sábado, septiembre 09, 2006

Esterilización forzada en inglés.../ forced sterilisation

Este es un artículo del Le Monde Diplomatique, sobre las prácticas del gobierno fujimorista contra la población peruana:


Peru: the scandal of forced sterilisation

Peru’s government wants to extradite former President Alberto Fujimori from sanctuary in Japan in connection with assassinations in the 1990s. But his government’s eugenic policy, which encouraged the sterilisation of 300,000 women from poor Amerindian communities, has not been mentioned

By Françoise Barthélémy

HALLYCOCHA is an Amerindian community in Laguna Pampa in the Andean uplands, 50 kilometres from Cuzco, Peru. Here farmers till the land using ox-drawn ploughs. In one of the ramshackle houses lives Hilaria Supa Huamán, her hands deformed by arthritis; she has just come back from her chacra, the small plot where she grows corn, maize and potatoes.

In 1991 Hilaria was one of the founders of the women’s Peasant Federation of Anta, which is a largely rural province with about 80,000 inhabitants. Three years later she became its secretary-general and in that capacity took part in the 1995 IVth World Conference on Women in Beijing. That gave her the opportunity to speak to President Albert Fujimori. "He began talking to me about a family planning health care programme he wanted to launch. I said: ’Fine, provided husbands and wives take decisions jointly.’ ’Of course,’ he said."

Some months later, under strong pressure from the village nurse and without any detailed information, Hilaria had tubal ligation surgery and found it hard to recover. "They insult you by saying: ’Do you want to breed like a pig? Your husband will be angry if you do nothing,’" she says. "Afterwards they assure you that you will soon be back on your feet. That’s not true. The scar outside heals, but internally healing is slow because our work is so physically demanding."

She is not alone is suffering side-effects. Her friend who lives in Mollepata says that she too is "very much weakened" after tubal ligation. Disturbing facts have emerged from several communities including Mollepata, Limatambo and Ancahuasi. It was claimed that women visiting the dispensary for health checks for their children were locked in, sometimes in groups of 10 or 20. They were told they were to be vaccinated and then taken individually to the operating theatre and anaesthetised. They came out feeling groggy. Later they realised they had been sterilised.

Hilaria, with others, decided to make public what was happening. She and her colleagues were consequently excluded from the leadership of the Peasant Federation. They claim that the reprisals were the work of a gynaecologist, Washington Ortiz, who had pressurised patients who had had surgery to withdraw complaints.

The protest movement has swelled. "At communal and regional level, our council condemns the practice of forced sterilisation," says Rosas Beltrán, mayor of Anta and director of the Peruvian Network of Rural Councils (1). "With the Cuzco public prosecutor’s office (2), we organised opposition and aid for the victims."

The health minister, Luis Solari, set up a special commission on the activities of the voluntary surgical contraception programme (AQV) on 8 September 2001, less than a year after Fujimori had been deposed by the Peruvian Congress and fled to Japan. Solari entrusted four people, including Hilaria Supa Huamán, with the investigation. Also in September 2001 the Congress appointed a commission to look into irregularities committed in the AQV programme under Fujimori; its head was Hector Chávez Cuchón, a Congress member and president of the Federation of Doctors for the Ayacucho, Andahuaylas and Huancavelica region.

In July 2002 the investigators appointed by the health ministry (Minsa) published their 137-page report which revealed that 331,600 women had been sterilised and 25,590 men had had vasectomies between 1995 and 2001, stressing that they were blackmailed, threatened, or bribed with food; none was properly informed.This had been done in the name of a public health programme with the real aim of cutting the birth rate in the poorest regions; its main victims were Amerindian people from under-privileged areas: the Andean sierra, the Amazon selva (forest) and shantytowns around Lima.

Many official documents had been destroyed but 56 survived to show what had happened and who was responsible. Fujimori had the prime responsibility; he had been given monthly updates about the number of operations by the offices of former health ministers Eduardo Yong Motta (1994-96), Marino Costa Bauer (1996-99) and Alejandro Aguinaga (1999-2000). As soon as the report was published, there was a heated debate about the programme’s statistics and real objective. Alejandro Aguinaga, however, vigorously defended a plan which, he claimed, had allowed hundreds of thousands of couples to avoid unwanted pregnancies or abortions and conspicuously reduced mortality rates for mothers and babies.

Former minister Bauer cited (in La Républica on 25 July 2002) an inquiry undertaken by a United States agency between 1996 and 2000 in support of his claim that "90% of women of child-bearing age are completely satisfied with the family planning methods made available to them". But on the same page of the newspaper a woman called Ligia Rios explained how members of the Peruvian Institute of Social Security (IPSS) harassed her until she agreed to be sterilised. After the operation she had fever, bleeding and abdom inal pain and had been forced to give up work.

When Minsa’s final report was submitted to the Peruvian Congress in July 2002, its members decided to charge Fujimori and his three former health ministers with "genocide" and "crimes against humanity". A year later the congressional commission on human rights, chaired by parliamentarian Dora Nuñez (Moralising Independent Front) took up the charges and called for an investigation by the public prosecutor. The congressional standing committee rejected the proposal. The debate got bogged down in committees.

Fujimori responded from Tokyo, where he had been living since the Japanese government gave him Japanese nationality, sheltering him from possible extradition. He claimed that he had not approved forced sterilisation: rather that, for the first time in their history, Peruvian women had been given the opportunity to opt for responsible motherhood.

Peruvian and foreign researchers have been trying to establish the facts (2). Mandated by the committee for the defence of women’s rights in Latin America, lawyer and sociologist Giulia Tamayo has collected evidence from about 100 women from Lima, Cuzco, Loreto, Piura and San Martín. Her report (published 22 June 1998 by El Commercio, Lima’s biggest selling daily) cited abusive practices, failure to obtain prior consent and post-operative complications. There were deaths because of negligence, poor hygiene, inadequate training of personnel, the poor health of patients (tuberculosis or malnutrition) or even as a result of an undetected pregnancy. In 1999 a related book was published linked to a video documentary, Nada personal (Nothing Personal), which dramatically revealed that what had at first appeared from the government’s point of view to be objectives to be achieved in sterilisation had soon turned into forced quotas that had to be met by health professionals and establishments. A good performance brought rewards. Poor performances brought penalties. Nada personal described a coldly devised government programme; its author was threatened and intimidated. The Peruvian authorities of the time have never acknowledged the existence of quotas. Everybody keeps silent. But it is undeniable that there was an extraordinary increase in "voluntary" surgical contraception: tubal ligations went up from 81,762 in 1996 to 109,689 in 1997. In 1998 numbers fell to 25,995.

Arequipa, known as Ciudad Blanca, the white city, is 2,300m above sea level in the western Andes. It has a long tradition of social struggle and anti-authoritanarianism and its citizens challenged the Fujimori regime. Juan Manuel Guillén, a former rector of the university, was its mayor until 2003 and helped organise the vigorous protests that forced the current president, Alejandro Toledo, to abandon the idea of privatising two electricity companies. Guillén says: "There is a close relationship between the neoliberal policy imposed on Peru by the International Monetary Fund and the World Bank and the family planning programme engineered by Fujimori. In exchange for loans and the renegotiation of Peru’s debt, the IMF demanded privatisation, including the health sector, and opening up to investment. But it also wanted control of population growth, where the target was the poor or very poor and potentially dangerous sectors. That violated individual rights and the rights of families, and the moral principles that should underpin society."

Fujimori skilfully presented the reproductive health programme, saying on 28 July 1995 that the state would give low-income and poorly educated families access to methods of family planning available to the better off. He ended his speech with: "We have been and will be a pragmatic government without taboos or sacred cows. Peruvian women should be in charge of their own destiny."

The Peruvian exchequer alone did not fund the project: the US Agency for International Development (Usaid) was the main source of technical and financial assistance, contributing $36m, seven times more than the second largest donor, the United Nations Population Fund. Usaid was given the go-ahead by a US Congress that had a Repub lican majority traditionally opposed to birth control programmes; but Congress was focusing on domestic issues at the time, particularly its opposition to President Bill Clinton. There was also $2m from Nippon Zaidan, a Japanese foundation whose president Ayako Sono is said to be one of Fujimori’s main protectors.

NGOs including the American Pathfinder organisation received funds, as did the Peruvian feminist organisation Manuela Ramos (3). With the militants from the Flora Tristán Peruvian Women’s Centre, they had been fighting for women since the 1970s and did not conceal their enthusiasm at a longed-for opportunity to demolish the "retrograde" positions of the Catholic Church, which some members believed were linked to Opus Dei. The church hierarchy did indeed immediately challenge the decision to promote artificial methods of birth control and introduce sex education in schools. When alerted to forced sterilisations, feminist NGOs identified the danger that conservative sectors in society would try to destroy the family planning programme. Although they condemned individual case "mistakes", these NGOs felt they had to back a governmental strategy supported by major international bodies.

In 1995 Fujimori was re-elected with 64% of the vote, his image enhanced by the victory over the Shining Path guerrillas. There had been his self- inflicted coup of 5 April 1992 when Congress was dissolved and the judiciary reined in; and there had been the "fujishock" of ultraliberal measures, projected as a necessary adjustment. "That was when Fujimori began taking radical decisions on the taboo that is birth control," says Raul Wiener, political analyst and co-ordinator of opposition to the Free Trade Area of the Americas. "As a good mathematician, Fujimori was fascinated by figures. Reducing the number of births per woman to reduce poverty made mathematical sense to him. Any method of balancing the equation was valid, including the most brutal approach."

Fujimori tabled a bill on 9 September 1995 amending the General Population Law to permit the use of sterilisation (4). Congress approved a law that made sterilisation as legal as contraceptive injections, pills, diaphragms and sheaths. It was important that sterilisation was to be free. There was a rush of enthusiasm in all the ministries - headed by the new ministry for the promotion of women and human development - and in the armed forces and the national police.

Doctors, engaged for renewable periods of three months, were no longer given the option of objecting on grounds of conscience. Sterilisation festivals were organised in the country and pueblos jóvenes (shantytowns); days of games, dancing, concerts, theatre, puppet shows, fireworks, sport, plenty of food and free dentists and hairdressers. Posters showed modern families with few children and backward families with many ragged kids. Notices in Spanish offered tubal ligations and vasectomies, free of charge. By the time the festivities were over, the urban doctors had done a lot of work. But what did Quechua-speaking and mostly illiterate women understand of the information or letters of consent they had to sign? "Women doctors, nurses and nursing auxiliaries chatted with the women in the local dispensary and won them over with oil, corn, sugar and rice," according to a tourist guide at Machu Picchu, who trained at the Central University of San Antonio Abat in Cuzco. "All of that coincided with the government’s implementation of food aid programmes and infrastructure projects in out-of-the-way places. Fujimori, wearing a poncho, climbing out of a helicopter and filmed by television, turned up to inaugurate his projects. He was adored. They called him Chino Bueno."

Those circumstances explain to some extent the cautious approach of serious newspapers such as La Republica or El Commercio. Outside Peru the World Health Organisation fulsomely praised Peru’s family planning successes (5). Inside Peru accusations of possible abuses came from the Catholic Church. But were they well-founded?

Not until 1996 did a journalist from El Commercio, Julia Maria Urrunaga, take an interest in what was happening in remote areas. She heard a sad story from Tocache, a small village in the Amazonian forest, and travelled there to find out how a young mother had died. This woman had been immediately discharged after sterilisation in hospital, and sent home by motorbike, a 20-minute journey jolting along a dirt track. An infection developed. She died.

Urrunaga went to the house and met women neighbours trembling with fear. They had had the same operation and now their angry husbands were calling them putas (whores). "I saw the dead woman’s two children," says Urrunaga, " They were front page news and the report disclosed what had been hushed up." Trade unions, women’s groups, opposition members of parliament including Beatriz Merino, and Catholics were mobilised. But predominantly urban society took little notice. Urrunaga says they care even less now. "With the social problems and the crisis Peruvians are facing, it’s everyone for himself, plus a deep-seated disenchantment with the leadership."

In 1992 Dr Ramón Figueroa was a surgeon in the public health sector in Cuzco, that living museum of Inca civilisation, 3,400m up in the Andes cordillera. For a few months he was also director of the regional hospital. After 1996, with other colleagues working through the Association of Doctors, he denounced the sterilisation campaigns, stressing their racist nature. "The atmosphere was tense. Tackling an authoritarian and repressive government, with the corruption it fostered, left us open to serious threats," says Figueroa, currently an activist in the Democratic Decentralist party. "We were called agents of subversion. Gradually that inhumane policy was more or less abandoned by the government, yet without any self-criticism."

Fernando Robles Callomanay, of Aymara origin, has been the mayor of Ilave, the second largest town in the Puno region, for two years. He says: "The government of the time had a policy of ethnic cleansing, attacking the Amerindians and not whites or creoles. The consequences affect several aspects of economic and social life, in particular demographics." The birth rate has fallen sharply; schools and colleges are empty. It will be necessary to amalgamate them and some will disappear because of a lack of students. Most campesinas who underwent the operation suffer from complaints such as sickness and depression. "They are disapproved of by family and friends. The few men who have had vasectomies are taunted as eunuchs."

In the US there was, albeit belated, indignation, particularly after the Population Research Institute sent its representative, David Morrison, to Peru with a film crew; in January 1998 he published a report that generated sufficient interest in the US Congress for public hearings to be organised, during which victims told their stories. The public prosecutor’s office in Lima investigated complaints and accusations.

That led the US Congress to review the aid earmarked for family planning programmes and on 22 October 1998 the Tiahrt amendment (6) regu lating the use of Usaid funds accorded to Peru and other countries was adopted. Either beneficiaries complied with strict conditions or they received no more aid. There were commendable warnings about respect for human rights. But, after a second mission in December 1999 to Ayacucho and Huánuco, Morrison revealed that coercion, mis information, threats and scheming continued. He denounced Usaid’s failure to stop sending money to the Peruvian government, even though that funding was now illegal (7).

Since then rules governing sterilisation have been reviewed and amended along with all aspects of birth control policy. Reactionary movements within the church are influencing political life. Luis Solari, a doctor with a degree from San Marcos University, is the number two in Perú Posible, President Toledo’s party. He is a member of the department for the protection of life of the Peruvian Episcopal Assembly and describes himself as a man of faith. On becoming health minister in 2001, he created the special commission that published the final report on forced sterilisation.

"By doing that, he rejected the early investigations, particularly those that placed women’s freedom at the heart of the issue, and imposed his own conservative views," says Roxana Vásquez, a lawyer and director of the NGO Office for the Defence of Women’s Rights. "What is our main concern? That women’s rights should be guaranteed. Abortion is banned, a criminal offence. A middle-class woman can have an abortion without risk. Those who die, more than 350,000 a year, because they have had to use needles, are the poor. Luis Solari and his successor as health minister, Fernando Carbone, were and still are opposed to the use of contraception."

Although the new health minister, Pilar Elena Mazzeti, is more open-minded, nothing can be taken for granted. The Truth and Reconciliation Commission (CVR) is calling for changes; it has tried to summarise and analyse the causes of political violence over the past 20 years. According to its final report of 28 August 2003, the conflict has brought to light the "enormous social divides that have existed and still exist in Peruvian society" and "the link between poverty and exclusion and the likelihood of falling victim to violence". Victims are mostly Quecha-speakers from the poorest provinces, "insignificant" people whose fate is of no interest to the rest of the country.

Salomón Lerner Febres, rector of the Catholic University of Peru and CVR president, believes that this tragedy has much in common with the women who have undergone forced sterilisation. "But they are no longer seen as a matter of concern. In this terrible story ideology has blurred the picture; the stubbornness of the feminists, the great eagerness of Opus Dei to get hold of the case and the impudence of political leaders relying on ignorance and indifference. In my university we are going to set up an institute for human rights and democracy. And we will be taking up the issue of mass sterilisation again."

(1) Founded in Lima in January 2000, the organisation was strengthened by its later amalgamation with the Network of Alternative Municipalities. It is supported by international technical cooperation agencies from France and the United Kingdom. See: Remurpe website
(2) See the study by Peruvian public health consultant Raquel Hurtado, Aplicación de la anticonceptión quirúrgica como política de población en el Perú y violaciones a los Derechos humanos, Lima 2000. See also the book written by Maria-Christine Zauzich published by the German Justice and Peace Commission, Munich, 2000.
(3) It is estimated that the Peruvian NGO Reprosalud Manuela Ramos received $25m from Usaid 1995-2000.
(4) The 1985 Law on Population Policy prohibited surgical sterilisation. A national population council was mandated to monitor compliance but will be replaced by Promudeh.
(5) At an international seminar in 1996 on the reform of the health sector, Fujimori’s opening speech was fully endorsed by both the WHO and the Pan American Health Organisation.
(6) The amendment is named after its main backer, Todd Tiarhrt, a Republican member of Congress from Kansas.
(7) See David Morrison, A pesar de abusos comprobables, la Usaid sigue financiando programas de planificación familiar en Perù, Population Research Institute review, Front Royal, Virginia, January-February 2000.

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