Reports of forced sterilisation and the death of women from poor medical care during and after sterilisation have deepened a murky scandal that rocked the government of ex-President Alberto Fujimori.
Alberto Fujimori may have quit, but women's rights campaigners are not about to forgive or forget crimes against women committed by the former president's government.
Peru was put under the scrutiny of international focus in 1997 when women's rights activists presented compelling evidence that women were being misled, bribed or physically coerced into having sterilisations. They documented 15 cases of women who they said had died because of the poor quality of care they received.
The accusations forced the ministry of health – which denied setting sterilisation quotas for health workers – to acknowledge that mistakes had been made, reluctantly admit culpability for six deaths, and announce compensation for the victims' families.
Now, women's groups say the government has reneged on its pledge to halt the abuses; they also charge that the victims' families have yet to receive any of the compensation.
Peru's state-promoted sterilisation campaign has its roots in Fujimori's programme to expand contraceptive provision – launched at the 1995 United Nations Conference on Women. The move was initially welcomed by women's groups. Women in Peru suffer the highest maternal mortality rate in the region and have no access to legal abortion.
The honeymoon was short-lived. Two years later reports of forced and unsafe sterilisations, mostly among rural, indigenous and poor women, made national headlines, thanks to investigations by Giulia Tamayo, a lawyer at the Lima-based Flora Tristan Women's Centre.
Although official figures indicate that more than 200,000 women were sterilised between 1996-98, campaigners say the number is much higher and accuse the government of poor record-keeping and a deliberate cover-up of cases of mistreatment.
They also suspect the death toll is higher than the six deaths the government has officially admitted to. Peru's ombudsman's office – an official department dealing with citizens' complaints about government policy – has discovered a seventh death while investigating 157 cases of alleged sterilisation abuses during 1996-98.
After a public ticking off in February 1998 by the United States House of Representatives Subcommittee on International Relations investigating the use of US funds, sterilisations performed fell from a high of 110,000 in 1997 to about 20,000 in 1998.
But Tamayo says abuses within the Reproductive and Family Planning Programme still continue, albeit on a smaller scale, as the health system has taken no steps to improve services for women, especially in poor rural areas. Nearly half of Peru's population is classified as "poor" by the World Bank, people living on less than US$2 a day. This includes women who suffer from anaemia, malnutrition and tuberculosis, which can compromise their recovery from surgery, Tamayo says.
Ill-equipped rural health posts, often without trained personnel, continue to perform most of the operations. A 1999 ombudsman's office report found that women's right to choose or reject sterilisation could not be guaranteed and post-operative care was lacking.
In early 1999 Tamayo's research team documented another eight cases where women had been sterilised without informed consent.
"I am convinced that the government's point of view is to see the population like an object that requires intervention, and not as people [with] rights," she says. Her team cites government documents that equate the solution to poverty and other social ills plaguing Peru's rural poor with a simple reduction in their numbers.
The government has blamed a few rural health officials for what it called "isolated incidents" of forced sterilisation. At the same time Tamayo was harassed and threatened; she received threatening phone calls and has been assaulted three times. Just before the release of her 1998 report, her house was broken into, papers were destroyed and her children's toys smashed.
"What I felt was panic for my children," she says, recalling the incident.
Internationally Tamayo has been acclaimed for her work. In 2000 she was awarded the human rights group Amnesty International's Ginetta Sagan Award, given to women who have shown courage and perseverance on behalf of human rights.
A women's legal aid group, DEMUS, is now petitioning the Inter-American Human Rights Court, the court of last appeal in the Americas region, claiming that the Peruvian government is guilty of the wrongful death of Maria Mamérita Mestanza and four other women.
In March 1998, DEMUS alleges, health officials threatened Mestanza and her husband with prison if she gave birth to another child. A Quechua speaker from the rural Andean province of Cajamarca, Mestanza believed she had no option and submitted to a sterilisation.
Medics failed to examine Mestanza after the procedure. When she complained of headache, vomiting and paralysis of her left arm, a doctor told her it was merely a symptom of the anaesthetic and prescribed aspirin. Eight days later, the 32-year-old mother of seven died from complications.
DEMUS expects the case to be heard in March 2001, hoping by that time Peru will have returned to the Inter-American Court: in 1999 Fujimori had declared that his country did not have to abide by the Court's decisions.
Mestanza's death is not an isolated instance of "medical negligence", says lawyer Maria Isabel Rosas -it represents the "systemic practice of compulsive tubal ligation [sterilisation] against poor women."