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Since 1991–the year Peruvian president Alberto Fujimori devoted to “family planning”–Peru has instituted several programs to curb teen pregnancy and maternal mortality. “Peruvian women must be in control of their own destiny,” Fujimori claimed. Yet for Marina Machaca, who charged that she was raped by a doctor at a public health facility in 1996, it has taken four years to gain control–and justice.

Machaca had gone to a clinic with a headache and fever, but there, she says, her doctor, Gerardo Salm-n Horna, drugged and raped her. Machaca pressed charges, but Horna was acquitted. Researchers at the Center for Reproductive Law and Policy (CRLP) and the Latin American and Caribbean Committee for the Defense of Women’s Rights (CLADEM) learned of her case while preparing Silence and Complicity, a first-of-its-kind report on violence against women in Peruvian public health facilities, which was published in 1998. They took her case before the Inter-American Commission on Human Rights, which, in October, forced the government to pay reparations to Machaca and improve the treatment of rape victims. At press time, activists from CRLP had joined CLADEM representatives in Peru to further negotiate the settlement.

Silence and Complicity contains frightening testimonies from women and girls that reveal patterns of verbal, psychological, and physical violence. It documents rapes of gynecological patients, the medical neglect and legal prosecution of women suspected of having had an abortion, and verbal attacks on unmarried women seeking reproductive services. Researchers also found that many health care workers believe that pregnant or sexually active women deserve pain and suffering.

CLADEM published a separate study last year that documented sterilization quotas targeting poor, rural women. The quotas were instituted by Fujimori the very year he began championing reproductive rights.

“The government’s reaction has been to blame a few ‘zealous’ health workers,” says Jo-Marie Burt of the North American Congress on Latin America, a U.S.-based research organization, “and deny that it was official policy.” But activists aren’t buying it. “They’re holding the government accountable,” says CRLP’s Kathy Hall Martinez.

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