Part 5. Human Rights and Reproductive Wrongs

Note: The following is excerpted
from Steven Mosher’s book, Population
Control—Real Costs, Illusory Benefits.

When the government sterilization team
arrived in their little town of La Legua, Peru, Celia Durand and her
husband, Jaime, looked at each other and shook their heads. Although
Celia had considered a tubal ligation in the past, she had begun to
hear rumors of women damaged or even killed during the national tubal
ligation campaign. She had decided that she didn’t want to be
sterilized that way. Maybe sometime later I will do it, she
told Jaime, maybe in a hospital. Certainly not in the little
medical post down one of La Legua’s bare earth streets, with
its windows opened wide to the dust, insects, and the smells from the
pigs and other animals rooting and defecating in the nearby streets
and yards. Certainly not in the middle of a Festivale de
Ligaduras de Trompas [Tubal Ligation Festival], as the banner
hastily hung in front of the clinic declared, with the doctors in a
hurry to cut, snip, and sew their way through a long line of
patients.¹

But then the campaign began in earnest.
Ministry of Health “health promoters” descended upon her
neighborhood, going door to door, house to house, pressing Celia and
her neighbors to accept sterilization. Interviewed later, Jaime
recalled the singular nature of their advocacy. It was sterilization
or nothing. No other contraceptive method was offered. The
promoturas, as they are called in Spanish, sought to allay
Celia’s fears about having the procedure done during the
campaign. “Do it now,” they told her. “You may
have to pay [to have it done] later.” Ligation is “easy,”
“safe,” and “simple,” they repeatedly
reassured her. Nothing was said about possible side effects or
risks. “All they told her was how easy it was, nothing more,”
Jaime said later.

And the promoturas were
relentless. Again and again they came to the family’s home,
refusing to accept ”no” for an answer. Celia finally
gave in. She would come in the following afternoon, she agreed, to
have the procedure.

Her mother, Balasura, continued to
worry. The two even quarreled about it. “Don’t go,
daughter,” Balasura remembers saying. “There is always
time later.” But Celia wanted the daily visits to end and,
besides, the health promoters had convinced her that the procedure
was safe and simple.

“Don’t worry, mama, I will
be back in a couple of hours,” she said as she left for the
post. That was the last time that her mother saw her alive.

Sometime during the procedure at the
medical post, the surgeon caused enough damage to Celia that she
slipped into a coma. Medical staff put off frantic visits from
Celia’s brother-in-law, mother and husband. Then, as her
condition worsened, they finally transferred her from the post to a
larger clinic in the nearby city of Piura. It did no good. Celia
Durand died without ever regaining consciousness. The date was July
3, 1997.

The sterilization campaign had begun
the year before. President Alberto Fujimori, elected to a second
term in mid-1995, had wasted no time in legalizing sterilization as a
method of birth control. He ordered the country’s Ministry of
Health, headed by Dr. Eduardo Yong Motta, to focus its efforts on
family planning, specifically, on tubal ligations. To train Peruvian
doctors and officials in how to structure and run a sterilization
campaign, Dr. Motta brought in Chinese, Indian and Colombian doctors
who had carried out such campaigns in their own countries.²
To monitor the success of the campaign, Fujimori himself set
national targets for the numbers of sterilizations to be
performed—100,000 in 1997 alone—and demanded weekly progress
reports.

Mobile sterilization teams, a fixture
of such campaigns, were soon being assembled in the capital city of
Lima. These teams of doctors and nurses, who often had no prior
training in obstetrics or gynecology, were hurriedly taught how to do
tubal ligations, and then sent to the countryside to conduct a series
of one- or two-week “ligation festivals.” Prior to a
team’s arrival in an area local Ministry of Health employees
would hang banners announcing the forthcoming “Ligation
Festival,” and fan out across the countryside to captar
[ “bring in” or “capture” in English] women
for tubal ligations. The effort was focused on the poorer provinces,
home to a high percentage of Peruvians of Indian descent.

The teams themselves operated under
very tight time constraints. Organizers sought to get as many women
as possible under the knife in as short a time as possible. Celia
Durand’s family discovered after her death that she had been
the last of the 15 patients scheduled for that afternoon.³
And as soon as the last surgery was finished, the team moved out,
heading for the next “Ligation Festival,” providing no
follow-up care.

How were tens of
thousands of Peruvian women induced to submit to sterilization? In
some cases, like Celia’s, harassment by repeated home visits,
along with false assurances of safety, was sufficient to bring them
in. Those who resisted official “invitations” found that
the encounters all too often turned ugly. Women in the Ayacucho
region, which PRI investigator David Morrison visited in 1998 and
again in 1999, routinely reported being subjected to harsh forms of
verbal abuse. If they objected to sterilization, officials shouted
that they were no better than “cats” and “dogs,”
or called them “animals” or “beasts.” The
women, mostly Quechua-speaking Indians, were repeatedly told how
“ignorant” or “stupid” they were for wanting
to have more children.⁴

Browbeating didn’t
work with everyone. Some had to be bribed with promises of
government benefits, while still others were threatened with
punishment unless they complied. Ernestina Sandoval, poor and badly
in need of assistance after a string of weather-related problems cost
her husband his job and then their home, was told about a government
program that would help feed her family. When she went to enroll,
however, she was told by officials that she would first have to
undergo sterilization. “They told me I had to bring a card
from the hospital saying I had been ligated,” Mrs. Sandoval
reported. “If I didn’t agree to do this they wouldn’t
give me anything.”

Maria Elena Mulatillo
enrolled her daughter, a sickly child, in a food supplement program.
Two months later government officials told her that, unless she
agreed to a tubal ligation, her little girl could not continue in the
food program. Maria refused and the officials followed through on
their threat. There were no more monthly cans of protein powder for
her daughter.⁵
Using food to coerce a poor, hungry women into surrendering her
fertility is bad enough, but there is something particularly
despicable in threatening to let her children go hungry unless or
until she agrees.

Why were doctors, nurses, and other
officials so insistent? Because they themselves were being
judged—and rewarded or punished—on the basis of the number of women
they “captured.” Dr. Hector Chavez Chuchon, president of
the regional medical federation of Ayacucho, testified before the
U.S. Congress that the central government was imposing sterilization
quotas on medical workers throughout Peru. He produced Ministry of
Health documents stating that each medical worker had to bring in
(captar) two women for sterilization each month or risk losing
their jobs.

“The Ministry of
Health denies that there are campaigns and quotas for
sterilizations,” Dr. Chavez testified. “[But] doctors
work under pressure from their superiors, are given quotas, and are
subjected to other, more subtle, forms of pressure. It is also true
that doctors work under very unstable employment conditions, and
could easily lose their posts.”⁶
Peruvian officials neatly corroborated Dr. Chavez’s testimony
by summarily firing his wife, a government dentist, after he returned
to Peru from his whistle-blowing expedition to the United States. He
himself would have been terminated from his government posts had U.S.
Congressman Christopher Smith (R, N.J.) not intervened. Maria Lopez,
the administrator of a local medical sub-post, was also among those
who went on record to say that she, and others like her, would be
demoted or fired if their posts consistently failed to meet its
family planning targets.⁷

Those who exceeded
their quotas were routinely rewarded. Stories appeared in major
Peruvian dailies like El Comercio and La Republica
about “health promoters” who were rewarded with special
prizes for bringing in more than their quota of women for
sterilization. A young medical student by the name of Javier Chavez
told PRI investigators that, while working with a group of “family
planning promoters,” whoever gained the most new “clients”
in a month received a special bonus of 20 Peruvian Soles
(about US$6) and sports clothes.⁸

Doctors and nurses struggling to meet quotas or
eager for bonuses often ignored the wishes of the women, simply
refusing to take no for an answer. Sterilization during a caesarean
section delivery—with or without the woman’s consent—was
a favorite tactic. Victoria Vigo Espinoza went into pre-term labor
when she was 7 months pregnant, and was rushed to the hospital on 23
April 1996. One of the first questions the obstetric nurse asked was
“How many children do you have?”

“This is the third,”
responded the petite brunette, in considerable pain.

“Are you going to
be sterilized?” the nurse then asked.

Victoria, worried about
her unborn baby and with waves of pain washing over her body, didn’t
bother to answer. It had been difficult for her to conceive children
because of an irregular menstrual cycle and infertility. She had
only gotten pregnant this time after undergoing months of hormone
therapy. Being sterilized was the last thing she was interested in.
She scribbled her name on a consent form without reading it, thinking
that she was giving her permission for a caesarean section, and was
prepped for surgery.

When Victoria woke up
the next day, her first thought was for her child. “Please
bring my baby to me,” she smiled at the nurse. Instead, the
intern who had attended her surgery and the doctor on duty somberly
filed into the room. Her son had died during the night, they told
her.

Victoria burst into
tears.

At this, the intern
became agitated as well. “She is very, very sad because of her
child’s death,” he said to the doctor. “Very sad,”
he repeated helplessly

“I want to go
home now,” Victoria finally choked out through her tears,
struggling to sit up.

The doctor attempted to
calm her down before she hurt herself. It was too soon after the
surgery to release her. “You will have another child,” he
said softly

“No, she won’t,”
Victoria heard the intern whisper to the doctor. “She is
ligated.”

The intern came back
later that afternoon, this time alone. “Have I been
sterilized?” Victoria asked him directly.

“Yes, Ma’am,”
he responded. “The doctor performed a ligation on you.”
He hesitated for a minute and then added, “Forgive me. I feel
guilty over what has happened.”

Victoria left the
hospital on the third day. “I felt completely defeated,”
she later testified. “I was depressed about never having more
children, and went to see a psychiatrist to overcome my depression.
And I still have faith that I may one day have more children.”⁹

If
agents of the state combed American communities, attempting to harass
women into accepting sterilization, issuing verbal insults and
threats to those who resisted, the outcry would be deafening. Add to
this already volatile mix the kinds of bribes and sanctions that were
imposed on Peruvian women
and riots might well result. How many American women would quietly
suffer the kinds of injuries, indignities, and coercion that the
Peruvian state inflicted upon tens of thousands of women over the
course of the mid-to late nineties?

Yet
neither Peru nor China is an isolated case. Women in dozens of
developing countries have suffered the kinds of human rights abuses
reported in Peru’s sterilization campaign, from lack of
informed consent to out-and-out coercion. For the use of bribes,
sanctions and bullying on both “acceptors” (women) and
“promoters” (doctors, nurses, and other government
agents) is commonplace in family planning programs, as are targets
and quotas.

In Bangladesh, for example, a system of bribes
was begun in 1976, with those who agreed to sterilization receiving a
sum equal to about the week’s earnings. In addition, women are
given a saree and men a lungi. Such inducements may
seem trivial compared to the gravity of permanently giving up one’s
fertility, but against a background of extreme poverty they loom
large. Population control workers were assigned a monthly target of
two sterilizations and one IUD.¹⁰

In El Salvador, hospitals, clinics and
fieldworkers have been given monthly targets for the number of
sterilizations they are to carry out, and women have been sterilized
without their knowledge or consent.¹¹

In South Africa under apartheid, Black South
African women were given Depo-Provera shots by health care workers
who told them that the injections will "help their milk supply."
Black women were often unable to apply for jobs unless they could
present a family planning card showing that they were on some type of
birth control.¹²

Vietnam has a two-child policy, but in other
respects its rigorous laws on birth control could have been copied
verbatim from its giant neighbor to the north. The country denies
third children a birth certificate and offers a reward of $20 to
women who have a hysterectomy. Punishment for having a third child
exists across Vietnam, but it appears the policy, which began in
1985, is most strict among the subsistence farmers who make up the
poorer echelons of society. Families who violate the policy are
denied land to grow rice—and thus effectively starved—until
they fall back into line. They are also fined about $80, a seemingly
paltry amount that is in fact the equivalent of 10 months’
income. The government encourages women to undergo a hysterectomy
following the birth of her second child, a procedure to which
approximately half of all village women have been subjected.¹³

Mexico has used similarly draconian methods to
cut its birth rate. Following the passage of a national population
law, the first in Latin America, in 1974, government doctors were
told that they must either sterilize or insert an IUD in every woman
who comes in to give birth. From the moment a woman in labor enters
a government-run clinic, she is bombarded with questions about which
method she wants: “temporary” (an IUD) or “definitive”
(sterilization). Even if she rejects both, she is often ligated or
has an IUD implanted anyway.¹⁴

Sometimes the deception
is even more complete, as in the case of the mobile medical clinics
of Guatemala. The clinics travel about the countryside offering free
medical examinations to all comers, but those who take advantage of
the offer often get more than they bargained for. Senora Flores went
in for a free physical, but after the exam she began to hemorrhage.
The bleeding and discomfort grew as the days passed. Finally, in
desperation, she undertook a journey to the nearest town to see a
doctor. He soon discovered the source of her troubles: An IUD had
been secretly inserted in her during the medical examination, and it
had led to a severe case of Pelvic Inflammatory Disease (PID). The
doctor removed the IUD, but warned her that, because of the damage to
her reproductive system, she may never be able to have children.¹⁵

For sheer brutality the
North Korean population control program cannot be outdone. The
policy is even stricter for the millions of inmates of that country’s
Gulag, where pregnancy is a crime and births are absolutely
forbidden. One former prisoner reported that “While I was
there, it was commonly known that pregnant women were taken to a
hospital outside the camp for forced abortion and that babies born
alive were killed. One day when we came back from our work outside
the camp, prisoners told us that a police doctor had inspected the
female prisoners in the morning and had found out that two of them
were pregnant . . . Both were ordered to run around the camp yard
with a heavily loaded stretcher. The first woman had [a] miscarriage
and collapsed. Then, two prisoners were ordered to kick the swollen
belly of Kim Son-hi. She miscarried about one or two hours later . .
."¹⁶

China,
Bangladesh, Guatemala, Pakistan, Cambodia, South Africa, Sri Lanka,
Indonesia: The roll call of countries where human rights have been
abused in the cause of limiting fertility is entirely too long. Many
of these countries received U.S. funding for their programs, others
were encouraged and financed by U.S.-funded international
organizations. Many received both.

You can read more in Steve’s book, Population Control: Real Costs, Illusory Benefits, available here.

Endnotes