As soon as the Battered Women’s Shelter opened in my Sister City in Nicaragua, I got to know the abused girls (all thirteen to fifteen years old), who came to live there. I have a favorite, Adelina, the silent, skinny, thirteen-year-old who came first. Adelina had been prostituted by her mother to a neighbor who paid in groceries. Social services found out, arrested Adelina’s mother and neighbor, and sent Adelina to us.

(Credit: Amnesty International/ Creative Commons)

Adelina thought she was in love with the perpetrator. I met her the next morning, after her night of wakeful tears. I knelt down, watching her draw and speaking to her through a finger puppet. “Me gusta tu dibujo,” the puppet said in a squeaky voice: “I like your drawing.” Eventually, by saying “I wish I could draw, but I don’t have any fingers,” in puppet-voice, I succeeded in making her laugh. That laugh founded an affectionate relationship.

She lived in the shelter for over a year, studied, and proudly got admitted to the Free High School for Adults. Then she was remanded back to her mother, continuing to arrive for therapy every day. Now I learn she is pregnant, by a boy three years older. He is a drunk who has been seen passed out on the waterfront. I am distraught and helpless. She is vomiting and miserable.

What can a pregnant girl of fifteen who doesn’t want a baby do, if she accidentally becomes pregnant in a country that forbids abortion? Answers: Bear it. Self-abort. Commit suicide. An Amnesty International report shows that in Nicaragua, where all abortions have been made illegal, and doctors who do the procedure are threatened with one to three years of prison, the highest number of adolescent deaths in pregnancy comes from suicide. Rat poison, a cheap and available means, is the most frequent method.

Compulsory pregnancy is the rule in Nicaragua. It may be coming to the United States, where many states limit access – and where 20 percent in a Gallup poll agree with Nicaragua: no exceptions for fetal anomaly, incest, rape, or risk to mother. Diminishing access in Texas has led 7 percent of women who need abortion care in the state to try self-abortion – even before the latest bill restricting abortion.

The data on teen suicide-by-poison is provided by the Nicaraguan Ministry of Health. The absolute number is probably higher, because doctors fear record-keeping. Suicide everywhere is terrible in family life, but in countries without abortion rights, pregnancy deaths can be public, tragic, unnecessary, and cruel. The cause is not pre-existing mental illness; the cause is desperation.

The desperation is easy to understand. At times a girl has been raped very young, perhaps by a relative. She has a horror of incest. A young girl is not ready physiologically to give birth healthily, nor is she ready psychologically to raise a baby. At times it is a woman’s male partner who doesn’t want a child: he is unemployed and drunk; he is likely to abuse her. Or a woman anxiously knows that something is going wrong with her pregnancy (but if she can’t afford prenatal care, this she does not know). Very few Nicaraguan women can afford to fly to Miami. Not even the risk of botching it, nor the certainty of mortal sin (which some believe in) prevents girls from finding suicide the least bad choice.

Even if the girl or woman arriving at a Nicaraguan hospital has a fetus that will die, or if she herself will die without help, she will be turned away. An American gynecologist I know – who has spent his professional life offering women abortions along with other reproductive health services in several high-quality hospitals and has sometimes been threatened with death – rejects the excuses. “The reason they give in Nicaraguan hospitals for ejecting women whose pregnancies are in crisis is that they don’t have the necessary equipment. That’s not true. If you can treat a miscarriage safely, you can do an abortion.” Dr. Phillip Stubblefield says these doctors should resign rather than refuse. A boycott of the law – with the loss of many doctors in a country so needy of trained medical professionals – would be an ethical response at the level of the damage that the law produces.

“Plan C”Is One Answer

(Credit: American Life League/ Creative Commons)

There is in fact one possible answer: safe nonsurgical or medical abortion, also known as RU 486 or mifepristone/misoprostol. Abortion activists call it Plan C. (Plan A is contraception; Plan B is the “morning-after pill.”) Plan C is two pills (mifepristone in combination with misoprostol) that can be taken safely, according to the London-based Royal College of Obstetrics and Gynecology, up to between nine and thirteen weeks of gestation. It is too late for Adelina.

By 2011, fifty nations around the world had approved medical abortions. In India it is sold over the counter, but not officially. Plan C is safer than carrying a baby to term. It is certainly safer than an illegal abortion that is self-induced or given by an untrained person.

In Nicaragua, women are unlikely to know that Plan C exists. Hospitals alone have the drugs, but only for obstetric use. It is not available even by prescription in pharmacies. Yet, it is legal to give information about Plan C in all countries that have signed the International Declaration of Human Rights. Nicaragua has; the United States hasn’t.

In the United States, only a doctor who is registered and tracks every pill can provide it, and only when a woman takes it in front of her/him.

Medical abortions accounted for 32 percent of first trimester abortions at Planned Parenthood clinics in the United States in 2008, according to a study published in the New England Journal of Medicine. Still, many women in the United States do not know about medical abortion or have been incorrectly led to believe it is risky or unavailable. The confusion is understandable, given the politicized history of abortion, and the fact that states have different laws regulating dissemination of information about medical abortion and administration of the procedure.

Women on Web, an organization based in Amsterdam, answers related questions online and offers a consultation. Another group, Women on Waves, sends the pills by mail after a pregnant woman fills out their form. The sites can be read in Spanish as well as other languages. No woman is turned away because she can’t afford the cost. Other sites advertising the pills for sale have been found to be fraudulent.

Where an abortion ban was rescinded, as in Nepal, in one year the number of deaths of pregnant women was reduced by half. Uruguay recently legalized first trimester interventions, while Colombia, Brazil, and Argentina allow abortion following rape and in other circumstances they consider extenuating. Gradually, in such countries, women seeking abortions are no longer considered “potential lawbreakers” but instead treated as “citizens with problems whom the State has a responsibility to help” (a distinction made by Iqbal H. Shah and Mary Beth Weinberger in the International Journal of Gynecology & Obstetrics). When a country’s legislators and jurists listen to the needs of the most vulnerable and provide appropriate care – desperation subsides – public health improves. By such standards should we measure the ethical level of a government.

Violent misogyny ill becomes democracies – whether it is Nicaragua or U.S. states turning against women. But the public too is culpable, the public that does not feel sufficient empathy for desperate woman – that could not explain any of the deep motives of the desire for an abortion. But now, the voices of these suicides shout their lamentable truth. These atrocious deaths must stop.


Margaret Morganroth Gullette, Ph.D., has been visiting her sister city in Nicaragua since 1989 to further adult education in the region. She is the award-winning author of four books and publishes in the mainstream press internationally. She is also a resident scholar at the Women’s Studies Research Center at Brandeis University.

(© 2013 Margaret Morganroth Gullette)




Bookmark and Share