Summary

In 1997, Peruvian mother of three Celia Ramos was getting care at her local medical post when health workers began pressuring her to have a surgical sterilization.

Celia refused—but the health care workers didn’t listen. They were part of a forced sterilization program in Peru between 1996 and 2000. Using misinformation, they eventually convinced Celia to agree to the operation. During the sterilization surgery, Celia experienced respiratory arrest. She died 19 days later.

In 2023, the Center for Reproductive Rights joined this case, representing Celia and other forced sterilization victims before the Inter-American Court of Human Rights (IACtHR)—the highest human rights court in the Americas. Celia Ramos v. Peru is the first-ever case to address Peru’s forced sterilization policy before the IACtHR.

On March 6, 2026, The IACtHR issued a ruling holding Peru accountable for the forced sterilization and subsequent death of Celia Ramos. The ruling advances the protection of women’s reproductive autonomy, consolidating the principle that the right to health is inseparable from civil and political rights, and that States bear a heightened duty to guarantee free, prior, full, and informed consent—with particular rigor in surgical sterilization procedures. It is also a foundational pronouncement on reproductive violence—recognizing it as a form of institutional violence and gender-based discrimination.

Background

Background

Throughout the 1990s, under Alberto Fujimori’s regime, a large part of Peruvian territory was under military control and lacked constitutional guarantees. Civilians lived in fear of violence committed by illegal armed groups as well as by the State.

Peru’s sterilization policy was part of the National Reproductive Health and Family Planning Program (PNSRPF), implemented by the State from 1996-2000.

The government promoted the program as a way to increase family planning access for low-income families—but it actually functioned as a forced sterilization program, targeting impoverished, vulnerable women from rural and indigenous areas.

It was characterized by:

• Misinformation and manipulative advertising campaigns.
• Sterilizations without valid consent.
• Goals and quotas imposed on medical personnel.
• Unsafe medical conditions for performing the operations.
• Impunity and lack of redress in reporting rights violations.

About the case

About the case

In 2010, the Study for the Defense of Women’s Rights (DEMUS) submitted Celia Ramos’s case to the Inter-American Commission on Human Rights, a regional human rights body that monitors human rights in the Americas.

The Commission concluded in 2021 that Celia’s rights were violated and recommended that Peru adopt measures of reparation and non-repetition.

In 2023, due to a lack of progress by Peru, the Commission referred the case to the Inter-American Court of Human Rights (IACtHR). The Center for Justice and International Law (CEJIL) and the Center for Reproductive Rights joined to provide legal representation to the victims.

The Center and its partners are seeking the IACtHR’s recognition that forced sterilization is a form of reproductive violence and gender-based violence—and therefore a violation of human rights.

Specifically, the case asks the IACtHR to:

• Provide truth, justice and reparations for Celia Ramos’s family.
• Establish a concrete reparation program for all victims of Peru’s forced sterilization policy and their families, as well as non-repetition measures.
• Strengthen States’ obligations regarding the right to prior, free, full and informed consent, especially regarding reproductive health.
• Recognize that forced sterilization is a form of reproductive violence and, as committed by the Fujimori regime, constitutes a crime against humanity.
• Include forced sterilization in transitional justice processes for victims of the armed conflict in Peru.

On May 22, 2025, the Center and its partners argued the case at a public hearing before the IACtHR in Guatemala City.

About the ruling

About the ruling

On March 5, 2026, the Inter-American Court of Human Rights issued its judgment, finding Peru internationally responsible for the forced sterilization and subsequent death of Celia Edith Ramos Durand in 1997. The Court also established important standards on reproductive autonomy, informed consent, and gender-based violence in healthcare.

This is a landmark decision addressing forced sterilization, reproductive autonomy, and reproductive violence. The ruling represents one of the most significant recent developments in regional and global jurisprudence on sexual and reproductive rights.

Recognition of a systematic policy of forced sterilization

The Court concluded that Celia’s sterilization occurred within a state policy aimed at promoting mass sterilization as a contraceptive method, particularly targeting marginalized women. Importantly, the Court held that Celia’s case was not an isolated incident but part of a broader discriminatory policy, characterizing it as a form of institutional violence against women.

Affirmation of reproductive autonomy, sexual and reproductive health and rights, and informed consent

The Court reaffirmed that reproductive health is an integral component of both the right to health and the right to personal autonomy, establishing robust standards on sexual and reproductive rights and informed consent in reproductive healthcare. Consent must be prior, free, and fully informed. Individuals must receive clear and understandable information about the nature of the procedure, its risks, alternatives, and consequences. The Court concluded that Celia Ramos did not provide valid consent, as she was subjected to pressure and lacked adequate information. As emphasized in the judgment, any sterilization performed under coercion or psychological pressure constitutes forced sterilization.

These standards significantly reinforce the Court’s developing jurisprudence on reproductive rights and represent an important contribution at a time when sexual and reproductive rights face increasing challenges both within the Inter-American system and globally.

Recognition of reproductive violence

The Court recognized, for the first time, the concept of reproductive violence. The judgment affirms that forced sterilization is reproductive violence and recognizes it as a form of gender-based violence prohibited under the Inter-American human rights framework. The Court also acknowledged that violations of reproductive autonomy frequently occur within contexts of power asymmetry and discrimination, particularly affecting women facing intersecting vulnerabilities such as poverty, ethnicity, and limited access to information.

Serious human rights violations and duty to investigate

The Court emphasized that forced sterilization in this context constitutes a grave human rights violation and reaffirmed that amnesties, statutes of limitation, or similar barriers cannot prevent investigation and accountability. The judgment also recognized the harms suffered by Celia Ramos’ daughters, husband, and mother, acknowledging both the devastating loss of Celia’s life and the decades of impunity that followed.

Protection of access to international justice

The judgment also addressed recent legislative developments in Peru. During the proceedings, the Court examined Law No. 32301, related to the APCI regulatory framework, which prohibits the use of international cooperation resources to support legal actions against the Peruvian State in domestic or international forums. The Court warned that measures of this nature may constitute reprisals against victims and human rights defenders and reiterated that restrictions that hinder access to international justice are incompatible with its procedural framework. In this regard, the Court established that our Peruvian partner organization, Demus, cannot be subjected to any form of sanction for its role in the litigation of the Celia Ramos case or in the subsequent stage of monitoring compliance with the judgment.

Reparations and structural measures

The Court ordered measures of reparation for the Ramos family, including economic compensation, educational measures, and a public apology by the State. Beyond the individual case, the judgment recognizes that these abuses were not isolated events but part of a broader state policy, reinforcing accountability for one of the most serious reproductive rights violations in the region.

The Court also ordered several structural measures, including:

• Continuing and advancing criminal investigations into those responsible without the application of statutes of limitation.
• The adoption of clear legal and regulatory frameworks on informed consent in reproductive health services.
• The creation of protocols and guidelines for obtaining valid informed consent in sterilization procedures.
• Establishing accessible complaint mechanisms for violations of consent in health services.
• Designing and implementing a comprehensive public policy on sexual and reproductive health.
• Designing and implementing a comprehensive public policy of reparations for women victims of forced sterilization, with the meaningful participation of victims registered in the national registry (REVIESFO).
• Allocating sufficient and sustainable budgetary resources to ensure the effective implementation of this reparations policy.

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