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Constitutional tribunal rules in favor of EC.

Peruvian feminists Rocio Villanueva and Karin Velasco visited Chile to share their experiences related to emergency contraception in their country to offer insights that could be useful to Chilean groups fighting for access to EC. Ms. Villanueva is a former Ombuds and is currently a consultant to the United Nations Population Fund in Peru. Ms. Velasco also works in the UNFPA.

Rocio Villanueva

"The first time that the Ombuds Office sued in support of emergency contraception, I was the Ombuds. Peru's Ombuds Office supported this method as part of its overall health policy, but interestingly there was an outpouring of solidarity from a range of agencies that are very highly regarded on the national scene, which had considerable impact in favor of our cause. For example, the Physician's Association, the Peruvian Association of Obstetricians and Gynecologists, a group of law professors from the Universidad Catolica and the Universidad de San Marcos, as well as a range of highly renowned intellectuals. The UNFPA and the Pan American Health Organization (PAHO) sent statements of support through the Amicus Curiae process, and several Ministers of Health signed a public statement in support of the distribution of EC. This is considerably different from what has happened in Chile.


"Another important element was the fact that emergency contraception had been sold in Peru with a medical prescription in pharmacies since 2002 but without any difficulties or "moral" objections. From 2002 until September 2006, over 1.7 million doses of EC have been sold. The consensus was that we could not allow a situation in which people with money could purchase the method in pharmacies while those without means had no access to it, and that meant that we needed the State to guarantee the distribution of EC through the public health system.

"With regard to the legal situation, there were two pending cases on the constitutionality of EC and, theoretically, both had to be brought before the Constitutional Tribunal. One was the request for a temporary injunction against the pill presented by an NGO, the Accion de Lucha Anticorrupcion Sin Componendas (The Unceasing Struggle against Corruption), which has no connection to health issues. However, this suit against the distribution of EC through the Ministry of Health did not call into question the sale of EC through pharmacies. Then, another proceeding that we call a "proceso de cumplimiento" (request for enforcement) demanded that the State distribute EC free of charge in accordance with the regulations of the Ministry of Health. The Constitutional Tribunal first heard this latter suit and finally ruled in the context of the landslide of declarations in favor of EC, described above.

"For organizations like ours that are committed to the defense of human rights, it was very auspicious that we finally achieved a ruling by the Constitutional Tribunal. Before it ruled, the Peruvian court even asked the opinion of the Catholic Church, the Mormons and the Jehovah's Witnesses. The Catholic Church did not respond, but the other two stated that it was matter of individual conscience.

"On November 13, 2006, the Constitutional Tribunal ruled that the Peru has to distribute EC free of charge in accordance with the Family Planning Regulations because EC is a contraceptive method. Thus, the full validity of the 1999 Family Planning Regulations, which were modified in 2001 to include EC, was established definitively, and the state was responsible for fulfilling these regulations through universal access to emergency contraception for all women.


"A significant difference with regard to the Chilean case is that in Peru a resolution by the Ministry of Health never would have been the object of a ruling by the Constitutional Tribunal because their rulings are limited to the constitutionality of laws. They have nothing to do with administrative matters. Peru's Constitutional Tribunal heard the suit against the EC regulations because the plaintiffs requested the Tribunal to rule on whether the State had violated a constitutional right. On the other hand, in the Chilean case, the issue was whether the regulations had violated a constitutional right."

Karin Velasco

"Without a doubt, the leadership and networking of PROMSEX was essential to the success of the strategy to defend EC in Peru. This organization called on the Physicians' Association and the Peruvian Society of Obstetricians and Gynecologists; it networked with universities, and many intellectuals joined the cause of human rights. PROMSEX sought the support of the UNFPA and the World Health Organization, which even held press conferences to present the latest scientific evidence and to support EC distribution as part of a public policy of rights and equitable access.

"Through its representative, Jairo Palacios, the UNFPA was totally committed to supporting this cause of emergency contraception as an emblematic case. If this battle were lost, it could pave the way for a challenge to other methods of fertility regulation.

"I think that in Chile more work needs to be done to network civil society, to build leadership so that more organizations can shoulder this responsibility without burnout. You need the support of international cooperation, of course, since this is a process that could take years. The Ombuds Office in Peru, for example, has been committed since 2002, when it published the first report on EC."


RELATED ARTICLE: Chile, a pioneer in family planning

"In Latin America and the Caribbean, Chile was a pioneer in family planning services. This was government policy since 1964 in an effort to confront maternal mortality and morbidity resulting from unsafe, clandestine abortions and always based on services that people used of their own free will. Years ago, we talked about "family planning," but slowly this term was replaced with the concept of individual rights in sexual and reproductive health, which emphasized guaranteed access to the services and people's and couples' rights to make decisions over their sexuality and reproduction. This concept was the foundation that a group of civil society organizations--specifically, APROFA and ICMER--used to work with the Ministry of Health to prepare regulations based on criteria proposed by the World Health Organization."

Guillermo Galan, President of APROFA, press conference, December 14, 2006.

RELATED ARTICLE: Just look at the evidence

"I am shocked that there is so much controversy surrounding a method that has existed in Chile for many years, just as in the rest of the world. On the other hand, EC is also clearly an emergency method: it is much better to use regular contraception, which is much more effective. But how do we prove this?

* For example, of 100 women who have a single, unprotected sexual relation during the second or third week of their cycle (the non-fertile period), eight will become pregnant. But if they use EC, only two will become pregnant.

* If they are using regular hormonal contraceptives during their whole cycle, of these 100 women only one will become pregnant. But if they are not taking their contraceptive as prescribed, six to eight would become pregnant.

* If these 100 women had a single sexual relation during their fertile period, 18 would become pregnant. And if they used EC after they had ovulated, all 18 would become pregnant. For this reason, it is important to ensure women's timely access to EC: the closer they are to ovulation, the less likely it is that Levonorgestrel (the active ingredient in EC) will be able to inhibit ovulation.

"How does Levornogestrel work? Studies from the last six years show that it inhibits ovulation and interferes with the migration of sperm from the cervix to the fallopian tubes. But the drug does not prevent implantation. When EC was first introduced, no experimental data was available yet, and it was suggested that perhaps EC prevented the implantation of a fertilized egg. Today, we know that there is no scientific basis for such an assertion since EC has no effect on the endometrium. Unfortunately, the lawsuit presented to the Constitutional Tribunal is based on this erroneous assumption."

Soledad Diaz, Instituto Chileno de Medicina Reproductiva (ICMER, Chilean Institute of Reproductive Medicine), press conference, December 14, 2006.

RELATED ARTICLE: Morals cannot be imposed through a public policy

"Today, there is social discrimination regarding access to emergency contraception as well as many other services. Policies for the regulation of fertility are not the same for all socioeconomic groups in the country. Therefore, when a regulation is public health policy necessary for confronting the increase in unwanted pregnancies, especially adolescent pregnancies, we must defend it.

"Interestingly, the controversy surrounding EC actually has increased the number of people who visit the health clinics to ask for information on this method, and we are obligated to provide it. It is unacceptable that a health policy like the National Regulations on Fertility Regulation is being subjected to a legal proceeding, which in the event of an unfavorable ruling could result in even greater discrimination. Moral judgments do not in any way support the health measures that Chile needs."

Anita Roman, president of the Association of Midwives, second president of the National Federation of Health-care Professionals, FENPRUSS, press conference December 14, 2006.
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Article Details
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Publication:Women's Health Journal
Geographic Code:3CHIL
Date:Oct 1, 2006
Previous Article:Emergency contraception: The arduous defense of a human right.
Next Article:Individual perspectives, regional realities: LACWHN.

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