Peruvian prosecutors have reopened an investigation into evidence that during the 1990-2000 government of Alberto Fujimori thousands of women were forcibly sterilised, a practice that human rights groups say was official state policy and constituted a crime against humanity.
Local NGOs say they have proof that more than 2,000 Peruvian women were forcibly sterilised under Fujimori. But they believe the true number is closer to 200,000. Most of the victims lived in rural areas, were poor and barely educated. The aim of the programme was to reduce poverty by lowering the birth rate among the poor, who at the time accounted for one in two Peruvians, the groups say.
"It was a premeditated development policy because it was done fundamentally in areas of extreme poverty, rural and Andean," said Francisco Soberon, executive director of Aprodeh, Peru's leading human rights organisation. It was also racist because it chiefly targeted indigenous Quechua peoples, Mr Soberon said. Alejandra Cardenas of the Center for Reproductive Rights in New York said that not since Nazi Germany has a government employed forced sterilisation as an instrument of state policy.
Officials in the Fujimori administration have denied that women were forced to undergo sterilisation; instead they say the women signed consent forms. But activists say the women were deceived or threatened. All investigations were shelved in 2009, but President Ollanta Humala revived the sterilisation cases as a campaign issue before defeating Fujimori's daughter Keiko in an election for the presidency in June.
A senior official from the Peruvian attorney general's office has now informed the Inter-American Commission on Human Rights (IACHR) in Washington, a regional body with a similar function to the European Court of Human Rights, that the chief prosecutor's office has decided to reopen the cases.
The chief prosecutor's resolution on reopening the investigation cited a decision by the IACHR that a case it took up indicated crimes against humanity may have been committed. That could potentially mean another criminal case against Alberto Fujimori, who is already serving 25 years for corruption and human rights abuses related to death-squad killings.
In 1999, a year before Fujimori fled into exile amid a corruption scandal, his government reported that 300,000 women had undergone sterilisation in the previous five years as part of a birth-control programme. Activists say they believe Fujimori personally ordered the coercive sterilisations, and three consecutive health ministers carried the policy out.
One of them, Alejandro Aguinaga, claimed at the time that "all the patients signed consent forms in order to submit to the operation". Aguinaga was an adviser during this year's presidential campaign to Keiko Fujimori who, when asked about the sterilisations by Mr Humala during a debate, said that the cases had been closed.
The case investigated by the IACHR involved Mamerita Mestanza, a 33-year-old mother of seven who died in 1996 after being pressured into sterilisation. "Mestanza was told that a law had been passed and that she and her husband were going to be fined or imprisoned because they had [more than] five kids already," Ms Cardenas said. She was thus coerced into signing a consent form, taken to the surgery, returned to the clinic complaining of internal bleeding and died a few days later.
In a 2003 settlement with the IACHR, Peru agreed to pay Mestanza's survivors more than $100,000 and to provide her children with free education and other benefits.
Six years later, the investigation came to an end when the chief prosecutor's office ruled that neither the Mestanza case nor 2,063 other cases of forced sterilisations constituted a severe violation of human rights and thus should be shelved under the statute of limitations.
Brutal measures: Countries that have used mass sterilisation
Canada From 1928 to 1972 roughly 3,000 procedures were performed across Alberta and British Columbia.
China Coercive sterilisation to enforce the one-child policy.
Czechoslovakia, Czech Republic Starting in 1973, sterilisation of Roma women was carried out. Denounced in 1977-78 as a "genocide", but the practice continued after 1989.
Germany One of Adolf Hitler's first acts was to pass a sterilisation law. By 1945, more than 400,000 operations had been carried out.
Sweden From 1934 until 1976, 21,000 were estimated to have been forcibly sterilised and 6,000 coerced into "voluntary" sterilisation.
US California was in vanguard of the eugenics movement: 60,000 sterilisations done from 1909 until the 1960s.