Nicaragua: At-risk pregnancy means death or prison

Nearly 90 women have died in Nicaragua as a direct or indirect result of the repeal, one year ago, of the legislation permitting abortion in cases of risk to the pregnant woman's health, according to women's and human rights groups. Ana María Pizarro, the head of the non-governmental organization (NGO) Sí Mujer, and Latin American coordinator of the 28th September Campaign for the Decriminalization of Therapeutic Abortion, told IPS that the reform of the abortion law has driven up the number of fatalities reported in this impoverished Central American country. Studies by Sí Mujer indicate that 12 young pregnant women died from lack of care in health centers where personnel were afraid of the penalties of up to eight years in jail and loss of their medical licence for doctors who carry out or assist in abortions, even when the action is taken to save the expectant woman's life. "In practice what is happening is a government death penalty imposed on women," said Pizarro, a gynecologist. Lobbied by the hierarchy of the Roman Catholic Church and conservative evangelical pastors, on Oct. 26, 2006 the Nicaraguan parliament approved the draft law to revoke article 165 of the criminal code, which had permitted abortion for medical reasons since 1893. It applied in cases where the pregnant woman's life was in danger, the fetus was deformed or irreversibly damaged, or the pregnancy was the result of rape or incest. It required certification by at least three doctors, and the authorization of the pregnant woman or her family. The law revoking article 165 was passed in the agitated political climate leading up to the Nov. 5 general elections, won by leftwing candidate Daniel Ortega, who formed a controversial alliance with the retired archbishop of Managua, Cardinal Miguel Obando y Bravo, the present coordinator of the government's National Council for Reconciliation and Peace. The parliamentary decision drew cries of outrage from some 30 local medical bodies, Central American human rights organizations, foreign diplomats, the World Health Organization, the Pan-American Health Organization and other United Nations agencies. According to women's movements, the repeal of the article was part of the political strategy of the leftwing Sandinista National Liberation Front (FSLN), now in power, and the rightwing Liberal Constitutionalist Party (PLC), to win Catholic votes in the close-run elections. The amended law entered into force in November 2006, and was incorporated in September 2007 into the new criminal code. Performing an abortion with the consent of the woman carries a prison sentence of one to three years. And if a doctor or health professional performs it, they will be banned from practicing medicine or their health profession for two to five years, the new criminal code says. Women who undergo abortions, whether self-induced or performed with their consent, also face prison terms of one to two years, says the controversial criminal code, which was approved by PLC and FSLN votes, with a majority of 66 out of a total of 91. Patricia Orozco, coordinator of the Feminist Movement fighting for the reinstatement of therapeutic abortions, said that the group has already presented 54 appeals to the Supreme Court to declare the law unconstitutional. "They have not replied, and we know that they won't, because the Supreme Court serves the interests of the Liberal and Sandinista parties, who make the laws in this country," Orozco complained. The Supreme Court's press office said that the court would rule on the appeals against the law in due time. However, the women's groups believe that the answer to their appeal will be delayed as long as possible, until it falls into oblivion. "But while women keep dying, we will not forget," said Orozco, who stated that women have been under dual attack all year. "Apart from having our right to life undermined, we have been attacked in the streets when we protest -- they have sent the police after us, have beaten us and have harassed us with legal charges of disturbing the peace," she complained. Violent police crackdowns on women demonstrating in favor of the right to therapeutic abortion were also reported to IPS by the Nicaraguan Human Rights Center (CENIDH). "We have documented more than five mass aggressions against women participating in peaceful protests in the streets of Managua," said an activist. In early October, Angela Heimburger, an Americas researcher with the New York-based Human Rights Watch, presented a study in Managua on the effects of implementing the ban on therapeutic abortions in Nicaragua since it was approved in 2006. "It has had a devastating impact on women's health and women's lives," Heimburger told IPS. The report, "Over Their Dead Bodies: Denial of Access to Emergency Obstetric Care and Therapeutic Abortion in Nicaragua", documents 11 cases, up until September, of women who died from causes related to the ban on therapeutic abortion and the denial of medical services in public hospitals. The Health Ministry neither confirmed nor denied these figures, and in fact has issued no statistics on maternal health since the therapeutic abortion ban was approved. "The government will always cover its tracks when it makes mistakes; we have no faith in its statistics," said Juana Jimenez, a leader of the Network of Women Against Violence, an NGO that has participated in the struggle for women's rights. According to the Autonomous Women's Movement (MAM), between 800 and 1,000 therapeutic abortions were performed every year in the public health services before the ban was imposed. That means that "now there are between 800 and 1,000 women at risk," a statement from the organization says. Among other effects of the ban, MAM indicates that 2,500 young women have crossed borders into other Central American countries where they can undergo abortions without running such a high risk. "Poorer women go to Costa Rica or Panama, and the wealthier fly to the United States," said the group, which announced that it would increase its protests and campaigns throughout the country. The medical situation is being monitored closely by the UN representative in Nicaragua, Alfredo Missair. "We know that the causes of maternal mortality are increasing, indirectly, from problems to do with providing or withholding healthcare, and that is a fact that must be faced," he told IPS. "Unfortunately, therapeutic abortion is misrepresented as an abortion issue, when it is really about interrupting a pregnancy that could cause the death of the mother and the baby. It's an issue that the country must make its own decision about, but mothers deserve an opportunity to exercise their right to life," Missair said. Latin America is one of the regions that is closest to meeting the Millennium Development Goals (MDGs), but it has an outstanding debt with the goal of reducing maternal mortality, said Missair. The UN estimates the maternal mortality rate in Nicaragua at 90 per 100,000 live births. "In developed countries, the maternal mortality rate is around 25 deaths per 100,000 live births," he noted.