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How Peru shelved its ‘registry of conceived persons’

In May this year Peru's staunchly Catholic health minister ordered public health care providers to keep a "registry of conceived persons" – demanding that women report pregnancies "from the moment of conception."

The pronouncements by two successive Peruvian health ministers were chilling.

In January 2002 then health minister Luis Solari legislated March 26 'National Day of the Unborn Child.'

In May 2003 his successor Fernando Carbone issued a ministerial regulation requiring public health care providers across Peru to keep a "registry of conceived persons" by demanding that women report their pregnancies "from the moment of conception".

It unleashed a fierce row when it appeared as part of a draft General Health Law which would have conferred constitutional rights – personhood – on the fertilised egg.

Medical experts declared that the proposed legislation rejected scientific consensus. Conception – the fertilisation of egg and sperm – and pregnancy are distinct events, according to the World Health Organization.

Pregnancy, says the UN body, is established "when the implantation of a fertilised egg in the lining of a woman's uterus is complete" – a process that cannot be easily verified until some weeks after conception.

Women's rights advocates charged that the proposed law would violate women's health and rights and further limit their reproductive options by denying them access to contraceptive methods, including interuterine devices and emergency contraception (often called 'the morning after' pill) because some Catholic politicians believe they interfere with the fertilised egg before implantation and are therefore 'abortifacients'.

Abortion is illegal in Peru unless a woman's life is in danger.

Carbone and Solari – conservative Catholics – said the registry would make pregnancy and birth safer, along with other reforms instituted in 2001 when President Alejandro Toledo took office, such as free health care, including prenatal visits, for women and children.

Although women's groups welcomed the decline in the number of women dying in childbirth from 163 per 100,000 pregnancies to 152 since 2001, they accused the government of failing to supply health clinics with legally approved, free contraceptives to the poor. According to Delicia Ferrando of Pathfinder International, a nongovernmental organisation working among women in Peru and other countries, signs pointing to family planning departments were even removed from public health centres in the capital Lima.

In Peru, where 54 per cent of the population lives in poverty – half of them in extreme deprivation – the burden of another child can be enormous. Although illegal, 350,000 women every year seek clandestine abortions, and one in seven is hospitalised as a result.

Instead of worrying about fertilised eggs, activists say, the government should be concerned about Peruvian women, who continue to die from complications of both pregnancy and unsafe abortion at one of the highest rates in Latin America. An estimated 50,000 women each year die or suffer serious injuries due to unsafe abortion.

Although Carbone tried to justify the register as simply a means to record prenatal care, opponents argued that the regulation was impossible to implement. Alexander C. Sanger, grandson of family planning pioneer Margaret Sanger, said: "If Peru had a functioning health care system, this might be laudable. But it doesn't. Given that its current registry system can't keep track of births and deaths accurately, it is hard to imagine how it will do a better job keeping track of embryos and prenatal appointments."

Meanwhile, political unrest – including a wave of social protests, strikes, resurgence of guerrilla activity by the Maoist Shining Path and the imposition of a 30-day state of emergency – forced Toledo to replace his prime minister and reshuffle his cabinet in June.

Carbone's replacement Alvaro Vidal, former head of the Peruvian Medical Association, immediately announced that his ministry will follow the WHO guidelines.

"Contraceptives [including emergency contraception] are now being distributed without any restriction or bias," Vidal told Panos Features two months after taking office. "A government must have a balanced policy in which the central element is the dignity of the person and the freedom of couples to choose their contraceptive methods."

What about conceptions registry? Vidal termed it "an internal regulation" which has "never been implemented" – because women won't accept it.

Vidal warned against any "extreme" or "biased" position, including "the idea that the only purpose of sexuality is procreation and that only 'natural' contraceptive methods are valid."

"Everyone is free to have their own philosophical or religious ideas and practices, but individual beliefs cannot be mixed with government health policy," he added.

Ironically, the religiously-inspired policies of Solari and Carbone may have contributed to the debate on reproductive health – especially unsafe abortion – by changing it from a Church vs. feminists confrontation to an issue of public health.

"Most people in the public health community now understand that abortion is a public health problem," says Susana Chávez of the Lima NGO Flora Tristan Women's Center. "Many feel that the only thing they accomplish by not providing abortion services is contributing to higher maternal mortality."

In fact, a growing network of urban and rural health professionals are providing women with safe – albeit clandestine – abortion services based on their ability to pay, along with counselling on contraceptive use.

Peru, however, remains an unlikely candidate for abortion reform. A June poll by the University of Lima found 71.9 per cent of respondents in the capital opposed legalising abortion, up from 67.2 per cent a year earlier.

Women themselves have mixed feelings.

Liliana was 17 – and already a teenage mother – when she became pregnant again and, at her family's urging, had a clandestine abortion. She felt guilty – "like a worthless person" – and says she would now advise a woman in a similar situation "not to do it." If her family wouldn't support her, "I'd tell her to look for help somewhere else, but to have her baby."

Alejandra, 47, had an abortion at 22. Already the mother of three children, she felt her meagre resources would not allow her to care for a fourth. She went to a woman in her neighbourhood, who injected what she calls a "soapy liquid" into her uterus. "It caused a huge haemorrhage and I got an infection and a high fever."

Alejandra's advice: "I couldn't say anything – it's a personal decision. I'm not the one who's going to have to raise the child or feed it."

Barbara J. Fraser is a freelance writer living in Peru. 

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