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Anna, Peru

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Informing Choices: Expanding Access to Emergency Contraception in Peru
By Anna-Britt Coe from the Center for Health and Gender Equity September 10, 2002

In recent months, a great deal of attention has been paid to violations of women's rights to informed choice in the Peruvian health system, with particular emphasis on those that occurred under the administration of former President Alberto Fujimori, resulting from pressures on health workers to achieve high rates of female sterilization, with or without consent. Less attention, however, has been paid to other critical reproductive health needs of Peruvian women.

Today, Peru has among the highest rates of unwanted pregnancy, unsafe abortion, and maternal morality in all of Latin America. Approximately 350,000 clandestine abortions take place annually in Peru, where abortion is illegal and safe abortions rare. Complications of unsafe abortion rank fourth as a cause of maternal deaths in the women's choices by working to prevent their access to a wide range of contraceptive methods, including emergency contraception (EC), and life-saving post-abortion care.

Poor reproductive health conditions in Peru are the result of social and cultural discrimination against women, and the general failure of the public health system to address women's needs. Women, for example, often have little control over the frequency and timing of sexual intercourse due to a range of factors, including economic and social dependence on men, and high rates of violence is a major factor in unwanted pregnancy.

According to a recent study on the prevalence of gender-based violence is a major factor in unwanted pregnancy. According to a recent study on the prevalence of gender-based violence in Peru conducted by Guezmes et. Al. (2002) half of all women in Lima, the nation's capital, and almost tow-thirds of all women in the department of Cusco have experienced physical and/or sexual violence by an intimate partner at least once in their lifetime. The same study found that sexual violence represents a significant proportion of all violence by intimate partners, including husbands.

Lack of access to contraceptive methods, poor quality of care in health services, and high rates of contraceptive failure further restrict women's choices. An estimated 25 percent of all sexually active women of reproductive age in Peru--approximately 850,00 women-- are not adequately protected against an unwanted pregnancy. Adolescent girls are particularly vulnerable as they have the least access to contraceptive methods of all women in their reproductive years. Lack of access to information and methods coupled with lack of control over sexual intercourse contributes to the heavy reliance on unsafe abortions among women in Peru.

Until relatively recently, the government of Peru gave low priority to reproductive health services. This changed somewhat in the early nineties, when government support for family planning programs began to build, and international donors shifted much of their family planning funding from NGO's to investments in the public sector. During this time, Peru's Ministry of Health (MoH) also invested in a significant expansion of family planning services. Emergency contraception was among the range of methods approved for distribution in government health facilities, though little was done to make it available in practice.

Between 1996 and 1998, the government adopted an unofficial policy that sought to achieve demographic objectives through an aggressive campaign aimed at increasing use of modern contraceptives, particularly female sterilization. Targets were set for the number of women to be sterilized, and family planning workers were expected to fulfill numeric quotas.

In practice, the policy was directed at poor women with little or no formal education. This strategy resulted in violations of informed choice and poor quality of care in Peru's family planning program,

updated: 7/2/2004