Victoria Vigo said doctors sterilized her without her knowledge. Human-rights groups say Vigo was one of many victims of a government plan to keep poor women from having too many children. (Simeon Tegel/GlobalPost)

Peru: forced sterilization cases reopened

Peru’s chief prosecutor has relaunched a criminal investigation into the forced sterilizations of thousands of poor and indigenous women, allegedly carried out by the government of disgraced former president Alberto Fujimori.

Human-rights groups claim up to 300,000 people, typically from rural areas, often illiterate and predominantly Quechua-speaking, were sterilized against their will during Fujimori’s presidency from 1990 to 2000.

Originally begun as a government initiative to help eradicate poverty, the practice is thought to have been one of just two cases anywhere in the world of forced sterilizations being adopted as state policy since Nazi Germany, said Alejandra Cardénas, of the Center for Reproductive Rights, in New York. 

The investigation is the latest of several attempts across Latin America to seek justice for abuses committed by authoritarian governments. Last month, Uruguay’s congress voted to lift an amnesty protecting members of the country’s rightwing dictatorship from 1973 to 1985. And the Brazilian congress has also launched a truth commission to investigate the country’s 1964-1985 military dictatorship. Meanwhile, Argentina continues to try alleged torturers and killers from its military dictatorship of the 1970s and 1980s.

Mamérita Mestanza died of complications

In Peru, the investigation centers on the case of Mamérita Mestanza, a 33-year-old mother of seven who died from complications from sterilization surgery that health officials allegedly harassed her to undergo. The case had been shelved in 2009 after it was decided that the statute of limitations had run out.

But last week the office of Peru’s attorney general, José Peláez, informed the Inter-American Commission on Human Rights that it was reopening the case and reclassifying the sterilizations as a crime against humanity, effectively removing the time limit for a prosecution. No official explanation was given but the new government of President Ollanta Humala has been highly critical of Fujimori’s record of corruption and abuses.

The news was greeted with cautious optimism by human-rights lawyer Silvia Romero, who urged prosecutors to focus on establishing the guilt of Fujimori and his three health ministers: Eduardo Yong Motta, Alejandro Aguinaga and Marino Costa Bauer.

There was “direct control” from the presidency over the sterilization program, Romero told GlobalPost. “There are obviously more people involved, but we think it needs to be a very specific, concrete investigation.”

All three former health ministers have, at different times, denied the compulsive nature of the sterilizations. Aguinaga, now a congressman for the Fujimorista party Fuerza 2011, did not respond to GlobalPost’s requests for comment.

Fujimori is currently serving a 25-year jail sentence for embezzlement, and for authorizing death squads during his rule. But the sterilizations are just one of a series of other alleged human rights abuses during his presidency over which he has yet to be formally accused.

A government policy

Fujimori first announced the practice of providing free surgical sterilizations in 1995 as a way of tackling poverty and population growth. The program initially received a warm reception, and USAID, the United State’s international aid agency, donated $35 million.

But human-rights groups sounded the alarm about doctors being pressured to meet quotas, and patients being bullied and tricked into undergoing procedures. 

Eventually, the regional human-rights commission became involved, and in 2001 oversaw a settlement between the Peruvian state and Mestanza’s family that included a $100,000 compensation payment. However, the commission also instructed Peru to bring the perpetrators to justice — a ruling with which the country has yet to comply.

One victim’s story

Victoria Vigo, 49, told GlobalPost that her fallopian tubes were severed without her knowledge during a Caesarian procedure in a public hospital in the northern city of Piura in April 1996. The mother of two only discovered the news by accident, after overhearing a conversation between two doctors.

“My daughter was premature and died a few hours after birth,” she told GlobalPost. “I was devastated, of course, and wanted to go home. One of the doctors tried to comfort me by telling me that I was still young and could have more children. But then I overheard the doctor who carried out the operation telling him that that would not be possible, as he had sterilized me.

“He had even omitted it from my clinical notes. He knew what he was doing. I could have gone on trying for years and years to have another child without even knowing that I had been sterilized. I felt mutilated, completely violated. What kind of values does a person like that have?”

In a state of shock, Vigo went home without confronting the doctor. She eventually sued him and in 2003, won $3,500 in compensation, in one of the rare cases that has so far come to court. During the trial, she said, the doctor argued that he had simply been obeying orders, and that the sterilization was official policy.

The Fujimori legacy

The sterilizations arguably helped swing the result in June’s presidential elections away from the former leader’s 36-year-old daughter, Keiko. On the campaign trail, Fujimori, who ran on her father’s legacy, was ambivalent about the sterilizations. She apologized to the victims, yet insisted that the procedures were carried out by individual “bad” doctors.

The issue dominated the news in the final days before voting, and Fujimori narrowly lost, despite having led the polls for the previous six weeks.

Vigo said she hoped that Alberto Fujimori and the other members of his government whom she believes devised the policy will finally be brought to trial. “I voted for him twice,” she said.

“He did good things as a president. I looked up to him, like a daughter to a father. And what he did to me was the worst kind of abuse of trust.”

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Further Reading

Peru's sterilisation victims still await compensation and justice

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From the Archives

1998 - Peru's sterilisation campaign and the US' hidden agenda

by Elizabeth Liagin

There has been uproar in Peru with the exposure by a women's group of cases of involuntary sterilisation under the government's mass sterilisation campaign.

The campaign is not only being funded by the US, but is also in the effective control of a US agency. In the light of the strategic theories and policy pronouncements of the US military officials and the US national security establishment, it is clear that such US involvement is not the result of benevolent concern to improve the quality of life of women but the product of a perceived threat to US security posed by a growing population "south of the border".

An unlikely victim

FELIPA Cusi was an unlikely victim of US international security policy. After suffering flu-like symptoms, the 30-year-old mother of five was taken to a rural medical centre near Cuzco, Peru. Once there, she was given anaesthesia and taken to an operating room where - without her knowledge or consent - she was sterilised.

In Tocache, another rural village, Magna Morales suffered an even worse fate. When government sterilisation workers canvassed the area, the 34-year-old mother of five desperately tried to evade them. After hiding in her house for several days, however, she went to a local market where she was spotted, seized, abducted and carried off to a makeshift clinic. She, too, was sterilised. Morales never recovered from the surgery, and died 10 days later.

More than a quarter million sterilisations were performed on Peruvian women between 1995 and 1997 - half during 1997. This June, the Latin American Committee on Women's Rights (CLADEM) issued a lengthy report describing 200 cases in which forced sterilisation was alleged. Renovaci—n, a conservative opposition party, has obtained affidavits from more than 1,000 women who say they did not freely consent to the tubal ligations they received in government clinics.

The campaign of mass sterilisations inaugurated by the Peruvian government three years ago has caused such widespread outrage that the US Congress recently began looking into the situation. The US provides most of the money used for national family planning programmes in Latin America.

Targeting fertility

According to Mark Schneider, Assistant Administrator for Latin America at the Agency for International Development (USAID), allegations that his agency is implicated in Peru's involuntary sterilisations are unfounded.

At a 25 February hearing before the House Subcommittee on International Operations and Human Rights, he also assured lawmakers that officials at Peru's health ministry planned to 'discontinue their campaigns in tubal ligations and vasectomies', hinting that the decision was the result of USAID pressure.

But sceptics point to discrepancies. Indeed, on 25 March, exactly a month after Schneider's appearance, USAID posted a notice titled, 'Grant to Provide Voluntary Sterilisation and Related Services in Developing Countries'. The New York-based group awarded the money, AVSC International, will concentrate its promotional activities in several emerging nations, including five in Latin America - Bolivia, Colombia, the Dominican Republic, Mexico and Peru. Under its five-year agreement with USAID, AVSC will get no less than $125 million.

Considerable evidence points not only to USAID financing Peru's sterilisation programme, but also to the US government spending an extraordinary amount of time and energy to create what bureaucrats call a 'policy environment' in which those sterilisations have taken place. Indeed, agency files suggest that Peru's Ministry of Health was virtually taken over by 'aid' operatives at the US embassy in Lima between 1988 and 1993.

An internal USAID memorandum circulated in October 1988 recommended setting 'targets' for fertility reduction - 1.9 million new contraceptive users by the year 2000 and a reduction in average family size from more than four children per household to about two and one-half. It also mentioned efforts to engage Peru's government in a 'policy dialogue' on 'liberalisation of sterilisation laws'. The government of Peru formally approved the use of sterilisation as a population control measure in 1995.

In 1993, USAID launched a huge 'health sector' project in Peru costing $60 million. As a condition for receiving the funds, the government was obliged to create an 'Interagency Advisory Committee on Health Management and Financing' to recommend policy reforms to the Ministry of Health and assist in their implementation. The committee was to include representatives of Peru's health and finance ministries along with officials from USAID, the World Bank and the Inter-American Development Bank.

Given Peru's dependence on external funding for health services, it is not difficult to see how this commission could assume control of the ministry. In fact, a cable to the US Embassy in Lima, written seven months before the start of the project, urged USAID's Peru bureau to take 'optimum advantage of policy dialogue/conditionality opportunities' and suggested working with the World Bank and other donors on a 'unified series of policy conditiona-lities to their combined assistance'. The February 1993 communiquŽ suggested that the US 'could substantially increase its ability to leverage the kind of policy change that is critical to the success of this project'.

USAID funds allocated to the project were not given directly to the Peruvian health ministry, but rather expended on its behalf by USAID. In fact, the seven-year project is run by a US-based 'Institutional Contractor' hired by the agency's Lima office, and charged with general programme administration, staff training and orientation, field work supervision, data collection and evaluation, and a variety of other management-level functions. Activities not specifically assigned to the contractor are, for the most part, carried out by USAID personnel at the embassy. In the words of USAID's official project paper, two full-time in-house project supervisors are given a 'lead role in policy dialogue and interagency leadership and coordination'. They are authorised to prepare the 'scopes of work' that identify project activities and goals and provide 'technical guidance in the area of health financing'.

Although the project agreement is legally binding on Peru, no such stipulation applies to the US. The record also suggests that USAID authorities attempted to conceal from Peruvian authorities the fact that population control would be the project's major focus. Since much of the money would come from a budget 'earmarked' by Congress for population activities, according to the 1993 State Department communiquŽ, the final project document 'must mention that family planning services are among those activities which will be supported'. An initial draft, the cable scolded, 'does not do so'.

Protecting Western interests

Spectacular efforts are needed to implement national population projects like the one in Peru, not to mention the deception and arm-twisting that goes on behind the scenes. And it can not be explained away simply as a misguided attempt to 'help' people who could arguably improve their lives by having fewer children. Similar USAID-initiated population policy 'reform' schemes are either in effect or in the planning phase for many African and Middle Eastern nations, virtually all of southern Asia, and most countries in Central and South America.

The agendas of the various US agencies involved in population issues have little to do with benevolent intent. Rather, the core belief is that unprecedented low levels of fertility in the 'advanced' nations of the West and relatively high birthrates elsewhere will lead to a shift in the balance of global power. This theory has been advanced consistently for a half-century by Western military officials, political analysts at the intelligence agencies, and the 'national security' establishment in general.

'Population has long been recognised as influencing national security and power,' wrote John Saunders in a 1986 book, Population Growth in Latin American and US National Security. 'Had it not been for unrestricted immigration and the contribution to national growth and development made by immigrants and their descendants, the population of the United States on the eve of World War II would have been less than half as large as it actually was and American national power significantly smaller. The consequences that this condition would have had for the history of Western civilisation are incalculable.'

Observations like this have been made frequently by high government officials since at least the start of the Cold War era. An 'outline plan of operations' prepared in January 1957 by a 'working group on Latin America' - including representatives from the Central Intelligence Agency (CIA), the Departments of State and Commerce, the US Information Agency and the military - was even more explicit about the 'threat' to Western interests posed by a growing census count south of the border.

'The rapid rate of population increase and economic growth in the area, with their implications for probable future strength and importance to the United States,' said the memorandum, 'should be taken into consideration in the execution of all programmes.'

Global power structure

In a 'Statement of US Policy toward Latin America' dated 15 November 1960, the National Security Council cautioned: 'We must never lose sight of the fact that the world population imbalance is heavily against us and is becoming ever more so.' Originally classified 'secret' and still only partially declassified, the memo predicted that high birthrates in the region could 'increase Latin America's population of approximately 190 million at present to some 500 million by the year 2000'.

A 1978 study by the Council on Foreign Relations worried about preserving the global power structure. Because differences in fertility nearly always favour the least economically advantaged group, the text declared, 'Population growth represents a threat to the status quo: to political dominance and economic and social stability.'

Perhaps most revealing of all was a research paper prepared in 1991 for the US Army Conference on Long Range Planning. That report, reprinted in the Summer 1991 edition of Foreign Affairs as 'Population Change and National Security', detailed changes in global demographics that are likely to result from below-replacement fertility in the West and high birthrates elsewhere. The study concluded that 'these projections point to a continuation of trends evident since the end of World War II. If these trends continue for another generation or two, the implications for the international political order and the balance of world power could be enormous.'

In regard to Latin America, the Army Conference research cited not a substantial increase of population in the region, but even more impressive economic growth. While the region's population multiplied seven times over between 1900 and 1987, the report said, per capita income increased by a factor of five. In other words, there were seven times as many people and, on the average, each of them had five times as much in terms of material resources. Thus, the collective wealth of the region was 35 times what it had been at the start of the century.

A threat to US interests

One might expect Western policy- makers to welcome such optimistic news from a historically 'under-developed' part of the world. However, that was not the opinion expressed in the report. 'By these projections a very different world would seem to be emerging,' the study continued. 'Such trends speak to pressures for a systematically diminished role and status for today's industrial democracies. Even with relatively unfavourable assumptions about Third World economic growth, the share of global economic output of today's industrial democracies could decline. With a generalised and progressive industrialisation of current low-income areas, the Western diminution would be all the more rapid. Thus, one can easily envision a world more unreceptive, and ultimately more threatening, to the interests of the United States and its allies.'

While public outrage in Peru may eventually halt its sterilisation campaign, at least temporarily, imposing population control on people in less-developed nations remains at the top of the Western foreign policy agenda. As the Army Conference study concluded, population trends throughout the world 'could create an international environment even more menacing to the security prospects of the Western alliance than was the Cold War for the past generation'.