176 International Family Planning Perspectives

Although governments develop family planning policies to guide program design and implementation, these poli-cies can have both intended and unintended consequences. As a result, policies may need periodic revision to achieve the desired outcomes. Over the last two decades, the gov-ernment of Peru has instituted a series of laws and policies designed to enhance access to family planning services and commodities. In practice, these policies have not always had their desired effect. This paper examines the policies Peru’s Ministry of Health has developed and implement-ed to promote access to family planning for all, and how those policies have affected contraceptive prevalence, method mix and source mix. In this article, we review policies and laws relevant to family planning and provide insight on how the family plan-ning policies have evolved and affected access to services, as well as how characteristics of and trends in the family planning market * have changed over time. Our assessment draws on multiple information sources, including family planning market segmentation data and literature on Peru’s family planning program. Additional sources, such as om-budsman reports, user and provider interviews and health facility studies, clarify specific points. A historic overview of key family planning policies and programs implemented in Peru, focusing on three time pe-riods, 1985–1995, 1995–2000 and 2000–2004, provides information on policies that have been put in place and the degree to which they have affected access to family plan-ning among the poor. Establishing Peru’s Family Planning Program In 1983, as a result of available donor funds, a favorable political environment and the government’s concern for population growth, the Ministry of Health began provid-ing family planning services. It began with a vertical pro-gram that was relatively autonomous in program content and supervision and in use of financial resources and com-modities.1 This effort was followed in 1985 by the estab-lishment of the first National Population Policy, which stat-ed that individuals and couples should be provided with information, health services and contraceptive methods, with the exception of voluntary sterilization, to assist them in making informed decisions about family size and fertil