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- Issue a national-level protocol on therapeutic abortion. The protocol should cover:
- eligibility criteria, including for harm to mental health;
- the right of the pregnant woman to be heard and to have her views considered;
- techniques and medical procedures to use;
- standardized data collection requirements;
- confidentiality protections;
- referral procedures;
- timelines and lines of authority for making decisions on therapeutic abortions; and
- accountability mechanisms for redress of grievances.
- Do not block the efforts of regional health ministries to disseminate evidence-based protocols on therapeutic abortion, including the Arequipa regional protocol.
- Formulate and incorporate clear-cut guidelines for legal abortion on mental health grounds, including the mental health risks to women carrying fetuses with congenital malformations or disorders incompatible with life, and in the case of pregnancy as a result of rape or incest.
- Ensure through information in the form of a technical guide for a variety of medical specialists (including oncologists, cardiologists, and internists) that physicians counsel women about the availability of therapeutic abortion for pathologies that could worsen in the course of pregnancy or could affect the pregnancy adversely.
- Ensure that women and communities have access to evidence-based information tailored to varying levels of literacy to prevent pregnancies that could endanger their health or life.
- Guarantee special attention to and access for adolescents in fulfilling their sexual and reproductive healthcare needs, including therapeutic abortion.
Implement the UN Human Rights Committee judgment in the case of K.L. v. Peru, recognizing adolescent girls as an especially vulnerable population that must receive safe, timely, free, non-stigmatizing, accessible, and appropriate services.
- Investigate whether any out-of-pocket expenses are associated with access to therapeutic abortion in public healthcare facilities. Ensure, with other ministries, that social and private insurance schemes provide coverage for therapeutic abortions and do not act as barriers for women to access healthcare services
- Monitor compliance and investigate instances where physicians or medical administrators have refused to provide therapeutic abortion services to eligible women and girls. Appropriately discipline healthcare providers who impede access to therapeutic abortions.
- Wage public information campaigns to inform women, health service practitioners, and the general public of the legal standards for non-punishable abortions and the public’s right to access services that are accessible, affordable, available, and of adequate quality. The Ministry of Health should spearhead this effort but also work with the Ministry of Education, Ministry of Justice, and other relevant ministries as appropriate to target specific audiences with appropriate messaging in Spanish and indigenous languages and to monitor the campaigns’ effect on actual service delivery.
- Ensure the ongoing participation of civil society actors, especially women’s rights and health organizations and professional medical associations, in the design, implementation, and monitoring of programs and systems to ensure access to therapeutic abortion and other vital components of sexual and reproductive health.
Issue a statement clarifying the existing penal code and its provision for therapeutic abortions. Disseminate the statement to members of the police force, prosecutors, the Executive Office, legislators, Ministry of Health administrative officials and their healthcare service employees, all regional government offices, and relevant medical associations.
- Devise and implement a public information strategy with other public ministries as appropriate to ensure that the status of legal access and entitlement to abortion is known to the general population, to dispel and remedy widely held misconceptions.
- Investigate outstanding complaints about denial of access to therapeutic abortion.
- Repeal immediately the clause of article 30 of the General Health Law that obliges medical practitioners to report to the police women who are suspected of having induced an abortion. Repeal the penal code provisions that criminalize abortion and impose penalties on women and girls who procure abortions.
- Appropriate adequate funds for public information awareness campaigns on the availability of safe and legal abortion services.
- Earmark funds for therapeutic abortion training and service delivery, including: training of all public hospital personnel and employees of possible referral centers; implementation of the best evidence-based termination, infection prevention, and pain management procedures; and provision of psychological counseling and social support services for women who undergo therapeutic abortions.
To the Medical College of Peru
- Continue to disseminate the recommendations on therapeutic abortion from the Peruvian Society of Obstetrics and Gynecology (Sociedad Peruana de Obstetricia y Ginecología, SPOG) and the Medical College of Peru to all levels of healthcare services in different disciplines throughout the country to inform physicians and other healthcare providers of their ethical and legal responsibilities. Reiterate that performing medical duties comes first, even in the absence of a national protocol.
- Promote the recommendations on therapeutic abortion from SPOG and the Medical College of Peru as part of the medical school curriculum.
- Introduce therapeutic abortion as part of the training and accreditation process for medical and midwifery school graduates, via the Peruvian Association of Medical Schools and the National Association of Midwifery Schools, respectively.
- Instruct members of the Medical College of Peru on the ethical and legal violations and the possibility of malpractice liability for those healthcare providers who refuse to attend women in need of therapeutic abortion.
- Clarify to local, regional, and national healthcare institutions the principle of conscientious objection, and the fact that it applies to individuals and not institutions.
- Develop and disseminate general pregnancy prevention recommendations, tailored for different specialties, for counseling women with pathologies that could worsen in the course of pregnancy or could affect the pregnancy adversely about the risks that pregnancy poses to their health and lives. Expand those guidelines to include counseling on pregnancy termination for pregnant patients whose pathologies or the treatment required to cure them could endanger the life and health of the fetus.
- Encourage scientific societies, the technical branches of the Medical College of Peru, to provide guidance for affiliated members on pregnancy prevention for women whose health or lives could be endangered. Utilize a woman-centered, risk reduction approach as part of the preventive care strategies.
- Pressure the Ministry of Health at the national and regional levels to implement fully the clinical guides on therapeutic abortion.
To the US Agency for International Development
- Clarify to the Peruvian Ministry of Health that the Mexico City Policy does not impact situations where the woman’s life is in danger, nor does it affect the provision of post-abortion care. As US policies change, provide funds, technical assistance, and the necessary inputs to assist the Ministry of Health in improving access to safe and legal abortion.
Follow the lead of the United Kingdom’s Department for International Development in funding and actively supporting the Safe Abortion Action Fund, managed by the International Planned Parenthood Federation, with designated funds for improving access to therapeutic abortion in Peru.
- Provide funding and support for raising awareness about therapeutic abortion among diverse audiences in Peru. Also provide funding and support for reproductive health programs including abortion prevention, access to legal abortion, and integral post-abortion care.
Support the Latin American and Peruvian affiliates (the Latin American Federation of Obstetric and Gynecological Societies (Federación Latinoamericana de Sociedades de Obstetricia y Ginecología, FLASOG) and Peruvian Society of Obstetrics and Gynecology (Sociedad Peruana de Obstetricia y Ginecología, SPOG), respectively) in developing and promoting ethical guidelines on the provision of humane therapeutic abortion care, including explicit condemnation of doctors and ad hoc medical committees who refuse to perform or approve therapeutic abortions.
- Encourage obstetricians and gynecologists to work with specialists in other fields of medicine to counsel women on pregnancy prevention, and to provide timely referrals for legal pregnancy interruption when the woman’s life or health is endangered.
- Research obstacles to access therapeutic abortions in the region, including Peru. Issue a report on the findings and disseminate it widely among policymakers, legislators, and other key stakeholders.
- Work towards adopting policies to advocate for the global decriminalization of abortion as a means of protecting women’s human rights and as an evidence-based means to reduce the rate of maternal disability and mortality associated with unsafe abortion, consistent with the UN Millennium Development Goals and the commitment to international human rights.
- Work with governments to prevent unwanted pregnancies and reduce the need for abortions, to ensure that health systems have the capacity to deal effectively with the complications of unsafe abortion, and to ensure access to quality abortion services where they are legal.
- Support the finalization and dissemination of a national evidence-based protocol(s) on the management of therapeutic abortion.
- Participate in monitoring and interagency reporting on maternal health and universal access to reproductive health services, including access to therapeutic abortion, in Peru.
- Raise public awareness in Peru and on a global scale that mental health and wellness is a fundamental component of the right to health, including sexual, reproductive, and maternal health.
- Provide increased technical assistance to the Peruvian Ministry of Health in registering and analyzing adequately the number of therapeutic abortions performed at each public sector hospital.
- Sensitize and educate policymakers, communities, and individuals about the role of therapeutic abortion in saving women’s lives.
- Generate and update an analysis of regional trends in and data on access to therapeutic abortion for policymakers and other key stakeholders.
- Recognize the serious adverse impact that the criminalization of abortion and denial of therapeutic abortion has on women in Peru, particularly with endangerment to their lives and physical, mental, and social health.
- Ask the incoming special rapporteur on the right to the highest attainable standard of health to follow up on the previous rapporteurs’ findings in Peru as a matter of urgency.
- Urge Peru’s compliance with the Human Rights Committee recommendations on therapeutic abortion in the Universal Periodic Review and at other opportunities.
July 2008
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