Silence and Complicity is a well-researched report revealing the shocking range of violence against women that is manifest in Peruvian public health facilities. As is noted by the authors, "In Peru, a complex web of silence, fear, and complicity serves to veil the violations of women's human rights occurring in public health facilities" (p. 13). The report details physical, psychological, and sexual violence as well as denial of the right to health and to informed decision making. The injustices exist on an institutional level with the absence of structures to protect against and punish acts of violence. Violations span all elements of the spectrum, from subtle inequalities in health care to devastating accounts of rape. Drawing from international human rights law as well as the national laws of Peru, the authors of this report charge the Peruvian government with the responsibility for violence perpetrated by agents of the state.
The Center for Reproductive Law and Policy and the Latin American Caribbean Committee for the Defense of Women's Rights undertook a collaborative effort to monitor women's rights in the sphere of sexual and reproductive health services. They embarked on a fact-finding report based in personal testimonies and collective interviews with women's organizations and national-level health personnel in both rural and urban settings. All testimonies were confirmed by second sources. Women were selected based on the priority groups of the Peruvian government's Ministry of Health: women in poverty, women in rural areas, adolescent and young women, and indigenous women. The report itself is divided into three parts based on the violations of different categories of rights protected under international treaties: "violations of the right to personal integrity and autonomy in decision-making regarding sexuality and reproduction, violations of the right to health, and violations of the right to be free from discrimination and violence" (p. 25).
The critiques in this report are based firmly in both Peruvian national laws and international consensus statements regarding women's health, which have been signed by Peru. These include, among others, the World Conference on Human Rights, the International Conference on Population and Development, the World Summit on Social Development, and the Fourth World Conference on Women. The report details the rights protected under these conventions and firmly establishes state responsibility for acts of violence committed by public health officials who are agents of the state. "The Inter-American Court of Human Rights has repeatedly held that states are responsible for the failure to prevent and punish violations of human rights and to legally guarantee their protection" (p. 31). The Convention of Belem de Para specifically holds governments responsible for violations of gender-related rights. Peruvian law, both in its constitution and specific acts of legislation such as the General Law on Health provide for the protection of human rights and health services. However, as exemplified throughout this report, many of these legal guarantees are far from being reality for the majority of women in Peru.
The poignant testimonies included in the report speak volumes about the injustices in the Peruvian health care system. Despite the law requiring free medical care during pregnancy and childbirth, the investigators cite several examples of down payments, charges for procedures, and differing prices for services in different hospitals. A woman describes a case in which she was hemorrhaging from a miscarriage and the social worker refused to admit her to the hospital, because she could not pay. She was only admitted when the doctor reluctantly ordered that she be allowed to after determining that she might die. Women recount appalling stories of pressure to undergo sterilization as their form of birth control, in order to meet health facility goals, and with the incentive of free care with this but not other methods. …