publications

I. Summary and Key Recommendations

In Peru interrupting a pregnancy is legal in order to save the life of the woman or to avoid serious and permanent damage to her health. Other forms of procuring or performing an abortion are criminal offenses that can result in prison terms and fines for pregnant women and girls, and for their healthcare providers.

In practice there are significant barriers to accessing lawful abortions. Legal “therapeutic” abortion—abortion needed to save the life of the woman or avoid damage to her health—is a vital public health service, and denial of this service jeopardizes a broad range of fundamental human rights of women and girls. This report examines the obstacles to accessing therapeutic abortion in Peru’s public health system.

Women and girls confronting crisis pregnancies that could kill them or permanently harm their health have an urgent need to be able to access safe, dignified, affordable abortions.  Human Rights Watch documented just the opposite in Peru.  Women, adolescent girls, health providers, and government officials all described a situation where women and adolescent girls who were clearly eligible for legal abortions were refused or unable to access the service, with terrible consequences to their mental and physical health.    

There is no reliable national data on the number of therapeutic abortions performed in Peru. There are no national-level guidelines on eligibility or administrative procedures for healthcare practitioners to respond to girls and women in need of a therapeutic abortion. It is impossible to ascertain accurately how many therapeutic abortions are actually being performed, and even the Ministry of Health recognizes that its own estimates are not reliable. Given the obstacles to accurately defining, accessing, and registering therapeutic abortions described in this report, it is likely that the performance of therapeutic abortions is both underestimated and underutilized.

The government has done little to ensure that therapeutic abortions are available when needed, and has actively obstructed some initiatives intended to improve access. Major obstacles to accessing therapeutic abortion in Peru include: (1) vague and restrictive laws and policies on therapeutic abortion, including ambiguity as to whether harm to mental health is considered a ground for a legal abortion; (2) the absence of a national protocol on eligibility and administrative procedures for therapeutic abortion; (3) ad hoc approval and referral procedures for legal abortions, and lack of accountability for failure to approve legal abortions; (4) healthcare providers’ fear of prosecution or malpractice lawsuits; (5) the cost of abortion procedures and coverage for therapeutic abortion under the social insurance system; and (6) low levels of awareness among women and healthcare providers about exceptions to the criminalization of abortion.

For many women and girls, the decision to undergo a therapeutic abortion is not an easy one to make, even with the expert counsel and advice of physicians. When policy makers and medical authorities make this decision for women and girls even more difficult, and complicate access to legal abortion services and information about them, the number of abortions is not reduced. Abortion care simply goes underground. For those with enough money and information, clandestine abortions may be performed in relatively safe circumstances in private clinics or even at home with studied pharmaceutical methods. For the many poor women and girls in Peru, the abortions are often induced by unqualified, unregulated practitioners or even by themselves through home remedies. Practices of clandestine abortion vary and some can carry grave risks, contributing to Peru’s high maternal mortality and morbidity rates.

Peru has an obligation under international human rights standards to ensure that access to therapeutic abortion in the public health system is a reality. The drastic restrictions on abortion generally in Peru, and the failure to ensure access to even abortions authorized by law, can lead to violations of the fundamental human rights of women including the rights to health, life, non-discrimination, physical integrity, and freedom from cruel, inhuman, or degrading treatment. International human rights authorities, including the United Nations Human Rights Committee, the UN special rapporteur on the right to health, and the UN Committee on the Elimination of Discrimination against Women have repeatedly and forcefully called on Peru to eliminate barriers to therapeutic abortion and to ensure compliance with their human rights obligations.

Ensuring access to therapeutic abortion in Peru is possible with political will. Yet Peru continues to neglect this issue, putting the lives of women and girls in jeopardy. Evidence-based technical protocols for the management of legal pregnancy termination are being shuttled within the Peruvian bureaucracy with little accountability or respect for time limits, while public hospitals continue to operate in the void; some lucky women will be assisted, but many others in medical need will not.

Peru should act immediately to remedy this situation. It should:

Absent a national-level protocol, it is firmly within the mandate of the regional and central ministries of health to approve hospital protocols and issue respective guidelines on standard medical procedures, to clarify any legal or medical ambiguity, and ensure the highest quality of care in the public healthcare sector.

Peru should also:

  • Rescind the law that requires healthcare providers to report cases of suspected induced abortions to the police;
  • Strengthen data collection and analysis at the regional and national levels;
  • Inform women, health practitioners, and the general public of the legal standards for abortions authorized by law.;
  • Ensure that social insurance schemes cover costs associated with therapeutic abortion;
  • Monitor and investigate instances in which healthcare providers refuse to provide therapeutic abortions to eligible women and girls, and discipline them appropriately; and
  • Consider working toward abortion law reform to ensure that all women are able to decide freely on matters relating to reproduction.

While it is not the subject of this report, Human Rights Watch also believes that ongoing public debate in Peru about the broader issue of women’s right to abortion is crucial to ensuring women’s human rights. Authoritative interpretations of international human rights law support the right of all women to decide independently in matters related to abortion, without interference from the state or others. Only through legal reform that does not criminalize access to health care, including abortion, can women make free and informed decisions about the best ways to protect their health and well-being and decide if and when to have children and found a family.