Case Study

Barriers to SRH Care and Experiences of Unintended Pregnancy Among Young Women in Nicaragua

Location:

Nicaragua

Introduction:

Over 89% of Nicaraguan women experience physical, sexual, or psychological abuse in their lifetimes. In addition, there is a high unmet need for SRHSexual and reproductive health services, with over half (65%) of pregnancies among women 15-29 unintended. The 2006 Nicaraguan “total ban” on abortion creates penalties for women who obtain abortion under any circumstances, as well as for providers, resulting in a chilling effect. Complications from unsafe abortion contribute to the country’s high maternal mortality ratio.

Project Description:

We conducted 10 in-depth interviews with women aged 16-23 who had experienced an unintended pregnancy. Topics included pregnancy and family planning history, circumstances surrounding unintended pregnancy, and experiences with abortion.

Results:

All of the women had only been pregnant 1 time and 5 had gotten pregnant between the ages of 14-17. Four considered an unsafe abortion and 2 became pregnant as a result of nonconsensual sex. One woman, Ana Maria* received an unsafe abortion.

Ana Maria was 19 when an older man in her village, her brother’s best friend, raped her. She didn’t tell anyone what had happened, not even her family. She was a virgin and knew little about pregnancy or how to prevent it. But sometime after her assault she began to suspect she was pregnant. Her fears were confirmed by a home pregnancy test and later by blood test at a community clinic. Desperate, Ana Maria told her rapist that she was pregnant. He coerced her to see a “natural medicine” practitioner and gave her the money to have an abortion. Ana Maria travelled to see the woman who terminated the pregnancy by inserting a long rod into her vagina. The woman told her she would experience some cramping and be fine in a few days. Hours later Ana Maria felt feverish and began passing dark fetid clots of blood. Her brother, seeing that she was ill demanded, that she tell him what had happened. When she did, he helped her to get to a nurse. Although many health providers are reticent to provide post abortion care because of the legal limits on abortion, one nurse helped Ana Maria. She received treatment for a perforated uterus – a common complication from unsafe abortion. As a result of her experience, Ana Maria reported feelings of depression and isolation.

Questions to Consider:

What were the missed opportunities related to SRHSexual and reproductive health prior to and following Ana Maria’s assault? Aside from the rape itself, what other forms of GBVGender-based violence did Ana Maria experience? What are the human rights issues that arise from the case of Ana Maria?

*A pseudonym has been used

Organizations:

Center for Humanitarian Emergencies, Emory University

View Case Study in Manual

Resources & References:

“Siempre me critican”: Barriers to reproductive health in Ocotal, Nicaragua. Revista Panamericana de Salud Pública, 37(4–5), 245–250.
Luffy, S., Evans, D., & Rochat, R. (2015).
Violence, unintended pregnancy, and the total ban on abortion: A qualitative examination of threats to women’s autonomy in Ocotal, Nicaragua (MPH). Emory University.
Luffy, S. M. (2015).

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