MANAGUA, Nicaragua -- Doctors and women's groups are warning that Nicaragua's ban on all abortions -- even to save the mother -- will endanger the lives of thousands of women every year.
With the new law, which imposes prison sentences of up to eight years for women and doctors , Nicaragua joins El Salvador and Chile as having the most restrictive anti-abortion laws in Latin America and among the toughest in the world.
In El Salvador, women who develop ectopic pregnancies -- when a fertilized egg gets stuck in a fallopian tube, giving it no chance of survival -- are kept under guard in a hospital. A prosecutor must certify that the embryo has died or the woman's tube has ruptured before doctors can intervene.
In Chile, where abortion is punished with three to five years in prison, legislators last week rejected without debate a bill that would have permitted it in limited circumstances. Nevertheless, rich women go to private clinics where secret abortions are recorded as tumors or miscarriages while poor women obtain back-alley abortions, with an estimated 32,000 suffering serious injuries every year.
Abortion is criminalized throughout majority-Catholic Latin America, except in Cuba. Exceptions are made in most countries to save the mother's life, a procedure known throughout the region as "therapeutic abortion." Yet women in the region, who have poor access to contraception, have some of the highest rates of abortion in the world -- with an estimated 3.9 million annually, or nearly one per woman over her lifetime.
According to the World Health Organization, South America is the continent with the highest rate of unsafe, clandestine abortions.
As many as 21 percent of maternal deaths in Latin America are associated with abortion, according to the Alan Guttmacher Institute, a US-based research center on reproductive issues.
Colombia was the one Latin American country to liberalize its law earlier this year, allowing abortions in cases of danger to a woman's life, rape, or severe fetal deformity -- exceptions that are now being challenged by a group of abortion opponents.
In Nicaragua, Dr. Oscar Flores Mejía, of Nicaragua's National Society of Obstetricians and Gynecologists, said the new law has sent fear and confusion through the medical community. He said many doctors understand the ban to mean they can do nothing "to interrupt pregnancy from the moment of conception until birth."
That rules out operations to save women with ectopic pregnancies, eclampsia, cardiac problems, or other life-threatening complications if doctors could not guarantee that the fetus would survive, Flores said.
"This law is forcing us to be delinquent in our jobs," he said .
The Rev. Rolando Alvarez, spokesman for the Managua archdiocese, said the Catholic Church fought for a ban without exceptions because church officials estimate that thousands of elective abortions were being performed annually under the guise of saving a woman's life. "Before it was penalized, all these murders were treated with impunity," he said.
The ban, which took effect Nov. 18, was passed unanimously by legislators courting church support and religious voters at the height of the electoral season in late October. Among those backing the new law is President-elect Daniel Ortega, a former Marxist.
Activists for women's rights say church leaders who supported the ban and legislators who voted for it will be responsible for thousands of avoidable maternal deaths each year. According to Health Ministry figures, 1,818 women last year and 902 in the first half of this year had legal abortions to save their lives in public hospitals. Nearly 8,500 others were treated for miscarriages, natural or induced. Officials say more abortions, for which there are no records, were performed in private clinics .
"What is going to happen to all those women who could be saved by therapeutic abortions?" said Magali Quintana of the advocacy group Catholics for Free Choice in Nicaragua. "They'll simply be waiting for their deaths."
According to Health Ministry figures compiled by Ipas, a nonprofit agency dedicated to reproductive issues, 50 Nicaraguan women died between 2000 and 2003 from medical conditions aggravated or caused by pregnancy. In many cases, officials never informed the women that abortions were permitted to save their lives, activists say. Scores of others died from sepsis or botched clandestine abortions.
Flores said 95 percent of members of the National Society of Obstetricians support legalized abortion to save a mother's life or in cases of severe genetic defects or rape. But politicians eager to garner electoral endorsements from religious leaders refused to listen to petitions from the medical association, he contended.
"For 115 years, Nicaragua has had a law on the books allowing therapeutic abortions . . . and now we are being told that we can't save a woman's life anytime in pregnancy if we can't guarantee that the baby will live too," he said. Doctors are also worried they could be held criminally responsible if they assist a patient who has suffered a natural or self-inflicted miscarriage.
Ana Isela Vega, who was three months pregnant when she suffered a miscarriage this month, was refused the necessary procedure to evacuate her uterus in a public hospital in the city of León, said Marta María Blandón, Central America director of Ipas. According to Blandón, the doctors worried they could not operate for legal reasons. Under pressure from women's groups who explained that the law did not forbid removing an already-deceased fetus, the doctors finally operated.
Both supporters and opponents of the abortion ban say the law does not forbid saving a woman's life if it is not in the course of performing an abortion. But some doctors are apparently erring on the side of caution to avoid being made an example by an overzealous prosecutor.
In the hardscrabble village of Cuajachillo outside the capital lives a family who believes their daughter was the first victim of the draconian ban. The public prosecutor for crimes against women is investigating whether doctors fearful of punishment even before the newly-passed abortion law had gone into effect stood by while Jazmina del Carmen Bojorge, 18, died from complications to her pregnancy.
Bojorge was awaiting her second child when she and her 5-month-old fetus died this month in a public hospital in Managua. Bojorge's family says they took her to a hospital when she complained of limb pains and weakness. When her condition worsened, doctors say they determined her fetus was dead, but Bojorge went into shock before they could save her.
"Now there is a dead woman, an orphaned son, a destroyed family, and this will not be the only case," prosecutor Débora Grandison told the Nicaraguan newspaper El Nuevo Diario. Grandison said outlawing therapeutic abortions was "condemning women to death."
The mother of the deceased teen doesn't understand the logic behind the law . If the doctors realized that fetal distress was putting the mother in danger, said Rosa Argentina Rodríguez Bojorge, "They could've at least saved my daughter so she could take care of her other child."
If negligence is proved, the Bojorge case "is a big warning that doctors are going to interpret the wording of the law very literally," said Azahalea Solís Román, a lawyer at the Center for Constitutional Rights in Nicaragua. The center will appeal to the Nicaraguan human rights council and the Supreme Court, arguing that the law violates a women's right to life.
Wilfredo Navarro, a national assemblyman who supported the ban, accused abortion activists and doctors of fueling an unwarranted scare as part of a campaign to overturn the law. "There's no going back. If doctors are going to kill babies, they can only do it outside of Nicaragua," he said.
Asked in an interview this month about the case of an 8-year-old Nicaraguan who was raped in 2002 and whose family fought successfully to get her a legal abortion the following year, Navarro replied, "If a 9-year-old is raped, she should have the baby, because that child has rights."