A review of A History of the Medical Control of Fertility in Peru, 1895-1976, by Raul Necochea Lopez.
In his dissertation, Raul Lopez challenges the body of scholarship by demographic transition theorists who study the history of population shifts in Latin America and who argue that the introduction of biomedical contraceptive technologies in the 1960s and the interventions of foreign countries promoting a Euro-American model of development have been primarily responsible for changes in the ideas and practices of medical fertility control in Peru. Lopez grants that biomedical technologies and transnational political actors have played a role, but his research illuminates the ways in which foreign birth control organizations working in Peru crafted messages that appealed to locally cherished family values, which facilitated eager participation in such programs. His research demonstrates how such organizations had to negotiate their interests with those of pre-existing local actors in order to take root in Peru. Lopez’s research also uncovers the use of indigenous and biomedical knowledges to control fertility in Peru long before the introduction of the birth control pill in 1960 or the IUD, and how not all of such practices were driven by foreign policy interests of outside countries (the U.S. in particular) nor oriented toward the limitation of birth rates.
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The recent history of reproduction politics between Peruvian citizens, medical authorities, feminists, the state, and the Catholic Church serve as the backdrop for the interest in the topic. Peru is a country plagued by high maternal mortality rates (currently 172 per 100,000 births, ranked 105th in the world; down from 230 per 100,000 in 1995) yet Peru is overwhelmingly Catholic (87.78%) and the Catholic Church openly opposes all contraception use. Unwanted pregnancies have often led Peruvian women to induce miscarriages or to seek illegal abortions. Injuries, hospitalizations, and death have been frequent results. Physicians and feminist critics argued that greater access to more effective and safer contraceptives could help diminish the recourse to abortions and also teen pregnancies, both of which contribute to the high maternal mortality rate.
In this context, surgical sterilization emerged in the 1990s as an option touted to empower women to assume greater control over their reproductive practices. The 1995 decision by the Peruvian government to legalize this option was welcomed by many advocates of women’s health and women’s reproductive rights, but recent accusations that women are being sterilized involuntarily has drawn critical attention to the practice and raised the specter of eugenics. Physicians in particular have suffered widespread accusations of abuse. Contradicting the notion that this is yet another historic episode of the state singling out poor and socially marginalized women for eugenic sterilization, Lopez has thoroughly combed the national archives of Peru to paint a much more nuanced picture of how Peruvians have sought and used biomedical technologies and indigenous knowledges since the late 1890s to increase the amount of control they wield over their reproduction and enhance its safety. His archival research also included the personal paper collections of a few of the physicians involved in the time period, as well as the archives of some US family planning organizations.
The dissertation tells the story of how at the end of the 19th century, biomedical experts in Peru identified population growth as the key to increasing the country’s prosperity and developmental progress. With this view, they considered abortion a threat to demographic growth and lobbied for its criminalization. Peruvian citizens often tried to work around these restrictions by inducing miscarriages for their unwanted pregnancies. Influenced by the cultural authority of the biomedical profession, policymakers accepted the view that rapid population growth was integral to the industrialization efforts of the state and looked to construct family planning policies in line with this goal. This objective found a natural ally in the teachings of the Catholic Church in relation to the acceptability of contraception use. In the post-WWII, Cold War period, when the leftist government of Juan Francisco Velasco Alvarado nationalized many industries, the U.S. and its capitalist allies began to interpret population growth in Peru as a threat, which precipitated a number of U.S.-based family planning organizations to make their way down to Peru and to promote the use of contraceptives.
For his thesis, Lopez draws upon Foucault in his analysis of how the biomedical understanding of the world becomes hegemonic and thereby the process in which people consent to the idea that medical science is the best way to make fertility into a positive and enriching aspect of life. Lopez also borrows Gramsci’s view of hegemony, which demonstrates how state order is maintained by the voluntary actions of citizens who grow accustomed to certain forms of life that multiple civil society institutions buttress. These theoretical frameworks allow Lopez to paint a nuanced picture of how foreign biomedical discourses on contraception clashed with pre-existing local practices and the complex negotiation between the two that ensued. We similarly learn how anxieties over the so-called “population explosion” of the 1960s clashed with both religious and military opposition to birth control, justified on different grounds but finding allies in each other. All these perspectives had to contend with women’s fears of being dishonored by out-of-wedlock pregnancies while outraged local male physicians assumed for themselves the right to police women’s sexual behavior.
Demographic transition theory finds its birth in the late 1920s and in many ways shares the same theoretical framework as economic history, which also becomes popular in the 1920s. Lopez’s main goal is to challenge the notion among demographic transition theorists that reproductive choices can be analyzed as rational acts of adapting to environmental and economic circumstances. We have seen and continue to encounter similar struggles within the fields of history (quantitative/demographic/economic historians versus cultural historians) and in anthropology (physical anthropologists versus cultural anthropologists), where scholars who seek to take a quantitative/data-oriented approach to the production of knowledge are pitted against those who seek to understand how people make meaning to structure their worlds and, thereby, their behavior in those worlds. As Lopez’s dissertation excellently demonstrates, any analysis of family planning practices – in this case in Peru but applicable anywhere – that investigates the influence of economic conditions and biomedical technologies, absent an analysis of the meaning-making practices that frame people’s reproductive choices, can easily result in shoddy conclusions. Such conclusions, which often have policy implications, deserve strong scrutiny.
Jason E. Glenn
Assistant Professor of the History of Medicine
Institute for the Medical Humanities
University of Texas Medical Branch
Archivo del Congreso del Perú, Lima (ACP)
Archivo del Ministerio de Salud, Lima (MINSA)
Archivo del Movimiento Familiar Cristiano, Lima (MFC)
Archivo General de la Nación, Lima (AGN)
Archivo Histórico de la Facultad de Medicina de la Universidad Nacional mayor de San Marcos (Thesis Collection)
Papers of Dr. Joseph Kerrins, St, Petersburg (Florida) and East Falmouth (Massachusetts) (KP)
Papers of Dr. Miguel Ramos Zambrano, Callao (MRZ)
Rockefeller Archive Center, Population Council collection, Tarrytown, New York (RAC-PC)
Records of the National Catholic Welfare Council, Catholic University of America, Washington, DC (NCWC)
Sophia Smith Collection, Papers of the Planned Parenthood Federation of America, Smith College, Northampton, Massachusetts (SSC)
McGill University. 2009. 374pp. Primary Advisor: Andrea Tone.