Civil Society and Democratic Governability in the Andes and the Southern Cone Project

representatives of the organizations of civil society, not 'to' civil society; is a play on words that the government and international cooperating agencies use often.²¹ (emphasis ours)
For some organizations,

The Mesa is made up of institutions linked to the process and the program of Cairo, we are not trying to unite all the feminist NGOs, because it is simply very difficult to have this kind of round table, too open, where interests differ [...] and so basically there are those institutions that have a role, a mandate and public activities on population issues and the implementation of Cairo and we believe that the Mesa is very representative of sectors that work on these issues.²² (emphasis ours)

The members of the MT interviewed were very emphatic in saying that they "do not represent" anyone other than their own institutions since 'civil society' did not elect them to form part of the Mesa. This is an aspect that has to be emphasized in order to understand the nature of this group. In as much as technical information is 'exchanged' one would suppose that there are benefits for those who form part of the MT. However, part of the Mesa's task is to 'monitor' the execution of the Action Program and this implies a different role for those who participate in which 'civil society' must hold the state (which is just another invited entity, one 'partner' more) accountable for the commitments it has made to the society of nations. The fusion of these two roles -- one that can be considered technical and another that is manifestly political because it is intended to recuperate for social organizations their function of holding governments accountable (one of the basic functions of democratic institutions) -- tends to erase the clarity of the political identities of the NGOs and feminists who form part of the Mesa.
On the other hand, if a significant group of private organizations around the nation (according to criteria of experience and specialization) would have elected representatives of civil society who were then held accountable for their monitoring of the implementation of the Cairo Action Program, conditions would have been created for these representative organizations to be accountable for their activities to the groups that elected them (to cite only one example of the chain of feedback in the case of representation). Those who elected their representatives would have been in a position to expect that their interests would be represented: "We weren't representatives of civil society. Who had elected us? There was no organic relationship [...] They expected us to work like a group of friends, to interchange information and with mutual trust,"²³ said one of the informants.
One of the persons interviewed commented that one could hardly expect that this group to be truly representative since in Peru, in the last decade, the legitimacy of the function of representation had declined significantly, not only in political parties but also in other types of social organizations in which there exists a clear arbitrariness in decision-making by leaders, lack of rotation of leaders, the centralization of power, etc. At any rate, the MT is not an entity that is accountable to society because no one delegated that function to it.
The MT is viewed in different ways by different members. While one government official felt that "the role of the MT is more political than technical since technical issues can be discussed officially and for political issues one sometimes needs more informal spaces. I, in the MT, could speak confidentially [...]."²⁴ For others, the MT provides the possibility for "interchange, providing information, consciousness-raising and, finally, if the government takes the decision to do or not do something, this is beyond our control [...] it is better to be there [in the MT] because inside you can do things, but if you are not there, you leave a void."²⁵ The latter opinion illustrates the findings of Alfaro²⁶ who concludes that one of the difficulties that some feminist/women's NGOs have in their relationships with the state is in confusing having an 'influence' on policies with the provision or transmission of information. It was not possible to have access to the internal documents of the MT which would have permitted an evaluation of concrete results in terms of influencing family planning policies and, even, the implementation of the agreements of the International Conference on Population and Development. It is thus difficult to evaluate the accuracy of the latter opinion. In addition, the technical secretariat of the MT was rotating and had few written regulations.
While for one official, the institutionality of the MT "was not something that interested us because what was important was to maintain a space for the interchange of information and, in some other matters, where it was possible, to create consensus [so that the Peruvian MT succeeds], probably if it had been institutionalized, it would have had many fewer accomplishments."²⁷ For another informant, the fact that there were practically no internal regulations limited its effectiveness:

The Mesa worked by consensus which implies that sometimes there were very long discussions that didn't lead to anything or which only got us to half-way points which, from my point of view, don't always reflect reality [...] there is a contradiction between its pluralism and its effectiveness [...] One of the things that limited the capacity of the Mesa to intervene opportunely, as in the case of VSC, is precisely its makeup because it is very difficult to come to agreements, the impression is that no one wants to step on anyone's toes.²⁸

This impression is shared by another informant who went as far as to say that "politically, the Mesa has its hands tied."²⁹
In the interviews, some people who are in the MT suggested that in its two years of existence, this entity has permitted them -- in addition to exchanging information --to freely express their opinions on the health policies of the government -- except for those that are especially sensitive such as abortion or VSC, as will be seen later -- and to offer suggestions for the monitoring of the Action Program (quality of care indicators) and to coordinate activities before the "Cairo + 5" meetings. In any case, its very existence can be used by the staff of the Population Fund as proof of the viability of a pilot project of reaching civil society-state agreements and construction of common agendas in the face of the difficulties in creating similar spaces in other countries where it had been expected that this would be possible (Chile, Colombia, Nicaragua, and Brazil). The official documents of the MT do not explicitly state that that this is a space for reaching agreements but some allusions to its activities can be understood in this sense. For example, the text of a communiqué states that the MT "represents an effort to reach agreements among its members"³⁰ and a representative of the United Nations Population Fund in Peru states that,

[The MT] has been a space for good will, where any difference in conceptions and strategies was discussed, an effort was made to find points of agreement [...] We think that this is very important and places Peru in a unique situation in the region and possibly in the world: civil society, the government and international cooperating agencies working together in the implementation of the agreements of an international conference [...] The fact that it was possible to engage in dialogue, agree on actions, design shared strategies, coordinate efforts and optimize human resources and materials is very meaningful. It is a special pleasure to confirm that it has been possible to carry this out in Peru as a pioneering experience.^31,32 (emphasis ours)

The sclerotic hardening of channels of participation (including the redefinition of what this concept means) and the authoritarian tendencies of this regime casts shadows over the very meaning of "developing consensus with the government." For an observer outside the MT:

[...] from one's position as a feminist, as an organization that defends women, what sense is there in using up your time [...] what sense is there in giving them [the government] all of your knowledge and methodologies, if you don't evaluate your capacity to influence? Are you going to convince a government agency? This is absurd and unrealistic [...] a government like ours, with the way it has acted, I think it would be naive, to say the least, to think that you are going to sit down and accomplish something.³³

This attitude of paralysis seems to be situated at the other extreme of the possibilities of dialogue with the state. While in interview # 4, it is possible to express opinions in the MT though without caring too much if the government does something or not, giving up in some way the possibility of political pressure, in the other case, information and knowledge is stored (for better times?). What seems to be in discussion is the relationship between the level of autonomy of social organizations vis á vis the government and their effectiveness in influencing policies: how effective can one be if one is autonomous?³⁴ An analysis of the set of strategies employed suggests that there is a certain opacity in the identity of the nongovernmental organizations as the voices of society and not the spokespersons of official policies.
The indeterminate characteristics of the role of civil society in holding the state accountable in this tripartite arena became evident a few months after the establishment of the MT when many denunciations came to light regarding violations of the rights of women in health establishments, especially in cases involving the blocking of fallopian tubes. Evidence was provided both by journalists and through a study sponsored by CLADEM and carried out by a researcher at Flora Tristán, one of the NGOs that had promoted the MT. Tensions rose to such a level that, in the opinion of one informant,

[...] the case of the VSCs was an extreme case which tested the viability of the MT [...] in this context it was evident that the MT wanted to avoid direct confrontation among its groups, such as the 'Floras' but the MINSA³⁵ and the Ministry of Education also had an interest in minimizing or negating the cases [...] These contradictions led to the Tripartita speaking out late and ambiguously, from my point of view [...] the statement didn't have the institutional weight that the situation required, it was precisely the desire to avoid internal divisions and [the fact] that regulating mechanisms do not exist; the rules are not clear.³⁶

THE TYING OF TUBES IS TO DECLARE THAT PERU IS A WHOREHOUSE³⁷

According to the ENDES (National Survey on Demography, Education and Health), in Peru in 1996, 60% of women married or living with partners did not want more children. This percentage went up to 75% in rural zones and for women in the Andes. In some departments of Peru such as Apurímac and Huancavelica, the percentage was as high as 82 and 85%. The "unsatisfied need" for family planning services was only 9% in urban areas but went up to 20% in rural areas. This survey concludes that in the five years before it was carried out, 35% of the births in Peru were "unwanted" and that there was a gap between the number of children wanted in rural zones (3.1 children) and the number that families had (5.6 children). In 1988, when there were 99,785 men and women using family planning methods covered by the public sector, the Ministry of Health, with the support of the United Nations Population Fund, began a systematic program of services that grew steadily between 1991 and 1996 (852,798 users). In 1996, contraceptive services became free in health centers but the demand began to decline: between 1996 and 1997 there were 805,155 users and between 1997 and 1998, 799,141. These years coincided with the so-called "VSC crisis."³⁸

Beginning in 1996, journalists from the newspapers El Comercio and later La República, opposition politicians, parishes, and women's organizations began to provide information about a family planning program in public health centers located in the poorest provinces of the country that gave priority to the recently available method of blocking fallopian tubes, among other contraceptive methods. Moreover, it was reported that efforts to convince women to tie their tubes were accompanied by offers of food donated to health centers by USAID-Prisma through the Food Program for High Risk Families (PANFAR). When this information came out, officials from the Ministry of Health and other agencies denied all the accusations. However, months later, more detailed evidence was provided by a study³⁹ about the human rights of women in public health centers sponsored by the Comité de América Latina y el Caribe para la Defensa de los Derechos de la Mujer (CLADEM) and the Centro Legal para Derechos Reproductivos y Políticas Públicas (CRLP) and carried out by two researchers from the Centro Flora Tristán.
The research revealed that during 1997 and 1998, the government established numerical quotas for VSC for health centers, that their staff (doctors and nurses) were assigned quotas for the number of clients who used this contraceptive method, that there were administrative sanctions or benefits depending on whether quotas were filled, and that in cities and villages, especially in the Andes, 'festivals' or campaigns for tube tying were organized. Evidence was also compiled indicating that some women had not given their signed consent for this surgical procedure or that they had not been informed that it was irreversible, and that food or other items had been offered as rewards. The women who had operations stated that there was a lack of good quality conditions and professionalism during the operations. In other cases, women were found to have died after the operation and no explanation were given nor was compensation provided to their relatives.
The information collected indicated that there were indeed violations of the human rights of women, including their right to health, and that practices existed that violated national and international instruments in at least 243 cases.⁴⁰ The Ombudsman's Office, through its Office of the Special Ombudsman for the Rights of Women, also carried out an investigation. Its latest report, still unpublished, includes 157 cases received between June 1997 and May 1999.⁴¹ Meanwhile, the Vice Minister of Health admitted that in the case of the blocking of fallopian tubes, it was possible that there had been "an excess of enthusiasm [!], some government employees could have committed excesses”⁴² and the daily El Comercio continued to publish more evidence and editorials on the subject⁴³ with an emphasis on slanting public statements against family planning and especially VSC and on the defense of women: "the conditions of misery and ignorance of rural women," the segment of the population which is the most "pauperized, the least educated."⁴⁴
It is not the purpose of this study to analyze in detail these denunciations, negotiations, complaints filed, accomplishments and disagreements in various arenas, public and private, regarding the implementation of surgical sterilization in the last three years (though these should be the subject of another study) but it is important to stress some pertinent aspects because they shed light on the complex but at the same time fragile interaction between the state and feminism in Peru.
One thing that stands out is the capacity of those sectors that oppose the use of VSC, whether feminist or conservative groups, to exercise political pressure on the international scene and, consequently, the importance that international venues have acquired in the last years both as instruments for the achievement of a better position in the exercise of political pressure and as arenas in which to settle internal conflicts that cannot be solved through national entities. Such venues included the United Nations and the CEDAW (1998), the Inter-American Court of Human Rights (1998), and the U.S. Congress (1998). In the case of the latter institution, two users of health services and a doctor presented testimony in U.S. congressional hearings regarding what was labeled as "a massive sterilization campaign" in Peru. Previously, in January 1998, a mission made up of an advisor to the Sub-Commission on International Operations and Human Rights of the U.S. Congress, a conservative member of the Institute for Population Research in the U.S., and a member of the "Alianza Latinoamericana para la Familia" visited Peru. One member, David Ziedler of the Alianza, state that in Peru "there is a war against poor women."
Another aspect that needs to be stressed is the visibility in the press studied of the positions taken by the Catholic Church and its allies. At times, during these three years, the conflict regarding VSC seemed to be a game of ping pong between two players: the church and the government. The protagonism of feminists was much less visible for two main reasons: the mimicry between the Catholic conservative and feminist discourses and the fragile articulations among feminists.
In effect, as has been noted above, the Catholic Church played a leading role in the protests from the time that the blocking of fallopian tubes and vasectomies were included as part of family planning services in public health centers. Since 1995, the first arguments employed against these measures emphasized, as they continue to do, the defense of the "dignity of the human being."⁴⁵ Later arguments also stressed the "dignity of the poorest population"⁴⁶ and portrayed "sterilization" as "an attack on the dignity of the woman."⁴⁷ Bishop Cipriani used the same phrase -- "the dignity of the woman" -- as the title of an editorial on family planning and the "mutilation" which was allegedly the result of VSC.⁴⁸ In a controversial statement a little while later, the same bishop stated that "the tying of tubes is to declare that Peru is a whorehouse."⁴⁹ Broader arguments -- human rights and the alleged unconstitutionality of the law that made VSC available in public health centers -- were employed early on in a communiqué by the Pontifical Catholic University of Peru which concluded that "the law gravely violates human rights."⁵⁰
The discourse of the Catholic Church emphasized appeals to the dignity of women but at different times, differing emphases prevailed in its discourse. Given the warning that VSC "opens the door to aggression against health and physical and moral integrity,"⁵¹ the campaigns for blocking fallopian tubes stressed that these "were carried out without the minimum guarantees for sanitary conditions and medical assistance."⁵² It was also argued that these campaigns constituted "coercion of individual liberty without precedents" and "against the freedom of the poorest women" (emphasis ours).⁵³
Together with the violation of human rights -- physical integrity, individual freedom -- a third theme of ecclesiastical argument was to accentuate the characteristics of the social sector subject to these violations. Thus, in an article entitled "The Poor are Innocent," an advisor of the Peruvian Episcopal Conference editorialized about the sterilization of poor women in rural areas: "[the] selective reduction of one social group which also has determined ethnic characteristics [demonstrates that the government was engaging in] racist eugenics."⁵⁴ This view was shared by Salazar Larraín, an opposition congressman linked to the Opus Dei, who in a speech before the congress stated that the VSC campaigns fomented "rural extermination."⁵⁵ Scandalized, another advisor of the Episcopal Conference stated that,

the whole country has discovered, with stupefaction, that the ignorance and misery of peasant women in some rural areas of the country has been taken advantage of to obligate them, without the previous provision of adequate information about the irreversibility of sterilization.⁵⁶ (emphasis ours)

Another line of argumentation was the simple equation according to which one sex without the capacity for reproduction would rob us of the soul and, therefore, "animalizes" us. Zoomorphism was also present in various comments by the church hierarchy ("we are neither swine nor horses to be sterilized," said the Bishop of Arequipa⁵⁷), a line of argumentation that culminated in these declarations by Bishop Cipriani, a member of the Opus Dei:⁵⁸ "If the Minister of Health wants to treat us like animals, he should be thrown out of the Ministry."⁵⁹
On February 18, 1998, the latter argument was perhaps the most visible point of agreement with feminists. Thirteen women's organizations, among them the two feminist NGOs that participated in the MT, issued an Open Letter to President Fujimori, in which, among other things, they demanded an end to demographic goals, the elimination of the priority given to VSC as a method (there was information that VSC was practically the "only option" that was offered to women who asked for a method of contraception), the revision of the Manual of Procedures for VSC, the implementation of the recommendations of the Ombudsman's Office (who had spoken out on the issue), and the replacement of the Minister of Health. Asked about the similitude to the demands of Bishop Cipriani, a feminist stated that,

It is only a coincidence [...] We are in agreement with family planning programs because it is our right to decide how to take care of ourselves. The problem is that the Church has gone to the other extreme and has generated chaos and confusion among Peruvians.⁶⁰ (emphasis ours)

But there was more one point of agreement. Perhaps the strongest or most convincing argument used by the Catholic Church to generate public compassion was to emphasize that the women who underwent VSC and/or were pressured to do it were 'poor', 'ignorant', 'had little education', were 'miserable', 'peasants' and, in addition, 'indigenous', without at any time mentioning that among the rights they had as citizens was the right to choose a method of family planning. In this case, what Guerrero⁶¹ calls a double-edged 'liberal discourse' was used about the indigenous population. On the one hand, Indians are seen as naive creatures, as not reaching the category of adults, are objects of manipulation, do not have a will, are incapable of expressing themselves and assuming their own defense, while on the other hand, the discourse suggests a strategy of condescension to those who are inferior, the magnanimity of treating Indians as 'human beings'.
This transition from the woman 'subject to rights' to the 'poor ignorant' woman against whose suffering the most conservative voices of the Catholic hierarchy and their followers raised their voices in face of the denunciations regarding the VSC campaigns (but were mysteriously silent in past years when the issue was the "social commitment of the Church") was also an angle (ignorance, misery, the conception of Andean peasant women as minors) that was used by some feminists:

We believe, in contrast to other radical positions, that couples have every right to plan their families. Nevertheless, what we will not permit is for the government, in its effort to reduce poverty, to decide to take advantage of the ignorant population to sterilize it. (emphasis ours)

Asked if denunciations existed about women submitted to this procedure without their authorization:
[...] this is a great problem. The clients still do not think this is a violation of their rights. In addition, you can imagine a Quechua-speaking woman telling the police what happened, obviously the only thing that this will accomplish is that they will make fun of them and hurt them.⁶² (emphasis ours)
On the other hand, despite the fact that the concept 'sterilization', used to describe voluntary surgical contraception, "was not a technically correct concept and in addition, implied a strong ideological component that did not benefit women,"⁶³ the word was used repeatedly in conjunction with 'mutilation' in the public declarations of the Church as well as by feminists. VSC campaigns, it was said, were "a form of forced sterilization."⁶⁴
Throughout 1997, though without a coordinated strategy, feminist groups in Lima presented evidence on the violation of the human rights of women to the Ombudsman's Office and other public institutions and made contacts with the press. In mid 1998, the recommendations of the report on violations of women's human rights in health centers⁶⁵ were discussed with the Peruvian Mission to the United Nations and CLADEM and the Centro Flora Tristán in Lima continued to meet with government officials. In sum, there was dialogue and political pressure by some groups of women starting in the first half of 1998 and some of their recommendations were beginning to be implemented by government at the same time as official denials continued. In the meantime, the Mesa Tripartita, almost one year after its establishment, still had not made a public statement on the issue.
Another of the actors that took part in the debate were doctors. In January 1998, the Colegio Médico del Perú decided to set up a high level commission to evaluate the Family Planning Program. This commission confirmed that the government had set up VSC quotas and that these affected the doctors’ rights, doctors and other officials were being pressured, etc. The conclusions of the evaluation led the Colegio Médico to ask for an end to the program of voluntary surgical contraception "that would permit it to be re-engineered to guarantee respect for the rights of individuals, doctors as well as clients."⁶⁶
According to the statements of some feminists, during the first part of the public debate, the point was to emphasize the central theme of violations of women's human rights that had to be stopped without affecting the right of access to family planning methods including VSC. In the first days of January 1998, in a letter to the president of the Commission of Women of the congress, the Centro Flora Tristán, stated that,

[...] throughout our existence, we have maintained a coherent approach to the struggle of women for their sexual and reproductive rights. We were the first to deplore the irregularities that were detected in the application of the program because we know how effectively this could provide arguments to those sectors that are not in favor of these rights, with the danger that what has been achieved so far can be lost.

Another feminist from the Movimiento Manuela Ramos said in an editorial that,
The majority of the arguments used do not stress what is essential: the reproductive rights of individuals, understood as the decisions about their reproductive capacities and access to the means by which these decisions can be implemented without endangering their health nor their lives.⁶⁷
This aspect of the issue was also underlined in the February 1998 Open Letter to the President of Peru mentioned earlier and is stressed again in the statement of the Movimiento Manuela Ramos on March 8, 1998:
We, the women of Peru, have the right to exercise our sexuality in accordance with our convictions, personal orientations and sexual preference, and to have access to the fullest range of contraceptive methods in order to carry out our decisions free from all forms of coercion, deception and violence [...] Neither in the private sphere nor in the public sphere, nor in the name of ideologies, religious beliefs, customs of 'reasons of state' can the sexual and reproductive rights of women be limited...
In spite of the fact that some women expressed drastic opinions, including Yolanda Rodríguez, the regional coordinator of the Red Nacional de Promoción de la Mujer, the third women's NGO that made up the MT, who asked for "the suspension of the Family Planning Program that is being carried in the whole country because of the unfortunate deaths of women who suffered botched operations to block fallopian tubes as part of this program”⁶⁸ (emphasis ours), these first months of 1998 (after the joint Open Letter to President Fujimori and despite the some internal tensions) left open the possibility of future joint actions. However, these did not take place.
Though other issues regarding this matter will be discussed later, here it is important to note that the diaspora of feminine wills in the world of NGOs was strongly influenced by the hardening of diverse opinions about strategies regarding relationships with the state. While some feminist voices became ever more strident and hardened their position vis à vis the Fujimori administration, others (some of them important women's NGOs) tried to maintain the dialogue which their fluid relationship with political authorities permitted them. The most important issue was, once again, strategy. In the context of denunciations about VSC, for some "agreement with the Church will not stop us from denouncing human rights violations for reasons of principle."⁶⁹ The subject was treated using two arguments:
To what extent is it necessary to retrace one's steps in the establishment of family planning services and to what extent can this strengthen the position of the Church? The answer we had was that never, in the case of violations of human rights of women, have we been held back by any other consideration.⁷⁰
From the other point of view, there were those who thought that,

When you work on human rights, every single case is important, it is not a question of percentages, but in this case, nevertheless, we face a policy, a program [...] and we reacted at a time when the information about VSC was being used by conservative sectors, such as the Church, to destroy family planning.⁷¹

We are looking for an objective analysis of the situation and for this reason we recognize that there were valid denunciations but the way the press presented the magnitude of the problem was not based on solid evidence.⁷²
Finally, it was thought that, "it is just as much a violation of the rights of women not to given them information so that they can make an informed decision as not to give them the VSC services, which is the democratization of access."⁷³ Thus, according to one feminist from a women's NGO, the question could be more complex: "What is the point of equilibrium between strategies of generating agreements and negotiation with the state and strategies of denunciation and control. This is the focus of tension that we are trying to resolve, although individually, each institution, each person."⁷⁴
This tension, ambivalent and contradictory, has marked the feminists of the 1990s. They are oriented towards effecting a transformation that brings women closer to equality in the 'really existing' democracies and, at the same time, towards trying to subvert, increase and radicalize democratic political systems.⁷⁵ María Luisa Tarrés describes this tension as a difficult equilibrium between ethics and negotiation in which you win

... with ethical values set within a strategic calculation [...] the ethical value is that which is priceless and refers to the dignity of individuals which cannot be negotiated. The strategic calculation simply refers to reasoning in terms of the costs and benefits that an action can have for individuals or groups and, by definition, incorporates negotiations. The separation of these dimensions has immense costs for movements that, like feminism, propose radical changes in generic relationships. If the movement only values ethical issues, the result will probably be its social isolation [...] On the contrary, if the activities of the movement are reduced only to strategic negotiation, women will probably gain some offices, increase their part of the cake but will not be able to change the recipe [...] A purely strategic action would lead to 'womanism', emptying the movement of its potential for cultural transformation.⁷⁶

The equilibrium to which Tarrés alludes is more precarious in Peru because negotiation of the 'possible' takes place in the framework of a lack of democracy. Even in the case of public entities open to dialogue, the lack of articulation between the affirmation of the right of women to self-determination and demands for the transformation of socioeconomic and political conditions that permit them to exercise these rights implies a high cost. Thus, while some feminists retreat and give priority to accountability and denunciations regarding the possibility of having a direct influence on policies, other groups emphasize state-centered strategies through moderation in discourse: negotiation. In the case of the evidence on VSC, the possibilities of strengthening and publicizing a feminist 'third way', equidistant from the Peruvian government and the Catholic Church, surprisingly disappeared.⁷⁷ One issue, that of sexual and reproductive rights, which also includes the whole gamut of contraceptive methods and which was the center of the efforts, mobilizations, studies, and public activities of feminists in the last decades, was taken out of their hands. Moreover, some feminist issues were selectively appropriated, re-elaborated, and gulped down by two new and uninvited guests at the table served by feminism, which ended up, as feminist Sonia Montaño suggests, thrown out of the banquet.⁷⁸ As a result, the image of the movement garnered from those interviewed inside and outside was that of:

A movement in crisis, disarticulated, absent from the debate between the government and the Catholic Church, without the capacity to bring people together and coordinate a plan, among feminists there are a series of disagreements and this also contaminates the Mesa [Tripartita].⁷⁹

According to the same source, one of the manifestations of this situation was the difficulty of establishing alliances within the women's movement and a turn toward human rights organizations.
A long comment by one of the informants on this aspect of the issue appears to be valid:

The place where a strategy should have been developed is CLADEM, but the issue appeared when CLADEM was weakened for the same reason that all women's groups and NGOs were weakening: there are different positions regarding how to work to obtain things and one of the issues involved is the relationship with the state at this time and the incapacity to debate. So it seems that we are all in agreement but no one does anything [...] In practice, you start to make alliances among these groups and this [inactivity] makes you lose a lot of strength and you begin to look for alliances elsewhere, but not as part of a well thought out strategy nor the accumulation of knowledge and experiences of a group that is supposedly there, sustaining your activities [...] we made alliances with human rights [groups] but they weren't sufficiently strong and well-developed to take further steps and evaluate them and then, too, the media had a very important role that many times forced [us] to hurry to take steps. I think that control of the situation was lost and this has to do with women's organizations having been caught in a situation of considerable weakness [...] This has a lot to do with the desire to play an important role by individuals more than by institutions [among women's NGOs] together with feelings of loneliness and a lack of confidence in others.⁸⁰

For one group, "it was a very complicated moment for Flora Tristán [...] they let us know that we were putting in danger the progress made in Cairo and that adopting a position of autonomy implied a confrontation with the government."⁸¹
AND SO WHAT IS THE MESA GOOD FOR?⁸²

While the debate continued its course, the meetings of the Mesa Tripartita were held periodically. Between July 1997 and October 1998, the few minutes taken in meetings do not mention the internal discussions that were the result of the ever more frequent denunciations and opinions expressed in the media regarding VSC. The reasons could go beyond the procedures for taking minutes and remind us of the lack of precision about the nature of the MT: to be or not to be a space for 'reaching agreements', and if it is to be such a space, on what basis are agreements to be reached regarding the monitoring of the Action Program of Cairo when those who carry out the implementation and those whose who held them accountable are in the same group? What are the mechanisms or procedures for the functioning of the MT? What are the characteristics of the identities of the organizations of civil society that are representative of/represent civil society? And, finally, to what extent do contractual relations between women's NGOs with the government neutralize their political activities?

One 'representative' of the government, the Ministry of Health, is part of the MT and

had the opportunity to present its position [but since] in the opinion of the Ministry there were "few" cases they didn't consider them important [...] then the denunciations became public and on a large scale because the MINSA didn't respond, didn't react, but this is a problem of the Ministry and not the Mesa.⁸³

This opinion is partially shared by another informant, who states that,
The subject of VSC was raised at the Mesa and we expected the MINSA to react, but the Ministry didn't give it importance, not in the Mesa and not in the media [...] and later they told us that it is not very ethical to make public a denunciation without first going through the Mesa Tripartita.⁸⁴
Here we seem to have another example of confusion in the identities of the actors that make up this space which was supposed to foster the reaching of agreements and monitoring the implementation of an international agreement assumed by the Peruvian government. For one person,

This is the way politics are carried out in this country: the Mesa is a public space that became domestic space, it was privatized and regarding the issue of VSC, informal conversations were held, there were rumors and opinions expressed on the telephone. In this way you lose the opportunity to use a formal channel, with formal mechanisms, to make denunciations.⁸⁵

This impression is shared by another member of the Mesa who commented that,
What we are trying to bring up in the MT are themes for discussion, which suddenly can't be brought up, to certain extent, officially, but you can bring them up unofficially: the problem of services, the denunciations that came out a year ago [regarding VSC], these are subjects that we took to the Mesa for an 'unofficial' conversation, more because of friendship than as a result of the offices we held.⁸⁶
Given this context, it is a bit strange that a government official, a member of the MT, who, according to the minutes of the meeting of October 10, 1998, requested that the members of the Mesa Tripartita "channel these types of matters [public denunciations regarding sexual and reproductive rights] first through the Mesa." Later, after an interchange of letters and a tense situation between one of the feminist NGOs in the Mesa and a representative of the public sector, an even more surprising a procedure was suggested, quite unusual among "a group of friends and trusted professionals." According to the minutes of this meeting:

The members of the Mesa, after reading both letters, agreed on the necessity of channeling through the Mesa, as the first instance, any indication of problems having to do with the issues of population, sexual and reproductive health that constitute the objectives of this Mesa.

Later, on February 5, 1999, almost two years after it was created, the Mesa Tripartita issued a public communiqué on the use of VSC that states that the information that in Peru a program is being carried out of "mass, coercive sterilization is considered erroneous [by the Mesa] because it does not reflect reality." The communiqué admits that there were quotas to be met, insufficient information to clients, etc., and states that the recommendations made have been implemented and that there have been changes to VSC manuals. The statement served to continue dividing opinion: for some, it was an achievement that the government (various ministries) had recognized its errors and the existence of what had been repeatedly denied in previous years, but for others interviewed, the communiqué was only a "whitewash" of Fujimori, almost 'shameful'. In fact, some changes had taken place as a result of the pressure of groups of women and public denunciations. For example, the VSC Procedure Manual was revised and according to information from the Ombudsman's Office, this could have had a direct impact in the denunciations processed: out of a total of 157 cases related to VSC collected by the Ombudsman's Office around the country, 137 (90%) took place between 1997 and March 5, 1998, the period during which the two previous manuals were used.
If, as some of the people interviewed for this study assure, the denunciations about the implementation of the family planning services and the emphasis on VSC were an extreme situation testing the capacity for action of the MT, it would seem to be necessary to go back further to find a global framework to analyze the experiences of the alleged consensus-building with the state. This framework is the political system. As indicated at the beginning of this paper, Peru is an atypical case. It has an administration that was elected in 1990 under the rules of representative democracy and later re-elected after a 'self-coup' that enjoyed the support of the majority of the population. A new period began, not only of reforms inspired in neoliberalism and its rules of the game, but also of the continuing closure of channels of citizen participation leading to a concentration of decisions and power in the hands of the central government and in the hegemonic figure of the president. The administrative capacity of municipal governments has been reduced and, to an even greater extent, there has been a reduction in the decision-making power of middle level personnel in public administration, something which has virtually disappeared.
Although there is no direct evidence, reliable sources contend that not only did methods of family planning other than VSC virtually disappear in public health services, but that this decision was taken directly in the executive branch based on the conviction that blocking fallopian tubes was the most efficient option, in terms of costs and benefits, to diminish demographic growth. This decision, of a basically technocratic nature, could have been the source of the quotas and 'festivals' of tube tying, the pressure on health centers to implement them, the threats against personnel in medical centers and hospitals to force them to carry out VSC, and the subsequent violations of the rights of women. As one informant states,

There is evidence of numerical goals, of pressure and the politization of the program, which is the worse that could happen. The program was politicized because the President himself thinks that this is one of the most important strategies in the struggles against poverty. Such quotas had to be met and that was that. It has to do with the vertical structure of the Peruvian government [and in taking the decision] the harm that this program and its quality could cause were not taken into consideration. It was a two-edged sword.⁸⁷

If this was a situation of high-level politics, the Mesa Tripartita was a little laboratory:

There were expectations that [the Mesa Tripartita] would be space for reaching agreements on policies, in which everyone had the capacity to participate in decision-making, but the political system is not propitious: Fujimori decides everything.⁸⁸

The Peruvian woman does not seem to have "her destiny in her hands" in this Family Planning Program despite the President's promise in his message to the nation on July 28, 1995. The intentions behind this speech and the even more belligerent, anticlerical and quasi feminist speech before the World Conference on Women in Beijing began to become evident not only in the hearings on the denunciations in the U.S. congress but also in the repercussions in the international press. For example, on December 26, 1998, the Spanish daily, El País, on the basis of the Tamayo investigation cited above, called attention to the issue with the title "250,000 Peruvian Women Sterilized in Three Years." It went on to say that the Fujimori government had applied "a systematic campaign of sterilization of thousands of women in the poorest areas of the country. In total, 250,000 Peruvian women were sterilized over a period of the last three years, many of them without their consent." Similar analyses appeared in the Sunday Telegraph of London, the BBC, the New York Times, and other media. The information was sufficiently ambiguous ("many of them without their consent") and the moral aspect was accentuated through reports of "a systematic campaign of sterilization of thousands of women" that got so out of hand that 250,000 thousand women "became sterile" that the impression could be nothing else than that there was an extermination in progress against a defenseless population.⁸⁹ This quarter of a million Peruvian women were, from the point of view of the international press, unthinking and submissive masses, in general terms: inhabitants of the Third World.
Nevertheless, the fact that this information received so much publicity internationally resulted in demonstrating that "The Emperor has no clothes." Possibly irritated by the internal repercussions of the denunciations and what he considered an attempt "to politically damage the government," Fujimori spoke before the United Nations' "Cairo +5" meeting using as his central argument an issue that had already been overcome in the Action Program of the International Conference on Population and Development in Cairo in 1994: the Peruvian Family Planning Program attempted to end the "vicious circle of poverty-unwanted children-poverty" because "we have to definitely break this circle using realistic population policies with a macroeconomic basis that permit the stability necessary for sostained national development."⁹⁰ Earlier, good sense would have prevaled over this line of argumentation which intrinsically contradicts previous presidential declarations about the freedom of women to plan their families and access for poor women to family planning services which were not available to them in the past.
But this was not everything. The Peruvian president settled, from his point of view, a tension that worred feminist activists, professionals from women's NGOs, and researchers: to what extent is it possible to maintain the identity of the original feminism, that persists in memory as a critical conscience and is recognized as part of a social movement, and not to obscure it with the identity of the expert that maintains contractual relations with the government. If at any time there were doubts that this was a false dilemma, President Fujimori provided clarification when, in the aforementioned speech, he said that

Evidently the [Family Planning] program has worked despite its critics and we would have advanced even more if they hadn't put so many obstacles in the way. Because not only have we had to fight against deeply rooted customs and the preaching of some conservative sectors, in addition, although it is difficult to believe, some non-governmental organizations that probably didn't have the participation in the budget they expected, joined in the campaign of some communications media and political sectors that, betraying their principles, acted against reproductive health programs. (emphasis ours)

In other words, the possibility to react critically, to hold the government accountable for its policies, and to pressure it for changes is not one of the faculties of society. If citizens, in this case NGOs, exercise their rights it is because they do not have access to the economic resources of the government. This degraded description of the contractual relationship of feminists with the current administration also can be understood in another sense: when they have "participation in the budget" of the government, do NGO's keep quiet?
In the "Cairo +5" meeting and in contrast to the strident presidential discourse, some of the persons interviewed agreed that the official Peruvian delegation to this meeting played a progressive role and engaged in dialogue to defend what had been achieved in Cairo in 1994. But what someone called the "Peruvian schizophrenia" in the meeting did not silence the reaction of women's NGOs, feminists, and collectives for reproductive health to the presidential speech. A communiqué rejecting its message was signed by dozens of Peruvian organizations and supported by other international networks attending the New York meeting appeared in Lima dailies on June 30, 1999. Of the three NGO members of the MT, only Flora Tristán signed.
RATHER THAN A CONCLUSION, MORE OF AN INTUITION

In previous studies in Chile and Colombia and in the fluid interchange between feminists worried about the course of the movement at the end of the 1990s, the subject of the relationship between feminism and the state has been recurrent. Feminists have fought to give their militancy and commitment a value that is not only political but also professional and thus many feminists have been able to have an influence in international forums, in national policies, and in arenas for public decision-making. The recognition of this ability and professional experience has led states and international cooperating agencies to ask, ever more frequently for feminists' advice and their professional services.

This incursion into the public apparatus coincides with the extensive transformations of Latin American states, drastic changes in economies, and the decline of social movements. In these new scenarios, the opacity of the original identities of feminists, who are ever more applauded for their considerable accomplishments in the public sphere and thus seduced by pragmatic viewpoints, lead to rely on state-centered strategies and to emphasize formal political spaces. Throughout these pages, I have stressed the recurrent tensions that occur among feminists in other countries in the region and that, in the case of Peru, these have become stronger as a result of the contraction of democratic openings on the terrain of the state that has put into question pilot projects such as the Mesa Tripartita.
But this dilemma, which initially could be seen as "state/government: yes or no," is much more complicated. The scenography -- or iconography -- at the end of the 1990s is clearly not like that of the 1970s, but the essence of feminism, which is the subversion of the situation of the woman in society, is unable to stop state and public discourses from manifesting and reinforcing the inequality of power between men and women and also among women. What is at issue here is something much more substantial than just the (op)position of feminists vis à vis their states. There has been a much more profound, and perhaps more dangerous, change in direction. Rejuvenated and in some circumstances, almost hegemonic, some feminist voices express a technocratic vision which is skeptical about the implications of political contexts and stripped of that political stamp which the persistent memory of feminism still tries to recover.
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