Against their will
It was meant to be another competitive match for Hilaria Supa, then-leader of the Women’s Federation of Anta, in the south-eastern Andean highlands of Peru. Her team showed up on the field in their traditional colourful polleras – multi-layered embroidered skirts – to play, Supa assumed, their usual fast and explosive game.
But something was wrong.
‘The women didn’t want to play football that day,’ recalls Supa, now a member of Congress, in her office in downtown Lima almost 18 years later. ‘That had never happened before. Those women loved the game!’
There was a good explanation, she would soon learn, for their unusual conduct.
‘We don’t have the strength to play,’ the goalie told Supa. ‘After what they did to our stomachs at the health post, we can hardly walk. Our entire bodies ache.’
As it turned out, the women’s fallopian tubes had been cut without their knowledge or consent.
What happened to the women of Anta was not an isolated case. In the 1990s, during a 10-year reign, President Alberto Fujimori set in motion a family-planning programme that resulted in the forced sterilization of more than 300,000 women. The vast majority of them were indigenous, impoverished and illiterate, living in remote rural communities with precarious infrastructure and services.
Threats and lies
In Chuschi, about 300 kilometres west of Anta, where communist Sendero Luminoso (Shining Path) guerrillas began their grisly war against the Peruvian state in the early 1980s, everyone was suspected of being either a terrorist or a collaborator. The army hunted down and executed locals, mistaking them for guerrillas. The guerrillas hunted down and murdered anyone perceived to be collaborating with the armed forces. Rivers of blood ran through the district for more than 15 years.
But the tragic fate of the people of Chuschi did not end there.
From around 1996, teams of nurses and medical practitioners arrived in search of women of childbearing age. They went from village to village, house to house. One sunlit morning, they knocked on Juana’s* door.
‘They came offering free medical services. So I told them about my stomach aches,’ Juana recounts in her native Quechua. ‘“You have a tumour,” a doctor told me at once. “You’ll have to go to the Cangallo health post to have it removed. You don’t have to pay for the operation.” But I didn’t have a tumour. I came back, along with 20 other women, taking baby steps all the way home. We couldn’t walk well. We were half dead.’
‘When the doctor came to my house,’ says Dolores*, ‘my husband was drunk. Even so, the doctor had him sign an authorization form. I didn’t know what was going on. The doctor said to me: “Don’t worry, the government will pay… The operation will get rid of all your ailments.” He lied. I ended up ligada – with my tubes tied.’
In Sorochuco, Matilde* hand-spins wool into yarn, lost in her memories.
‘My children were malnourished. A nurse came to offer me food supplies if I agreed not to have any more children,’ she recalls. ‘She took me to the health post… I didn’t really understand what was done to me there… Nobody explained it to me. As a poor mother of four, I was desperate to feed my children.’
In La Encañada, Mamérita Mestanza gave in to pressure from staff at her local health centre to agree to the sterilization procedure, following threats that she would be turned in to the police. Eight days after the operation, on 5 April 1998, she died as a result of an untreated post-operative infection. Hers was the first case to be investigated, and was taken to the Inter-American Commission on Human Rights (IACHR) on 5 June 1999. In 2001, the IACHR reached a friendly settlement with the Peruvian State under which it promised to compensate Mamérita’s family, investigate fully the case of forced sterilizations, and bring the perpetrators to justice.
María* is sitting on the muddy ground in the foothills of the tiny Andean village of Acobamba as she relates the story of her aunt.
‘She didn’t want to go with the doctors. She tried to escape, but was caught, dragged and forced into a car,’ she says, crossing and uncrossing her hands atop her pollera. ‘When we arrived at the health post, women were screaming and crying in fear. Blood was splashed on the walls. I saw my aunt dead on a stretcher… but then she woke up. After that, she didn’t want to share her bed with her husband. She became a sort of ghost, he said. He became afraid of her and left her.’
Berta*, another survivor, tells her own story.
‘“You have too many children!” the nurses said. “Let’s go to the health post right now! We’ll give you pills and painkillers there.” I didn’t want to go. But they forced us…
‘I fell asleep. When I woke up, there was blood everywhere. Some women were dead. One husband demanded: “Give me back my wife! What have you done to her?” But she was already dead.’
More women died later on, while working in the fields: ‘After the operation, many of them suffered from severe headaches and haemorrhages. They couldn’t carry any weight… and then they died.’
Many fatalities occurred among the victims of the national sterilization campaign due to medical malpractice and serious irregularities, according to a congressional investigation that was made public in June 2002. The exact number of deaths is still unknown.
Rewards and repercussions
Clotilde* is sitting under the shade of an avocado tree on a sunny summer afternoon as she recalls the never-ending visits she received in 1996 from medical staff from the Ministry of Health (Minsa). She remembers the year because her youngest son was then just one year old.
‘A nurse said to me: “You can’t go on having children like animals! You have to have your tubes tied. It’s a new law”’
‘A nurse said to me: “You can’t go on having children like animals! You have to have your tubes tied. It’s a new law. You have to do it, otherwise we won’t get paid,”’ Clotilde recounts, running a hand-embroidered handkerchief across her forehead.
The more she and her husband resisted, the more aggressive the nurse became.
‘My husband and I were afraid and unwilling to break the law. We didn’t know what to do. The nurse spoke to my husband for a long time. Eventually he relented: “Let’s leave it up to God,” he told me. “If God wants to save you, you’ll be saved. If not, what else can we do?”’
The nurse, Clotilde recalls, quickly put a piece of paper in front of her husband. He signed it, and Clotilde was taken to the operating table.
The nurses were not exaggerating about possible repercussions. During the Fujimori regime, Minsa imposed upon health practitioners mandatory monthly quotas for the number of sterilizations to be performed throughout Peru. A memorandum dated 12 October 1997, which bears the signature of the director of the Huancabamba health centre, reads: ‘All staff are obliged to recruit two patients for AQV – Voluntary Surgical Contraception. Failure to comply will result in the termination of contracts, suspension of schedule extensions and poor-performance reports in personnel files.’
What’s more, healthcare providers were to be rewarded with food provisions and trips. As another Minsa document reveals: ‘Incentive for enlisting a patient: food supplies (15 kilos)… Top prize for attaining the greatest number of AQVs: a trip within the country for three persons.’
In the Peruvian Amazon, medical care is practically non-existent. Many villages don’t have hospitals or health facilities, so health practitioners were often parachuted in to perform sterilizations to targeted population clusters. In many instances, medical teams didn’t have a sufficient quantity of anaesthetic for the procedures. But in order to achieve their targets, they went ahead anyway.
‘In many of these remote villages, people had a very basic understanding of Spanish. On top of that, most had never been examined by a doctor,’ explains Sigfredo Florián, a lawyer with the Legal Defence Institute (IDL), representing several victims. ‘So women didn’t really understand what was done to them at these so-called health facilities; they believed that they had been sexually assaulted.’
As a result of the women’s complaints, indigenous leaders filed a formal grievance to the minister of health in December 1997. ‘Several women had their tubes tied without their consent and without receiving adequate information about the procedure,’ the document reads. A copy of their complaint was forwarded to the International Labour Organization and the United Nations Population Fund (UNFPA).
In her film A Woman’s Womb (2010), Mathilde Damoisel reveals that Fujimori’s so-called family-planning programme received generous funding from the US Agency for International Development (USAID) during the Clinton presidency, as well as support from the World Bank and praise from UNFPA.
For years, Fujimori and his ministers have maintained that surgical contraception was the ‘informed choice’ of sterilization patients and that surgical procedures were never carried out against their will. Member of congress Rafael Rey clarified this point, or so he thought, during an interview on national television. ‘Women were not sterilized against their will,’ he said emphatically. ‘They may have been sterilized without their consent but not against their will.’
The government also denied the existence of monthly quotas, incentives and clandestine health facilities, despite abundant evidence to the contrary. Fujimori’s daughter Keiko, likely to win Peru’s presidential election this June, has chosen to put the blame on ‘irresponsible doctors’. Outraged by her remarks, Peru’s Medical Association (CMP) released an unequivocal public statement, published last October in La República newspaper. ‘The Fujimori regime imposed tubal ligation as a programme with monthly quotas, incentives and sanctions against the will of thousands of women who were poor, indigenous and spoke Quechua. Tubal ligations were performed in inadequate conditions and they formed part of Fujimori’s anti-poverty and health-reform policies,’ said César Palomino, chair of the CMP. Several physicians produced records showing orders under which doctors were expected to perform as many as 12 tubal ligations per hour.
Investigations into forced sterilizations have been shelved twice – in 2009 and 2014, under the presidencies of Alan García and Ollanta Humala respectively – for lack of evidence. In December 2015, Humala’s government announced that the investigation would be reopened, setting up a national registry of victims as part of the probe. To date, no-one has been charged.
In the streets of Lima, Sabina* sells cooked corn and potatoes to raise money for her treatment for ovarian cancer. A mother of four, she endured her worst nightmare after the birth of her daughter. ‘A nurse hosed me down with cold water, put me on a stretcher, tied my hands and feet, and sedated me with an anaesthetic… By the time I woke up, a doctor was already stitching my stomach,’ she recalls. ‘Twenty years have gone by and the government is still unwilling to compensate us, let alone investigate our cases. Who knows if there will ever be justice for us? I might be dead by the time they finally decide to conduct a proper investigation.’
*Names have been changed