By Robyn Marshall
Doctors in Peru performed about 110,000 sterilisations last year, plus 10,000 vasectomies, as part of a government birth control campaign. The number of women sterilised was more than three times the number in 1996.
Since 1961, Peru has reduced its fertility rate from six children per woman to three and a half. Investigations have uncovered numerous cases of coercion and abuse in poor communities throughout the country. The Office of the Public Defender in Peru is investigating 35 cases of illegalities in tubal ligation and nine deaths from alleged complications and unsanitary operations.
One woman told a journalist that health workers bullied her into having her tubes tied, saying it would be simple, her husband would not find out and she would be home working the next day. The 31-year-old mother of five now complains of nausea, pain and tiredness. The consent forms she signed were meaningless — she is illiterate.
She and three other women were lined up on tables to be operated on the same day, one after the other. Her neighbour complains of problems urinating after her sterilisation.
Another woman said she was bribed with monthly food deliveries, while another said she was sterilised without giving any form of consent.
During a vaccination campaign last May, Peruvian health workers tried to convince poor women with four or more children to consent to tubal ligation.
President Fujimora's government is determined to control the population growth of the poor. In particular, the campaign aims to stop the growth of poor communities in sections of affluent suburbs around Lima.
The two women referred to come from a small settlement in the middle of an up-market development called La Molina. This suburb has paved roads, moved lawns and shops, while the women operated on live in rough shacks and collect water from a single tap at the bottom of the hill — an eyesore for their wealthy neighbours.
Many of the people in the small community were driven out of their original homes in the Sierra during the violence of the 1980s between the army and the Sendero Luminoso (Shining Path) guerillas. Their community needs piped water, paved roads and a health clinic to provide real choices for family planning.
One Peruvian doctor, Hector Chavez, described the pressure on doctors to perform sterilisations. He claimed that women were not given adequate information about the irreversibility of the operation, or the risks involved.
He said that many doctors disagree with the sterilisation program but are forced into performing operations for fear of losing their jobs. The Peruvian regional health authority required fulltime doctors to sterilise two patients a month and contract workers to sterilise three women a month.
The Peruvian government denies there are quotas and maintains that any abuses are the fault of the individual doctors. Chavez was dismissed a few weeks after these allegations were made for "not fulfilling his duties".
Peru's family planning program has received praise from both the United Nations' Population Fund and the World Bank for reducing the country's population growth.
The Peruvian women's organisation Flora Tristan is struggling to determine the number of women affected. Already, hundreds have come forward claiming they were misinformed, tricked, pressured or bribed to agree to the operation.
Also, it is not yet clear how many women's organisations working in the field of reproductive health knew of the abuses but kept silent. Although government agencies performed nearly 80% of the tubal ligation, nongovernment organisations (NGOs) often work loosely with government departments or at least are aware of what is happening in the communities. NGOs can't function in Peru without the government's consent.
Some genuine women activists are now afraid that all they have worked for will be lost if women become wary of programs for family planning and stay away. Once again, birth control will be turned into a taboo subject.
The sterilisation program was run without consulting community groups or the NGOs. Once Fujimora had decided reproductive issues were important, the decision was removed from women themselves.
The campaign was launched to achieve maximum affect on international public relations — Fujimora announced it at the UN Women's Conference in Beijing in 1995.
The Peruvian women's group Demus says that women's health must be taken out of the federal government's control and decentralised. It says that women's reproductive health is heavily influenced by social issues, such as education, access to economic resources and legal protection, and that all women must have the right to control their own bodies, which takes precedence over demographics and population control.