## Facts

- L.C., a Peruvian girl born in 1993, was repeatedly sexually abused beginning at age 11 and became pregnant at age 13 as a result.
- After learning of the pregnancy, she attempted suicide and suffered severe injuries, including spinal damage and paralysis.
- A neurosurgeon recommended urgent spinal surgery to prevent further injury and immobility.
- After the pregnancy was confirmed, the hospital postponed the spinal surgery because of the pregnancy.
- L.C.’s mother requested a therapeutic abortion under Peruvian Penal Code Article 119 (allowing abortion when necessary to save life or prevent serious and permanent harm to health).
- A hospital medical board took 42 days to review the request and denied it on the ground that L.C.’s life was not in danger; the hospital treated the decision as final and not appealable.
- L.C. miscarried spontaneously; spinal surgery occurred about three and a half months after it was first indicated, and rehabilitation and psychological care began months later.
- The delays contributed to permanent, severe paralysis, disrupted L.C.’s schooling, and imposed major financial burdens on her family.
- An individual communication was submitted under the Optional Protocol to CEDAW; the author did not file an *amparo* action due to the urgency and expected adjudication delays.

## Issues

1. Whether Peru violated CEDAW by failing to ensure timely, non-discriminatory access to a lawful therapeutic abortion and necessary medical treatment for L.C.
2. Whether the lack of effective procedures for requesting and reviewing therapeutic abortion, and the hospital’s restrictive approach focused on “danger to life,” constituted discrimination in health care.
3. Whether gender stereotypes—prioritizing fetal interests over the adolescent’s physical and mental health—improperly influenced clinical decision-making in violation of CEDAW.
4. Whether domestic remedies were effectively unavailable given the urgent medical circumstances, making the communication admissible.

## Decision

- The Committee found the communication admissible because available domestic proceedings would not have provided timely relief in the urgent medical context.
- The Committee found Peru in violation of CEDAW for failing to guarantee non-discriminatory access to health services, including therapeutic abortion, and for failing to provide effective legal protection and procedures to secure that access.
- The Committee concluded that medical decision-making reflected prejudices and stereotyped assumptions that placed fetal interests over L.C.’s health and autonomy.
- The Committee determined that Peru’s failures had severe, foreseeable consequences for L.C.’s dignity, development, and ability to pursue education and life plans.
- The Committee recommended individual reparation (compensation, rehabilitation, and support) and general measures, including establishing effective mechanisms for therapeutic abortion access, professional training, and legal and policy reforms.

## Legal Principles

- A State that permits therapeutic abortion in law must implement accessible, prompt, and effective procedures so the service is available in practice, especially when delay risks serious harm.
- Denial or postponement of medically indicated treatment due to pregnancy, without adequate justification and without balancing the patient’s physical and mental health, can constitute sex-based discrimination in health care.
- Decisions influenced by stereotypes that treat motherhood or fetal interests as overriding a woman’s or girl’s health and autonomy are incompatible with obligations to eliminate prejudices and ensure women’s full development.
- Effective protection requires mechanisms to contest and review denials of lawful reproductive health services; treating internal medical-board decisions as final without appeal can breach duties to ensure practical remedies.
- Adolescent pregnancy resulting from sexual violence requires heightened attention to vulnerability and barriers to access; failure to address these conditions can amount to compounded discrimination.

## Conclusion

The Committee held Peru responsible under CEDAW for discriminatory denial and delay of lawful therapeutic abortion and related urgent health care, driven by inadequate procedures and stereotyped prioritization of fetal interests, and it ordered reparation and systemic reforms to ensure timely, reviewable access to reproductive health services.


L.C. v. Peru, Comm. No. 22/2009, U.N. Doc. CEDAW/C/50/D/22/2009 (CEDAW Oct. 17, 2011)