Secrets and lies

Peru has been heralded as a family-planning 'success story'. Since 1961 the country has reduced its fertility rate from six children per woman to three-and-a-half. But the line between planning families and controlling population is a fine one - as Stephanie Boyd found out when she met some of the 110,000 women who were sterilized last year.

LEOPOLDINA VEGA hasn't felt well since her operation. Peeking out shyly from behind the door of her house, she is at first reluctant to talk about her experience. After some reassurance she finally consents to tell her story. The thirty-one-year-old mother of five complains of nausea, pain and fatigue. She speaks of health workers who bullied her into having her tubes tied. They said it would be so 'simple' her husband would not find out and she would be home working the same day. She describes the consent forms she signed but being illiterate did not understand. And she shudders when she tells how she and three other women were lined up on tables to be operated on the same day, one after another. Lastly she recalls the doctors who abandoned her after it was over, dropping her off at home and never returning.

Reports she has seen recently on television of women who have died or suffered severe complications after being sterilized have made her anxious. 'My health isn't important,' says Leopoldina, her voice wavering. 'It's my children I worry about. Who will take care of them if I die?'

Residents say health workers tried to convince women with four or five children to consent to tubal ligations during a vaccination campaign last May.

Investigations by opposition politicians, local journalists and a US congressional subcommittee have uncovered numerous cases of coercion and abuse in poor communities across the country. Peru's Office of the Public Defender is investigating thirty-five cases of illegalities in tubal ligation operations, including nine deaths from alleged complications and unsanitary operating conditions. Doctors performed about 110,000 such sterilizations in Peru last year (more than three times the 1996 figure) and 10,000 vasectomies as part of a Government birth-control campaign.

Leopoldina's neighbour, Martha Mallón, has had problems urinating since she was sterilized. After her fifth child in June last year workers at the government clinic convinced her to have her tubes tied the following day. 'They said I would be able to care for my children better and that I would not have any more.' When she told her husband he was furious. After learning about the side- effects and consequences from the media she now regrets the whole thing.

The local press has labelled the campaign 'an attack on Peru's poor'. But the meaning didn't sink in until I went to visit the community where Leopoldina and Martha live. It's a small settlement tucked inside an up-market development called La Molina. This Western-style suburb is complete with paved roads, mowed lawns and convenience stores, while the two women live in rough shacks and collect water from a single tap at the bottom of the hill. The Government's logic was clear: their community was an eyesore and an unwelcome blight on its wealthy neighbours. Why should it be allowed to grow?

However, what struck me most about Leopoldina and Martha's community was not the poverty, but the possibilities. Its people are survivors, having left their homes in the Sierra during Sendero Luminoso's armed violence of the 1980s and built new lives in Lima. Although houses are without running water, the settlement is not a 'slum' and the people are not starving or malnourished. Their children play in streets which are free from garbage or sewage. Houses have electricity and many are equipped with televisions. Reforms like piped water, paved roads and a health clinic to provide real choices for family planning would not be difficult. But infrastructure would only encourage the inhabitants to stay. And the Government's response is clearly not about building futures, but about simple population control.

In February 1998 a delegation from Peru travelled to the US to testify before a Congressional Subcommittee on International and Human Rights Operations. Peruvian physician Héctor Chávez described the pressures on doctors to perform sterilization operations. Two women also testified - one claiming she was sterilized without her consent and the other that she was bribed with monthly food shipments.

Dr Chávez told the Subcommittee that women were not given adequate information about the irreversibility or the risks involved prior to their operations. He also said that many doctors disagreed with the sterilization campaign, suggesting they were pressured into performing the operations for fear of losing their jobs.

Chávez said his regional health department required full-time personnel to sterilize two patients a month and contract workers to sterilize three. Joseph Rees, chief council of the US Congressional hearing, concluded: 'I don't think there is any question that women in Peru, especially very poor mestizo [mixed race] women, have been misled into having sterilizations and that in some cases they were lied to, or offered food, in exchange...'

The Peruvian Government denies there are quotas and maintains that abuses are the fault of individuals and not the health system. A few weeks after Dr Chávez's delegation returned to Peru he was dismissed from his post for not 'fulfilling his duties'.

The media hype has brought forth opinions - and raised battle flags - from all sides of the reproductive health debate. Women's groups have long been at war with Peru's influential Catholic Church for its rigid stand against birth control and abortion rights. Church leaders are claiming their position protects women's health and rights, while the notion of 'family planning' is just another disguise to control women's bodies.

High-profile reports in the New York Times, Miami Herald and Washington Post have provoked international condemnation of the Government's campaign. And in the US there is also concern that American aid dollars may have been used to fund the sterilizations - though aid officials in Washington claim that this is not the case. Nonetheless, before the abuses were made public Peru's family planning program (one of the most ambitious in Latin America) received praise from both the UN Population Fund and the World Bank for reducing the country's population growth rate.

The Peruvian women's organization Flora Tristan is struggling to determine the number of women affected. Already hundreds have come forward claiming they were misinformed, tricked, pressured or offered gifts or money if they agreed to the operation. And it is not yet clear how much women's groups working in the field of reproductive health knew about the abuses - but kept silent - until the media safely broke the story. Although government agencies perform nearly 80 per cent of Peru's tubal ligations, non-governmental organizations (NGOs) often work loosely with government departments or are aware of what's happening in the communities where they work. Whether they receive direct government funding or not, NGOs in Peru can't function without Lima's consent. Treading too harshly on government toes is never wise.

But the dilemma for the women's groups goes beyond the compromising position of funding. Family-planning activists fear losing all they've worked for if donors become wary of funding programs or if a conservative backlash frightens women away from clinics and turns birth control back into a taboo subject.

The sterilization campaign was the first time the Government had run a women's health program without enlisting the help of NGOs or community groups. And this gets to the crux of the problem. After working for years to raise awareness about the importance of reproductive health, the issue was taken away from the women themselves once it was finally deemed 'important'. In President Fujimori's dictatorial style, the campaign was scripted to achieve maximum public-relations points: he announced it at the UN Women's Conference in Beijing in 1995.

Mary Vargas, a lawyer working with the Peruvian women's group Demus, says that women's health should be decentralized, taken from federal government and given to local groups who work closely with women and know their community's needs. Vargas cautions that fixating on numbers and population neglects the social aspect of women's reproductive health, which is heavily influenced by factors such as education, access to economic resources and legal protection.

It is these social and political factors that must be changed in order to create a fair and representative family planning program. Like other women's activists, Vargas argues that demographics and population control should not take precedence over women's right to control their own bodies. She insists that having access to reproductive health methods and proper information is 'a fundamental right for women everywhere'.

Stephanie Boyd is the associate editor of Latin America Press, a weekly news publication based in Lima, Peru.

For further information contact the Peru Support Group. e-mail: [email protected]