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Published in Miami Herald

A year after elections in Nicaragua returned Daniel Ortega to power, scores of pregnant women have died, many as a consequence of a new law that prohibits doctors from providing lifesaving treatment.

In the run-up to the hotly contested elections last November, Sandinistas in the National Assembly helped to overturn a legal provision that had permitted lifesaving abortions since 1893. Nicaragua thus joined the handful of countries in which abortion is a crime punishable by prison for both a woman and her doctor -- even in cases of rape, incest or when a woman's life is at risk.

During the past year, the new law has had a devastating impact on women in Nicaragua.

  • Pregnant women suffering from illnesses such as kidney failure have died because they were not allowed to interrupt their pregnancies to treat their conditions.
  • A poor, single mother died of a heart attack after doctors refused to treat her severe hemorrhaging because the fetus was still alive. Neither the fetus nor the woman survived, and her 3-year-old son now lives with his indigent grandmother in precarious conditions.

Human-rights organizations have come under fire for addressing the issue of abortion, but many critics have simply missed the point. The issue isn't abortion per se but the human-rights violations that occur when access to safe and legal abortion is restricted. Freedom of religion is a basic right, but the Nicaraguan government should not use religious doctrine as a pretext for violating women's fundamental rights to life and health. Untreated ectopic pregnancy In many other countries, even Catholic hospitals perform therapeutic abortions necessary to save a woman's life. Although Nicaragua's health ministry issued protocols on emergency obstetric care, it has since failed to follow up by clarifying what other procedures could be considered therapeutic abortion. Even according to the government's own figures, maternal mortality has shot up by 100 percent in the past year. One woman died in April from an untreated ectopic pregnancy -- that is, when a fertilized egg is implanted outside the uterus and has no chance of survival. Normally, doctors around the world intervene as soon as the ectopic pregnancy is detected. But Nicaraguan doctors are now reluctant to act out of fear that their interventions might be considered criminal. Another reason women are dying in Nicaragua is that they are afraid to seek medical help. Women seeking abortions fear mistreatment and discrimination by medical personnel, as well as the threat of prosecution by the authorities. Human Rights Watch interviewed several women who were able to obtain safe but illegal abortions. None of them was able to obtain the procedure in the public sector, however, despite the medically certified risks to their health posed by their pregnancies. Here, traffic intersections feature giant posters of Ortega with the slogan, ''Arise ye poor of the world!'' Under Ortega's government, however, the sad irony is that richer, better-informed women can fly to Miami or seek a costly and illegal abortion in Managua, while poor women often die preventable deaths after they are rejected from public health services or denied emergency obstetric care. Ortega has made many promises to end the misery of the disenfranchised in Nicaragua. A good place to start would be to guarantee the state's obligation to ensure the health and lives of Nicaraguan women. The Sandinista government should inform women about their right to procure emergency obstetric care in the public-health sector and remind doctors of their obligation to treat them. Nicaragua has a long history of struggle for social justice. But the total ban on abortion denies equality and protection to women in the poorest and most vulnerable sectors of Nicaraguan society.

Lance Lattig and Angela Heimburger are editor and women's rights researcher at Human Rights Watch, respectively.

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