“Over Their Dead Bodies”: Denial of Reproductive Rights in Nicaragua

In September 2007 the Human Rights Watch published a report on the total abortion ban in Nicaragua entitled: Over Their Dead Bodies: Denial of Access to Emergency Obstetric Care and Therapeutic Abortion in Nicaragua.

One year ago – Women’s Rights Sent Back to the Middle Ages: The Nicaraguan Abortion Ban

One year ago the Nicaraguan government made a panicked pre-election decision that sent women’s rights “back to the middle ages,” according to activist Juana Jiménez of the country’s Women’s Autonomous Movement (MAM). The new legislature introduced a total abortion ban that covers the previously legal exemptions of rape, malformation of the fetus, and risk to the life or health of the mother.

“They bought 200,000 possible votes with the lives of more than three million Nicaraguan
women,” Jiménez said. According to both government and non-government sources, this move was implicitly motivated by the desire to secure political support from the Roman Catholic Church and the Evangelical Church. Nicaraguan President Enrique Bolanos signed the law in the presence of Roman Catholic bishops and Protestant evangelist leaders.

Although the ban spurred immediate protest from representatives of U.N. agencies, the European Union,
the World Health Organisation, the Pan American Health Organization (PAHO), Save the Children, the International Women’s Health Coalition and Human Rights Watch
, it was vigorously renewed by Congress in September.

Today – The Report

HRW’s “Over Their Dead Bodies” documents the environment of fear that permeates the country’s health care system leaving women afraid to seek obstetric services and doctors reluctant to provide even legal pregnancy-related care, especially on an emergency basis. These types of cases include a crisis in pregnancy where treatment may be concurrent with a miscarriage, or the treatment of hemorrhaging after a woman has sought an illegal abortion.

According to the report:

“The effect [of the ban] has been on the medical personnel,”said Dr. Jorge Orochena from the Health Ministry to Human Rights Watch. “There have been situations that should have been treated [but] out of fear they haven’t been treated fast.”

This sense was confirmed by a medical doctor from a low-cost clinic close to a major hospital in Managua. She commented to Human Rights Watch, “The day they passed the law [criminalizing all abortion] people come to my clinic from the hospital, bleeding. They start coming, and they say, ‘In the hospital they tell me to come to your clinic, that you can treat me, that they can’t.’… Many of those cases didn’t even have to do with abortion.”

For example:

Angela M.’s 22-year-old daughter is another case in point. Her pregnancy-related hemorrhaging was left untreated for days at a public hospital in Managua, despite the obligation, even under Nicaraguan law and guidelines, to treat such life-threatening emergencies. In November 2006, only days after the blanket ban on abortion was implemented, Angela M. told Human Rights Watch of the pronounced lack of attention:

She was bleeding.… That’s why I took her to the emergency room … but the doctors said that she didn’t have anything.… Then she felt worse [with fever and hemorrhaging] and on Tuesday they admitted her. They put her on an IV and her blood pressure was low.… She said. ‘Mami, theyare not treating me.’… They didn’t treat at all, nothing.”

From comments made by the doctors at the time, Angela M. believes her daughter was left untreated because doctors were reluctant to treat a pregnancy-related emergency for fear that they might be accused of providing therapeutic abortion. Angela M.’s daughter was finally transferred to another public hospital in Managua, but too late: “She died of cardiac arrest.… She was all purple, unrecognizable. It was like it wasn’t my daughter at all.”

Another case where a doctor’s fear under the new law resulted in unnecessary death.

The case of 24-year-old Olga María Reyes illustrates how doctors’ fear of being perceived to have provided an abortion can contribute to deadly delay in access to emergency obstetric care. Reyes died in a public hospital in León in April 2007 when she was six to eight weeks pregnant, due to the delayed removal of an ectopic pregnancy, according to the doctors who spoke to her family. When Reyes finally presented the public hospital in León with an ultrasound result from a private clinic that diagnosed her with a ruptured ectopic pregnancy, she was left unattended for hours despite the fact that Health Ministry regulations require immediate attention to ectopic pregnancies. Reyes was eventually operated upon, but too late. She died of cerebral arrest due to excessive hemorrhaging.

(Treatment of an ectopic pregnancy is actually legal in Nicaragua because it involves the removal of an inviable fetus.)

In another case:

A medical doctor at a large public hospital in Managua, however, testified to one case:

Here [at this hospital] we have had women who have died.… For example, [name withheld] came here and had an ultrasound. It was clear that she needed a therapeutic abortion. No one wanted to carry out the abortion because the fetus was still alive. The woman was here two days without treatment until she expulsed the fetus on her own. And by then she was already in septic shock and died five days later. That was in March 2007.

Other cases involved women with special considerations who are forced to seek illegal abortions in order to protect their own health.

30 year-old Mariana S. has a permanent health condition and needs daily medication. When she found herself pregnant, she suspended the use of the medication, as recommended by her pharmacist. She told Human Rights Watch of the rapid deterioration in her health: “Right after I got pregnant I started having these horrible health problems.… I got really sick, it really affected me.… I didn’t feel good just walking on the street, I almost passed out.… I spent like five days without sleeping… feeling horrible and in pain.”

A single mother of two, Mariana S. decided that she had to terminate the pregnancy in order to be able to care for her children. She was aware of the blanket ban on abortion: “I was very afraid.… It was very traumatic not to be able to talk about it, because it is a crime.”

After attempting to induce an abortion with injections and pills, Mariana S. found a clinic she could afford and fortunately had no complications from the intervention.

She said of the newly imposed ban, “I think they would have given me [an abortion before the ban] because of the [permanent health] problem I have … They should decriminalize therapeutic abortion [again] because they would save more lives like that. In my case, for example, the abortion saved both me and the two children I already have.”

The report covers more of these stories and admits there is no way to know the overall effect of this legislation, especially concerning the unspoken stories of women who are too afraid to seek treatment at all. The report also clearly outlines recommendations to Nicaragua’s President, Ministry of Health, and National Assembly, as well as a list of recommendations for UN agencies in their dealings with the country.

When politicians make medical decisions on a blanket basis, you can bet there’s an election involved. Once legislation is passed, however, it cannot be easily undone without admitting such. In the interim, people die.

More Reading:

Nicaragua’s Total Ban On Abortion Spurs Critics

Nicargua Votes To Ban Abortion

Nicaraguan Abortion Ban Called Threat to Lives



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