Nicaragua update: Doctors Respond to the Criminalization of Therapeutic Abortion

October 26th, the Nicaraguan National Assembly voted to criminalize therapeutic abortion, making Nicaragua one of only three countries in the Western Hemisphere where abortion is illegal even in cases where a pregnant woman's life is in danger. Nineteen medical associations opposed the ban, and now that it's likely to be signed into law, physicians are understandably alarmed. The proposed ban carries four- to eight-year prison sentences for women who seek abortions, as well as anyone who assists them – a scenario that could force doctors to choose between upholding the Hippocratic Oath and respecting the Nicaraguan Penal Code.

Two days after the National Assembly voted, the Nicaraguan Society of Obstetricians and Gynecologists (SONIGOB) sent an urgent letter to President Enrique Bolaños and the Minister of Health asking what actions would be taken to protect both patients and health workers in light of the new law. First, the letter requests that 24-hour functioning Ultrasound machines be installed in any health facility serving women who are admitted for complications from unsafe, illegal abortions (an estimated 36,000 Nicaraguan women seek illegal abortions every year, and the Ministry of Health reports that 1,800 wound up in the hospital with complications from unsafe procedures last year alone). Ultrasound machines are necessary because, as the letter argues, the new law will require physicians to establish whether or not a fetus is viable before they can take urgent action to save a pregnant woman's life. This is particularly essential in light of the harsh penalties that accompany the new law, which may make women even more reluctant to admit to having sought or provoked an abortion.

The letter from SONIGOB goes on to request 24-hour legal support for physicians trying to determine if providing the best care for their female patients will require them to break the law, as well as physical protection for health workers against family members who have been informed that a doctor cannot intervene to save their wife's, daughter's, sister's, or mother's life because of the prohibition against therapeutic abortion. SONIGOB's request may sound alarmist, but consider the case of ectopic pregnancies, of which there were 400 in 2005 alone, according to the Nicaraguan Ministry of Health. In an ectopic pregnancy, the egg implants outside the uterus, most commonly in the fallopian tube, with close to zero chance of survival for the fetus. With very rare exceptions, if left untreated, ectopic pregnancies end when the woman's fallopian tube bursts, destroying the fetus's chances for survival, and potentially killing the woman. The standard treatment for an ectopic pregnancy is a therapeutic abortion, as a means to save the woman's life as well as preserve her future fertility. In Nicaragua, however, that option is now illegal – so doctors will have to wait for the fallopian tube to rupture, risking the woman's life without increasing the fetus's chances for survival. No wonder doctors are seeking protection from angry family members.

SONIGOB has already estimated that the new law could increase pregnancy- and childbirth-related deaths in Nicaragua by as much as 65 percent. If that happens, it will be a tough pill to swallow for the anti-abortion activists who rallied support for this measure by falsely claiming that medical technology has advanced to the point where life-threatening pregnancies need never be resolved by therapeutic abortion (in a strategy somewhat reminiscent of the one currently employed by anti-abortion doctors in South Dakota).

The letter from SONIGOB should be enough to put that myth to rest. But even if the myth were true, let's come back down to reality for a few moments. This is Nicaragua, the second poorest country in the Western Hemisphere, where people can't afford basic health care, where my friend's neighbor was recently charged up front for her 16-year-old son's emergency appendectomy. In the same issue of La Prensa where I read about SONIGOB's letter, the front-page article was about a fire that had raged for four hours in Managua's central marketplace the day before because there were no working fire hydrants in the vicinity. Given these realities, I doubt that the average Nicaraguan woman will be enjoying the benefits of state-of-the-art medical technology any time soon.

When it comes down to it, however, the fundamental truth of Nicaragua's abortion ban is this: rich women, including the wives and girlfriends and family members of the same politicians who voted for the ban, will still be able to fly to Miami for safe, legal abortions – therapeutic or not (despite anti-abortion National Assembly member Wilfred Navarro's declaration that he had "never sent one of his women to have an abortion," in a clear bid for the Bill Napoli award for Outrageous Statements about Abortion Made by a Parliamentarian). Meanwhile, poor women – and 45 percent of Nicaraguans live in extreme poverty – will be stuck here, forced to choose between seeking an unsafe, illegal abortion, and continuing a pregnancy that could end their lives. I hate to borrow a phrase from Feminists for Life, but really – don't women deserve better than choices like these?

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