U.N. Agency Shuns Women's Health

LIMA, Peru — It was more than a year ago, when Peru was going through the social and political unrest that would lead to the resignation of President Alberto Fujimori and the incarceration of his spy chief Vladimiro Montesinos. The Lima delegation of the United Nations Population Fund discreetly approached the Ministry of Health to suggest it was time to do some housecleaning on population issues.

The U.N. agency, known as UNFPA, funded a report examining the government's population programs. That report, leaked recently to the Register, confirms that abuses that prompted an international outcry in 1998 have not been eradicated.

But the report has never been publicly released, and UNFPA has maintained its support of Peru's population control program — even though the abuses documented by the report are specifically banned by the Program of Action of the United Nations’ 1994 International Conference on Population and Development in Cairo.

The UNFPA-funded investigation into Peru's population control programs arose out of the international scandal over massive forced sterilizations among poor Peruvian peasants. The sterilizations severely damaged the credibility of Fujimori's “exemplary” population control policy, announced by Fujimori at the United Nation's Fourth World Conference on Women in Beijing in 1995.

In fact, even the openly pro-birth control U.S. Agency for International Development withdrew funding from the Peruvian program when, USAID officials said, “we understood that the Peruvian government was using a quota system to make its sterilization goals.”

In late 1999, when Fujimori's regime was already beginning to collapse, UNFPA finally decided it was important to know how real the allegations against the population control program were.

As part of a project funded by UNFPA, the Peruvian Ministry of Health commissioned six experts of the Cayetano Heredia Medicine School of Lima to carry out an investigation whose results were presented to the ministry in August 2000.

The investigation was conducted between December 1999 and January 2000 at 11 different locations around the country, especially in rural areas, involving visits to some 70 health centers.

Even though the Fujimori government has been out of power since November 2000, and new president Alejandro Toledo was elected in June, the report remains secret — at the direct instruction of UNFPA, sources told the Register.

When contacted Dec. 6, Stirling Scruggs, the UNFPA's director of information, and Marisela Padron Quesa, director of UNFPA's Latin America and Caribbean division, both denied any UNFPA knowledge of the report.

The next day, however, UNFPA's representative in Peru, Mirtha Carrera-Halim, admitted that UNFPA had funded a report with the same title and conducted by the same individuals, but with a different cover date from the version obtained by the Register.

Pressed repeatedly on the matter, Carrera-Halim eventually said, “I suspect that it might be the same [report].”

A copy of the document, entitled “Study on the Quality of Reproductive Health and Family Planning offered by Agencies of the Ministry of Health” and dated August 2000, was given to the Register by a Ministry of Health employee on condition of anonymity.

The investigation team, headed by Drs. Rubén Espinoza and Nancy Palomino, is far from being pro-life: In the report's introduction, the team acknowledges applying a “gender perspective” and an openly pro-birth control approach to their analysis.

Women's Health Neglected

The report's summary states that “the results show that most of the Reproductive Health/Family Planning (RH/FP) personnel is made of very young, female obstetricians with very little expertise in FP.”

In contrast to the undertrained personnel, the “reproductive health care” equipment at the health centers is quite modern, the report found. But the zeal to promote contraception had resulted in the neglect of other key women's health issues.

“There is a good motivation to perform FP activities, nevertheless, health services are mostly focused on contraception,” the report said. As a consequence, “there is a high rate of missed opportunities to detect the two main gynecologic cancers in the country,” that is, uterine and breast cancer.

Dr. Raúl Cantella, a local pro-life leader and president of the Peruvian Foundation for the Prevention of AIDS, Malaria and Tropical Diseases, said “the spending on population control resources was definitely at the expense of investment on medicine and equipment needed to treat other critical diseases.”

Cantella says that Peru has very high rates of tuberculosis, malaria and other serious diseases that require systematic government action.

“Neglecting these health problems to give priority to population control, even in underpopulated areas, is a crime that the new government will have to correct,” Cantella said.

Asked to comment on the findings of the UNFPA-funded report, Carrera-Halim said that she had only become the UNFPA representative in Peru in April and had never seen the report until earlier in the day of her Dec. 7 interview with the Register.

Then, displaying an detailed knowledge of the report's contents, Carrera-Halim pointed out that it had found that 86% of the women who went to the government's “reproductive health” centers had gone there seeking contraceptive methods. This, she suggested, showed that the health centers were simply responding to patient demand by concentrating on contraceptive services.

Coercion Continues

Asked if the patients’ requests for contraceptives might reflect instead an understanding, shared by both patients and health care personnel, that the only real objective of the centers was to promote contraception, Carrera-Halim said, “The study does not establish that, so we do not have a basis to decide that one way or the other.”

The August 2000 report stated that the population control programs retained a tendency to impose birth control methods, including forced sterilization, on patients.

“The concept of ‘reproductive rights’ is frequently reduced to the decision among different contraceptive methods,” said the report. “[T]here were several cases in which the RH/FP providers believed there were situations in which the decision could be ‘external’ to the person.”

According to the report, “There are notorious deficiencies among RH/FP providers regarding the respect of personal and reproductive rights; in this particular field, there is a clear contradiction both in the discourse and the practice, between a formal acknowledgement of the person's rights and its practical denial.”

As examples of this attitude, the report quoted several health workers. Said one, “Some of those people [peasant patients] have a … wrong way of thinking about family planning, you know? [They are] wrong about the different methods … they give excuses, they say, as an example, that [contraceptive] pills make them fat, or give them headaches, or other problems. … After a tubal ligation [sterilization procedure], some of them come and say it is harmful, that they are turning crazy, that they have a pain here or there.”

Dr. Fernando Llanos, president of the Peruvian Institute of Health, said that the attitude reflected by this quote of an anonymous health worker “is a perfect example of what has been happening in the health field: a complete disregard for the human person and an obsession for applying birth control at any cost.”

Llanos said it was revealing that the health worker would cite as an “example” of “how wrong” peasants are by naming “precisely some of the symptoms that are known to be associated with contraceptive pills, like weight gain or headaches.”

Response to the Report

Despite the findings of the August 2000 report, Carrera-Halim rejected the argument that UNFPA has an obligation to withdraw its support from Peru's “reproductive health” programs until it can be demonstrated that the abuses have stopped. “The United Nations does not run governments,” Carrera-Halim said.

UNFPA “monitors” the programs it supports and expresses its concerns through appropriate “channels” to national governments when abuses are reported, Carrera-Halim explained. In Peru, after the allegation of abuses came to light, UNFPA participated in a “tripartite commission” of investigation, composed of representatives of the government, local non-governmental organizations and outside aid agencies.

But Carrera-Halim said it is ultimately up to the Peruvian government, not UNFPA, to make a final judgement whether human-rights abuses have taken place.

Asked if UNFPA shared in the responsibility for the documented abuses in Peru's “reproductive health” initiative, given that UNFPA has helped fund it, Carrera-Halim replied, “I'm not going to answer that question. You can derive your own conclusions.”


Carrera-Halim denied the allegation by Ministry of Health sources that UNFPA has ordered the Peruvian government to suppress the August 2000 report. “The study belongs to the government,” she said. “And although we have the right to receive copies … we cannot tell the government what to do with it.”

The reason the report had not yet been released, Carrera-Halim said, was probably that there had been two changes of government since it was submitted to the Fujimori regime last year.

Dr. Cantella expressed skepticism about UNFPA's claims. “I would not be surprised if UNFPA, in fact, had demanded the report not to become public,” he said.

Added the Peruvian doctor, “When even USAID was distancing itself from Fujimori's obviously brutal population control campaign, UNFPA was sticking close, providing founds and even praising Fujimori for its ‘resolve.”

Alejandro Bermúdez is based in Lima, Peru.