Nela Julcarine leaving a healthcare centre on the outskirts of Lima. She is one of
several social workers who denounced the ways in which state medical officers pushed
women into undergoing surgical sterilisation.
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The male is by nature superior,
and the female inferior; and the one rules, and the other is ruled.
Aristotle,
Greek philosopher
(384-322 B.C.)
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Two Peruvian organizations working
on behalf of women’s rights have waged a successful campaign to reverse coercive
family planning policies
 The first rays of morning sun
appear through the window. The water boils, the dry clothes must be brought in, the
children woken up. In the humble house where Damiana Barrientos lives in one of Lima’s
southern suburbs, a new day is beginning. But for Damiana, this is no ordinary dawn:
today she must go to court.
In February 2000, Damiana won the right to free medical care from the Peruvian health
ministry until she makes a full recovery from an operation performed against her
will. “Everything began in the maternity ward of a Lima hospital in 1998 when I gave
birth to my baby, who died a few days after I had a caesarean,” says Damiana. “There
they cut my fallopian tubes and forged my signature on a paper saying I had consented.
But complications emerged afterwards, and now I’m suffering from a dropped uterus.”
She went to the courts, but though the state acknowledged that there were “deficiencies
in the quality of care,” her case was closed. Thanks to lawyers from the Committee
for the defence of women’s rights in Latin America and the Caribbean (CLADEM-Peru)
and to the Movimiento Amplio de Mujeres group (MAM), Damiana’s case was taken to
the Inter-American Commission on Human Rights, where it is now awaiting sentence.
To date, CLADEM has filed legal complaints over 243 cases of forced sterilisation.1
Since 1996, when the first evidence emerged of serious violations of human rights
through the implementation of voluntary surgical sterilisation, MAM and CLADEM have
sought to reform the family planning policy embraced by the Peruvian government in
1995, and aimed at reducing the birth rate in rural areas from 5.6 children for each
woman to an average of 2.5 children by the year 2000. “Our goal was to ensure that
women could freely opt for one of the various methods of family planning and get
the government to provide information on all the alternatives rather than impose
voluntary sterilisation as the only possible method,” says CLADEM’s Giulia Tamayo.
“Health
festivals”
According to
CLADEM, the family planning programme heralded by President Alberto Fujimori as a
way to make health services more democratic and transform women into “masters of
their destiny” has been converted since 1996 into a policy of forced sterilisation
devoted to meeting national quotas, with surgical sterilisation as the only option.
To make the latter more popular, “health festivals” were organized in which women
were goaded into agreeing to undergo the operation. “We decided to have only two
children. That’s why we chose to have our tubes cut, and we are happy!” Messages
like this featured prominently on the colourful banners hoisted in villages to announce
the health festivals, which would last between one and three days and include sporting
activities and public concerts.
During the festivals, vaccination campaigns, tests for breast and uterus cancer and
dental check-ups were promised, but not all of these services were provided. No official
information is available on the number of festivals held between 1996 and 1998, though
according to the health ministry, there were 463 “campaigns” in the first half of
1996, which were attended by 120,000 people in remote rural areas.
“These massive campaigns were preceded by home visits carried out by medical workers
with the aim of winning over fertile women with more than four children. People lived
in a state of permanent anxiety,” declares Tamayo. Reports collected by Tamayo indicate
that couples were explained the benefits of the surgery, which was presented as the
only option, before being forced to sign a document. Those who underwent the operation
were then presented with 15 kilogrammes of food, while the health worker who successfully
persuaded the woman in question was awarded a bonus.
CLADEM gathered together a large number of complaints proving that the poor sanitary
conditions in which the sterilisations were carried out had caused serious complications,
sometimes leading to death, and that these after-effects were not just limited to
isolated cases as the government had claimed, but were part and parcel of a vast
systematic practice. In the absence of any official answers to its questions, CLADEM
called on the press at the end of 1997 to make the complaints public and put direct
pressure on the government.
“Not all of the family planning programme is wrong. We don’t oppose it, but we want
to point out the traumatic results of the coercive implementation of voluntary sterilisation,”
observes MAM’s María Esther Mogollón. In 1998, her organization decided
to check out reports that had emerged from Lima and the country’s interior. “Fifty
volunteers visited hospitals in 19 out of the 25 districts where the programme had
been applied to talk with those affected and with doctors,” says Mogollón.
“The two most serious problems we saw were medical negligence and a lack of information
for women,” she adds. MAM has since decided to distribute pamphlets listing the rights
of health service users, and urging them to contact an emergency advice hotline in
the event of any abuses of those rights.
Official statistics report that 800,000 couples were attended by state family planning
services in 1998, but that only 3.5 per cent chose voluntary sterilisation, and that
so far the total number of sterilised men and women in Peru stands at 300,000 —in
a proportion of 10 women to each man. Unofficial figures, in contrast, suggest that
almost 500,000 people have undergone the surgery.
Following the campaigns mounted by CLADEM and MAM, the health ministry has been forced
to change its methods, and now incorporates the MAM pamphlet in the information it
distributes, as well as offering two advice sessions to would-be patients: one on
contraceptive methods, and the other on the contraceptive method chosen, including
(if necessary) a briefing on the possible complications and irreversible nature of
surgical sterilisation. A 72 hour-period between signing the consent form and the
operation has also been granted to allow for any second thoughts.
A year after the introduction of these reforms, Peru’s family planning programme
now maintains a much lower profile. No health festivals have been staged this year,
while according to authorities, demand for voluntary sterilisation has dropped by
30 per cent. The main goal of the women’s rights groups has been to condemn the devastating
effects and psychological damage that have followed the operations, but their campaigns
have helped ensure that poor rural people can plan their family freely, and learn
the ways of responsible parenting.
1. These 243 complaints,
which included 30 deaths, are collected and detailed in the report Nada personal.
Reporte de derechos humanos sobre la aplicación de la anticoncepción
quirúrgica en el Perú (“Nothing personal. A human rights report
on the implementation of surgical sterilisation in Peru”), released in mid-1999.
The author, lawyer Giulia Tamayo, was awarded Amnesty International’s Ginetta Saga
prize for her work on behalf of women’s rights.
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