Nicaragua: Working for Safety Despite Abortion Ban

Karim Velasco

After more than a hundred years of legally allowing women access to a therapeutic abortion, in October 2006 the Nicaraguan National Assembly banned this procedure in all circumstances. Now women's health groups are working to mitigate the damage.

Editor’s Note: With this post we welcome Karim Velasco, a
lawyer based in Lima, to Rewire. Karim will join our
Global Perspectives team reporting on reproductive and sexual health
and rights issues internationally.

After more than a hundred years of legally allowing women access to a
therapeutic abortion if her life or health was in danger, in October 2006 the Nicaraguan National Assembly
banned this procedure in all circumstances under pressure from conservative
movements and the church. A year later,
despite international pressure and claims to respect the human rights of women,
the hopes and efforts of women’s rights organizations and medical associations
were shattered when a new Penal Code reaffirming the ban was approved in
September 2007 by the National Assembly.

Although
in January 2007 a
group of civil society organizations filed an appeal to the Supreme Court to
declare the amended provision unconstitutional, the appeal had to be
resubmitted since the Penal Code had been rewritten.

Besides the importance of drawing a legal strategy to challenge the ban on
constitutional grounds, it is necessary to think of the consequences and
challenges that this ban is already bringing to public health. The CEDAW
Committee
, Pan-American Health Organization (PAHO), UNFPA and the Interamerican Commission of Human Rights
among others warned the Nicaraguan government of the alarming effects that the
ban on therapeutic abortion would have not only on women’s lives and health
but also on health service providers’ behavior.
And it is now clear that clandestine abortions and maternal mortality rates
have spiraled since the ban was introduced.

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According
to UNICEF,
the adjusted maternal mortality ratio is estimated to be 170 deaths for every
100,000 live births, one of the highest in the region. PAHO, Human Rights Watch (HRW), and IPAS have
documented cases of women who died because they were denied or delayed
treatment for obstetric emergencies, mainly because of the fear of prosecution or
misperception of the law on the part of medical personnel. Some women have reportedly
tried to get medical treatment because of constant bleeding or proved ectopic pregnancies
but were left unattended for hours or transferred to a different health center,
which in some cases led to their deaths. Women
have no choice but to look for emergency obstetric care elsewhere, even though
in many cases they need to be treated for incomplete miscarriages that have
nothing to do with induced abortions.

The
ban on therapeutic abortion is not only affecting the access to emergency
obstetric care, it is also affecting the quality in delivering the service. For
IPAS
the ban has a double impact on the health system: i) the economic costs of
treating these preventable emergencies, caused by delays in care, consume a
major portion of the health sector’s limited budget,
and ii) health
providers find themselves having to choose between appropriately treating the
patients by ignoring the law or denying them the necessary care to preserve
their health and lives.

It
is also important to highlight the fact that not only medical staff fear
prosecution. Women also fear seeking treatment because they are afraid of
being accused of having induced an abortion themselves. This vicious circle is
certainly affecting the most vulnerable women, that is, young poor women. IPAS
has even pointed out that "75 percent of the maternal deaths recorded this year
[2007] were women who lived in rural areas and more than 80 percent were
adolescents and youth." Although the
strong link between adolescent pregnancy and poverty is not new, the ban on
therapeutic abortion severely worsens the risks for these women.

Up
to now the only serious attempt carried out by the government to mitigate
consequences of the ban was the issue of "mandatory protocols for the provision
of emergency obstetric care." In December
2006 the Ministry of Health issued the Norms
and Protocols for Treatment of Obstetric Emergencies
.
According to Human Rights Watch these
guidelines "cover most if not all obstetric emergencies, including ectopic
pregnancies and post-abortion care. If fully implemented, it is possible that
these guidelines could overcome a good part of the negative consequences of the
blanket ban." However, HRW’s research also shows that doctors and health
officials are not willing to implement the guidelines; they usually ignore them
or delay their implementation due to fear of prosecution. It is not clear to them
whether the protocols are compatible with the ban or not, which usually leads
to leaving patients unattended or turning them away from the hospital. Unfortunately, the Ministry of Health "does
not monitor the full implementation of protocols, does not systematize complaints
received for the delay or denial of care, and so far has not studied the impact
of the law on the lives and health of women."

PAHO
and Human Rights Watch
have issued a list of recommendations to the Nicaraguan government to amend the
Penal Code and decriminalize
therapeutic abortion, guarantee women immediate access to emergency
obstetric services and postabortion care and appropriately implement the
guidelines on emergency obstetric care. HRW
additionally called on donors and United Nations agencies to expand funding for
reproductive health related programs in Nicaragua and to support campaigns
seeking to educate women about their right to access contraception.

In
an attempt to lessen the impact of the ban IPAS Central America‘s
work is not only focusing on "ensuring access to high-quality postabortion care
(PAC)", but has also included among its activities "improving the availability
and quality of abortion-care services in the context of comprehensive
reproductive health care."

Similarly,
it is imperative that additional initiatives are implemented to mitigate
the impact of the ban on women’s lives and mental and physical health,
especially by the government and national organizations.

News Politics

Tim Kaine Changes Position on Federal Funding for Abortion Care

Ally Boguhn

The Obama administration, however, has not signaled support for rolling back the Hyde Amendment's ban on federal funding for abortion care.

Sen. Tim Kaine (D-VA), the Democratic Party’s vice presidential candidate, has promised to stand with nominee Hillary Clinton in opposing the Hyde Amendment, a ban on federal funding for abortion care.

Clinton’s campaign manager, Robby Mook, told CNN’s State of the Union Sunday that Kaine “has said that he will stand with Secretary Clinton to defend a woman’s right to choose, to repeal the Hyde amendment,” according to the network’s transcript.

“Voters can be 100 percent confident that Tim Kaine is going to fight to protect a woman’s right to choose,” Mook said.

The commitment to opposing Hyde was “made privately,” Clinton spokesperson Jesse Ferguson later clarified to CNN’s Edward Mejia Davis.

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Kaine’s stated support for ending the federal ban on abortion funding is a reversal on the issue for the Virginia senator. Kaine this month told the Weekly Standard  that he had not “been informed” that this year’s Democratic Party platform included a call for repealing the Hyde Amendment. He said he has “traditionally been a supporter of the Hyde amendment.”

Repealing the Hyde Amendment has been an issue for Democrats on the campaign trail this election cycle. Speaking at a campaign rally in New Hampshire in January, Clinton denounced Hyde, noting that it made it “harder for low-income women to exercise their full rights.”

Clinton called the federal ban on abortion funding “hard to justify” when asked about it later that month at the Brown and Black Presidential Forum, adding that “the full range of reproductive health rights that women should have includes access to safe and legal abortion.”

Clinton’s campaign told Rewire during her 2008 run for president that she “does not support the Hyde amendment.”

The Democratic Party on Monday codified its commitment to opposing Hyde, as well as the Helms Amendment’s ban on foreign assistance funds being used for abortion care. 

The Obama administration, however, has not signaled support for rolling back Hyde’s ban on federal funding for abortion care.

When asked about whether the president supported the repeal of Hyde during the White House press briefing Tuesday, Deputy Press Secretary Eric Schultz said he did not “believe we have changed our position on the Hyde Amendment.”

When pushed by a reporter to address if the administration is “not necessarily on board” with the Democratic platform’s call to repeal Hyde, Schultz said that the administration has “a longstanding view on this and I don’t have any changes in our position to announce today.”

News Politics

Democratic Party Platform: Repeal Bans on Federal Funding for Abortion Care

Ally Boguhn

When asked this month about the platform’s opposition to Hyde, Hillary Clinton’s running mate Sen. Tim Kaine (D-VA) said that he had not “been informed of that” change to the platform though he has “traditionally been a supporter of the Hyde Amendment.”

Democrats voted on their party platform Monday, codifying for the first time the party’s stated commitment to repealing restrictions on federal funding for abortion care.

The platform includes a call to repeal the Hyde Amendment, an appropriations ban on federal funding for abortion reimplemented on a yearly basis. The amendment disproportionately affects people of color and those with low incomes.

“We believe unequivocally, like the majority of Americans, that every woman should have access to quality reproductive health care services, including safe and legal abortion—regardless of where she lives, how much money she makes, or how she is insured,” states the Democratic Party platform. “We will continue to oppose—and seek to overturn—federal and state laws and policies that impede a woman’s access to abortion, including by repealing the Hyde Amendment.”

The platform also calls for an end to the Helms Amendment, which ensures that “no foreign assistance funds may be used to pay for the performance of abortion as a method of family planning.”

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Though Helms allows funding for abortion care in cases of rape, incest, and life endangerment, the Obama administration has failed to enforce those guarantees.

Despite the platform’s opposition to the restrictions on abortion care funding, it makes no mention of how the anti-choice measures would be rolled back.

Both presumptive Democratic nominee Hillary Clinton and Sen. Bernie Sanders (I-VT) have promised to address Hyde and Helms if elected. Clinton has said she would “fix the Helms Amendment.”

Speaking at the Iowa Brown and Black Presidential Forum in January, Clinton said that the Hyde Amendment “is just hard to justify because … certainly the full range of reproductive health rights that women should have includes access to safe and legal abortion.” In 2008, Clinton’s campaign told Rewire that she “does not support the Hyde amendment.”

When asked this month about the platform’s opposition to Hyde, Clinton’s running mate Sen. Tim Kaine (D-VA) said in an interview with the Weekly Standard that he had not “been informed of that” change to the platform though he has “traditionally been a supporter of the Hyde amendment.”

“The Hyde amendment and Helms amendment have prevented countless low-income women from being able to make their own decisions about health, family, and future,” NARAL President Ilyse Hogue said in a statement, addressing an early draft of the platform. “These amendments have ensured that a woman’s right to a safe and legal abortion is a right that’s easier to access if you have the resources to afford it. That’s wrong and stands directly in contrast with the Democratic Party’s principles, and we applaud the Party for reaffirming this in the platform.”