This article examines Peru’s population policy since the 1994 International Conference on Population and Development and assesses to what extent its policies and programmes have affected reproductive health and rights. It is drawn from data collected during ongoing monitoring of sexual and reproductive health policies and programmes in Peru since 1998 for the Centre for Health and Gender Equity (CHANGE). Accomplishments since 1994 in Peru demonstrate good faith on the part of the government and foreign donors to make progress towards fulfilling the ICPD agenda by addressing key reproductive health concerns and promoting women’s rights. Unfortunately, this progress has not been consistent. It has been overshadowed by two periods of anti-choice policies and interventions. The first, in 1996–97 under the Fuijimori government, was a demographic approach that used numerical targets and undue pressure on women to accept sterilisation as the government’s main poverty reduction strategy, which led to documented abuses. The second, in 2001–03 under the Toledo government, was a far-right approach that worked to limit access to essential services, including emergency contraception, condoms and post-abortion care. In spite of their contradictory nature, these two policy approaches have been the greatest obstacles to making long-lasting improvements to reproductive health and rights in Peru.