Public Health Issue: The Abortion Ban in Nicaragua

Introduction

The topic of abortion has long been subjected to controversy due to the varied opinions on whether the healthcare service should be allowed. The issue is especially relevant to consider in the context of Nicaragua due to a severe restriction on abortion through nationwide legislation. This means that a significant group of individuals is denied access to legal and safe abortions, which creates further issues with treatment that may be threatening to the lives of Nicaraguan women and girls.

Criminalizing abortion contributes to both physical and mental pain, with the level of suffering from the absence of a solution leading to death and suicide¹. Furthermore, criminalization does not mean that abortions will not take place². Some individuals seek illegal options, thus further risking their health and well-being. It is imperative to study the problem of Nicaragua’s denial of access to safe and legal abortions. Also, the impact of the issue will be studied to develop solutions that are necessary to relieve the public health burden.

Background to the Issue

There is no public health benefit to criminalizing abortion. Abortions are safe when they are conducted at a pregnant women’s request.³ The World Health Organization defines safe abortions as an abortion granted within a reasonable time frame of the pregnancy duration, and if the abortion is conducted or assisted by a trained professional⁴. Safe abortions are done using manual vacuum aspiration or pharmacological drugs to abort pregnancy.⁵ Decriminalizing and providing access to low-cost unrestricted abortion is the only way to ensure safe abortions and because of modern medical laws that limit or altogether ban access to abortions are only punitive.⁶

Unsafe abortions are conducted by someone who is inadequately trained or take place in an environment that is not up to medical standards. The training and environment expected of a safe abortion depend on the stage of pregnancy and the procedure and whether the abortion will be medical or surgical 26 countries, which hold 5% of the worlds biologically female population, have laws that prohibit abortion regardless of the circumstances.⁷ Nicaragua is the only country to have passed national legislation due to restricted access to abortion since 2000⁸.

In the 2012 guide on Safe Abortion: Technical and Policy Guidance for Health Systems, the World Health Organization’s Department of Reproductive Health and Research established a framework for appropriate and legal measures pertinent to the public policies on abortions.⁹

In the document, recommendations are made for a medical and surgical abortion, for care preceding induced abortion, and post-abortion care. Safe abortion care is defined as an issue pertinent to public health and human rights, which is why it is imperative to allow legal access of the population to the service.¹⁰ Moreover, whether abortion is widely available upon request or is legally more restricted, the likelihood of women having an unintended pregnancy and seeking induced abortion remains the same.¹¹ Therefore, there is no benefit in restricting abortions on a nation-wide level because they will take place inevitably, only to risk women’s health.

Abortion Ban Impact

The government of Nicaragua established a ban on abortions in 2006, which continues to have an adverse effect on public health.¹² The law punishes abortions with no exceptions, even in cases when they are threatening to women’s lives or have been the result of rape. Furthermore, the new law results in the denial of treatment for obstetric complications in pregnant women.¹³ Whether the medical conditions experienced by pregnant women are caused by the pregnancy (for example, spontaneous miscarriage) or aggravated by it (for example, malaria), there is no legal treatment that the population can access to improve their health and eliminate the pregnancy that is putting their lives at serious risk.

As a result of the denial of access to abortions, women and girls are getting unsafe clandestine abortions.¹⁴ They are also afraid to seek medical care in cases when such abortions cause complications or avoid disclosing the reasons for them when seeking care.¹⁵ The problem is exasperated by the dilemma experienced by healthcare providers that are caught between the ethical conflict of helping patients who are suffering and having to report them to law enforcement for suspected abortions.¹⁶

Moreover, healthcare providers who are caught helping women who have had illegal abortions will also be subjected to legal prosecution. Under the criminal law of the country, women and girls who terminate their pregnancies are likely to receive a sentence of up to two years in prison while medical professionals “can be sentenced to up to six years for offering the service to the public”.¹⁷ Such an attitude toward abortions has established an environment of fear and uncertainty among the target group. The current laws should be abolished to develop regulations that would consider the health of the population as well as its human rights.

It is also a matter of concern that the government has been continuously manipulating the statistics regarding abortion and sexual violence rates. According to Lakhani, in 2012 and 2013, the Ministry of Health of Nicaragua reported a total of 51 and 71 maternal deaths, respectively¹⁸. However, the leaked documents revealed that the real actual deaths were 71 and 87 in 2012 and 2013, respectively.¹⁹ This creates a significant challenge because the public is not given the truth regarding the true consequences of unethical pregnancy treatments in the country. Nevertheless, the ban on abortion continues to be effective despite the high rates of sexual violence against girls and women in the country.

For example, in 2013, forensic doctors in Nicaragua examined 6,609 victims of sexual violence, of whom 51% were under the age of 13.²⁰ This points to the need to introduce policies that would consider the health and well-being of young girls in regulating abortions. In 2012, 1,609 girls who had sexual intercourse between the ages of 10 and 14 became mothers.²¹ While sex with a child under 14 constitutes statutory rape under the penal code of Nicaragua, the government has consistently failed to produce accurate and transparent reports on the numbers of young girls getting pregnant from rape since 2012.²² Therefore, getting access to government statistics regarding abortions and unwanted pregnancies in Nicaragua is next to impossible because of the intentional hiding of the truth.

The ban on abortion in the country is concerning because the rates of pregnancies do not seem to reduce as a result of the policy. According to Kalantari for PRI, Nicaragua’s teen pregnancy rate has been on the rise, with girls becoming mothers at a very young age (see Figure 1)²³. In 2014, the country was second in the rates of teen pregnancies in Latin America and the Caribbean, and the population cannot get therapeutic abortions even when they were raped.

The issue is exasperated by the lack of public education on safe sex practices among people. Moreover, in “the last decade, the rate of 10- to 14-year-old girls having babies in Nicaragua has increased by almost 50% over the last decade,” with one out of three teenagers having a baby before the age of 18.²⁵ Girls often become the victims of circumstances within the machismo culture that prevails in the country. Machismo is a sociocultural notion that explains the male and female socialization in Hispanic cultures. It represents a set of values and beliefs that elevate the role of masculinity in shaping social, political, and cultural frameworks.²⁶

Within an environment dominated by males, teenage pregnancies are more likely to occur. The rights of young women and adolescent girls are not treated to the desired extent, which also means that they do not have the power to decide what they should do with their bodies. Essentially, the Nicaraguan ban on abortion disrespects the rights of women who would like to get abortions at a young age to avoid becoming parents. Respectively, the ban is unhealthy for women of all ages because of the risks that pregnancies may cause, including psychological and physical issues. While the machismo culture is hard to overcome due to its sociocultural roots, the solution is to challenge the system from the legislative standpoint.

Lacking Awareness

The lack of public awareness and education among young people in Nicaragua is a problem that contributes to the increasing rates of teen pregnancies.²⁷ According to Marta Lopez from the Luisa Amanda Espinoza Association of Nicaraguan Women (AMNLAE), a vast majority of adolescent and teen pregnancies are results of sexual abuse.²⁸ The research supports these findings by Isaza et al. for the Planned Parenthood Global report, which found that 93% of childhood pregnancies in Nicaragua were the consequences of rape.²⁹ It is imperative to note that around 80% of these teens had no prior sex education.³⁰ Therefore, there is a significant gap in knowledge about how young people should act when being involved in sexual relations.

Moreover, Lopez mentioned that the topic of sex has always been a taboo topic both at schools and at home, which is why such groups as AMNLAE took the education into their hands. They started to educate teenagers around Nicaragua about how they should approach their sexual health, giving peer advice and free contraception.³¹ Lopez also reported that girls were often misinformed about the existing methods of contraception.³²

For example, it was found that peers would often think that condoms were a bad taste, and that “birth control shots would make girls skinny while pills would make them fat.”³³ The misinformation is a problem for Nicaragua, which fails to invest in educational efforts to ensure that young people understand the value of contraception and can prevent unwanted pregnancies willingly. An educational intervention should occur at a systematic level, at schools that are intended to prepare young people for future life.

While it is imperative to eliminate the abortion ban and amend it to fit the needs of the population, the government should also pay attention to the problem of lacking education.³⁴ In the meantime, the role of such groups as AMNLAE is imperative for ensuring that young people understand prevention measures and can educate their children in the future so that they do not make the same mistakes. Becoming engaged in education and personal development is vital for the public. Supporting each other and creating an environment that would facilitate the decreasing numbers of childhood pregnancies is imperative.³⁵ The advocacy of international organizations, coupled with the work of healthcare providers, can eliminate the stigma of abortion and encourage the public to be more vocal about their dissatisfaction with the existing ban.

Concluding Remarks

The criminalization of abortions in Nicaragua will not have a positive impact on the health of the population. Despite the fact that abortions are banned in the country, women and girls will continue seeking ‘underground’ services in order to relieve the burden of unwanted pregnancies. Limited transparency on statistics should also be addressed, as the government fails to provide correct numbers and rates on pregnancies resulting from rape. Overall, the lack of attention to the needs of people on the part of the government will continue to drive illegal abortions, and the international community should pay attention to the problem of diminishing human rights.

Works Cited

1. Bateson, Ian. “This Is What It’s Like on the Front lines of Nicaragua’s Abortion Crisis.” Huffington Post. 2017. Web.
2. Berer, Marge. “Abortion Law and Policy Around the World: In Search of Decriminalization.” Health Human Rights, vol. 19, 2017, pp. 13-27.
3. Center for Reproductive Rights. “The World’s Abortion Laws.” Reproductive Rights, 2019. Web.
4. Hurtado, Aída, and Mrinal Sinha. Beyond Machismo: Intersectional Latino Masculinities. University of Texas Press, 2016.
5. Isaza, Ximena Casas, et al. “Stolen Lives: A Multi-Country Study on the Health Effects of Forced Motherhood on Girls 9-14 Years Old.” Planned Parenthood. Web.
6. Kalantari, Shuka. “Nicaragua’s Teen Pregnancy Rate Soars.” PRI. 2016. Web.
7. Lakhani, Nina. “Lies and Statistics.” In Focus, vol. 44, no. 1, 2014, pp. 80-83.
8. —. “Nicaragua’s Staggering Child-Sex Abuse Rates.” Al Jazeera. 2014. Web.
9. “Nicaragua: Abortion Ban Threatens Health and Lives.” Human Rights Watch. 2017. Web.
10. Panel on Understanding Cross-National Health Differences Among High-Income Countries. “US Health in International Perspective. Shorter Lives, Poorer Health.” NCBI, 2013. Web.
11. Sámano, Reyna, et al. “Family Context and Individual Situation of Teens Before, During and After Pregnancy in Mexico City.” BMC Pregnancy and Childbirth, vol. 17. 2017, p. 382.
12. “The Impact of the Complete Ban of Abortion in Nicaragua.” Tbinternet OHCHR. Web.
13. The Lancet. “Abortion: Access and Safety Worldwide.” The Lancet. 2018. Web.
14. Walsh, Janet. “Nicaragua’s Abortion Ban Makes Victims the Criminals.” Human Rights Watch. 2017. Web.
15. World Health Organization. “Safe Abortion: Technical and Policy Guidance for Health Systems – Second Edition.” Apps WHO, 2012. Web.
16. —. “WHO Launches New Guideline to Help Health-Care Workers Ensure Safe Medical Abortion Care.” WHO. 2019. Web.
17. —. “Global Report on Urban Health: Equitable Healthier Cities for Sustainable Development.” Apps WHO, 2016. Web.

Footnotes

1. Walsh, Janet.
2. Walsh, Janet.
3. Berer, Marge, 14.
4. World Health Organization, “Safe Abortion: Technical and Policy Guidance for Health Systems – Second Edition.”
5. World Health Organization, “WHO Launches New Guideline.”
6. Berer, 15.
7. Center for Reproductive Rights.
8. The Lancet.
9. World Health Organization “Safe Abortion.”
10. World Health Organization “Safe Abortion.”
11. World Health Organization “Safe Abortion.”
12. “Nicaragua: Abortion Ban Threatens Health and Lives.”
13. “The Impact of the Complete Ban of Abortion in Nicaragua.”
14. “Nicaragua: Abortion Ban Threatens Health and Lives.”
15. Bateson, Ian.
16. “Nicaragua: Abortion Ban Threatens Health and Lives.”
17. “Nicaragua: Abortion Ban Threatens Health and Lives.”
18. Lakhani, Nina, “Lies and Statistics,” 82.
19. Lakhani, “Lies and Statistics,” 82.
20. Lakhani, “Nicaragua’s Staggering Child-Sex Abuse Rates.”
21. Lakhani, “Lies and Statistics,” 82.
22. Lakhani, “Lies and Statistics,” 82.
23. Kalantari, Shuka.
24. Kalantari.
25. Kalantari.
26. Hurtado, Aída, and Mrinal Sinha, 100.
27. World Health Organization, “Global Report on Urban Health: Equitable Healthier Cities for Sustainable Development.”
28. Sámano, Reyna, et al. 382.
29. Isaza, Ximena Casas, et al.
30. Isaza, et al.
31. Kalantari.
32. Kalantari.
33. Kalantari.
34. Panel on Understanding Cross-National Health Differences Among High-Income Countries, 9.
35. “Nicaragua: Abortion Ban Threatens Health and Lives.”.