In Nicaragua, doctors say no-exceptions abortion ban causing deaths

Two weeks after Olga Reyes danced at her wedding, her bloated and disfigured body was laid to rest in an open coffin — the victim, her husband and some experts say, of Nicaragua's new no-exceptions ban on abortion.

Reyes, a 22-year-old law student, suffered an ectopic pregnancy. The fetus develops outside the uterus, cannot survive and causes bleeding that endangers the mother. But doctors seemed afraid to treat her because of the anti-abortion law, said husband Agustin Perez. By the time they took action, it was too late.

Nicaragua last year became one of 35 countries that ban all abortions, even to save the life of the mother, according to the Center for Reproductive Rights in New York. The ban has been strictly followed, leaving the country torn between a strong tradition of women's rights and a growing religious conservatism. Abortion rights groups have stormed Congress in recent weeks demanding change, but President Daniel Ortega, a former leftist revolutionary and a Roman Catholic, has refused to oppose the church-supported ban.

Evangelical groups and the church say abortion is never needed now because medical advances solve the complications that might otherwise put a pregnant mother's life at risk.

But at least three women have died because of the ban, and another 12 reported cases will be examined, said gynecologist and university researcher Eliette Valladares, who is working with the Pan American Health Organization to analyze deaths of pregnant women recorded by Nicaragua's Health Ministry.

Before the ban took effect on Nov. 18, 2006, fewer than a dozen legal abortions were recorded per year in Nicaragua. They were performed only when three doctors agreed a woman's life was in danger. However, the Roman Catholic Church estimates that doctors and other medical staff carried out about 36,000 "secret" abortions a year, because under the old law they had little fear of government reprisals.

This year the Health Ministry has recorded 84 deaths of pregnant women between January and October, compared with 89 for all of last year and 88 the year before. It listed hemorrhaging as the most common cause, with 27 cases reported. The ministry refused to comment further on the ban.

Abortion rights groups have disrupted Congress several times, demanding that lawmakers lift the ban. On Oct. 25, unable to get past increased security, they held up signs at Congress' front door that read: "Women assassins" and "They want to keep us quiet and dead." A minority of lawmakers are still trying to lift the ban, but don't have enough votes.

The Roman Catholic Church mobilized nearly 300,000 people to march and sign petitions in support of the ban.

"A child is not a sickness," said Henry Romero, a priest who helped lead the campaign. "When two lives are in danger, you must try to save both the woman and the child. It's difficult to say now that it isn't possible to save both."

Law student Reyes was one of the three confirmed fatalities. She knew something was horribly wrong, and went with her husband to their small town's medical center. They were sent to Bertha Calderon maternity hospital, more than an hour away in Managua. There, Perez said, Reyes was given a cursory exam, sent home and told to return the next day.

By that time, the bleeding and cramping were worse. Perez said he rushed her to a hospital in nearby Leon, but after she had an ultrasound that confirmed her condition, they left her bent over and in agony for hours in a waiting room. When a doctor at a shift change saw her condition, she was rushed into surgery. She suffered three heart attacks and an exploratory surgery.

Valladares said doctors should have acted quicker.

"They knew she had a limited amount of time before she bled out. The whole world knows that with an ectopic pregnancy," Valladares said. "They didn't treat her, out of fear."

The hospital director, Olga Maria de Chavez, said Reyes arrived late at night, and was told to return the next morning when specialists were available. The doctors who handled her case in Leon refused to talk to The Associated Press.

Walter Mendiata, president of Nicaragua's Association of Gynecologists and a supporter of the abortion ban, said doctors are taking the new law too far. He argues that surgery for an ectopic pregnancy isn't the same as carrying out an abortion.

"There's no discussion in a case like that," he said. "It's urgent, and you operate."

But he acknowledged that many doctors fear they will be accused of performing an abortion, which could mean a license suspension and several years in prison, even though no one has yet been prosecuted.

Some doctors privately admit to carrying out what they believe are illegal procedures, while others say they won't jeopardize their careers.

"Many are thinking that instead of taking the risk, it is better to let a woman die," said Dr. Leonel Arguello, president of the Nicaraguan Society of General Medicine.

Doctors frequently see women coming in with infections, many likely brought on by illegal abortions that they refuse to disclose for fear they might be punished, said Dr. Carla Cerrato. Because the people with some medical training who used to do illegal abortions have disappeared, Cerrato said, women more frequently take drugs or pull the fetus out on their own using wires or other crude objects.

"What we are seeing are complications that before we never saw," Cerrato said, sitting in the dingy pre-labor room at a crowded public hospital in Managua.

She added that she sees hysterectomies and severe infections that leave women sterile or dead because obstetricians can't take any action that might harm a living fetus.

"We have to wait until the fetus dies," she said. "But often, for the woman, it's too late."

That appears to be what happened with Reyes. Her aunt, Gioconda Reyes, a devoted Catholic dressed in a worn T-shirt in which Jesus promises eternal life, said the sudden death has changed her views.

"I don't support abortion to get rid of unwanted pregnancies, but in cases like that of Olga's, it is necessary," she said, adding: "How could they let four days pass when every minute was precious? They denied her the right to medical care, to a life."

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On the Net:

Human Rights Watch report: http://hrw.org/reports/2007/nicaragua1007