A History of Family Planning in Twentieth-Century Peru.

Stern, Alexandra Minna

A History of Family Planning in Twentieth-Century Peru, by Raul Necochea Lopez. Chapel Hill, University of North Carolina Press, 2014. 256 pp. $32.95 US (paper).

In this well-researched and smartly-organized book, Raul Necochea Lopez expands and complicates the historical narrative about reproduction, contraception, fertility, society, and the state in modern Peru. Necochea is particularly interested in exploring the shifting constellation of actors and organizations that promoted, suppressed, and interacted with family planning during a long period marked by urbanization, civil war, political upheaval, and advances in reproductive medicine and technologies. Moving chronologically, the book's seven substantive chapters follow the variegated development of family planning from the beginnings of academic medicine in the nineteenth century to the formulation of population policies after World War II. Although Necochea does not offer an in-depth assessment of the extensive sterilization campaign carried out in the 1990s, which involved tens of thousands of tubal ligations performed on Indigenous women, he does provide a compelling historical context for understanding how such a social program could have emerged in Peru under the neoliberal regime of Alberto Fujimori (president, 1990-2000).

This book explodes several pieces of conventional wisdom that frequently undergird studies of reproduction and fertility in Latin America. First, Necochea demonstrates that abortion, while illegal, was not heavily criminalized for the first two-thirds of the twentieth century in Peru. For many decades, with high rates of maternal and infant mortality, other common forms of pregnancy loss easily could overshadow abortion. At the same time, many leading physicians sympathized with the economic and social conditions that prompted women to seek therapeutic abortions. Indeed, by examining criminal cases from Lima involving abortion or suspicious miscarriages between the early 1960s and late 1970s, Necochea reveals that a drastic rise of police investigations of such cases did not start until around 1973. This chapter is doubly impressive, because of Necochea's multi-layered archival research (medical records, legal documents, and a range of primary sources) and his careful discussion about the need to analyze abortion in Peru in its unique social, political, and medical milieu. This caveat is particularly important for Anglophone and American readers accustomed to thinking about abortion as a stand-alone contested and stigmatized practice throughout the twentieth century.

Second, one of Necochea's most fascinating chapters explores the seemingly unexpected programs run by the Catholic Church, which offered birth control pills alongside health exams, sexual education, and parenting classes. Rather than reject birth control as unnatural, after WWII some Catholic leaders in Peru promoted the use of oral contraceptives, viewing them as compatible with the responsible regulation of fertility. Necochea delineates how domestic Catholic groups sought to improve the welfare of Peruvian families in various ways, such as women's empowerment. He then traces religious debates about family planning through various levels of Catholic hierarchy, highlighting the tension between the Church's commitment to addressing poverty among struggling, and often large, families, and the papal entreaties to reject reproductive technologies and interventions. Necochea profiles Dr. Joseph Kerrins, a New England Catholic, who, with his wife, undertook mission work in Peru in the 1960s. Allying with local Catholics, the Kerrins encouraged the use of oral contraceptives, which they called "anovulatories," for shorter periods of time (18 to 24 months) to support healthy and well-managed families. Eventually, the Kerrins joined forces with American pharmaceutical company Warner-Lambert to distribute one of their brands of the pill, an alliance that backfired when the Kerrins were denounced as foreign agents of US imperialism.

Necochea adds nuance to the history of family planning in other chapters as well. For example, he deftly analyzes the contours of eugenics in early twentieth-century Peru, which was as concerned with racial degeneration and racial poisons, such as tuberculosis and syphilis, as with female sexual morality and policing male sexuality. He elucidates the contradictory position of the state vis-a-vis family planning. Like most governments around the world, starting in earnest in the nineteenth century, Peru became invested in studying and shaping its population through intertwined policies targeting immigration, reproduction, and demography. For the most part, these efforts were aimed at urban populations and, depending on the decade, were directed by some configuration of religious, medical, public, or international entities. Overwhelmingly, Peru's heterogeneous family planning proponents stressed that environmental and structural factors needed to be addressed for families to achieve higher levels of education, income, and reproductive control. These sentiments were articulated clearly in the 1976 Population Policy Guideline, a landmark document that, according to Necochea, remains both unfulfilled and exceedingly relevant today.

With this monograph, Necochea models the kind of history that, in his words, will permit us to better grasp "the vast, underexplored, and rich territory of inquiry that we have only begun to consider, one that emphasizes the common features of the region in response to the conundrum of determining the place of birth control programs within national development strategies" (122). A History of Family Planning in Twentieth-Century Peru is a wonderful achievement and a welcome addition to the scholarly literature on reproduction, gender, the state, society, and governance in modern Latin America.

Alexandra Minna Stem, University of Michigan