MANAGUA, Nicaragua (WOMENSENEWS)–After 19-year-old Jazmina Bojorge bled to death in early November at a public hospital in the Nicaraguan capital due to complications from pregnancy, her family appeared on local television and tearfully accused doctors of delaying her treatment for fear of being prosecuted under the nation’s abortion ban.
Bojorge, five months pregnant, arrived at the hospital with painful, premature contractions. After staying the night, she was sent to a different medical center for an ultrasound because hospital equipment was inadequate. Doctors tried to stop the contractions, but they were unsuccessful and the fetus died. Efforts to induce labor to expel the fetus failed and Bojorge went into shock. Her placenta had separated from the uterine wall and her uterus filled with blood. She died two days after arriving at the hospital.
It was Bojorge’s second pregnancy. She left a young son behind.
While authorities investigate her death, her story has heightened concerns about the impact of a new abortion ban that would outlaw so-called therapeutic abortions in cases in which the woman’s life is at risk. The ban was approved by lawmakers in October and is expected to be signed into law today.
"The penalty for therapeutic abortion is already claiming victims: the poor women of Nicaragua," Dr. Ana Maria Pizarro, director of a Managua women’s health clinic, told the local press after Bojorge’s death. "If they had intervened immediately this would not have happened," she later told Women’s eNews.
Previously, Nicaraguan law permitted therapeutic abortions if at least three doctors certified that the procedure was necessary to protect a woman’s life. It also allowed the termination of pregnancies resulting from rape or incest and when the fetus had grave, lethal defects such as anencephaly, or lack of brain development.
That clause is set to be eliminated. All abortions will be illegal, with prison terms of up to six years for women who receive them and medical personnel who provide them.
Legal Challenges in the Works
Nicaraguan and international rights groups, medical associations and community organizations pressured President Enrique Bolanos not to sign the ban into law. If it is signed as expected, they say they will go to court to block it, arguing that it violates a range of constitutional guarantees including the rights to life and equality for women.
"The new penal code doesn’t just go against basic human rights: It goes against fundamental principles of humanity," said Jose Miguel Vivanco, the Washington-based director of the Americas for Human Rights Watch, headquartered in New York.
Opponents are preparing to seek a legal injunction against the ban before Nicaragua’s Supreme Court, based on constitutional and medical arguments. They also are monitoring women who may need therapeutic abortions in order to develop a case to be presented to the Inter-American Commission on Human Rights in Washington, said Marta Maria Blandon, head of the Central American offices of Ipas, an international reproductive rights organization based in Chapel Hill, N.C.
National health ministry estimates put the number of clandestine abortions in Nicaragua at 30,000 each year.
The Catholic Church and anti-abortion groups spearheading the new law argue that therapeutic abortion has been routinely used to end unwanted pregnancies illegally under the guise of protecting the mother.
"It is a prosperous business," said Max Padilla, a Catholic activist who helped organize a lobbying effort and massive public demonstration in favor of the ban. "Now the people involved in that business are defending their livelihoods, presenting false cases."
Presidential Race Complicated Debate
The debate is fierce and emotional and politically entangled with the divisive presidential election campaign that ended early this month.
The assembly voted unanimously to pass the ban just days before Sandinista leader Daniel Ortega won his presidential election bid on Nov. 5. His leftist Sandinista Front supported the bill in what pro-choice critics saw as a political bargain with Catholic leaders and conservative factions.
"Twenty-six Sandinista votes sent us to our deaths," Blandon, a long-time women’s rights activist, said in an Internet campaign urging feminists to vote for Sandinista breakaway candidate Edmundo Jarquin for president.
President Bolanos, a conservative whose term ends in January, plans to sign the law, a spokesperson said. The president wants harsher jail sentences for violators, a proposal which has not been approved.
Health experts and women’s organizations predict a rise in Nicaragua’s already high maternal mortality rates that the United Nations Population Fund estimates to be 230 deaths per 100,000 live births.
In a nation where 8 of 10 people struggle to live on less than $2 a day, poor women with limited access to maternal health care will be most vulnerable, say activists and health workers.
"Women who can only go to public health services will die," said Blandon, of Ipas.
Almost 2,000 Nicaraguan women receive therapeutic abortions at public hospitals each year, Blandon said. Health ministry records show a far lower number, with only six such abortions recorded last year. But those did not include ectopic pregnancies and other abnormalities, which numbered more than 1,800 cases. Figures for private services are unavailable.
Death Rates Rise After Abortion Ban
In neighboring El Salvador, deaths among pregnant women have increased since a similar ban was imposed in 1998, Blandon said, although El Salvador’s mortality rate remains lower than Nicaragua’s.
She does not believe the ban will dent the number of illegal abortions. Only women who cannot afford clandestine procedures will delay needed treatment or try dangerous measures at home, she said. Doctors may be reluctant to help them for fear of being accused as accomplices to a crime.
Dr. Leonel Arguello is president of the nationwide Nicaraguan Society of General Medicine, which is urging Bolanos to veto the ban.
Arguello has repeatedly pressed high-ranking officials at Nicaragua’s health ministry to intervene in individual cases and force public health services to treat pregnant women at risk. Along with a small army of health workers and rights activists he has been tracking pregnant women at dilapidated city hospitals and remote rural clinics as they face confusing and often contradictory responses from health workers over the pending ban.
"For the general population and much of the medical community, therapeutic abortion now is prohibited," Arguello said. "Doctors are afraid to act."
That worries Eripcia Chevez.
In May, Chevez had an emergency therapeutic abortion two months into her pregnancy when doctors discovered the fetus was forming outside the uterus and had ruptured a fallopian tube, causing severe internal bleeding.
"I would like to try again, but I’m afraid to get pregnant. That operation saved my life," Chevez, 28, a swimming teacher, said in an interview at her home in Leon, where she lives with her two children, 9 and 11, from a previous marriage, and her second husband. Her husband wants a child, she said. "But he is afraid of losing me."
Lorraine Orlandi is a freelance reporter who has covered human rights and related stories in Latin America for the past 10 years. She was based in Nicaragua from 1997 to 2000 and now lives in Mexico City.
For more information:
Human Rights Watch, Women’s Rightshttp://www.humanrightswatch.org/women/
International Planned Parenthood Federation, Western Hemisphere Region
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