by Jill Clark-Gollub

On November 5th I was able to meet with two healthcare workers in a poor community of Nicaragua and get their take on birth control in their country and the nation’s infamously strict ban on abortions.

My local host for this visit is the Jubilee House Community (JHC) based in Ciudad Sandino—a municipality that since the 1960s has been the site for relocation of poor residents of neighboring Managua after natural disasters. One of the biggest calamities was Hurricane Mitch in late 1998 that killed thousands and left several more thousands homeless and mostly abandoned by the neoliberal government of the day. This led to an influx of 12,000 people to Ciudad Sandino who were, and unfortunately have remained, the poorest residents of this working class area.

In 1999 JHC began to operate, with local staff, a community health clinic for the resettled residents of this neighborhood called Nueva Vida. We were able to meet with the clinic’s physician, Dr. Jorge Flores, and its director, Josefa Rayo, who explained the services that they provide and how, since the FSLN government returned in 2007, they have been coordinating with the Ministry of Health in its reinstated mission to provide free medical care to the entire population. This means that Nueva Vida Clinic is continuously evolving in the services it provides as the government is able to meet more of the health needs of the population. It is a dynamic and apparently effective relationship.

Among the varied services the Nueva Vida staff provides to residents are sex education and mentoring programs for youth to encourage them to strive for goals that would be hindered by teen pregnancy. This led to a frank discussion between these health workers and our group of international visitors about sexual and reproductive freedom in the country. A law prohibiting abortion was passed by the legislature in 2006, before Daniel Ortega came into office and at a time when the FSLN did not hold a majority of seats, and while polls showed over 80% support for the law in this heavily Christian country. The law is very similar to one passed in El Salvador around that time, prohibiting abortion under any circumstances, even to save the life of the mother. I have heard from Salvadorans that their law is strictly enforced, with tales of women being chained to hospital beds lest they get an abortion. Conversely, I have heard from different groups of Nicaraguan women that such draconian measures are not applied in their country.

These health workers explained to us the delicate dance that the authorities have been doing to balance the Ministry of Health’s explicit mission to save lives with the anti-abortion sentiments of the population. We learned that each hospital has a Scientific Medical Committee that looks at legal and ethical issues that may arise when a patient’s religious beliefs conflict with the sound medical advice of professionals. These are the kind of delicate matters that physicians everywhere must deal with, using the utmost discretion and respecting the privacy of all involved.

The doctor and director also confirmed what I have heard on previous visits with Nicaraguan peasant women: that the public healthcare system strongly encourages family planning and provides contraception free of charge, including sterilization services once women (and men) decide to have no more children, thereby reducing the demand for abortions. There are also services and medications for the trans population, both at Nueva Vida Clinic and in the public healthcare system.

It was refreshing to talk to people involved in healthcare in Nicaragua to learn the nuances of the county’s sexual and reproductive health policies.

* FoLA’s Jill Clark-Gollub is currently in Nicaragua as part of an international team of independend observers to the country’s November 7th elections.