San José, Costa Rica, since 1956

Abortion Ban Blamed for Maternal Deaths

MANAGUA – Women and girls are dying in Nicaragua because of a law that puts a fetus’ right to life above that of the mother, according to several human-rights reports released in the past few weeks.

An Amnesty International report released in July found 33 women and girls died during pregnancy in the first 19 weeks of this year, up from 20 maternal deaths reported in all of 2008. Ten weeks later, the number of maternal deaths has already climbed to 50.

The report also showed that the number of suicides among women has increased significantly, which investigators think is linked to unwanted pregnancies from rape.

Esther Major, the report’s head researcher, said the government-reported numbers, although shocking, represent just a “bare minimum” of what’s really happening because many cases are unreported.

In any event, Major said, every case is an “unnecessary tragedy.”

“Why would you obligate a 10-year-old girl to carry a child?” the Amnesty International investigator demanded.

Since Oct.26, 2006, Nicaragua has banned abortion in all forms, making it one of only five countries in the world to outlaw lifesaving medical interventions known as “therapeutic abortions.” The ban was upheld by the new Penal Code passed into law in 2007, which prohibits all abortions regardless of maternity health risks or to terminate pregnancies caused by rape or incest.

The law is being challenged before the Supreme Court.

Meanwhile, new evidence by various interest groups shows that the denial of medical attention to at-risk pregnant women is increasing the number of maternal deaths by prohibiting doctors from doing their job. The victims, the reports found, are predominantly the youngest and poorest women in society.

Fear of the law and its criminal sanctions has forced some women to take their chances with unsafe abortions since “the doors are closed to women in the hospitals,” according to Lucy Idania del Gadourbina, a social worker with the Ixchen health clinic in Matagalpa.

But the risky nature of the underground business is taking a toll of its own. Leonel Argüello, president of the Nicaraguan Society of General Medicine, said at least four teenagers have died this year from illegal abortions.

Argüello said women who suffer vaginal bleeding during pregnancy are “afraid to

go to the hospital” because it’s difficult to prove the difference between a miscarriage and an abortion.

In Amnesty’s findings, one woman admitted to hospital following a miscarriage, asked health workers not to intervene because she feared her neighbor would report her for having an abortion.

Doctors Scared of Ban

Doctors, too, say they’re scared of the new law.

Rene Martín Castillo, a doctor in Granada, says the law requires doctors to first conduct an ultrasound on all woman who experience a miscarriage, before cleaning the uterus.

Difficulties and delays in getting ultrasounds are putting woman at greater risk of a post-miscarriage infection, the doctor explained.

Doctors say the abortion ban, which threatens medical professionals with jail sentences for conducting an abortion or even providing information about abortions, has changed the way health-care workers respond to pregnant women in need of medical attention.

Doctors argue the Penal Code’s ban on abortions contradicts health guidelines and protocols established by the Ministry of Health, as well as their oaths as medical professionals.

Argüello says, “As a physician you are in the middle of two problems.” He said doctors are being forced to choose one law over another, and at their own judgment and risk.

Though Argüello says he thinks Nicaragua’s General Health Law carries more weight than the Penal Code, in practice he says it has become common for doctors to delay helping a patient rather than put themselves at risk of breaking the law.

Some doctors will either wait in hopes that the woman will go to another doctor, or stall for time by consulting other doctors, he said.

Either way, the delays, Argüello said, “take precious time from the life of the woman.”

Dr. Castillo said this scenario happens frequently in the case of an ectopic pregnancy, where the fetus begins to grow in a woman’s fallopian tubes, putting her life at danger.

“It’s necessary to wait until the tubes break to perform the operation,” Castillo said. “We have to wait to be completely sure from the legal point of view. All of the doctors are scared.”

The doctors’ uncertainty means women’s lives are being put at unnecessary risk.

According to the Amnesty report, a rupture in the uterine wall or fallopian tube could cause permanent internal damage and possibly death if there is no immediate intervention.

While no physician has been prosecuted under the new law, Major said her interviews with doctors revealed they “are acutely aware” of that possibility.

“They are vulnerable and they know it,” she said.

The Penal Code stipulates that a doctor could be charged if he or she causes injury or death to the fetus, regardless of intent.

Treatment for a pregnant woman with an illness such as cancer, HIV/AIDS or malaria, or who suffers a cardiac emergency, will depend on “on whether the individual doctor feels sufficiently confident to provide the best practice treatment and defy the law,” says the Amnesty report.

Apparently, many doctors don’t feel sufficiently confident, which is evident in the increasing number of maternal deaths.

Rising Death Toll

A recent report by Ipas, an international non-profit organization promoting women’s reproductive rights, documents several cases of women who died in childbirth last year, leaving behind orphaned children.

Another activist group, Catholics for the Right to Choose, also presented a recent study of incidents of sexual violence reported in the media during 2008. Of the 318 women and girls who reported rapes last year, 94 cases were incest, resulting in 46 unwanted pregnancies of girls between 10 and 20. Fifteen of those pregnancies were rape victims 10 to 12 year olds.

Ipas’ Mayte Ochoa said her organization’s study of maternal deaths in 2008 found that poor women – those living in the rural areas, without education or good access to health services – are the ones dying.

“This law is discriminatory because it is affecting only the poorest and youngest women,” Ochoa says. Wealthier woman can go abroad for an abortion, but the poor “do not have this opportunity to save themselves,” she said.

Church and State

Though the Supreme Court announced last February that it is done hearing arguments and is prepared to hand down its ruling, no decision has been announced yet (NT, March 27).

Ochoa said rights activists don’t know what to expect, or how to interpret the continued delay. “There is no certainty of anything,” she says.

The problem, she said, is that many in the rights movement think the verdict will be a “political decision” based on the government’s pact with the church, rather than a ruling based on law.

Catholic priest Mario Camp of Granada’s San FranciscoChurch defends the ban on therapeutic abortion, saying, “Our first duty is to defend life from its first moment.”

While acknowledging he does not know much about medicine, the priest put the onus on doctors to save both the woman and the baby.

“The health of a mother is an excuse,” Campo said, implying there is no real need for therapeutic abortions. “I know abortion has become a huge business.”

But prior to the complete ban, there was an average of only nine therapeutic abortions recorded each year from 1999 to 2005.

Activists say it’s the criminalization of therapeutic abortion that’s causing more deaths in Nicaragua and making abortions an underground business.

Amnesty researcher Major said the death total would be even higher if it were not for “the goodwill” of intervening doctors who defy the ban.

The Silent Government

Amnesty International says it repeatedly requested interviews with President Daniel Ortega, the National Assembly’s Commission on Women and the Nicaraguan Institute for Women. But none of them agreed to a meeting.

“You have a government who will not accept responsibility for the law,” she said. Though Amnesty International did meet with the Minister of Health, Major says “Nobody would articulate the reasons why this law is in place.”

The Nica Times also requested interviews with the Ministry of Health and the Nicaraguan Institute for Women, but neither replied.

While the Sandinista administration remains non-responsive, national and international rights groups are demanding the self-proclaimed revolutionary government of the poor live up to its image by reversing the abortion ban before more impoverished women die unnecessarily.


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