Poor women are victims of the government's birth-control campaign, say prelates and congressmen

LIMA, Peru-Since its implementation in 1995, Peruvian President Alberto Fujimori's birth control policy has had an unintended result-women injured or killed while being sterilized, often without their consent.

The Peruvian Conference of Catholic Bishops (CEP), which has categorically denounced the government's birth control campaign since its introduction, claims that poor women in rural areas have been forced (or deceived) into accepting permanent sterilization.

For the past two years, the government has responded that the Catholic Church was just “inventing horror tales” to derail the birth-control program that had been approved by Congress.

A year ago, Peruvian Congresswoman Lourdes Flores Nano, who originally supported the government's population policy, announced that several peasant women came to her office to complain about being deceived and sterilized without consent. The government dismissed her allegations, suggesting Flores, who is thought to have presidential ambitions, was using the issue to gain a higher political profile.

Late last year, when the conservative daily El Comercio issued a series of articles supporting the bishops ‘position with hard evidence and dramatic cases, public opinion began to shift. An unlikely ally, the Lima-based feminist organization Flora Tristan, denounced the program saying that women's rights were being violated by the campaign.

Since then, mild suspicion has turned into a flood of accusations against the government and, in particular, the Ministry of Health. The disturbing cases of Hilaria Supa, Felipa Cusi, and Angelica Condori, and other women from poor shanty towns either killed or severely damaged during ill-performed sterilizations, were featured prominently by El Comercio and even the Miami Herald and Associated Press.

“Two years ago, bishops from rural areas in the Andes and the Amazon basin began claiming that women were either forced to undergo sterilization or offered material benefits in exchange for their acceptance,” said Bishop Alberto Brazzini, chairman of the Life and Family Commission of the Peruvian bishops’ conference. “Each bishop spoke independently, but all described the same pattern.”

Giulia Tamayo, a lawyer for the Flora Tristan organization who is assisting women to obtain restitution from the Ministry of Health, said “Different means and forms of pressure were applied without making any distinction between married and single women, young or old. The only two clear patterns for the government's policy were: women and poor.”

Independent Congressman Rafael Rey, who leads a task force investigating the allegations, claims that he has 1,000 well-documented cases and some 300 testimonies of health workers who confirm the charges. “What you read in the press is just the tip of the iceberg,” he said.

According to Rey, the government's population policy is marked by what he calls “two rigid parameters: permanent methods and quotas.”

“With those two factors, which force health agents to push for a fixed number of sterilizations and to favor them over other non permanent methods, you can imagine the rest.”

Rey's investigation has demonstrated that medium-level officials of the Ministry of Health must meet determined quotas for each region in the country, and can incur professional “penalties” for failing to attain them. Regional directors, in turn, distribute their quotas among each hospital or health center, even among those who have no facilities or adequate equipment to perform the surgical procedures. The load is ultimately borne by the rank-and-file health workers, normally young doctors, nurses, and obstetricians, who desperately attempt to meet the quota.

“This policy, from a managerial perspective is, highly efficient, but from the human side, it's devastating,” said Rey.

Congresswoman Nano agreed, and said that her week-long investigation in the southern Andes showed that “there were no moral limits for health workers in their effort to meet the pre-established number of tubal ligations.”

Nano said she found evidence of:

ï Women offered food, clothing, and sometimes even money to agree to a tubal ligation.

ï Women being menaced and called ignorant for not consenting to the operation.

ï Town people offered money to “tip” health workers about potential targets (women of reproductive age with more than three children).

ï Women sterilized without consent after giving birth.

ï Women threatened with being banned from receiving health treatment unless they consent to tubal ligation.

Bishop Brazzini said that most of the affected women normally direct their rage at health workers.

“Often they are really population-control zealots, but we have also seen that several obstetricians and nurses hate to do it, but in practice are unable to make a conscientious objection because they would lose their jobs.”

“Threats are nearly always implicit and often explicit,” the bishop added.

The vice minister of health, Alejandro Aguinaga-regarded by many as the real force behind the population campaign- has energetically denied that any coercive measures have been “promoted, suggested, or even officially accepted by the government or health authorities.”

Rey responded that, in a strict sense, the health ministry official's statements may be true, but wonders aloud whether such incidences … are the predictable consequences of establishing quotas and imposing them upon health workers.”

Aguinaga insisted that “there have been, in fact, isolated cases [of abuse or coercion], but they are just an exception in an impeccable population policy that respects personal freedom.”

The government has publicly punished one doctor-whose botched surgery resulted in the death of a mother of three-and announced that another rebuke will follow. Further investigations have also been promised, together with assurances that the birth control policy will continue promoting permanent methods such as sterilization.

So far, the official figures since the policy was implemented place the number of dead women at 10 with more than 100 severely injured, but Peruvian bishops claim that the numbers are even greater. All the bishops have been asked by CEP secretary general Bishop Luis Bambaren Gastelumendi to provide any information to help confirm such cases. Bishops will bring pictures, medical reports, recorded testimonies, and even affidavits confirming that sterilization has been imposed upon poor women, and quotas upon health workers.

“Last year, 110,000 sterilizations were performed according to the law. They all had to be freely accepted by women who supposedly signed letters of consent. Where are those 110,000 letters?” Bishop Brazzini asks.

According to the prelate, “the government only pays lip service to freedom and women's rights, because it insists on the quota policy that has been rejected even by the [United Nations’] Cairo summit.”

In fact, late last year, President Fujimori opened the 11th Latin American Conference on Sexually Transmitted Diseases by saying that his government policies has resulted in 1 million couples now using birth control methods and that he was expecting another million by the end of 1998.

“These are the kind of statements that become policies, that become quotas, that result in more pressure and violations,” said Bishop Brazzini.

By Jan. 30, the Catholic bishops, at the end of their annual meeting, are expected to issue one of the harshest documents ever written against a government policy. They are expected to point to foreign aid, namely the U.S. Agency for Interamerican Development (AID), as the culprit in promoting the campaign.

The Register had access to excerpts of the bishops’ draft, which said in one paragraph: “The dramatic and scandalous cases of victims of the population policy have been presented by the authorities as exceptional anomalies of an allegedly positive program. We want to say to our people that this is not true. The violations against liberty and the right to life are a predictable consequence of the anti-life logic, which places figures and quotas above our concrete men and women. How can the government speak of a personal freedom-respecting program when at the same time the president announces a quota for this year?”

The bishops don't want this policy modified, they want it stopped–altogether stopped, explains Bishop Brazzini. “If we do not do our best to stop it, the deaths that have occurred, and those to come, will be on our consciences.”

Register Latin America correspondent Alejandro Bermudez writes from Lima.