Last November it became a crime for a woman to have an abortion in Nicaragua, even if her life was in mortal danger. So far it has resulted in the death of at least 82 women.
This central American country has become the third country in the world, after Chile and El Salvador, to criminalise all abortions. It is a blanket ban. There are no exceptions for rape, incest, or life- or health-threatening pregnancies.
María de Jesús González was diagnosed with an ectopic pregnancy, meaning the foetus was growing outside the womb and not viable. The longer González remained pregnant, the greater the risk of rupture, haemorrhaging and death.
She was not stupid and did not want to die. She resorted to her only alternative and summoned two traditional healers to terminate the pregnancy, without anaesthetic or proper instruments. It was more akin to mutilation than surgery, but María de Jesús González insisted. Maria died. She knew her chance of surviving the butchery was small. But being a practical woman, she recognised it was her only chance, and took it.
The story of why it was her only chance is an unfolding drama of religion, politics and power that has made Nicaragua a crucible in the global battle over abortion rights.
González was told at the hospital that any doctor who terminated her pregnancy would face two to three years in jail and she, for consenting, would face one to two years. "Nicaraguan doctors are now afraid of going to trial or jail and losing their licence," says Leonel Arguello, president of the Nicaraguan Society of General Medicine. "Many are thinking that instead of taking the risk, it is better to let a woman die."
For the Nicaraguan rich, a problematic pregnancy need not be a death sentence. You can fly to Miami or bribe a discreet private clinic in Managua. But in this wretchedly poor country most young women do not have money. Their choice is to go through with a pregnancy that may kill them, or attempt a DIY termination that may kill them.
As a result of the blanket ban enacted last November at least 82 women have died, according to advocacy groups. The anti-abortion camp, in contrast, is euphoric. The new law, it says, is a beacon in the fight to protect the unborn. It is time to celebrate.
Abortion has long been illegal in Nicaragua but there had been exceptions for "therapeutic" reasons if three doctors agreed there was a risk to the woman's life. Those exceptions were no longer necessary, said the Nicaraguan Pro-Life Association, because medical advances obviated the need to terminate pregnancies. "The conditions that justified therapeutic abortion now have medical solutions," says a spokesman.
Pope Benedict XVI welcomed the ban but added that women should not suffer or die as a result. "In this regard, it is essential to increase the assistance of the state and of society itself to women who have serious problems during pregnancy."
The Pope seemed to acknowledge an increased risk to women's health but Nicaragua's government has made no formal study of the law's impact. Women's rights organizations say their 82 documented deaths are the tip of the iceberg. The Pan-American Health Organization estimates one woman per day suffers from an ectopic pregnancy, and that every two days a woman suffers a miscarriage from a molar pregnancy. That adds up to hundreds of obstetric emergencies per year.
Doctors say they have been put in an impossible position. "We face extremely grave ethical conflicts, all because of politics," says Carla Serrato, a gynaecologist from Nicaragua's state-run Alemán Nicaragüense Hospital. Ligia Altamirano Gómez, an obstetrician, says they fear being overruled by the law. "We are pushed toward illegality."
In an attempt to clarify matters, the health ministry issued protocols last December that said doctors should respond to most obstetric emergencies, including ectopic pregnancies and post-abortion care.
To terminate an ectopic pregnancy is legal; it turns out, because since the foetus is not in the womb the procedure would not be an abortion.
But such is the climate of fear and confusion that the protocols are widely ignored and misunderstood. The doctors who turned González away from the hospital in Managua thought it was illegal, as did medical staff the Guardian interviewed in Ocotal, González's home town.
"The ban has people frightened. You could lose everything - that's the first thing on your mind," says Dr Arguello, a leading critic of the ban. So far there have been no prosecutions but many doctors are unwilling to take the risk on behalf of women who are often poor, uneducated and from a lower social class.
The legal strategy to overturn the ban is to ask the Supreme Court to declare the law unconstitutional - while fully expecting to lose since it is stacked with government supporters - to clear the way for a campaign involving the UN and international courts of human rights.
They expect to get a sympathetic hearing in Europe, not least at an abortion conference in London later this month organised by Marie Stopes. There are likely to be calls for donor countries such as Britain, Spain and Denmark to threaten to cut aid to Nicaragua. So far there has been so sign of that.
The campaign's problem is that at home it is politically outgunned and unpopular. Lobbying for abortion rights, however limited, is a hard sell to a population largely deferential to the pulpit. The taboo is especially strong in rural areas.
Source: The Guardian, 08/Oct/07