Peru's Family Planning Became Coerced Sterilization
Probes find some doctors bribed, pressured, or deceived women into being sterilized.
LIMA, PERU — When Victoria lost her new-born baby in 1996, she was devastated.
"What kept me going was the thought that next year I could try again," the Peruvian woman says. "I was so sad but I had the hope that I'd have another chance."
That hope evaporated when she overheard a doctor saying that she had been sterilized by a tubal ligation. She says no one had ever discussed the operation with her or her husband nor asked for her consent. "I wanted another child," Victoria says in almost a whisper.
Victoria's case is only one of a string of allegations that have emerged over the past few months in connection with sterilizations performed by the Peruvian Ministry of Health through its Family Planning Program.
In 1995, the government launched what was widely regarded as an extremely progressive family planning program.
It promised all women access to any family planning method they chose, free of charge.
But mounting allegations and investigations are raising serious questions here. Instead of the progressive program described in its glossy brochure, critics claim that the Ministry of Health actually has been waging a massive sterilization campaign in which women - especially poor and indigenous women - were pressured, bribed, or deceived into receiving the surgery.
In 1997, state doctors performed 110,000 tubal ligations - up from 30,000 the year before. Among them were some atypical candidates: women with no children, 15-to-19-year-olds, and menopausal women, according to various inquiries.
According to Maria (not her real name), a woman who has worked as an obstetric nurse for the health department for five years, health department employees were under pressure to fill quotas - between eight and 36 per month - for tubal ligations.
"They imposed quotas on us and they made it clear that our job stability depended on filling them," says Maria, adding that this pressure came directly and explicitly from the highest levels of the Family Planning Program.
Maria says the pressure was accompanied by financial incentives: Doctors and obstetric nurses, herself included, were paid roughly $10 to $30 for every tubal ligation client they recruited.
Problems began when pressure was transferred to clients. "In order to try to maintain their job, many people pass on the incentives they receive to the patient in an attempt to convince them to agree to the surgery," Maria says. "This is going on in the poorest sectors of the country where people are capable of doing anything for money."
Both newspaper reports and investigations have revealed numerous accounts of women who were promised food for undergoing surgery.
"It was the strategy in one hospital where I worked where the chief - who was wondering how he was ever going to fill his quota - started waiving the hospital bills for women who gave birth if they agreed to tie their tubes before they left the hospital. This was the month we had the most tubal ligations," Maria recalls.
According to Maria and the investigations, women were misinformed about their options to get them to agree to the procedure. They were often only told about tubal ligations, or told other contraceptive methods didn't work or weren't available.
According to an investigation by Congressman Rafael Rey, there have been three deaths so far that appear to be the result of surgery and many cases of women with severe complications. Maria is not surprised at the number of complications; she has seen doctors perform as many as 20 of the surgeries in one day.
Initially the Ministry of Health denied the charges. According to Jorge Para, an adviser to the Family Planning Program, the reports of offering food in exchange for agreeing to a tubal ligation is a misunderstanding.
"Some of these people receive food as a part of the government program for families in high risk, it's just a coincidence that these women also underwent the operation," he said.
More recently the Ministry has admitted some errors were made, but say they were a handful of isolated errors, committed by maverick medical personnel.
And it still remains to be seen how extensive the abuses were. Mr. Para insists there was never a massive campaign, nor a policy for one at the level of the ministry.
"It could be that some director in a lower level would demand that his employees fill quotas because he wanted to look good with us. But it is absolutely prohibited to set quotas or offer incentives. We can't do it, it's not legal. If it is proven that this happened, that person will be punished," Para says.
Since the scandal has hit the newspapers, Maria has noticed that calls to check whether quotas have been met have stopped and in general no one is talking about tubal ligations at all. But Maria and many others want more than just a halt to these practices.
"The ministry is going to try and blame it on a few doctors or regional directors, but they have to assume their share of the blame," Maria says.
"What happened has to be brought to light. Not so we can see all the terrible things that occurred, but so this never happens again."