We welcome a guest post today from Raúl Necochea López, author of A History of Family Planning in Twentieth-Century Peru. Adding to the burgeoning study of medicine and science in Latin America, this important book offers a comprehensive historical perspective on the highly contentious issues of sexual and reproductive health in an important Andean nation. Necochea López approaches family planning as a historical phenomenon layered with medical, social, economic, and moral implications. At stake in this complex mix were new notions of individual autonomy, the future of gender relations, and national prosperity.
In the following post, Necochea López reports on Peru’s recently established guidelines that finally bring the country’s laws regarding therapeutic abortion out of a 90-year legal limbo.
I was in Santiago recently, attending a workshop on the history of family planning in Latin America, with colleagues from Chile and Argentina, myself representing Peru. One of my tasks was to discuss how therapeutic abortion came to matter to physicians in my country in the 1920s. After all, it had been this generation of physicians who witnessed the legalization of therapeutic abortion in 1924. Article 163 of the Penal Code defined therapeutic abortions as those demanded by women and performed by clinicians, in consultation with a committee of their peers, “if there is no other way to save a mother’s life or avoid a permanent and severe lesion in her.” However, Peruvian authorities at the time did not answer crucial questions to make the law applicable, such as which lesions counted as permanent and severe, or what interventions should be used to cause an abortion, or how far into a pregnancy an abortion could be provoked. As a result, the law remained in a legal limbo that made it difficult to enforce, while endangering women’s lives and vexing medical professionals.
By some fascinating coincidence, this all changed on the very day of my talk in Santiago, on June 27, 2014, with the publication of Peru’s Ministry of Health’s new guideline, which standardizes the procedures to be used should the need for an abortion arise for pregnancies under 22 weeks. (You can read the text of the guideline here.) The guideline goes no further than the framework set in the 1920s: an abortion must be desired by a woman and performed by a physician. It names ectopic pregnancies, cancer, heart disease, severe chronic hypertension, and advanced diabetes among the conditions that merit consideration of an abortion. The guide does not, therefore, change the law’s narrow construal of abortion as something justified only when a serious organic lesion could be worsened by a pregnancy. Thus, for example, neither fetal anomalies incompatible with life nor pregnancies that result from rapes are valid reasons to demand an abortion. However, a woman’s mental health might become an important factor, if the medical committee reviewing her case believes that the pregnancy could severely and permanently damage her health.
The publication of the guideline is a step forward, but Peruvians (or Latin Americans, for that matter) do well to stay skeptical about reducing the issue of therapeutic abortion to one determined by the political will of their authorities. The medical profession, as demonstrated by the power of the committees overseeing abortion decisions, is an important player in this ongoing drama, just as it was in the 1920s. For this reason, the same questions that were posed ninety years ago remain valid today: To what extent will physicians block or facilitate the fulfillment of the rights of their patients, and why?
Raúl Necochea López is assistant professor of social medicine and adjunct assistant professor of history at the University of North Carolina at Chapel Hill. A History of Family Planning in Twentieth-Century Peru will be published by UNC Press in October 2014 and is available for pre-order now.