Because of favorable reports from the UNFPA and the World Bank, the president of Perus Council of Ministers, Alberto Pandolfi, announced last year that the goal of 130,000 sterilizations per year, set for 1997 would be set again for 1998.
The rigorous compliance with international standards and targets has to be carefully questioned, if it leads to abuses of laws supposedly provided to empower women. Women have the right to decide in a free and informed manner over their reproductive health as was stated in the Platform for Action at the UN Fourth World Conference in Beijing 1995. The issue is not the abolition of the sterilization law, as many opponents might be quick to point out now, but a review of how the law is applied.
Around 20 cases of sterilization abuse are currently under investigation in the judicial system and the Peruvian Ombudsman has taken 35 cases (at the beginning of April). There are at least four official inquiries under way, including one by a United States congressional committee into whether US Agency for International Development (USAID) money was used unwittingly in the sterilization campaign. Because some US-sponsored food programs are operated from the same Peruvian Government medical posts that administer family planning in rural areas, some of the food might have possibly been used to bribe women to undergo sterilization.
Flora Tristan, one of the largest feminist organizations in Peru, is conducting a study to document cases of abuse and determine the number of women affected.
So far the explanations or statements given by the Peruvian government have not revealed much. Because there is neither hard evidence nor any proof of directives setting targets and quotas, nobody is assuming responsibility. The Minister for Health, Mr. Costa Bauer, has announced an inquiry into the issue but considering how other scandals in Peru are handled, little can be expected (an inquiry into serious phone tapping in June 1997 has still not brought any concrete results). The government has to clearly respond to the allegations and assume responsibility for bringing cases of negligence and abuse to justice.
While an investigation into the reports about forced sterilization is urgently required, it is also extremely important to put pressure on the Peruvian government, and particularly on the Ministry of Health, to ensure that the family planning program is thoroughly reviewed. It has to be reformed in such a way that it not only guarantees the right to information and adequate medical care but that it also provides adequate trainingwith an ethnic and gender perspectiveto health workers. An awareness-raising campaign directed at the larger public should bring the message across that family planning services are not merely a government policy but a womens right to decide about her own body. Having access to reproductive health services and proper information is a fundamental right for women everywhere.