Reproductive Rights In Nicaragua: From the Sandinistas To the Government of Violeta Chamorro

Lois Wessel. Feminist Studies. Volume 17, Issue 3. Fall 1991.

As the National Opposition Union (UNO) government threatens to overturn the achievements made during the Sandinista years of 1979-90, Nicaraguan women are struggling to maintain the reproductive rights gained in the revolution and to expand in those areas where the revolution fell short. Although women’s participation in and access to education and work increased under the Sandinista government, traditional gender roles, the Catholic church, the war, and obstacles within the Sandinista National Liberation Front (FSLN) prevented reproductive rights from becoming a primary concern of the revolutionary government. Since the surprising electoral defeat of the Sandinistas in February 1990, Sandinista organizations have been going through a process of self-criticism. Within this context, the fight for reproductive rights has focused both on the past shortcomings of Sandinista policies and on the current campaign to win these rights in spite of the present conservative government.

Birth Control and the Sandinistas

During the Sandinista years, access to health care and education increased, and Nicaragua won worldwide recognition for eradicating polio and reducing illiteracy. The Family Code stated that legally women and men had equal rights and responsibilities to the home and family. Equal rights for women and men were established in the 1987 Constitution. Nevertheless, contraceptives and sex education were only minimally promoted. This was due to many factors, including poverty, the Church (including the prorevolutionary sector), perceived underpopulation (although Nicaragua has a very high birth rate, even in the Latin American context), machismo, and the fear of repressive population control programs.

Nicaraguan machismo promotes the view that men feel powerful when they have many children with different women. According to Cenzontle, a women’s educational center in Managua, a man getting a woman pregnant is the highest expression of machismo. In Nicaragua men say, “me tienen tres hijos” (they have three of my children); in other words, someone else is raising his three kids. Cenzontle does not place the blame entirely on men, noting that “there are many women who get pregnant hoping that this will help them keep the man they love, or even create love.” In Nicaraguan culture, the mother figure is very important. The celebration of Mary’s conception is one of the biggest holidays, and she is honored almost as much as her son, Jesus. On Mother’s Day those women who don’t have children are honored as “potential mothers.”

The dynamics of poverty and underdevelopment also contribute to large family size. For the poorest sectors, more children means more people to work for the family—either farming or in the city, even if only selling gum on the streets, begging, or shining shoes. Large families are also a form of financial security for parents. Furthermore, people have large families because many of the children die from preventable diseases. And there are always chores for children: grinding corn, fetching water, feeding the animals, caring for younger children, and so forth.

The Catholic church in Nicaragua prevented many prorevolutionary Christians from advocating birth control. Progressive Christians supported the Sandinistas, and the FSLN did not want to alienate them. Furthermore, the Sandinista party did not want to incite the anti-Sandinista Catholic hierarchy by openly promoting contraceptives. Although television ads and billboards flourished promoting breastfeeding and immunizations, there were few public campaigns encouraging birth control or sex education.

After winning power, the Sandinista government wished to repopulate the war-torn country and produce a larger work force. Therefore, initially it did not promote family planning. Many leading FSLN politicians said it was women’s duty to produce children for the revolution. President Ortega with his parade of children was seen as an example. In the early years of the revolution, daycare centers and health clinics flourished. Having children seemed easier because the state helped provide for the child’s well-being, so this opened the door to a postwar babyboom. Moreover, right after the triumph of the revolution, the Nicaraguan Ministry of Health (MINSA) turned down international offers to donate contraceptives for fear of attempts at manipulative population control. Before the Sandinista government came to power, internationally funded clinics (the majority with financing from U.S. Agency for International Development) sterilized thousands of Nicaraguan women. One woman noted: “I didn’t know there were other options. I thought having my tubes tied was the only way to prevent getting pregnant.”

Most of MINSA’s work in family planning focused on extending coverage to high-risk women—those with several children or health problems, a history of miscarriage or abortion, and older women. Even though technically the young sexually active woman is considered to be at risk during pregnancy and childbirth, there were few special efforts to increase sex education or access to birth control for these women. Most of the women who were encouraged by health professionals to use family-planning methods were already at the hospital or health center for an obstetrical or gynecological problem. Healthy women were untouched by efforts to expand family-planning services.

Although the strategy of decentralizing health services and focusing on primary care generally proved beneficial in Nicaragua, it also meant limited access to family-planning methods. MINSA tried to encourage the use of health centers, but because people still believed that the hospitals had better physicians and more equipment and supplies, they tended to seek hospital care for primary care needs. Unfortunately, contraceptives were not readily available at the hospitals. In addition, many women who were hospitalized due to a miscarriage, an induced abortion, or childbearing were told to seek follow-up family-planning counseling and methods at their health centers; they thus left the hospital unprotected from further pregnancies.

The supply of contraceptives at local health centers was sporadic due to bureaucratic red tape and to the irregular nature of foreign donations. For the most part, the only methods available were IUD’s and oral contraceptives, and by the time the pills reached the health centers, they were frequently close to their expiration date. Many Nicaraguan health workers claimed they wouldn’t know how to fit diaphragms even if they had access to them. Even when the fear of AIDS increased, condoms were rarely available. Many supplies, including birth control pills, escaped the official distribution channels and ended up for sale in local markets. Market women who displayed their goods in the blazing sun acted as pharmacists and convinced people what to buy. Many women were told the pink pills prevented pregnancy and the yellow pills were abortive. According to a standing joke, a pregnant woman says, “Well, I bought birth control pills from that sunny spot in the market.” In addition, MINSA faced severe shortages of medicine. Almost half of the medical specialists fled the country, and the U.S. trade embargo and contra war led to epidemics of measles, diarrhea, malaria, and other preventable diseases.

By the mid-1980s, MINSA began to emphasize sexually transmitted diseases (STDs) and annual pap tests. With the increase in migration and patterns of multiple partners, STDs increased. Nevertheless, most health campaigns focused on treatment rather than prevention. Some efforts were made through the voluntary health educators program, the “brigadistas de salud,” and by the ministries of Health and Education to conduct sex education. However, the feminist view of a woman’s right to control her body was never promoted. The entire political sphere focused on building a new society for the collective good, and individual rights were often seen as bourgeois or counterrevolutionary. A prochoice movement never materialized, although almost all Nicaraguan women know someone who was sterilized or died from a back-alley abortion.

Women’s Organizations and the Sandinistas

During the eleven years the Sandinistas were in power, the government and the pro-FSLN women’s organization AMNLAE (the Asociación de Mujeres Nicaragüenses Luisa Amanda Espinoza) focused almost exclusively on women as mothers, especially the mothers of “heroes and martyrs,” or those killed fighting the contra war. Grassroots efforts to organize daycare centers and birth control clinics were not priorities of either the government or AMNLAE, making many people see AMNLAE as an arm of the FSLN. Milu Vargas, a feminist lawyer and founder of AMPRONAC, the organization that preceded AMNLAE, says that AMPRONAC was more independent and that the FSLN hindered the development of an autonomous women’s movement. Still, for many women the overall survival of the revolution was key to furthering women’s rights, and they chose not to challenge the FSLN directly.

Participation in women’s activities or in anything outside of the home was difficult because the women were accused of being vagabonds, whores, or bad mothers. And of course those women who did participate in community activities still had to deal with all the domestic chores. Despite these inhibiting factors, women’s organizations formed within many of the mass organizations, including the CST (Central Sandinista de los Trabajadores, the bluecollar union), the ATC (the Asociación de Trabajadores del Campo, the farmworkers’ union), CONAPRO (the professionals’ union), and UNAG (the Unión Nacional de Agricultores y Ganaderos, the small farmer and cooperative union). At the same time, many feminist professionals, including lawyers and health workers, began to discuss reproductive rights, rape, and domestic violence in forums, debates, and the media.

The Abortion Debate

In 1985, Dr. Ligia Altamirano published the rate of self-induced abortions at Bertha Calderón, the national women’s hospital. In 1988, Dr. Ana Maíia Pizarro showed that thirty-seven women died at Bertha Calderón Hospital from self-induced abortions during a thirty-eight-month period. In 1990 the Masaya hospital reported more cases of self-induced abortion than births. The latest general figures state that one-third of all maternal deaths are the result of self-induced abortions. Maternal mortality figures from illegally induced abortion now run at approximately 90 per 100,000 live births, compared with .01 per 100,000 legal abortions in the United States (although some studies show the Nicaraguan figure as high as 319 per 100,000 live births).

It is probable that these earlier studies underestimate the incidence of maternal mortality from abortion because hospitals often recorded hemorrhage or infection as the cause of death. Later on they began to list incomplete abortion as the cause. Legal records also underestimate the magnitude of the problem. Supreme Court statistics from the last thirteen years show only two cases of illegal abortion in the entire country. Both of those cases were women who died from infections. Dr. Pizarro blames the physicians: “The majority will treat a botched abortion or do abortions in their clinics. They’ve seen the problem, but they don’t do family planning counseling with the patient. Furthermore,” she added, “there’s too much red tape in the hospitals, and sometimes we can’t even get an IUD out of the stockroom…. Maybe this time the woman will survive the abortion her sister or friend induced with an unsterile instrument. Next time? Who knows? We have to change the entire consciousness around birth control to prevent this.”

The abortion debate heated on many fronts, but it was mostly professional middle-class women who demanded legalization or decriminalization without officially guaranteeing the right to abortion so as not to offend those opposed to its legalization. AMNLAE spoke of the need to reduce maternal mortality from self-induced abortion, expand accessibility to contraceptives, and increase sex education programs. In Sandinista forums on the new Constitution in 1987 and on the Sandinista electoral platform in 1989, some women called for an end to maternal mortality and for more affordable birth control. However, the majority of women representing Sandinista associations, including unions, the youth movement, and professional organizations, did not publicly demand legal abortion. They were divided on the issue and followed the Sandinista party’s lead.

In spite of the fact that the Sandinistas never legalized abortion, access and availability increased during their administration. The 1974 penal code which makes abortion illegal was not enforced. When a “right to life” law was proposed during the Constitutional debates in 1986, the late Carlos Núñez Tellez, president of the National Assembly, said the country was not ready to make a decision with respect to abortion. Nevertheless, the Sandinista party was lenient in allowing therapeutic abortion services in hospitals and later elective abortions at a nongovernmental agency.

In 1989, MINSA issued abortion guidelines that included the establishment of therapeutic abortion committees to review and approve cases at every hospital and health center with in-patient services (usually a few beds for postpartum care). In addition to health and genetic factors, the guidelines included the review of cases for socioeconomic reasons. Even before official ministerial approval was granted, a committee functioned at Bertha Calderón Hospital where ten to fifteen women a week requested the termination of a pregnancy for medical or socioeconomic reasons. The majority of the cases were accepted by a five-person committee which included a nurse (who was an AMNLAE activist), an obstetrician, the hospital director, the assistant director, and a neonatologist. These hospital workers had seen numerous women who had induced abortion with a coat hanger or toxic chemicals and they knew that the women denied therapeutic abortions would probably try more dangerous methods. In addition, hospital costs were lower when safe abortions were performed than when women came in hemorrhaging from back-alley abortions.

Dr. Pizarro studied those women rejected by the committee. After visiting their homes, she commented that the majority were very poor. Several of the unwanted children had died from malnourishment and diarrhea in the first few months of life, those still living were poorly cared for, and a few had been abandoned. Some of the women had sought abortions elsewhere, and a few even admitted to inducing an abortion in order to be admitted to the hospital for a supposed miscarriage.

No hospital other than Bertha Calderón formally created such a committee. MINSA’s approval of therapeutic abortion committees was not well known, and few hospitals wanted to risk possible legal problems resulting from performing abortions, for the legality of the guidelines was subject to debate. In addition, many hospital directors were not in agreement with the guidelines, nor did they have adequate resources to make abortion services available. For the most part they either referred patients to Bertha Calderón or discussed specific cases on a case-by-case basis. According to one physician who served in the Matagalpa Province during the war, most of the legal abortions performed there were for women raped by the contras.

In 1989 abortion services became available at an independent women’s clinic with European funding which performed first-tri-mester abortions for a moderate fee. Legal and mental health services were also available, making it the first fee-for-service comprehensive women’s clinic in the country. In just one year the group expanded to two new sites and began to offer consciousness-raising workshops which dealt with sexuality, birth control, the church, the legal status of abortion, women’s rights, and relaxation techniques for women who sought abortions. The clinic’s motto, “you are not alone in your problems,” was publicized in newspapers and on billboards, reinforcing the view that an unwanted pregnancy is not an individual woman’s problem but a broader social issue.

Women’s Rights and the Uno Government

Since the UNO victory, the women’s movement has been increasingly vocal regarding the shortcomings of the FSLN’s policies and practices with respect to women. They acknowledge the many attempts made by the Sandinistas to address women’s concerns, especially the 1987 women’s proclamation in which machismo was formally cited as a problem. However, they also criticize the sexist attitudes of many of the leading Sandinistas who did not put the proclamation into practice.

Although the gains of the revolution are threatened by the new government, Sandinista organizations are working to protect rights granted during the revolutionary years. Their motto, “ni un paso atrás” (not one step backwards), reflects their commitment to maintain the benefits for workers and poor people granted by the Sandinista government. The UNO government’s attempt to overturn Sandinista policies led to two massive strikes in the three months after Violeta Barrios de Chamorro took power. The women’s movement participated actively in these strikes. The March Eighth Women’s House organized housewives to protest in front of the president’s office with pots and pans, banging to show their disapproval of the new economic measures. Many women find today’s situation very difficult. The severe economic crisis has worsened since IMF policies were instituted under the Chamorro government. Reduction in funds for education and health care and privatization of state enterprises means that fewer social services are available. Women are especially hard-hit by this situation because they generally earn less, are often single heads of household, and face the “Rosie the Riveter” syndrome where men demobilized from the army or fired from state jobs have now taken over their jobs. According to Sandinista Magda Enríquez, the new government is “not just sending women back to the house, but is trying to convince us that this is `our place.'” For the first time in Nicaragua the term “feminization of poverty” is being used to describe the situation women face. Poor women are forced to sell everything from ice water to their bodies in the informal economy. Enríquez protests that “the laws prevent us from deciding what to do with our own bodies with respect to how many children we want to have, and at the same time [the government] has canceled several maternal and child health programs and our children die from malnutrition and preventable and curable diseases….” Feminist lawyer Marvis Jirón pointed out that the new government has passed three new laws protecting cattle and none protecting women. In addition, the Sandinista law preventing exploitation of women in advertising has not been enforced recently. New ads on TV and in the written press use women’s bodies to sell tires, beer, irons, and more.

For the reproductive rights struggle, a more hostile environment exists. The profamily, pro-Catholic government has promoted antiabortion campaigns with the support of the U.S. “right-to-life” movement. A two-hour TV program recently aired which included the antiabortion film The Silent Scream and a roundtable discussion with U.S. and Nicaraguan priests and physicians. The program criticized agencies that promote family planning and all methods of birth control besides rhythm. This program is being shown in churches around the country, and the Catholic church is preaching with renewed fervor against premarital sex, birth control, and abortion.

Both President Chamorro and Minister of Education Sofonias Cisneros have declared that sex education will not be taught in the schools, claiming that parents can teach the children at home; however, many Nicaraguan parents are ignorant about sex. Several government positions have been cut, such as the coordinator of the national sex education committee. Under the Sandinistas, MINSA put up billboards that read: “Prevent AIDS, use a condom.” The new MINSA head, Ernesto Salmerón, has announced the signs will be replaced with ones that say: “Prevent using condoms, be faithful to your partner.”

The new director at Bertha Calderón Hospital has shut down the therapeutic abortion committee and now decides each case without consulting his colleagues. Before he took over, an average of thirty therapeutic abortions were performed each month. The first month he was in charge, one abortion was granted. One of the cases rejected was that of a severely retarded adolescent with two incapacitated parents. She had been raped by a neighbor. Her older sister, the only family member earning a salary, presented the case. The director decided that this poor family needed more wage earners and that the retarded woman should bear the child who eventually could help provide for the family! Feminists in the hospital helped the woman get an abortion elsewhere. According to Isabel Beteta, an AMNLAE activist and nurse at Bertha Calderón Hospital, “the rate of induced abortions is bound to increase as fewer birth control and abortion options are available…and of course it’s the poorer women who suffer: the richer ones have access to decent health care. Our job here is going to get tougher.” An average of five women arrive daily at Bertha Calderón for treatment of self-induced abortions. The number of women seeking illegally to terminate their pregnancies is in direct relation to the profound economic crisis and the lack of sexual education and family planning.

Right before the elections, Chamorro said during an interview on Catholic Radio that one of her first tasks as president would be to shut down the private feminist clinic that performs abortions. Fearing reprisals from the government, the clinic stopped performing abortions immediately after the elections. Then it began again on a limited basis. The government did not take drastic measures against the clinic. However, the clinic still fears attacks and has begun to promote other services. Furthermore, with rising inflation, more and more women are unable to afford their stillmoderate fees.

In spite of difficulties, the present situation offers the women’s rights movement new opportunities. Still supportive of the Sandinista party, mass organizations now have new levels of autonomy and independence. In the past, most prorevolutionary forces were subject to guidelines from party leadership. Now, mass organizations have begun to respond to their members more directly. For example, the Casas de la Mujer, or local women’s houses in poor “barrios” (there are thirty in the country) previously hesitated to offer abortion services. Now women at several of the women’s houses in Managua and Matagalpa are preparing to train health workers in the aspiration abortion procedure performed during the first trimester of pregnancy, despite the threat of antiabortion penalties. Furthermore, AMNLAE leaders who in the past were hesitant to demand the legalization of abortion, because it wasn’t endorsed by the FSLN party, are now openly working for legalization.

Luz Marina Torres directs one of the Casas de la Mujer in Managua which holds consciousness-raising workshops and trains women for nontraditional jobs such as auto mechanics and electricians. She says that if abortion wasn’t legalized under the Sandinistas, there’s even less of a chance with the UNO government. Nevertheless, she sees the electoral defeat as an achievement because now the women’s movement can be independent of the FSLN. Once temporarily expelled from the FSLN for helping a friend get an abortion, Torres notes:

Now we can actively fight for the right to control our bodies. It’s a sin to bear an unwanted child and watch it starve to death. But we won’t settle just for the right to abortion. We want sex education and birth control-birth control that is safe and inexpensive. Our struggle now is laying the foundation for the day we have laws and health centers which protect our right to decide about our bodies.

Torres sees potential for an expansion of the women’s movement. “For ten years we focused on current events, mainly the war, and we worked mostly with the mothers. At the Casas de la Mujer we didn’t involve women who weren’t supportive of the revolution or women who didn’t have draft-age sons. We didn’t focus enough on other problems women face. It’s logical that the women’s movement worked against the U.S.-backed war, but it must also focus on other very political issues like rape and birth control.” The Casa that Torres runs, the March Eighth Women’s House, has begun workshops to teach women about the progressive laws that protect them: “If we want to keep the legal gains we’ve made, women need to know what these gains are,” she says.

Feminist lawyer Milù Vargas shares Torres’s feeling that the electoral defeat was a blessing in disguise. “We can now work to enrich the FSLN and bring in new concepts of men and women in society,” she noted. Vargas has started the Center for Constitutional Rights (named after the center in New York) which trains female paralegals to defend the rights women won under the Sandinistas. The center is also drafting new legislation on domestic violence, rape, and abortion to introduce to the National Assembly. It plans to organize women to lobby when bills concerning them are being discussed. “Women are no longer going to defend the country as our first priority. We are going to defend women as our first priority. That means fighting for the right to abortion and against violence,” she notes.

Today in Nicaragua the reproductive rights movement can grow. With high rates of maternal mortality from self-induced abortions, a highly politicized population, and the dedication and creativity of thousands of energetic women, the struggle for access to abortion, birth control, and sex education is unlikely to diminish in spite of the power of the right-wing government and the Catholic church. Even AMNLAE has now been forced to take gender consciousness into account. Under the UNO government, dozens of new nongovernmental organizations have been formed which focus on gender issues. Almost all the mass organizations are starting feminist clinics to provide birth control, sex education, and even “menstrual regulation” (a euphemism for early abortion). A women’s theater company in Matagalpa has traveled across the country presenting a play about a woman who dies from inducing an abortion. Puntos de Encuentro, a new education center that raises issues of sexuality and gender among young people, is producing a video which it hopes will be used throughout Latin America. Dozens of community groups are discussing the problem. Women are voicing their concerns and looking for creative solutions.