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The Peruvian Population Control Program Hearing

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The Peruvian Population Control Program Hearing THE PERUVIAN POPULATION CONTROL PROGRAM HEARING BEFORE TE SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS OF THE COMMITTEE ON INTERNATIONAL RELATIONS HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTH CONGRESS SECOND SESSION FEBRUARY 25, 1998 Printed for the use of the Committee on International Relations U.S. GOVERNMENT PRINTING OFFICE 48-459 CC WASHINGTON : 1998 For sale by the U.S. Government Printing Office Superintendent of Documents, Congressional Sales Office, Washington, DC 20402 ISBN 0-16-056586-3 i-1 (0,1-6 7 COMMITTEE ON INTERNATIONAL RELATIONS BENJAMIN A. GILMAN, New York, Chairman WILLIAM GOODLING, Pennsylvania LEE HAMILTON, Indiana JAMES A. LEACH, Iowa SAM GEJDENSON, Connecticut HENRY J. HYDE, Illinois TOM LANTOS, California DOUG BEREUTER, Nebraska HOWARD BERMAN, California CHRISTOPHER SMITH, New Jersey GARY ACKERMAN, New York DAN BURTON, Indiana ENI F.H. FALEOMAVAEGA, American ELTON GALLEGLY, California Samoa ILEANA ROS-LEHTINEN, Florida MATTHEW C. MARTINEZ, California CASS BALLENGER, North Carolina DONALD M. PAYNE, New Jersey DANA ROHRABACHER, California ROBERT ANDREWS, New Jersey DONALD A. MANZULLO, Illinois ROBERT MENENDEZ, New Jersey EDWARD R. ROYCE, California SHERROD BROWN, Ohio PETER T. KING, New York CYNTHIA A. McKINNEY, Georgia JAY KIM, California ALCEE L. HASTINGS, Florida STEVEN J. CHABOT, Ohio PAT DANNER, Missouri MARSHALL "MARK" SANFORD, South EARL HILLIARD, Alabama Carolina BRAD SHERMAN, California MATT SALMON, Arizona ROBERT WEXLER, Florida AMO HOUGHTON, New York STEVE ROTHMAN, New Jersey TOM CAMPBELL, California BOB CLEMENT, Tennessee JON FOX, Pennsylvania BILL LUTHER, Minnesota JOHN McHUGH, New York JIM DAVIS, Florida LINDSEY GRAHAM, South Carolina ROY BLUNT, Missouri KEVIN BRADY, Texas RICHARD J. GARON, Chief of Staff MiCiAEL H. VAN DUSEN, Democratic Chief of Staff SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS CHRISTOPHER H. SMITH, New Jersey, Chairman WILLIAM F. GOODLING, Pennsylvania TOM LANTOS, California HENRY J. HYDE, Illinois CYNTHIA A. McKINNEY, Georgia DAN BURTON, Indiana GARY L. ACKERMAN, New York CASS BALLENGER, North Carolina ENI F.H. FALEOMAVAEGA, American PETER T. KING, New York Samoa MATT SALMON, Arizona DONALD M. PAYNE, New Jersey LINDSEY 0. GRAHAM, South Carolina EARL F. HILLIARD, Alabama ILEANA ROS-LEHTINEN, Florida ROBERT WEXLER, Florida GROVER JOSEPH REES, Subcommittee Staff Director and Chief Counsel ROBERT R. KING, Democratic Professional Staff Member DOUGLAS C. ANDERSON, Counsel CATHERINE DuBoiS, Staff Associate (i) CONTENTS WITNESSES Page Mr. Mark Schneider, Assistant Administrator for Latin America and the Caribbean, U.S. Agency for International Development .................................. 4 Dr. Hector Hugo Chavez Chucon, President, Regional Medical Federation of Ayachucho, Andahuaylas, and Huancavelica, Peru ...................................... 24 M s. Victoria V igo Espinoza ..................................................................................... 26 M s. Avelina Sanchez Nolberto ................................................................................ 27 APPENDIX Prepared statements: Hon. Christopher H. Smith, Chairman, Subcommittee on International Operations and Hum an Rights .................................................................... 37 Mr. Mark Schneider .................................................................. ........... 42 Dr. Hector Hugo Chavez Chucon .................................................................... 51 M s. Avelina Sanchez Nolberto ......................................................................... 52 M s. V ictoria Vigo Espinoza .............................................................................. 54 Additional material submitted for the record: Communique statement signed and sealed by the Ministry of Health ........ 55 Report on staff delegation to Peru, February 19, 1998, Grover Joseph R ee s ................................................................................................................5 7 Government of Peru, Ministry of Health, statement of the Reproductive Health Program, February 1998 .................................................................. 94 Inspector General's Report .............................................................................. 97 (111) HEARING ON THE PERUVIAN POPULATION CONTROL PROGRAM WEDNESDAY, FEBRUARY 25, 1998 HousE OF REPRESENTATIVES COMMITTEE ON INTERNATIONAL RELATIONS SUBCOMMITTEE ON INTERNATIONAL OPERATIONS AND HUMAN RIGHTS Washington, DC. The Subcommittee met, pursuant to notice, at 1:20 p.m., in room 2167 Rayburn House Office Building; Honorable Christopher H. Smith [chairman] presiding. Representatives Present: Smith and Burton. Staff present: Grover Joseph Rees, staff director. Mr. SMITH. At this hearing of the Subcommittee on International Operations and Human Rights we will hear testimony of shockin human rights violations in the country of Peru, a country witg whose government and people the United States has a close and friendly relationship. Indeed, I should begin by saying that I myself consider the Foreign Minister of Peru, Eduardo Ferrero, a personal friend. I have had cordial meetings with President Alberto Fujimori both in Lima as well as in Miami, and I have a special feeling for the Peruvian people. One of the obligations imposed by friendship, however, is hon- esty. I hope that today's hearing will help us to know the truth both about the Peruvian population program and about the U.S. role, if any, in this program. To that end, we invited the Peruvian Embassy in Washington to send a witness to this hearing, but our invitation has been declined. The Embassy is invited to submit a written statement which will be made a part of the record. [This statement appears in the appendix.] Peru is a heavily Roman Catholic country with one of the lowest per capita incomes in the Western Hemisphere. Its population den- sity is also relatively low. Until 1995, the family planning program operated by the Government of Peru was not a particularly high priority among that government's health programs. Sterilization was illegal except when necessary to preserve health. In July 1995 President Fujimori announced that family planning would be a major priority for the government. Shortly thereafter, the Congress legalized sterilization as a method of family planning. In spring and summer of 1996 government health workers began to conduct sterilization campaigns, often styled "ligation fairs" and, to a lesser extent, "vasectomy fairs", primarily in areas that were poor and/or rural. Reports began to appear shortly thereafter of sterilizations without consent or without informed consent. These (1) reports came from the Catholic Church, from human rights organi- zations, from feminist groups, and eventually from the govern- ment's own ombudsman. Critics of the government program alleged: That sterilizations are performed pursuant to prescribed national and regional goals rather than to patient demand; That women, particularly those who are extremely poor and/or il- literate, are often pressured into undergoing tubal igations; That these women are not given adequate information about the risks and disadvantages of the surgery or about the availability of alternative methods of family planning; That women are not encouraged to take time to make a consid- ered decision about whether they want an operation that is perma- nent and likely to be irreversible; And that the surgery is often performed in substandard facilities, with resulting medical complications. There have also been reports that consent to sterilization has been imposed as a condition of receipt of food in government oper- ated food programs, including programs supported by the United States, and that health workers in some locations have been paid a bonus for each woman they persuade to undergo a sterilization. In January I asked my staff director and chief counsel of the Subcommittee, Grover Joseph Rees, to travel to Peru in order to in- vestigate these charges. He met with doctors, human rights work- ers, government officials, and several of the victims themselves. His report made the following conclusions: That the government had announced goals or quotas for the number of people to be sterilized nationwide, in particular regions, and even in particular hospitals. That these goals emanated from a very high level in the central government. That health officials, doctors, and other health workers would generallyy feel an obligation to meet these goals and would fear that their contracts would not be renewed if they failed to meet those goals. That other abuses, such as lack of informed consent, pressure to consent, bonuses per woman sterilized, and trading food for con- sent, were probably not mandated by the central government but were the natural outcome of the mandate that the goals must be met. I also asked Mr. Rees to determine the extent, if any, to which U.S. foreign assistance funds might be supporting the abuses in the Peruvian population program. His conclusions were as follows: The U.S. family planning program in Peru is the largest in the Western Hemisphere and one of the largest in the world. It is con- ducted primarily through non-governmental organizations but also consists in some aid to programs of the Government of Peru. To its credit, the USAID Office of Population, Health and Nutri- tion made efforts to distance itself and its funds from the steriliza- tion campaigns as soon as they became evidence in 1996. Unfortunately, these
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