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IV. Illustrative Cases of Lack of Access and Its Consequences

In spite of ongoing contacts with various hospitals and nongovernmental health organizations, Human Rights Watch was not able to secure interviews with many women who should have been eligible for therapeutic abortions and were denied services. Key factors behind this were difficulties in identifying such women, reluctance to speak about intimate matters, and a lack of awareness that their rights had been violated. In Peru it is rare for cases of the denial of therapeutic abortion to be exposed in public. Those that are brought to light illustrate just how difficult access to legal, therapeutic abortions can be, how the many obstacles can combine to defeat access, and how serious the consequences can be. The three case studies below illustrate both the barriers and the consequences.

Case of M.L.²⁴

M.L., a 31-year-old married woman with one son, told Human Rights Watch that she had hoped for a daughter when she got pregnant in 2004. But an ultrasound at 30 weeks of gestation revealed that her pregnancy was not normal; despite a lack of apparent symptoms. M.L. was hospitalized and was told that the fetus was malformed, but was not given details. After a week in the public maternity hospital, medical staff members informed M.L. that the fetus had no brain and no bladder and was not going to live: it would die at birth if not in utero.

M.L. asked for a therapeutic abortion, but was refused. She told Human Rights Watch, “They didn’t want to induce me because they told me that the law did not permit it, that it couldn’t be done.”²⁵ M.L. took them at their word and was ignorant of the possibility of convening a review by a medical committee of her case.

M.L. began looking for alternative ways to procure a therapeutic abortion. She found clandestine abortion providers, but her husband did not want M.L. to risk her life with an unsanitary and unsafe procedure. Moreover, in a private clinic she consulted, the operation would have cost 2,000 soles (about US$700), a price too high for M.L.

She returned to the hospital two months later (at about 38 weeks of gestation), where an amniocentesis test was performed and M.L. started to have contractions. Hospital staff gave M.L. an intravenous drip, which, according to M.L., was intended to prevent early labor. She said she overheard hospital staff discussing how to prevent early labor.

Shortly after that, M.L. returned to her parents’ village.  She described herself as depressed and despondent; she said she cried continuously and did not eat.

When her pregnancy was full-term, there was no fetal movement. She was admitted to the hospital in great pain: “I was screaming with the pain. I thought I was going to die. I shouted out that I couldn’t take it any more…. It wasn’t fair that they made me wait so long when they knew that they were going to operate on me…. Then they had to make a vertical cut [for a Cesarean section] due to the emergency.”²⁶ The hospital told M.L. that the fetus was a girl, but refused to allow M.L. to see the body. To this day, she explained to Human Rights Watch that she has nightmares about what actually happened to the body.

M.L. said she continued to feel severely depressed and struggles to afford treatment for her depression. She never learned the cause of the malformation and fears that something is genetically wrong with her or her husband, even as they long for another child. She said, “I wouldn’t want this to happen to any other woman; it’s something horrible that happened to me…. I dropped down to 40 kilos (about 88 pounds). People don’t know how much one suffers [in this situation]; they don’t want to know the truth about that kind of suffering.”²⁷

Case of K.L.

The case of K.L. is one of the rare high-profile therapeutic abortion cases in Peru, and the information that follows is from publicly available sources (Human Rights Watch did not interview K.L.).²⁸ In 2001 when K.L. was 17 years old, she learned at 14 weeks of pregnancy from doctors at a public hospital that the fetus she was carrying was anencephalic (which, as described in the chapter above, is an anomaly incompatible with life for the fetus and a condition that jeopardizes the pregnant woman’s health). The attending physician recommended interrupting the pregnancy. K.L. struggled with the news and discussed her situation with her family.

Knowing that continuing the pregnancy could endanger her physical and mental health, and feeling emotionally unable to continue the pregnancy knowing that the fetus would not survive, K.L. (via her mother, as she was still a legal minor) petitioned the Loayza Hospital in Lima for a therapeutic abortion and had all of the necessary tests carried out. Two weeks after she was counseled to end her pregnancy, K.L. returned to the hospital only to find out she needed the approval of the director. A week later, the hospital director denied her request based on his view that the pregnancy itself did not pose a serious threat to her health. K.L. had no choice but to carry the pregnancy full-term against her will. During this time she suffered from malnutrition and severe depression. When she finally gave birth three weeks after her due date—lateness is a common occurrence in anencephalic pregnancies—hospital employees forced her to breastfeed for four days until the baby died. K.L. was later diagnosed with severe depression requiring psychiatric treatment.²⁹

Two Peruvian organizations, DEMUS and the Latin American and Caribbean Committee for the Defense of Women's Rights (Comité de América Latina y el Caribe para la Defensa de los Derechos de la Mujer, CLADEM), together with the US-based Center for Reproductive Rights, presented K.L.’s case to the United Nations Human Rights Committee (HRC) in 2002. The HRC found in favor of K.L. As described in Chapter VI, below, the HRC ruled that Peru must compensate her and undertake policy reforms to ensure that similar rights violations do not recur.

Case of L.C.

Human Rights Watch interviewed the mother of L.C., a girl from a poor area in Lima, who was raped repeatedly when she was 14 years old over the course of several months by a man 20 years her senior. She became pregnant and told no one.

According to an interview with her mother, L.C. grew desperate and depressed, and then attempted suicide; she threw herself off the roof of her family’s living quarters. Her mother first learned of her daughter’s rape and pregnancy in the hospital emergency room. “The girl cried and after she told me that there was a man who drives a motorcycle who abused her.” ³⁰ L.C. survived, but fractured several cervical vertebrae in the fall and became quadriplegic. Her pregnancy continued.

In the public hospital the girl’s mother told Human Rights Watch that she requested a therapeutic abortion for her daughter so that the doctors could operate on her spinal column and improve her chances of future mobility. According to the mother’s testimony, “the doctor said they can’t because it’s criminalized.”³¹ But L.C.’s mother understood that the final decision could be made by an ad hoc medical committee if the patient could provide the appropriate documentation to the hospital director. According to L.C.’s mother, after several meetings and unexplained delays, the medical advisory committee finally refused the petition for L.C.’s legal abortion on the grounds that the pregnancy no longer posed a threat to her physical health: “Just like that, even though my daughter is the way she is, they said, ‘We can’t, señora. That is a criminal offense.’”³² Later L.C. miscarried while in the hospital, her mother told Human Rights Watch. But by that time, the planned operation on her spine would have had little or no effect on restoring her range of physical activity.³³