Women take part in a march to mark International Women's Day in Managua, Nicaragua, March 8, 2017. © 2017 Oswaldo Rivas/Reuters

For more than six years, Ana’s partner raped her repeatedly in their home several hours from Nicaragua’s capital. He threatened, humiliated, and tormented Ana and their two young children. When she begged him to leave, he refused.

Twice, the rapes resulted in unwanted pregnancies. The first time, Ana told her partner she wanted to get a clandestine abortion. “He said he would kill me,” Ana told me. Afraid for her life, she continued the pregnancy and gave birth to her second child.

After many more rapes, Ana realized she was pregnant again. This time, she kept it a secret. She didn’t tell her partner, nor any friends or relatives. “People look at you sideways, but they don’t know,” Ana said. “They don’t put themselves in your shoes.”

Ana sought out an illegal abortion. She could go to prison for years for this, and so could the underground abortion provider who helped her. The country’s 2006 law punishing abortion—without any exceptions—has not stopped abortion, but has made it more unsafe.

I interviewed Ana (not her real name) earlier this year for a Human Rights Watch investigation into the impact of Nicaragua’s total ban on abortion. We found that women and girls, often afraid to seek medical care when complications arise from clandestine abortions, delay seeking care and do not disclose the cause of their condition to doctors. Activists and service providers described cases in which doctors or hospital administrators turned women and girls with suspected abortion complications over to police.

September 28 is the Global Day of Action for Access to Safe and Legal Abortion. Action is certainly needed, and not just in Nicaragua. Around the world, women and adolescent girls lack adequate sexual and reproductive health care and information, including contraceptives. Many end up with unwanted pregnancies, often as a result of rape. In places with highly restrictive laws—especially those with total bans, like Nicaragua— women and girls risk their lives with unsafe back alley abortions.

Governments are taking note, in good and bad ways. This year saw examples of both in Latin America. Chile at long last ended its draconian ban on abortion, adopting a law that decriminalizes abortion if the pregnant woman’s life is at risk, the pregnancy results from rape, or the fetus will not survive. But in Honduras, which has one of the world’s highest rates of sexual violence and adolescent pregnancies, Congress refused to amend its abortion law. It is maintaining its ban not just on abortion, but also on emergency contraception. Nicaragua’s National Assembly also rejected without debate a citizen’s initiative, which garnered more than 6,000 signatures, to decriminalize abortion when a pregnant woman’s health is at risk, including in cases of rape.

Ana is one of many women in Nicaragua who has faced a health risk from an unwanted pregnancy. “I decided to end the pregnancy because of my health,” she told me. She faced severe complications with her prior pregnancy. “If I had another pregnancy, it would be dangerous,” she said her physician told her. To avoid this health risk, and terminate a pregnancy she in no way wanted, Ana took an abortion medication—which is generally safer than other clandestine abortion methods. But if there were complications, seeking medical help would have put her in legal peril.

Lawmakers should not delude themselves, or the public, about restrictive abortion laws. These laws increase the incidence of unsafe abortions. A 2017 World Health Organization publication makes this clear. It cites data estimating that the average rate of unsafe abortion is “four times higher in countries with more restrictive abortion laws than in countries with less restrictive laws.”

It also notes that restrictive abortion laws are associated with higher levels of maternal mortality, saying, “The average maternal mortality ratio is three times higher in countries with more restrictive abortion laws (223 maternal deaths per 100 000 live births) compared to countries with less restrictive laws (77 maternal deaths per 100 000 live births).”

This is a human rights crisis. The denial of a pregnant woman or girl's right to make an independent decision regarding abortion threatens a wide range of human rights. Decisions about abortion should belong to a pregnant woman or girl—without interference by the state or others. To comply with human rights obligations, governments must ensure access to comprehensive sexual and reproductive health care, including abortion. Nicaragua should start by repealing its abortion ban, at a minimum by following Chile’s lead and decriminalizing under specific circumstances.  

Ana was the victim of a crime resulting in an unwanted, health-threatening pregnancy. But Nicaragua’s cruel, twisted abortion law treats her as the criminal for getting an abortion. This September 28, put yourself in Ana’s shoes, and fight for women’s reproductive rights, including access to safe, legal abortion.