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“These type of large-scale campaigns of targeted sterilization unfortunately are not that uncommon in 20th-century history,” said Stern, and Peru’s program “has the most in common with the sterilizations that occurred in the U.S. during the late 1960s and early 1970s under the broad umbrella of family planning and population control.”

In the U.S. they were typically funded with newly available dollars from Medicaid’s expansion, and although numbers vary widely one U.S. study estimated that 100,000 sterilizations paid for with federal funds during 1972-1973 were coerced, Stern said.

Reckoning with that legacy is North Carolina, where nearly 7,600 men and women were forcibly sterilized through 1974. A panel created by the state’s governor recommended last month that victims be given $50,000 each as compensation. That could cost as much as $100 million. The state Legislature will decide.

Peru hasn’t even begun to discuss that question.

Its prosecutors have barely addressed the question of whom to hold accountable for the policy that Fujimori framed as a “family planning” program while announcing it at a 1995 women’s conference in Beijing.

Fujimori would later boast from exile, three years after his corruption-suffused autocratic regime collapsed, that the “completely voluntary reproductive health program” had dropped Peru’s birth rate from 3.7 children per woman in 1990 to 2.7 children a decade later.

Officials of his government claimed any abuses in the sterilization program, which also neutered nearly 25,000 men, should be blamed on overzealous local medical authorities.

Director Jeannette Llaja of DEMUS, an advocacy group that has long supported the sterilization victims, rejects such explanations.

“This was no spontaneous decision by bad health care providers,” she said. “It was something directed by and known to the highest authorities.”

Supervisors imposed sterilization quotas on health workers, she says, with one supervisor she knows of coming under such intense pressure that she had herself sterilized.

The program, while still active, became so controversial that the U.S. Congress cut aid payments to Peru that were used to fund the program.

After his government fell, Peruvian lawmakers initially recommended genocide charges against Fujimori. The chief prosecutor at the time, Nelly Calderon, told the AP she found no evidence of genocide so Fujimori was never charged.

A prosecutor who subsequently supervised the investigation of three Fujimori health ministers and lower-ranking officials, Victor Cubas, said the testimony he reviewed showed most of the sterilizations were coercive and carried out “under a government-approved plan.”

That probe was shelved in 2009, however, after Cubas’ bosses determined the statute of limitations had run out on the alleged crimes of serious bodily injury and manslaughter, and that human rights charges did not apply.

A senior official of President Ollanta Humala’s attorney general’s office reversed that assessment, however, when he informed the Inter-American Commission in Washington during an October hearing that his government was reopening the investigation because it qualified as a “crime against humanity.”

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