Behind The Mask of “Progress”: Peru’s Forced Sterilization Program From 1996-1998

Brianna Cheng Behind the Mask of “Progress”: Peru’s Forced Sterilization Program from 1996-1998 Edited by Ashton Connor Mathias & Marie Fester

Paradoxically, Fujimori sought to appeal to "popular sectors", but his policies caused the most harm to poor, indigenous women.

ABSTRACT As President of Peru from 1990 to 2000, Alberto Fujimori went to great lengths to underscore his commitment to women’s rights: he increased the participation of women in high levels of the Peruvian government and appealed to feminist organizations across the country. A prominent component of Fujimori’s “feminism” was the initiation of a national family planning program. This program was based on the principles of the International Conference on Population and Development in Cairo in 1994, famous for its emphasis on reproductive rights. Yet, Fujimori’s family planning program was mobilized to carry out a forced sterilization campaign. Primarily poor rural Indigenous Peruvian women were sterilized without consent, resulting in high levels of complications and deaths. This paper offers an examination of the intersections between neopopulism and neoliberalism in Fujimori’s family planning program. Specifically, it argues that Fujimori’s government enabled its sterilization campaign and impeded feminist opposition to the program with neopopulist rhetoric. The campaign must be considered a racialized neoliberal policy so as to not marginalize it as an unfortunate, isolated incident in Peruvian history. Rather, Fujimori’s campaign was a calculated initiative that corresponded with Fujimori’s macroeconomic policy. More broadly, this paper complicates the typical separation of more “traditional” political concepts such as neopopulism and neoliberalism from the study of gender in politics and additionally seeks to shed light on the historical embedment of Malthusian thought in neoliberal policies.

INTRODUCTION I n 1998, Giulia Tamayo, a lawyer working for the Latin American and Caribbean Committee for the Defense of Women’s Rights (CLADEM), a feminist human rights group, discovered evidence of abuses in Peruvian hospitals committed by the state-run family planning program. She documented 243 cases of female sterilization under questionable circumstances in nineteen different departments, prompting The Defensoria del Pueblo Peru (Office of the Public Defender in Peru) to conduct a full investigation of the program. Under the program, Peruvian doctors conducted 217 446 surgical sterilizations on women from 1996 to 1998. It was found that for every 100 000 operations, there were 7.35 deaths due to poor sanitation conditions during surgery, poor medical practices, and lack of post-operation care. Of the 157 cases of sterilization investigated in 1999, forty-one had no record of consent at all. Most of the women sterilized belonged to poor, rural, Indigenous communities. 1 Ironically, during this time, Peruvian President Alberto Fujimori was championing himself as a modern leader that encouraged the economic, social, and political elevation of women in Peruvian society. One prominent measure was the installation of a reproductive healthcare and family planning program that was based on the principles of the 1994 International Conference on Population and Development in Cairo, the fifth World Population Conference held by the United Nations. How then, in this period of increased national and international

rhetoric surrounding human rights and women’s reproductive rights, did Fujimori institute a destructive national sterilization campaign that derailed women’s reproductive agency? Furthermore, how can this campaign be understood in the broader context of the Fujimori regime’s neopopulist, neoliberal politics?

Political scientists tend to regard gendered politics as a separate sphere of study in comparison to more “classical” political theories such as populism or neoliberalism. However, I hope to demonstrate through an analysis of the Fujimori government’s coerced and unsafe sterilizations the intimate relationship between these concepts and gendered politics. In this paper, I argue that Fujimori’s administration ironically enabled its forced sterilization campaign against indigenous women through neopopulist rhetoric of women’s rights; this same rhetoric prevented adequate change to the program through limiting feminist opposition. This campaign must be considered as one of Fujimori’s neoliberal policies so as to not marginalize it as an isolated incident, but part of a calculated, racialized economic policy.

CONCEPTUALIZING NEOPOPULISM AND ITS RELATIONSHIP WITH NEOLIBERALISM IN 1990S LATIN AMERICA

The definition and characteristics of populism and neopopulism are highly contested. In order to fully understand how Fujimori’s neopopulism shaped the sterilization campaign of 1996-1998, and national gendered politics during his regime in general, it is necessary to first outline the form that Fujimori’s neopopulism took. Kurt Weyland, a prominent scholar of Latin American political science, distinguishes neopopulism from the “classical populism” that spread throughout Latin America from the 1930s to the 1950s in that neopopulism does not entail the same economic policies like distributive measures and import substitution industrialization (ISI). Rather, neopopulist leaders of the 1990s typically, though not by definition, enacted neoliberal policies including austerity measures and structural adjustment programs, but retained the political features of classical populism. Weyland defines a neopopulist as an individual leader seeking or exercising power through rallying support from popular sectors. A neopopulist capitalizes on charisma and relies on noninstitutionalized or minimally institutionalized support from the masses. 2 Like classical populism, Latin American neopopulism often coalesces in the concentration of political power in a single person, harming democratic institutions. 3 Fujimori is often posited as the prototypical neopopulist due to his neoliberal economic policies, as well as his personalistic leadership style and heterogeneous support base. To address the former, Fujimori implemented institutional neoliberal reforms to restructure the inflation-stricken economy he inherited. A comprehensive structural adjustment program was put in place, which included the deregulation of financial and labor markets, the reduction of tariffs, the privatization of enterprises, and a broadening the tax base. The percentage of Peruvians in poverty rose to 54% after this shock. 4 Yet, Fujimori remained a popular leader; political scientist Jennifer Holmes and scholar of public administration Sheila Amin Gutierrez de Pineres contend that this support derived primarily from Fujimori’s improvements in security in the midst of war against

rebel groups. 5 The Peruvian president’s popularity relied upon the direct linkages between himself and his followers for support, rather than relying on institutionalized forms of mediation— a distinctly populist political trait. He carefully crafted his image as a strong, yet distinctively “progressive” leader to gain a wider base of support, especially from lower-class sectors. Due to a lack of institutional checks, Fujimori became increasingly authoritarian throughout his presidency. In 1992, Fujimori initiated a self-coup as Congress was dissolved and Fujimori took authoritarian control. Fujimori asserted that the coup was necessitated by the existence of dangerous insurgents, justifying his choice and furthering his “strong man” image. In a 1993 plebiscite, the Peruvian people approved a new constitution whereby Congress and the judiciary had a formal reduction of powers. 6 Fujimori remained highly authoritarian in nature until the end of his tenure as President in 2000, representing the breakdown of democracy that so often accompanies neopopulism.

NEOPOPULISM’S ROLE IN FUJIMORI’S FORCED STERILIZATION CAMPAIGN I do not seek to argue or imply that populism or neopopulism in general produces a specific type of gendered politics. In fact, to suggest that populism produces specific gendered dynamics undermines the utility of populism as a political concept that can be applied to a variety of different regimes. Rather, I contend that it is possible to discern how a specific regime’s populist elements influenced its state’s gendered politics.

During his tenure as president, Fujimori consistently pursued seemingly “feminist-friendly” projects and evoked the rhetoric of elevating the status of women when it boosted his constructed image of a progressive, modernizing, charismatic leader. 7 He touted his appointment of an unprecedented number of women to high political positions in the Peruvian national government, including Martha Chavez, the first president of Congress, along with other female ministers, vice ministers, and executives in state agencies. 8 Perhaps most tellingly, Fujimori boasted that he was the only male head of state to address the UN World Conference on Women in Beijing in 1995, announcing his “dedication to the improvement of the position of fifty per cent of the population which had been excluded [from full citizenship] for a long time.” 9 He presented himself as a genuine, casually progressive, non-elite leader, wearing blue jeans and tennis shoes while he announced his reproductive health and family planning program that was heavily based upon the International Conference on Population and Development in Cairo’s Programme of Action (POA), which controversially established access to reproductive and sexual health care services, including family planning, as one of its central goals. 10 Prior to this family planning program, surgical contraception, including sterilization, was illegal in Peru barring cases where pregnancy would cause a demonstrable fatal risk. Fujimori legalized these forms of contraception and asserted that this was a step towards giving Peruvians more choice in their reproductive decisions. 11 The Catholic hierarchy in Peru were adamantly opposed to all forms

of artificial sterilization, especially surgical sterilization. 12 Fujimori broke from the Catholic hierarchy through imposing these new measures, accusing them of sabotaging the health of Peruvian women. 13 This demonstrated to his supporters that he would not be manipulated, while also presenting a popular anti-establishment elite stance.

Eventually, a coerced and unethical sterilization campaign was conducted through the family planning program. In order to secure funding and legitimacy for this program, Fujimori garnered the support of the women’s movement, the international community, and the social and political left in Peru. The government received sixteen million dollars from United States Agency for International Development (USAID) to support its family planning plans in 1996. However, the money did not fund the improvement of rural healthcare conditions, such as creating and maintaining hygienic working environments, medical supplies, or beds. Rather, make-shift mobile medical services were funded and rural doctors received quotas to sterilize women. 14 Thus, Fujimori’s coerced sterilization campaign was mobilized through securing the support and funding for a family planning program that hinged on the neopopulist promotion of international reproductive rights rhetoric.

THE COMPLICATIONS OF BACKLASH AGAINST FUJIMORI’S POLICIES Fujimori’s neopopulist exercise of power also complicated feminist movements’ and non-governmental organizations’ (NGOs) backlash to the sterilization campaign. After the 1992 self-coup, Peruvian media was heavily censored and objectors and opponents of the regime were denied basic human rights. 15 Due to this repressive political environment, feminist activist groups had difficulty opposing the forced sterilization campaign after it was revealed to the public. Criticizing the government threatened not only the individual activists within these groups, but these groups’ very existence. These fears were sharpened by the fact that Fujimori remained a popular president: publicly opposing his policies could damage the image of the feminist movement in Peru. Several feminist groups were aligned with the regime to maintain economic support, such as Manuela Ramos and Flora Tristan, complicating their ability to speak out. 16 Because Fujimori had positioned himself as a leader in women’s rights and had implemented various pro-women measures as part of his neopopulist strategy, many women’s groups were hesitant to criticize his family planning program in fear that many of the benefits that women had received would be rolled back. They also did not want to create a negative image of reproductive rights in the public eye as such criticism would effectively place themselves in line with the Catholic Church, who were also publicly criticizing Fujimori. 17 It must be made clear, however, that despite these barriers, various women’s groups in Peru researched women’s experiences with the family planning program, challenged the government, and spurred dialogue that objected to paternalistic health care systems. 18 Consorcio Mujer, a consortium of Peruvian feminist NGOs, for example, conducted community surveys to show officials there was no unmet need for sterilization, decreasing pressure to fulfill impractical sterilization quotas. 19

26Behind the Mask of “Progress”: Peru’s Forced Sterilization Program THE CORRELATION OF NEOLIBERALISM AND MALTHUSIAN THOUGHT IN CONTROLLING WOMEN’S REPRODUCTIVE RIGHTS These sterilizations cannot simply be seen as the failure of a generally well-meaning family planning initiative; they must be understood as one of Fujimori’s regime’s deliberate neoliberal policies with similarly harsh, and perhaps even more shocking, consequences for the Peruvian public. The Cairo conference’s POA, the very programme that Fujimori based his family planning initiative on, did not challenge neo-liberalism, but in fact endorsed it. The intersection between population, development and economic growth, and thus the underpinning of the POA’s neoliberal nature, was Malthusian thought. In 1798, Thomas Malthus argued that if population growth continues beyond agricultural capacity, resources would become scarce and world living standards would regress. 20 In line with this thought, the POA’s ultimate goal was “population stabilization.” 21 Thus, women’s reproductive rights were not instated to benefit women, but a means to an end in controlling population. 22 This created problematic results: globally, most funding for contraceptive research was targeted towards long-lasting or permanent provider-controlled surgical, hormonal and immunological methods, placing efficacy over safety. 23 The recommended means of population control by the POA represented a neoliberal, macroeconomic approach: governments were encouraged to introduce user fees for health services and contraceptives. As well, the POA emphasized private sector production and distribution of contraceptives and recommended that governments “review legal, regulatory and import policies that unnecessarily prevent or restrict the greater involvement of the private sector.” 24 Furthermore, “traditional” neoliberal economic reforms disproportionately disadvantage women, particularly poor and racialized women. These policies often restrict or reduce women’s access to housing, sanitation, food, and clean water, causing a rise in poor health, including reproductive health. 25 The POA fails to address these issues, further revealing its alignment with neoliberal principles. Like the POA, the Fujimori regime’s family planning program espoused the need to elevate women’s reproductive rights while also seeing them as a means to an economic end. In practice, however, the 1996-1998 coerced and unsafe sterilization crisis bypassed the idea that providing accessible contraception and reproductive healthcare would naturally bring the birth rate down. Rather, permanent sterilization of Peruvian women was a government imperative that sought to control female bodies for means of economic growth. The Peruvian population ballooned from about six million in 1940 to over twenty-five million in 2000. 26 Government documents show that behind the scenes, the presidency and prime minister’s office saw the sterilization as an economic development measure that would lead to an increase in GDP per capita. In one document entitled “Basic Social Policy Guidelines,” developed in 1993, population growth was predicted to impede the economy’s capability of employment and social services. Another document named “Social Policy: Situation and Perspectives” stated that the number of people who decided upon a permanent method of family planning was one of thirteen indicators of success in promoting economic growth. 27 As

such, population reduction in the form of permanent sterilization was essential to the Peruvian government’s conception of prudent macroeconomics.

The government’s forced sterilizations were targeted towards poor, indigenous, rural areas, revealing that their neoliberal family planning project was clearly racialized. Quotas were created for the number of women sterilized in rural Peru. Christina Ewig reveals that Fujimori met weekly with local healthcare officials to promote increased quotas, further suggesting that the status of women or the improvement of reproductive health were not actual considerations in Fujimori’s family planning program. 28 The provision of food or clothing, deception, and threats were utilized to coerce women into sterilizations. 29 Yet, these rural areas were not overpopulated and had a lower comparative population density to urban areas. 30 Throughout the 1920s and 1930s, eugenics were actively employed in attempts to solve overpopulation and poverty throughout the “Global South.” 31 The Fujimori regime’s focus on indigenous women in their sterilization project reveals that the specter of eugenics still looms over neoliberal understandings of population politics. Indigenous women are thought to be easily coerced, and the very “need” to control these women’s reproduction demonstrates the reduction of these women to their womb: a womb that will inevitably overproduce poor Peruvians. The insistence on sterilization, rather than other forms of birth control, insinuates that these women could not be trusted to use other contraceptives, reinforcing an image of uneducated, unteachable indigenous women. The experiences of these women are rendered invisible in the late twentieth century discourse of the “right to choose,” a slogan regarding abortion rights touted by predominantly white women’s groups. 32 In the Peruvian forced sterilization campaign, racialized constructions deem that racialized women should not be granted the “right to choose” because they are believed to be incapable of responsibly choosing for themselves.

CONCLUSION

Mujeres de Anta (Women of Anta), an NGO meant to publicize violations committed by the Peruvian government and fight for reproductive justice, was founded in 2001. One member of the association stated, “They made my husband sign a document, and they told him that they would heal me, but given that he could not read, he did not know what the document was about ... and they also threatened my husband that if I did not show at the local clinic, the police would take him prisoner. My husband made me go because he was afraid.” 33 This fearfilled quote provides a reminder of the tangible, extremely harmful effects of the Fujimori regime’s campaign. As such, these women deserve space in political science literature. This paper has shown the ways in which Fujimori’s populist regime enabled an unsafe and coercive sterilization campaign for the purpose of economic growth. While many women did in fact receive increased reproductive freedom and access to contraceptives and resources as a result of Fujimori’s family planning campaign, the campaign itself was built upon racialized Malthusian principles. Paradoxically, Fujimori sought to appeal to “popular sectors,” but his policies caused the most harm to poor, indigenous women. Often, scholars characterize a regime through the presence or lack of presence of legislation.

This paper sought to problematize this notion: Fujimori’s institution of a gender quota in Congress was thought to represent an increase in gender equity in Peruvian politics and furthermore, an extension of citizenship and adherence to liberal values. Yet, Fujimori’s regime also co-opted feminist ideology in pursuit of an economically conservative political project. To gain additional theoretical power and prominence in scholarship, further research concerning how “classical” political concepts such as populism and neoliberalism can be nuanced with gendered analyses is required. Perhaps this research will shape the scholarly field to more tangibly represent how politics influences people’s lived experiences.

NOTES 1 Christina Ewig, “Hijacking Global Feminism: Feminists, the Catholic Church, and the Family Planning Debacle in Peru,” Feminist Studies 32, no. 3 (2006): 646-647. 2 Kurt Weyland, “Clarifying a Contested Concept: Populism in the Study of Latin American Politics,” Comparative Politics 34, no. 1 (2002). 3 Kurt Weyland, “Neopopulism and Neoliberalism in Latin America: How Much Affinity?” Third World Quarterly 24, no. 6 (2003): 1107. 4 Roberts, “Neoliberalism and the Transformation of Populism,” 96-96. 5 Jennifer S. Holmes and Sheila Amin Gutierrez de Pineres, “Source of Fujimori’s Popularity: Neo-liberal Reform or Ending Terrorism,” Terrorism and Political Violence 14, no. 4 (2002): 93-112. 6 Philip Mauceri, “An Authoritarian Presidency: How and Why Did Presidential Power Run Amok in Fujimori’s Peru?,” in The Fujimori Legacy: The Rise of Electoral Authoritarianism in Peru, ed. Julio Carrion (University Park: Penn State University Press, 2006): 39-60. 7 Stéphanie Rousseau, Women’s Citizenship in Peru: The Paradoxes of Neopopulism in Latin America (New York: Palgrave MacMillan, 2009), 24. 8 Stéphanie Rousseau, “Populism From Above, Populism From Below,” in Gender and Populism in Latin America: Passionate Politics, ed. Karen Kampwirth (University Park: Pennsylvania State University Press, 2010), 144. 9 Quoted in Jelke Boesten, “Free Choice or Poverty Alleviation? Population Politics in Peru under Alberto Fujimori,” European Review of Latin American and Caribbean Studies, no.82 (2007): 7. 10 Ewig, “Hijacking Global Feminism,” 640. 11 Ewig, 640. 12 Ewig, 640. 13 Jadwiga E. Pieper Mooney, “Re-visiting Histories of Modernization, Progress, and (Unequal) Citizenship Rights: Coerced Sterilization in Peru and in the United States,” History Compass 8, no. 9 (2010): 1042. 14 Boesten, “Free Choice,” 6-7. 15 Ewig, “Hijacking Global Feminism,” 651. 16 Ewig, 651. 17 Ewig, 651. 18 Bonnie Shepard, “Let’s Be Citizens, Not Patients!”: Women’s Groups in Peru Assert Their Right to High-Quality Reproductive Health Care,” in Responding to Cairo: case studies of changing practice in reproductive health and family planning, ed. Nicole Haberland and Diana Measham (New York: Population Council, 2002): 339-354. 19 Bonnie Shepard, “Let’s Be Citizens, Not Patients!,” 350. 20 Thomas Malthus, An Essay on the Principle of Population (London: J. Johnson, 1798). Retrieved December 7, 2019 via Online Library of Liberty. https://oll.libertyfund.org/titles/malthus-anessay-on-the-principle-of-population-1798-1st-ed. 21 United Nations, International conference on population and development programme of action (Cairo: UNDP, 1994), 21. 22 Sumati Nair, Sarah Sexton, and Preeti Kirbat, “A Decade after Cairo: Women’s Health in a Free Market Economy,” Indian Journal of Gender Studies 13, no. 2 (2006): 171-193. 23 Asoka Bandarage, Women, population and global crisis: a political-economic analysis (London: Zed Books, 1997), 90. 24 Asoka Bandarage, Women, population and global crisis:, 91.

25 Nair, Sexton and Kirbat, “A Decade after Cairo,” 179. 26 Boesten, “Free Choice,” 4. 27 Ewig, “Hijacking Global Feminism,” 642-644. 28 Ewig, “Hijacking Global Feminism,” 644. 29 Carlos Caceres, Marcos Cueto, and Nancy Palomino, “Sexual and Reproductive Rights Policies in Peru: Unveiling False Paradoxes,” SexPolitics: Reports from the frontlines (2008): 140. 30 Boesten, “Free Choice,” 7. 31 Boesten, “Free Choice,”, 4 32 Kalpana Wilson, “Towards a Radical Re-appropriation: Gender, Development and Neoliberal Feminism,” Development and Charnge 46, no. 4 (2015): 813. 33 Quoted in Mooney, “Re-visiting Histories,” 1044.