The Lancet on Nicaragua's New Abortion Ban
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The Lancet on Nicaragua's New Abortion Ban         

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Date: Jan 21, 2007 20:00

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The Lancet on Nicaragua's New Abortion Ban

Via NY Transfer News Collective * All the News that Doesn't Fit

[Registration req'd at The Lancet to access this article.]

sent by Lynette Dumble (activ-l)

The Lancet 369:15-16, 2007

World Report

Nicaragua tightens up abortion laws

by Jill Replogle

Doctors in Nicaragua are outraged by the removal of a legal loophole
that permitted abortions for women whose health is at risk. Critics
say the amendment, which was fast-tracked through the legislature
without a single opposing vote, will endanger women's lives. Jill
Replogle reports.

On Nov 2, in a haphazard cemetery in the hills outside the capital
city Managua, Jazmina Bojorge Rodrmguez was buried in a simple grey
casket. She was 19 years old. The funeral procession of fifty or so
friends and relatives wound along the dirt road to the cemetery on
foot. The coffin-bearers, wearing simple work clothes, passed round
cheap rum to ease the pain and strain. Women shuffled along in
flip-flops, carrying bouquets of wildflowers and bougainvillea to
place on the grave.

Bojorge was 5 months pregnant with her second child when she went to
the Fernando Velez Paiz public maternity hospital in Managua, with
bleeding, pain, and a fever. She had begun to have uterine contractions

The hospital's ultrasound machine was not working, so she was sent to
another hospital to find out if the fetus was alive, which it was.
Then Bojorge was taken back to Velez Paiz and put on medication to try
and stop the contractions. After 12 h of waiting for the woman's
condition to improve, the doctors determined that the fetus had died.
They stopped the treatment and waited for Bojorge to abort naturally.
However, she began to haemorrhage and she was taken to the operating
room for caesarean section. It was too late; the placenta had detached
and the uterus was filled with blood. Bojorge died shortly afterwards.

Women's groups and some doctors say Bojorge was the first victim of a
recent change in Nicaraguan law, which prohibits abortion in all
cases, even if the mother's life is in danger. The law puts Nicaragua
among just 2%% of countries worldwide that do not permit life-saving

The combination of her doctors' fear of being prosecuted under the new
law, lack of diagnostic equipment, and the delay in taking medical
action proved fatal in Bojorge's case, says gynaecologist Ana Maria
Pizarro, from the Nicaraguan women's health organisation, SIMujer
(Servicios Integrales de la Mujer or Integral Services for Women).

She and other doctors, along with activists for choice and human
rights, fear that many other women-especially those who are poor-with
complicated pregnancies will follow Bojorge to the grave. We think
this is the beginning of a long chain of maternal deaths, says Pizarro.

The new law was passed by the Nicaraguan legislature on Oct 26,
shortly before the country's Nov 5 presidential elections. Despite
appeals from the EU and the UN not to vote on the controversial
legislation during election time, the bill was fast-tracked through
the legislature, and was passed without a single opposing vote.

Nicaraguan president Enrique Bolaqos signed the bill into law 3 weeks
later, in the presence of Catholic and Evangelical church leaders, who
campaigned heavily for the law.

The legislation does not actually create a new law, but rather removes
an article from the country's penal code that permitted abortion for
therapeutic reasons. Under this article, which refers to therapeutic
abortion, the procedure had generally been allowed to protect the
mother's health, in the case of rape or incest, or when severe fetal
malformation was detected. Abortion for any other reason has been
illegal in Nicaragua for more than 100 years.

Doctors face up to 6 years in jail for doing an abortion; women who
abort face up to 4 years' imprisonment. President Bolaqos had
originally asked for an increase in abortion-related penalties-up to
20 years for doing an abortion, or 30 years if the mother on whom the
procedure was done sustained psychological or physical damage.

Bishop Juan Abelardo Mata Guevara, president of the Episcopal
Commission of Life and the Family, says the loophole allowing
therapeutic abortion had been abused. Abortions have been carried out
that were unnecessary [for medical reasons], says Mata. He adds that
medical science has advanced and doctors should be able to save
women's lives without killing the unborn child.

The law has been hotly debated in Nicaragua over the past decade, with
both the Catholic Church and Evangelical Church hierarchies demanding
a stronger antiabortion law.

Pro-choice groups have countered with a campaign aimed at convincing
the mostly Catholic population that therapeutic abortion is a human
right and does not contradict Church teachings.

The debate came to a head several years ago when a 9-year-old
Nicaraguan girl, Rosita, was raped in Costa Rica and became pregnant.
Her parents, illiterate campesinos, were working in the neighbouring
country as coffee pickers when it happened. The family's fight for a
legal abortion for Rosita became an international battle between
anti-abortion and pro-choice camps.

In the end, Rosita had a legal but clandestine abortion. The names of
the doctors who did the operation were kept secret along with the location.

Later, a representative from an anti-abortion group filed a lawsuit
against the parents and anyone else that aided or consented to the
girl's abortion, including some members of women's rights groups. But
the court dismissed the charge.

The Catholic Church, however, excommunicated the girl, her parents and
all others involved in the abortion. Prior to this year's Nov 5
presidential elections, the issue again became front-page news. Church
leaders held an anti-abortion march on Oct 6, where they presented 290
000 signatures supporting a complete outlaw of abortion.

Along with posters and banners for different candidates, the streets
of Managua were overhung with banners that read don't vote for
candidates who support abortion and, on the other side of the
spectrum, murderers of women, don't vote for them followed by the
names of the three leading candidates for president, all of whom
declared their support for a total abortion ban.

Only one candidate, Edmundo Jarqumn of the left-leaning Sandinista
Renovation Movement, publicly supported the right to therapeutic
abortion. He won just 674%% of total votes. Daniel Ortega-whose entire
Sandinista National Liberation Party legislative bench voted in favour
of the new law-won the election.

Latin American nations have taken diverging paths on the abortion
issue, with some countries enacting increasingly restrictive measures,
and others loosening up legislation on the matter. In 1997, El
Salvador passed a law similar to the one recently enacted in
Nicaragua, prohibiting abortion with no exceptions. An aggressive
law-enforcement apparatus in El Salvador makes sure that those who
break the law are punished, including aborting women, some of whom are
serving prison sentences of up to 30 years. Whether Nicaragua will
effectively enforce its recently passed legislation is yet to be seen.

Colombia, by contrast, has loosened up its abortion law earlier this
year. The country's constitutional court ruled that abortions were
legal to save the life of the mother, in the case of rape or severe
fetal malformation. Nevertheless, the new legislation has caused a
legal quagmire, with women's groups suing doctors who refuse to uphold
the new law, and anti-abortion groups seeking to overturn the high
court's decision.

Doctors and other opponents of Nicaragua's new law say the new
legislation responds to religious dogma without taking into account
the opinions of the medical community. It's really the start of an
inquisition, says Marta Marma Blandon, director for Central America
of Ipas, a US-based reproductive rights group. We feel like we don't
have a lay state anymore. She fears the law would keep women from
seeking professional help in the case of a spontaneous abortion, for
fear of being sent to jail.

As in most other countries where abortion is illegal, the poor will
bear the brunt of the law, said Blandon. People with money can get
high quality services, legally or illegally. It's not uncommon for
wealthy women to fly to Miami or nearby countries where laws are less
restrictive to have abortions, she says.

Nicaraguan doctors say the new legislation will limit their ability to
practise, and could prevent them from treating common, but potentially
deadly, complications like ectopic pregnancies. Oscar Flores Mejma,
member of the Nicaraguan Society of Obstetrics and Gynaecology, says
the law puts him in an impossible position. If he ignores his
professional obligation to give necessary care and does nothing,
Flores says, he must sit back and watch the woman die and then face a
lawsuit from the family. And if I act, I go to jail-so I don't have
any option but to stop practising my profession.

Flores says the medical associations-20 different associations have
publicly expressed opposition to the new law-will present a
constitutional challenge to the penal reform, on the grounds that it
is a threat to human life and limits doctors' ability to practise.

Doctor Ramiro Lspez, head of quality control for the public-health
ministry, says his office is working on a list of cases in which
medical interruption of a pregnancy is necessary to save the mother's
life. He says that it may be possible for doctors and mothers with
life-threatening complications to plead self-defence and avoid
criminal prosecution under the new law.

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