To Risk Not Saving a Life: Abortion Ban in Nicaragua and its Societal Implications

• A born-again Marxist now upholding an ultramontane pedigree, President Daniel Ortega has puzzled both sides of the political spectrum.
• The Church has taken on an incredibly influential role when it comes to issues of social justice and personal rights.

About a month ago, 22-year-old Olga Reyes was suffering from an ectopic pregnancy in which a fetus develops outside of the uterus, making its survival an impossible outcome. Such a pregnancy also can put the mother in grave danger, as there is a risk of excessive bleeding that can lead, in extreme cases, to death. Unfortunately, this is exactly what occurred in the case of Reyes. If an ectopic pregnancy goes undetected, the only chance to minimize death or injury of the mother is to terminate the pregnancy through an abortion. In most countries—even many of the most conservative ones—abortions are permitted when a mother’s life might be in danger.

Reyes, however, was Nicaraguan, and since November of last year, all forms of abortion (including those in which a mother’s life may be in danger) have been illegal. Because an environment of fear has been created by the Church’s behavior, most Nicaraguan doctors are hesitant to treat cases like that of Reyes’. Her doctors at Bertha Calderon Maternity Hospital refused to intervene, even when an abortion could have potentially saved her life. A little more than a year ago, Reyes would have been alive; the abortion ban was not in effect, and abortions were permitted in extreme circumstances like hers. Since being enacted in November of last year, the abortion ban has left an indelible mark on Nicaraguan society, necessitating an evaluation of the roles of religion, public health, and gender in the country.

Religion
Nearly three-fifths (59 percent) of Nicaragua’s population is Roman Catholic. As a result, the opinions of the Church community are held in the highest of esteem, and Church beliefs are treated as scripture. For instance, a decade ago, there was a good deal of controversy surrounding a Catholic-supported movement to flood the country’s public schools with textbooks produced by the Catholic archdiocese of Managua. Such efforts to influence Nicaragua’s future generations with pro-Catholic textbooks indicated the length to which the Church would go in its efforts to influence the country’s social policies.

The abortion ban, although more prone to receive mass media attention than the use of Catholic textbooks in Nicaragua’s public schools, is, to a certain degree, similar in that it is another example of the strength of the Church’s ongoing power and the Faustian bargain Ortega was prepared to make. In 2006, with legislation related to the abortion ban about to come up in the National Assembly, Nicaraguans were anxiously waiting to see which side of the debate the three main presidential candidates would take. Future President Daniel Ortega (who once declared himself to be an atheist) had recently started attending Catholic services, according to a 2006 article in Pine Magazine. Although he was the most leftist liberal candidate in the race when compared to the two social conservatives against whom he was running, Ortega knew he could not win the general election without attracting the necessary support of at least some of the more conservative Catholics in Nicaragua. As a result, when the movement to enact the ban began prior to the election, Ortega said and did nothing to oppose it. In order for him to win, Ortega undoubtedly (and probably correctly) believed that he would need to cater to some of the more symbolically important forces to be found in Nicaragua, among the Church and its constituents.

Given Ortega’s rapid change of heart on matters of great importance to the party, many former Sandinistas who once were close allies of his, were amazed at what appeared to be Ortega’s opportunistic nature regarding a number of key issues. Having once been an ardent atheist and foe of Cardinal Obando and Church strictures, Ortega now became an active opponent of the right to an abortion and a supporter of Obando and the primacy of the Catholic Church. Yet soon after victory, however, Ortega seemed to switch sides once again, coming out in support of Venezuelan President Hugo Chavez’s Bolivarian Alternative for the Americas (ALBA). In addition, it should certainly be noted that, at the time of his support of the abortion ban, Ortega also was anxious for the Church to prove forgiving for his own alleged sexual abuse shortcomings regarding his young step-daughter.

Interestingly, some of the leaders of the Catholic Church have used recent technological and scientific break-throughs in medicine to make the claim that a country can be consistent with Catholic principles without ever putting the life of the mother in danger. Henry Romero, a priest, was quoted last month in an Associated Press story saying that “when two lives are in danger, you must try to save both the woman and the child. It’s difficult to say now that it isn’t possible to save both.” Church leaders often cite somewhat questionable interpretations of scientific findings that claim that, because of major improvements in the field, one no longer has to balance the religious anti-abortion message with the idea that a mother’s life must be protected at all costs.

The Church’s Heavy Hand
Yet the problem is that, in certain (admittedly rare) cases, the mother’s life still may be put in jeopardy, even with the remarkable advances in science. Meanwhile, Church leaders like San Salvador’s Archbishop Leopoldo Brenes (who led the successful movement to ban all abortions in El Salvador) and Obando of Nicaragua, refuse to admit that therapeutic abortions—abortions that are necessary to save the life of the mother—are necessary. As Brenes told the Washington Post a year ago: “This idea of ‘therapeutic abortion’ was being abused….People were easily getting doctors to say that the abortion was being done to save the mother’s life, when in reality it was a person who just said, ‘I don’t want this child.’” Although, to an extent, he might have been right to some extent, he still has chosen to ignore the more scientifically orthodox statements put forth this October by Human Rights Watch (HRW). In its report on this subject, the organization noted that, no matter how far we have come scientifically, the need for therapeutic abortions never will be entirely eliminated.

For the past 115 years, largely because of religious factors, almost all abortions were banned in Nicaragua (excluding therapeutic abortions, which could have saved Reyes’ life), highlighting the critical role religion has had in Nicaragua for quite some time. Yet the 2006 ban, which even prohibits those abortions that can save a mother’s life when she is in danger, indicates that the Catholic Church has taken on a newer and bolder position in Nicaraguan society and politics. The HRW report on the abortion ban cited the Center of Reproductive Rights’ research, which says that, along with Chile and El Salvador, Nicaragua is one of only three countries in the world with an entire “blanket ban” on abortion. Only in countries where the influence of religion is so great could such a ban be possible. When a protest against the ban was organized in Nicaragua last October, the Catholic Church immediately mobilized more than 3,000 militants to march in the street in support of it. With the Church being able to count on such numbers in so short amount of time, there is no question regarding its influential sway, particularly when contrasted with citizens (of Nicaragua and elsewhere in the region) who have been trying to reverse the ban with few resources to do it.

Although the weight of Nicaragua’s Catholic community has been one of the central factors in putting the ban into effect, it should be noted that not all Catholics in the country support the prescription. In addition to the significant portion of the population opposed to the ban, some Catholics have “switched sides” to now support therapeutic abortions (and, in some cases, other forms of abortion). For example, Catholics for Free Choice in Nicaragua, an organization made up of Nicaraguans who support abortion in certain cases, has mobilized some of the population to protest the ban, as it believes the ban will lead to tens—if not hundreds—of avoidable maternal deaths.

Public Health Aspects
There has been little debate among members of Nicaragua’s medical community regarding the pros and cons of the abortion ban, given the fact that 95 percent of the members of the country’s National Society of Obstetricians believe that, at the very least, therapeutic abortions should be permitted. Yet, given the fact that there is a growing sense of fear of prosecution among Nicaragua’s or even the cancellation of one’s license as a result of malpractice proceedings, even legal pregnancy-related operations have become less likely. For instance, treatments for hemorrhaging women have declined due to a prevalent culture of fear. Doctors simply do not want to get involved in matters relating to difficult pregnancies, as they worry that they may be putting their careers at risk. As Dr. Oscar Flores Mejia of Nicaragua’s National Society of Obstetricians and Gynecologists told the Boston Globe in 2006, after the ban was put in place: “This law is forcing us to be delinquent on our jobs.”

Underground Abortions
Another reason that many of Nicaragua’s obstetricians are so opposed to the ban is the fact that Nicaragua—and Latin America in general—has had a very high rate of unsafe abortions for a long period of time. It is often hard to make a compelling case for a therapeutic abortion, and, as a result, many Latin Americans resort to unsafe methods to eliminate their fetuses. For example, in Chile (where, like Nicaragua, abortion is entirely proscribed), more than 30,000 woman suffer injuries because of unsafe abortions each year. In fact, according to the Alan Guttmacher Institute, Latin America has the world’s highest rate of maternal deaths due to unsafe abortions, with slightly more than one-fifth of all pregnancy-related deaths caused by unsafe abortions. Such “back-alley” abortions often require desperate pregnant woman to use hangers or unsafe medicines to expel the fetus from the womb. Of course, such practices occur mostly in countries where an abortion is illegal or hard to obtain. The World Health Organization, too, has made similar findings regarding the high rate of unsafe abortions in Latin America, advocating the position that something should be done to alleviate the problem. If one adds such a problem to the fact that it has been only a little more than a year since the ban was put into place, there is a growing fear that the abortion policy in Nicaragua could put the country on an even more dangerous road to a continued elevation of unsafe abortions and, more than likely, deaths.

The ban has also brought back to the spotlight the stormy issue of contraception in Latin America. Due to both the influence of the Catholic Church and to the ineffective methods of sex education in the country, it can be very difficult for teenage girls in Nicaragua to receive informational and practical tools necessary to prevent undesired pregnancies. Furthermore, it should be noted that, when young girls (and, for that matter, boys) are taught about sex and pregnancy prevention, they are not necessarily provided with accurate information. According to the previously mentioned Guttmacher Institute report, almost half of all Nicaraguan women have at least one child before they reach the age of twenty. It also states that “36 percent [of sexually active women between the ages of 15 and 19] have an unmet need for effective contraception.” As a result, such studies and reports highlight the fact that aspects of the recent abortion ban are much more than a simple case of domestic policy making; rather, Nicaragua and, to an extent, other Latin American countries, have been unsure of how to responsibly handle pregnancy and maternity issues for decades.

The ban brings back the longstanding debate that many Nicaraguans have had about the pros and cons of abortion and contraception, among other sexual health matters. Given the inadequacies in the government’s education of its citizens regarding the provision of accurate reproductive health information, one must question how eager the country is to repair its image. Although cases like Reyes’ do not occur every day, the Pan American Health Organization reported that, in 2005, there were 397 ectopic pregnancies; given the fact that deaths from such pregnancies can be avoided without an abortion if they are detected early enough, educating Nicaragua’s population is now more important than ever and more urgently needed in a timely manner.

Gender and Women’s Rights
Although not as prominently discussed in the press as the abortion ban’s relationship to religion and public health, the equally critical, if widely ignored matter of women’s rights and gender roles in Nicaraguan society also has been brought to light. In 2002, after an eight-year-old girl was raped and as a result became pregnant, she and her family fought to have an abortion. When Nicaraguan Assemblyman Wilfredo Navarro was asked about the case in the aforementioned Boston Globe article, he responded that “…she should have the baby because that child has rights.” Although one can sympathize with the fact that the Assemblyman wanted to protect the rights of the unborn child, his marked lack of empathy for the rape of a young girl and the problems that it would cause for her and her family has to be noted as an alarming indicator of the state of female rights in the country.

As a male, Navarro is unlikely to have had to deal directly with pregnancy (let alone pregnancy following rape), and if anything, he shows a lack of sensitivity, respect and understanding for the rights of half of Nicaragua’s population. Such attitudes appear to be pervasive among the highest ranks of Nicaragua’s political and religious elites. The abortion ban was motivated largely by the leaders of the Catholic community in the country and in the region, many of whom have never consistently shown much sympathy for the plight of women citizens. The aforementioned Archbishop Brenes never will have to balance the pros and cons of saving his own life versus that of a fetus because pregnancy is simply something with which he will never have to contend. Thus, with the overwhelming majority of the National Assembly composed of males and the leaders of the Catholic Church mostly male, the voices of many Nicaraguan women have been silenced and their opinions on the abortion ban ignored. Even before the total ban came into effect, 50 Nicaraguan women died between 2000 and 2003 from pregnancy-related complications of which they were neither fully aware of, nor told were preventable. Such statistics presumably mean much more to Nicaragua’s women, than the country’s male leaders who have not demonstrated a particularly strong desire to respond to those figures in an effective, appropriate manner.

Gender hierarchies and male leadership issues aside, the total ban on therapeutic abortions has shed light on what HRWcalled in October a violation of “international human rights standards on the right to life, the right to health, the right to non-discrimination, and a number of other established human rights.” Obviously, the only people whom the right to life directly affects in the case of therapeutic abortions—and, for that matter, any abortion—are women. The internationally agreed upon human rights norms that HRWcited in its October report suggest what many objective critics long have known: bans on any sort of abortion that would save a mother’s life are contrary to established legal standards that protect a women’s right to life. In a country and region where there is a tendency for males to dominate politically, economically, and culturally, the ban on therapeutic abortions has put women even lower on the societal totem pole, which shows an alarming disdain for international legal gender questions.

Conclusion
Reyes was not the first victim of the abortion ban. Just after the interdiction was implemented in 2006, Jazmina del Carmen Bojorge died in a similar fashion, as her doctors failed to appropriately treat her when, five months into her pregnancy, she was feverish and suffering from abdominal pain. At the time, Juanita Jiménez of the Women’s Autonomous Movement in Nicaragua pointed out that doctors were scared of the repercussions had they aided Bojorge. Furthermore, women are now nervous about trying to get any sort of treatment for complications during their pregnancies. As a United Nations official told Human Rights Watch, “Women are afraid of seeking treatment. That’s the first step….And doctors are afraid of providing treatment.…And the combination may have caused deaths.”

Bojorge was the first Nicaraguan woman to have drawn significant international media attention, Reyes is just the most recent case, and, unfortunately, there will be more to come unless the powerful combination of the Church and state have a radical change of heart. Petitions to declare the abortion ban unconstitutional have been filed in the Supreme Court, but for now, the chances of reversal are highly unlikely. A reversal would require much more coordination between Nicaragua’s women’s rights activists and international human rights groups than currently exists. Until that day, however, they will continue to live, like few other women in the Western Hemisphere, without even the most rudimentary guarantee of the right to their survival if a pregnancy goes wrong.

This analysis was prepared by COHA Research Associate Michael Glenwick