Forced Sterilisation and Transformative Reparations: The Inter‑American Court’s Seminal Judgment in Ramos Durand et al. v. Peru

[Clara Sandoval is an international human rights lawyer, Honorary Professor at Essex University, and founding member of the Essex Transitional Justice Network. She is also a visiting professor at the Geneva Academy, and Director of Programmes at the Global Survivors Fund where she works on reparation.]

The author served as expert in this case, providing analysis on Peru’s reparations framework, including REVIESFO, and outlining the forms of reparation that could be necessary to adequately address the violations that took place. 

On 5 March 2026, the Inter‑American Court of Human Rights (IACtHR) delivered a landmark judgment in Ramos Durand et al. v. Peru, holding the State internationally responsible for the forced sterilisation and subsequent death of Celia Edith Ramos Durand in 1997, and for the profound harms suffered by her three daughters, mother and husband. The decision is the result of litigation carried out by CEJIL, the Centre for Reproductive Rights (CRR) and DEMUS on behalf of the victims, and crystallises the connection between economic, social and cultural rights (ESCR) and civil and political rights (CPR) through the right to health (paras. 110-114) and the imperative of free, prior, full and informed consent in reproductive health care (paras. 115-119). 

The Court recognised that Peru’s National Reproductive Health and Family Planning Program (PNSRPF) between 1996 to 2000, was a coercive state policy, disproportionately impacting approximately 24.563 men and 314.605 women most of them indigenous, rural, and poor women (para. 52). While the Court stopped short of labelling Peru’s policy as a crime against humanity, it underscored the gravity and systemic nature of the violations and the institutional violence underpinning them.

This is the first time that the IACtHR has considered that forced sterilisation constitutes a form of reproductive violence (para. 173), and the first time that a regional human rights court has directly confronted Peru’s forced sterilisation policy and recognised its systemic, state‑driven nature. This moment did not arise in isolation. It builds on a foundational trajectory of cumulative strategic litigation over more than two decades—from the seminal case of María Mamérita Mestanza that ended up on a friendly settlement agreement in 2019 before the Inter‑American Commission (CIDH), to the landmark views of the CEDAW Committee in the communication submitted by Maria Elena Carbajal Cepeda et al. CEJIL, DEMUS and the CRR were also among the litigants in the case of Mestanza. 

While the judgment introduces significant normative developments, its contribution to reparation should not go unnoticed. Once again, the Inter‑American Court demonstrates why it remains at the forefront of international reparation praxis, advancing a transformative and far‑reaching approach that few international tribunals have been willing or able to match. This is important to remark given the current backlash facing human rights law, especially in the areas of gender and reproductive rights. 

Key Findings on the Merits

The Court found violations of a wide catalogue of rights in relation to Ms Ramos and her relatives, including life, personal integrity, personal liberty, private life, access to information, family, equality before the law, and health, and also the rights of the child of Ms Ramos’s daughters. The Court further held that Peru breached its obligation to start an investigation ex officio (para, 188-191), and to carry out an investigation with heightened due diligence as a result of Ms. Ramos’ death (paras. 192-197) due to investigative failures and an impermissible 23‑year delay.

The Court expressly recognised forced sterilisation as “reproductive violence,” (para. 173) using article 7 of the Belém do Pará Convention, situating it within a broader, discriminatory policy context and advancing the jurisprudence it had begun to develop in I.V v. Bolivia and Beatriz and Others v. El Salvador. It reaffirmed that consent is not a formality; it must be free of coercion, informed, and genuinely autonomous — particularly for irreversible procedures like surgical sterilisation. In doing so, the judgment tightens the link between economic, social and cultural rights and civil and political rights by treating health (under article 26 of the American Convention), information, and (reproductive) autonomy as interdependent pillars of human dignity (paras. 115-119).

When considering the alleged violation of the right to life, the Court also found that there was medical negligence (paras. 165-171) because of the absence of adequate pre-surgical assessment, and the decision to perform the procedure in an ill‑equipped facility, all connected to the complications that caused Ms Ramos’ death.

The Transitional Justice Process in Peru and Forced Sterilisation: a Damaging Omission

While the judgment is groundbreaking, there remain notable omissions. Despite having sufficient information to present a fuller picture of the context in which Peru’s forced sterilisation policy operated, the Court did not fully explore the broader historical and political landscape. The programme was implemented during the authoritarian regime of Alberto Fujimori, a period marked by both state repression and the armed conflict with the Shining Path. Yet, despite occurring squarely within this era, forced sterilisation was excluded from Peru’s transitional justice mechanisms when the country transitioned back to democracy, leaving a major chapter of state policy unnamed and unaddressed.

Indeed, Peru’s transitional justice architecture, built around the Truth and Reconciliation Commission (CVR) and a subsequent Integral Reparations Plan (PIR), long omitted forced sterilisation, an exclusion that discriminated against victims of reproductive violence and hindered access to justice, truth and reparation. 

Although the case of Mestanza was filed before the CIDH on June 15, 1999, explicitly alleging a massive, compulsory and systematic state policy that targeted poor, Indigenous and rural women, the Truth and Reconciliation Commission (CVR) created in June 2001 did not incorporate forced sterilisation among the core violations it investigated. This despite the possibility of addressing it under categories such as torture or other serious injuries. 

That omission carried into the design of Peru’s Integral Reparations Plan (PIR) in 2005, which followed the CVR’s lines and consequently excluded survivors of forced sterilisation from the programme and its Victims’ Unified Registry (RUV). Later amendments in 2021 broadened categories by referring to “sexual violence in its various forms,” yet they still failed to explicitly recognise forced sterilisation as reproductive violence, leaving survivors without prompt, adequate and effective reparation. Sexual and reproductive violence are not the same even if they could be related.

Proceedings concerning forced sterilisation advanced in parallel to, rather than within, Peru’s transitional‑justice framework: the friendly settlement in Mestanza was approved on 26 August 2003, two days before the CVR released its Final Report on 28 August 2003. Subsequent measures such as the register for victims of forced sterilisation (REVIESFO) (2015) functioned primarily as an assistance registry, not as a reparation’s register.

While the Court expressly recognised that “the PNSRPF constituted a State policy aimed at promoting mass sterilisation as a contraceptive method, directed primarily at women in situations of vulnerability on the basis of their ethnicity and socioeconomic status, and implemented through threat and coercion,” (para. 152) it did not engage with the relationship between this policy and the broader context of Peru’s authoritarian years under then President Fujimori. Nor did it address how, despite occurring during this period, forced sterilisation was subsequently excluded from Peru’s transitional justice mechanisms, including the Truth and Reconciliation Commission and the Integral Reparations Plan. 

A fuller engagement with these omissions would have strengthened the historical and institutional analysis underpinning the judgment. Such analysis would have also assisted the Court in considering the claim that this policy enabled the commission of crimes against humanity, an argument advanced by the victim’s legal representatives but left without substantive response, but addressed with great rigour by Judge Nancy Hernández López in her concurring opinion.

Reparations for Ms Ramos and her Family, and Reparations for Thousands: Crafting Transformative and Structural Remedies

In the immediate wake of the judgment at the beginning of March, public reporting highlighted compensation for the Ramos family (approximately US$340,000) and renewed focus on accountability for other officials after national criminal proceedings faltered. But the core challenge remains structural: How to avoid these violations from happening again? How to respond to the thousands of victims that have waited for more than a quarter of a century to access justice and reparation? How to move from piecemeal assistance to a rights‑based national reparation’s policy that recognises reproductive violence and guarantees non‑repetition?

The judgment orders a suite of individual and family measures including advancing criminal investigations and prosecutions (paras. 221-225), compensation for psychological rehabilitation (para. 230), publication of the decision (paras. 231-234) a public act of acknowledgment (paras. 235-237), a scholarships for university studies for Ms. Ramos daughters (paras. 238-240) and compensation (paras. 252-261).

Individual and family measures are essential building blocks but to be transformative, Peru’s response should address discrimination and the root causes that made this violence possible.  

The Court adopted this approach. To prevent this violence from happening again, the Court ordered Peru to adopt a normative instrument consolidating all rules on free, prior and informed consent, expressly incorporating the Court’s guidance on this matter; to review hospital protocols relating to informed consent and disseminate them nationwide; to prepare and circulate a practical guide on how to obtain informed consent in the context of sexual and reproductive health; to establish a national mechanism for receiving complaints regarding the absence of informed consent; and to adopt a national sexual and reproductive health policy that includes guarantees for informed consent in relation to pre‑conception methods (paras. 247-250). These measures are crucial to ensure that medical and health personnel will not ever coerce pour women in Peru to undergo a sterilisation procedure. 

But the judgment also responded to the thousands of victims, live or death, that are still waiting for justice and reparation. It took the REVIESFO, the register for victims of forced sterilisation in Peru to another level by requiring Peru to register all deceased victims, like Celia and not only those that are alive, but for the purposes of providing them access to reparation and not assistance, and to “design, activate and ensure continuity in the implementation of the public policy on reparations for women victims of forced sterilisation, as ordered by the Sala Constitucional de la Corte Superior de Lima.” It further held that victims must participate in the policy’s design—including Ms Ramos’s next of kin—and directed the State, within one year, to report to the Court “the projected number of victims to be covered by the policy and the time it will require to provide effective reparation,” while assigning a sufficient and sustainable budget to deliver it (para. 251).

This combination of individual, family and structural reparation measures is how reparation becomes transformative not only for Celia and her family but also for all the victims of forced sterilisation in Peru. The Court continues to make the most of its reparation mandate, continuing to provide measures that can make a significant difference for future generations but also to those harmed by human rights violations. 

Conclusions

The judgment in Ramos Durand et al. is seminal. It recognises forced sterilisation as a form of reproductive violence rooted in institutional discrimination, and it stands as the first regional ruling to confront Peru’s state‑driven sterilisation policy, acknowledging the thousands of women affected and the decades of impunity that followed.

More importantly, it takes reparations beyond individual and family harm, continuing to pave a jurisprudential line on registries, meaningful victim engagement, and comprehensive reparation policies that ought to guide domestic practice, as well as ensuring that key prevention measures are put in place to transform medical practices that could affect other women in the future.

But a key message from the Court is unequivocal: wherever systematic forced sterilisation has occurred, national policy and domestic reparation systems must recognise it, repair it, and ensure it never happens again.

Now begins the long haul of ensuring compliance with the judgment, at a time when the political landscape could not be more challenging. Still, the IACtHR, together with civil society organisations, victims, and other stakeholders in Peru, will continue to drive the actions needed to transform this ruling into reality.