Government Obstacles, Misinformation Impede Access
(Lima) - The Peruvian government's deliberate refusal to streamline procedures and approve guidelines for legal abortion is endangering the lives and health of women and girls who are often forced to use unsafe solutions for risky pregnancies, Human Rights Watch said in a new report released today.
The 52-page report, "My Rights, and My Right to Know: Lack of Access to Therapeutic Abortion in Peru," documents the difficulties women face in accessing therapeutic abortion - those needed to save the life of the woman or avoid serious health risks - in Peru's public health system. While no reliable statistics are available on how many women have been turned away from a legal abortion, in interviews with women, healthcare providers, rights activists and government officials, Human Rights Watch found that women in general lack accurate information about their right to a legal abortion, and public health care professionals are often unclear about the intent of laws guaranteeing women access to legal abortions.
"Women and girls confronting pregnancies that could kill or permanently harm them are refused legal abortions, or don't even know they have a right to get one," said Angela Heimburger, a women's rights researcher at Human Rights Watch and author of the report. "The government not only has an obligation to raise awareness about the right to safe, dignified and affordable legal abortions, but it should make getting the procedure as painless as possible."
Abortion is legal in Peru when a pregnancy endangers a woman's life and when it is necessary to protect a woman's health. But because a legal abortion is rarely available in a public hospital, many women seek unsafe and clandestine procedures to deal with a risky pregnancy. Human Rights Watch found several obstacles to making legal abortion accessible. Ambiguities about abortion in Peru's legal system raise fears of prosecution among health care professionals and women. The absence of a national protocol provides no standardized outline for when a therapeutic abortion can be performed. The public health care system is ill-equipped to deal with referral procedures, and circumstances under which a therapeutic abortion can be approved are unclear. Peru has legal abortions, but in practice it is nearly impossible for a woman to have one.
Peru's failure to ensure access to legal therapeutic abortion constitutes a violation of fundamental human rights. Women are entitled to the highest attainable standard of health, life, nondiscrimination, physical integrity and freedom from cruel, inhuman or degrading treatment. United Nations human rights officials and experts have repeatedly and forcefully called on Peru to eliminate barriers to therapeutic abortion to ensure compliance with its human rights obligations.
In the case of K.L. v. Peru, in which a 17-year-old girl was forced to carry a non-viable pregnancy to full term, the United Nations Human Rights Committee in 2005 found that the Peruvian government had violated a series of K.L.'s rights and "has an obligation to take steps to ensure that similar violations do not occur in the future" (http://www1.umn.edu/humanrts/undocs/1153-2003.html). To date, the Peruvian government has taken no action, failing to abide by the Human Rights Committee's recommendations.
Denying access to legal abortion can compound a risky pregnancy with severe emotional distress. For example, M.L., a married woman and mother of one, told Human Rights Watch that at 30 weeks of pregnancy, doctors told her the fetus would not survive. She asked for a legal abortion, but was refused by those same doctors at a public hospital in Lima. "They told me that the law did not permit it, that it couldn't be done," she told Human Rights Watch. An emergency Cesarean section was performed to remove the dead fetus several weeks later when she was at full term. She suffered from depression as a result and, four years later, is still trying to recover emotionally. "I wouldn't want this to happen to any other woman. It's something horrible that happened to me."
The Peruvian government has actively obstructed some local initiatives intended to improve access to therapeutic abortion. In the absence of a national protocol to regulate and standardize this medical procedure, several hospitals and a regional government have attempted to establish their own. But national health authorities have rescinded most of these local and regional initiatives, and in one case removed a hospital director for "exceeding his authority."
In Peru, as is the case around the world, restricting access to legal abortions does not reduce the number performed. Abortion care simply goes underground. For those with enough money and information, clandestine abortions may be performed in relatively safe circumstances. For the many poor women and girls in Peru, however, abortions are often induced by unqualified, unregulated practitioners or even by themselves through risky home remedies.
"Peruvian women and girls entitled to therapeutic abortions should never have to be driven underground or forced to pay exorbitant fees at private clinics. Such abortions should be readily available in the public health system, as required by law," said Heimburger. "Forcing poor, often illiterate women and girls into the hands of untrained providers carries grave risks for them and their families left behind."
Human Rights Watch calls on Peru to act immediately to:
- adopt a nationwide protocol on therapeutic abortion;
- work toward abortion law reform to ensure that all women are able to decide freely on matters relating to reproduction;
- inform the general public and health practitioners that therapeutic abortions are in fact authorized by law; and
- investigate instances in which healthcare providers deny therapeutic abortion to eligible women and girls, and take appropriate disciplinary measures.