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The Cost of Nicaragua's Total Abortion Ban

Woman and child.

Rosa Argentina with her grandson Lesker, now in her care since the death of her daughter.

Macbeth's witches flashed briefly through my mind as I followed an herbal healer into a thatched hut, high on a forested hill in northern Nicaragua. A lone candle cast shadows onto a wood-fed stove where a cauldron bubbled. On the dirt floor, a mangy dog settled near the fire.

Luna, who asked that I not use her full name, began to prepare a concoction. From her garden she had plucked a precise set of ingredients: seven coffee leaves and buds, seven leaves from a plant she called diacepan and five leaves from the tree of the prickly guanabana fruit. She crushed them together in a bowl, added chamomile and a few drops of essence, before tossing them into a boiling pot. When brewed together, Luna explained, they make a bitter potion "that induces contractions" in pregnant women.

From a corner of the hut, a woman sat watching us. She looked about 50 years old, but Luna told me she was only 33. Luna said the woman was five weeks pregnant with her eighth child and desperately wanted to end the pregnancy.

Nicaragua is one of just three countries in the Western hemisphere to ban medical abortions, even when a pregnant woman's life was at risk or she had been the victim of rape or incest.

I had met Luna in the rural town of Weslala, a bumpy six-hour drive northeast of Managua, the capital of Nicaragua. I had come to the country for Channel 4 TV in the UK to find out more about the impact of the country's controversial total ban on abortion, which the Nicaraguan assembly passed in November 2006. Nicaragua's medical associations, human and women's rights groups, and the World Health Organization had all opposed the ban. With the passing of the bill, Nicaragua became one of just three countries in the Western hemisphere to ban medical abortions, even when a pregnant woman's life was at risk or she had been the victim of rape or incest.

I was especially interested in the impact of the ban on working class and rural women. The rich, I'd heard, could always fly to Miami for an abortion, but what about the needy? Nicaragua is the second poorest country in Central America. For many, life is already a struggle in a country faced with extreme poverty; add to that the high birth rates and high levels of domestic abuse and incest, as cited by Nicaraguan social workers, and the experience becomes even more bleak. What kind of medical treatment could a poor woman receive when dealing with complications from a botched illegal abortion? What is a 12-year-old rape victim to do if denied the right to a legal abortion?

female patient and family.

A woman with pregnancy complications waits to be seen at a large teaching hospital north of Managua.

Luna told me that because of the recent abortion ban, more women with dangerous or unwanted pregnancies were bypassing legitimate doctors, who were hesitant to perform abortions since the law passed. Instead, these women were turning to healers like her for remedies that had been passed down for generations. Luna's recipe came from her Mosquito Indian father. The concoction is very effective Luna assured me, but if her patients suffered negative side effects, like excessive bleeding, she urged them to go to the hospital.

"I am not a murderer," she said after pouring her remedy into a large Pepsi bottle and handing it to her patient. "I am a Catholic, and the church forbids elective abortions. But I'll help a woman if her life is at risk or if she already has many children. I don't want women to die."

Nicaraguan activists and health care specialists say they have medical data showing that at least 80 women have died in the past year because of the ban. They lay the blame squarely on an alliance between Nicaragua's all-powerful Catholic Church and President Daniel Ortega, head of the leftist Sandinista National Liberation Front.

If you look at Nicaragua's recent history, it's an unlikely partnership. In the 1980s, Ortega was the poster boy for the Sandinista revolution -- a secular, Marxist movement whose ranks once included feminists and abortion rights advocates. But things have changed. After almost a decade of Sandinista dominance, Ortega lost the presidency in 1990 and two subsequent presidential bids in 1996 and 2001. But then he reached out to the Catholic Church. In 2005 Ortega "remarried" his wife of 27 years in a Catholic ceremony. In 2006, on the eve of Ortega's fourth (and successful) attempt to reclaim elective power, he ordered his party to throw its weight behind a law, backed by the Catholic Church, banning therapeutic abortions.

"The Sandinistas were not thinking about the fetus when they helped pass the law," Quiros told me. "It was not because they were thinking about getting to heaven, either. They just wanted votes."

In the eyes of feminist activist Ana Quiros, it was pure political opportunism.

I met Quiros at a rally marking the International Day for the Elimination of Violence Against Women. Six hundred women from a smattering of feminist groups had gathered in Managua to bang drums, wave banners and demand that the ban be overturned.

"The Sandinistas were not thinking about the fetus when they helped pass the law," Quiros told me. "It was not because they were thinking about getting to heaven, either. They just wanted votes." And it was the Catholic Church, she believes, that helped deliver those votes during the 2006 election campaign.

Eighty five percent of Nicaragua's nearly six million citizens are Catholic and despite the country's revolutionary past, the church wields enormous influence.

I went to see one of the Catholic Church's key proponents of the ban in a working-class neighborhood of Managua. During a fiery sermon before a small parish, Father Henry Moreno talked about the evils of abortion and thanked his congregation for supporting a ban that "saved the life of the unborn."

"In other countries the church is asleep, but in Nicaragua," Moreno boomed, "the church is very much alive."

Afterward, seated in his vestry, Moreno explained how the Catholic Church had long disapproved of Nicaragua's penal code, which has been on the books since 1893. The law under the old statutes banned elective abortions but allowed therapeutic abortions, which Moreno claimed gave doctors the loophole they needed. "They carried out abortions on demand under the pretext they were needed for medical reasons," Moreno said.

Women's Rights protestors

Activists gather in Managua during the International Day for the Elimination of Violence Against Women.

The Catholic Church has been pushing for a change to the penal code for years, he said. But it wasn't until the summer of 2006 that the church, backed by the Vatican, saw its opportunity to mount a massive campaign to change the law. Posters and billboards were plastered all over Managua. An enormous anti-abortion rally was organized where hundreds of thousands of Catholics and members of Nicaragua's growing evangelical community turned out to support the total abortion ban. Enough signatures were collected to petition the National Assembly to repeal the law.

Falling on the eve of presidential elections, the call to criminalize therapeutic abortions was taken up by four out of the five participating parties, including the Sandinistas. Just two weeks before the presidential elections, the bill passed 52-0, with 9 abstentions and 29 absentees.

"The fact the ban coincided with an electoral year was not our problem," Moreno told me. "But it was definitely used by politicians to gain votes."

Moreno also assured me that the law was not killing women. Pregnant women had died since the ban went into effect but that was because of inexcusable medical negligence, not because of the ban, he said.

"The fact the ban coincided with an electoral year was not our problem," Moreno told me. "But it was definitely used by politicians to gain votes."

"The [pro-life] doctors who worked with us say there is always the possibility of saving a pregnant woman's life, even if she's at great risk," Moreno told me. This is, he argued, because modern medicine has advanced so much that doctors no longer have to make a choice between saving the mother or the baby's life. They can save both.

Try telling that to the mother of 19-year-old Jazmina Bojorge, who activists claim was the first victim of the ban.

One afternoon I visited Rosa Argentina, Jazmina's mother, in a rural hamlet about 30 minutes outside of Managua. I went with her lawyer, Ana Evelyn Orozco, who is representing the mother in a pending court case. (Argentina is now caring for her daughter's 5-year-old son, Lesker.)

According to Orozco, Jazmina entered a Managua hospital five months pregnant, shortly after lawmakers voted to enact the ban. She was hemorrhaging and had begun contractions. But doctors delayed treating her because the hospital lacked an ultrasound to check if the fetus was still alive. Hours after being sent to another facility for an ultrasound, Jazmina hemorrhaged again. She soon went into septic shock and died two days after checking in to the hospital.

Orozco told me that the doctors spent so much time trying to prove whether or not Jazmina's fetus was still alive that they neglected to save her life. What Jazmina needed, said Orozco, was a therapeutic abortion, but the new law had paralyzed doctors.

"They were afraid of breaking a law that carries serious penalties," Orozco told me. Penalties, she added, that could land them in prison for up to eight years.

Jazmina's doctors dispute Orozco's claims. They say that her client's death was the result of an unfortunate set of medical circumstances.

When I asked [the doctor] if he would be willing to break the law and perform the abortion, he shook his head: "In addition to going to jail for many years, I could lose the prestige I have worked 25 years to secure."

I questioned Dr. Luis Somarriba, an obstetrician at a teaching hospital north of Managua, in Leon, about the total ban. "Our hands are tied," he told me.

He pointed to one of his patients, a tired-looking woman of 36, seated on a narrow hospital bed. Her case was complicated. She was several months pregnant and had a heart problem exacerbated by the pregnancy. Because of this, she might not survive childbirth. In the meantime, Somarriba said, she is on a heart medicine that will almost certainly harm the fetus.

"What she really needs is a therapeutic abortion to save her life," he said.

When I asked him if he would be willing to break the law and perform the abortion, he shook his head: "In addition to going to jail for many years, I could lose the prestige I have worked 25 years to secure."

To date, no one has gone to prison under the new law and almost no one I talked to could recount either a doctor or a patient being penalized for elective abortions. (With the new law, patients can also be jailed.)

Still, medical practitioners are scared. According to a recent report by Human Rights Watch, "Doctors in Nicaragua are now afraid to provide even legal health services to pregnant women." They worry that natural miscarriages could lead to suspicion surrounding their work.

A doctor at Berta Calderon, Managua's largest maternity hospital, explained that the Health Ministry instructed doctors to grill patients coming in with obstetric complications, particularly those that lead to miscarriages. She told me that information regarding these complicated pregnancies is sent to the ministry for review. Now, medical personnel are reluctant to intervene quickly in cases of potential or obvious miscarriages; they are concerned about being accused of inducing an abortion.

It's also scaring the patients, according to activist Ana Maria Pizarro, who heads the Si Mujer private women's clinic in Managua.

Women who miscarry or suffer the aftermath of a botched abortion are afraid to seek treatment, she said. They're frightened of being sent to jail.

"Today," Pizarro explained, "there are two paths open to women with obstetric complications, jail or death."

She predicted that more women would be forced to seek treatment from quacks and that abortions would be driven further underground.

Nicaraguan activists have vowed to fight the law. Last year, they petitioned Nicaragua's Supreme Court to declare the ban unconstitutional and a breach of women's rights. The court has yet to hear the case.

Reporter,Kate Seelye

Reporter, Kate Seelye.

Kate Seelye is a Middle East correspondent based in Lebanon and a regular contributor to FRONTLINE/World.

In her last broadcast story for FRONTLINE/World in May 2006, she traveled across Gaza and the West Bank to investigate the militant Islamist group, Hamas. Fresh from the group's election success, Seelye builds a portrait of an organization teetering between a political awakening and a familiar cycle of bloody resistance.