By Anastasia Moloney
BOGOTA, Oct 16 (Thomson Reuters Foundation) - Teenage pregnancies and backstreet abortions helped push Peru's capital to the bottom of a global poll on Monday when Lima was named as the world's worst megacity for women to get healthcare.
The Thomson Reuters Foundation asked 380 experts in women's issues about access to healthcare and maternal health, as well as about sexual violence, harmful cultural practices and access to finance in 19 megacities worldwide.
Lima - where abortion is illegal except when the mother's life or health is at risk - scored bottom when it came to healthcare, followed by Kinshasa in Democratic Republic of Congo, Karachi in Pakistan and the Egyptian capital of Cairo.
Three other Latin American megacities with populations of more than 10 million - Mexico City, Sao Paulo and Buenos Aires - were ranked joint sixth and ninth in the danger list.
By comparison, London was named as the best city for access to good healthcare for women, followed by Paris and Tokyo.
Peru's public ombudsman, Walter Gutierrez, said women in Lima face unequal access to health services, with wide gaps between the wealthy and those who are either poor or indigenous.
"We know that on the issue of health access there's a significant gap, in particular women's access to health, especially reproductive health and also maternal mortality," Gutierrez told the Thomson Reuters Foundation.
Studies show that at least one in every five girls under 19 has become pregnant in Peru, with more than half of all pregnancies among girls aged 12 to 16 due to rape.
CALLS FOR CHANGE
But across the country getting free 'morning after' contraceptive pills is a struggle, while abortion is illegal except to save the life of the mother or her physical health.
Susana Chavez, head of the Lima-based reproductive rights group PROMSEX, said the poll highlighted the lack of family planning services for teenage girls, reflected in the "very serious issue" of Peru's high teenage pregnancy rate.
A 2009 court ruling that public health services do not have to provide free emergency contraception was overturned by a Lima court last year, but women still found it hard to get access to emergency contraception in the socially conservative nation.
"We haven't reduced the teen pregnancy rate. On the contrary it has increased, including in city outskirts," said Chavez.
Chavez said Peru's abortion law contributed to maternal death as women and girls, including rape survivors, were forced to undergo often dangerous backstreet procedures.
Rights groups estimate women in Lima have 100,000 abortions a year - and complications from botched abortions are a leading cause of women dying in Peru, commonplace across the region.
Latin America and the Caribbean have some of the world's most restrictive abortion laws, with six countries in the region operating blanket bans.
Peru's ombudsman and reproductive rights groups say Peru's law should be changed to allow abortion when a pregnancy results from a rape or if a foetus is unviable.
But a conservative-majority congress and religious voices - influential Evangelical Christian groups and the Roman Catholic Church - have so far "buried" attempts for lawmakers to debate a bill that would ease Peru's abortion law, Chavez said.
The poll was conducted online and by phone between June 1 and July 28 with 20 experts questioned in each of the 19 cities with a response rate of 93 percent. The results were based on a minimum of 15 experts in each city.
(Reporting by Anastasia Moloney @anastasiabogota, Editing by Belinda Goldsmith and Lyndsay Griffiths.; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)