“We Urgently Need a Secular State For the Sake of Women’s Health”

A gynecologist and activist on women’s issues describes some of the extremely serious health problems women face due to the lack of state policies on population, health and education that are at all in touch with reality.

Ana María Pizarro

What has happened to Nicaragua’s public policy related to quality of life, health and education, particularly for women, in recent years? To answer that, we need to go back and analyze various facts that I think are fundamental.

Today’s formal population policy—
“education in values for family life”

Most people probably don’t know that Nicaragua has a population policy that has been set out in two documents prepared by two successive governments. Very few countries in the world could say the same. A country’s population policy has to do with birth, death, migration, health, education, the population’s territorial distribution and, naturally, the structure and infrastructure at the inhabitants’ service. It is the policy that most directly deals with our daily life: how we are born, how we reproduce, how we die, where we live, the health we enjoy, our access to education, how we move around...
The first of these two documents, the “National Population Policy,” was issued in September 1996, toward the end of Violeta Chamorro’s government. It was the first time a population policy had ever been designed in Nicaragua. Like all documents jointly prepared by the United Nations agencies and various government ministries, the population was not consulted.

Among those who signed the document was then-Education Minister Humberto Belli, a man very close to the Vatican who will go down in national history for his negative influence on everything related to population policies. Not surprisingly then, this document reflects the whole education policy of the Chamorro administration (1990-96), when emphasis was put on “education in values for family life.” Deciding on this course for national education totally ignored the important role of providing information to help shape modern and non-discriminatory attitudes in accord with the evolution of humanity.

Just a few months later, at the end of 1997, the new Liberal government of Arnoldo Alemán, which supposedly had a more secular ideology than Chamorro’s essentially Conservative government, drafted another population policy, but it continued to favor a traditional moralistic approach. And this is the course we’re still on.
Some countries in Central America and the rest of Latin America have no document expressing their population policy. Other countries have one that has survived successive governments, since these policy documents aren’t government plans and have no concrete activities or projects. In Nicaragua’s case, which has the luxury of two, it must be said that neither document is very well known and most public officials have barely glanced at either one of them.

The previous unwritten policy: Let a hundred babies bloom

The Sandinista government never wrote up a population policy, although aspects of one showed up in the leaders’ speeches. It was a pro-birth government that encouraged women to have all the children they could, based on both the Latin American reality and the national reality. Latin American revolutionaries of the sixties and seventies opposed any population control or family planning proposal or even the use of birth control methods on the grounds that they were feeding into an objective of US imperialism. Where did that thinking come from? From US ideologues like Robert McNamara, who had said it would be cheaper to invest in eliminating future guerrilla fighters in their mother’s womb than have to do battle against them later in the mountains.

Massive US projects to sterilize poor, indigenous and black women abounded in Brazil, Bolivia and other Latin American countries in those decades, responding to the prevailing philosophy that population control was a means of controlling subversion. To the discourse that the more Latin American poor there are, the more guerrillas there will be bearing arms in liberation struggles, ergo sterilize the women, the revolutionaries responded by echoing the logic but reaching the opposite conclusion: ergo go forth and multiply.

Both the anti-birth and pro-birth projects decided about women’s bodies for them, without knowing or caring if they agreed. Both the North’s population controllers and the South’s population promoters got to decide whether women gave birth or not. The leaders of the Sandinista Front were children of that revolutionary pro-birth thinking, and supplemented this “Latin American reasoning” with their own national logic: women had to bear children to replace those killed in the war. That idea was overtly present in many speeches by Sandinista leaders and seldom questioned in those years.

These two antagonistic positions dominated our continent’s panorama for many years, while women were stuck between the two, with neither voice nor vote and in most cases giving birth in risky conditions.

Meanwhile, traditional Catholic morality has steadfastly promoted the idea that maternity is women’s supreme destiny, that generous service and even the willingness to give one’s life to others are feminine virtues par excellence, as demonstrated by the Virgin Mary, who silently assumed her maternal destiny. For a long time, then, this Catholic discourse paradoxically coincided with that of the leftwing revolutionaries.

Into the breach came the world population summits

Such ideas still prevailed in 1974, when the United Nations organized the first world conference on population and development, held in Bucharest. The second was held in Mexico in 1984 and the third in Cairo in 1994. The influence of the US philosophy on population had a determining effect on the results of all three.

In Bucharest, population increase was seen as an enemy that had to be beaten. By 1984, however, the US philosophy had changed. Population growth ceased being seen as a threat and began to be seen more neutrally insofar as the United States had ensured its military presence around the planet. In fact, the intervening years had proved key for the installation of US military and missile bases in Europe, Asia, Africa and of course Latin America, (Panama, Honduras, etc.). The US military presence was of such magnitude and ensured such a degree of control that the issue of population growth lost relevance for the American strategists. And with that, the efforts that had been dedicated to sterilization campaigns or the distribution of birth control methods began to wane.

Ten years later in 1994, largely thanks to the influence of the first lady, the Clinton government assumed a modern vision that included some respect for women’s rights. Nonetheless, the President was surrounded by a huge residue of people still interested in population control, who wisely adopted a new twist; they began to promote “family well-being.” A multitude of organizations began to proliferate all over Latin America, pushing the idea of family well-being and presenting the population with the image of “the happy family”: a father and mother with one boy and one girl. Today, approaching the end of another decade in which we have seen a massive redistribution of wealth to the rich with the accompanying growth of poverty in Latin America, the “happiness” concept is being low-keyed and emphasis is shifting to “well-being,” which couples are told they can ensure by having only one child.
Once again, the use of birth control is spreading all over Latin America, but the population control discourse and its expression in the practice of unconsulted sterilizations has been transformed into the more upbeat notion that a couple’s decision to reduce the number of children ensures family well-being by reducing poverty. In these years, countries such as Mexico and Brazil have managed to drastically reduce the net number of children per woman through family planning campaigns.

But doing so has not reduced poverty or brought about family well-being, because poverty is not reduced and well-being is not achieved by controlling women’s bodies and reproduction.

New concepts: Sexual and reproductive rights

It is in this context that more progressive ideas found real space in the 1994 Population and Development Conference in Cairo, whose documents emphasize the inequity of the world’s distribution of wealth. Extraordinary advances were made in Cairo, and were favored by the strong US stance on the human rights issue.

Two new concepts appeared in that conference: sexual rights and reproductive rights, both of which are at the epicenter of the ideological debates currently raging in Nicaragua. The international community achieved enormous consensus around these progressive modern ideas that year.

Only eight countries did not join in: Argentina, Nicaragua, El Salvador, Honduras, Guatemala, Ecuador, Malta and, at the head of them all, the Vatican. Like Switzerland, the Vatican has observer status in the United Nations, which gives it the right to be present at all conferences, but not to either speak or vote. Unlike Switzerland, however, the Vatican gets its opinions heard, its reservations about the texts being debated presented, its demands for changes strongly registered and more than a small share of votes favoring its position counted. How? Fundamentally, it functions as a powerful and very special lobby, getting the delegates of countries under its influence to speak for it. The way it works the conferences is to call the bishops of those countries to point out the problems. They in turn call the country’s President to tell the delegates at the conference what to say and how to vote. We saw this clearly happen time after time in the processes that culminated in the Cairo population conference and the conference on women in Beijing. The operation typically takes all of about an hour.

All countries sent official delegations to these huge world conferences and many Latin American ones were of dubious representation. Some delegates were first ladies or officials elected for this mission just because they were Catholic “mothers” or “fathers,” with little or no competency to discuss political and economic affairs, laws, decrees or budgets. This explains how the documents coming out of these international conferences can be drafted by people with extremely high technical capacity and then influenced on many points by the plethora of bishops and other religious representatives who attend to control their country’s official delegates. I have personally witnessed delegates being sent back to their country for nothing worse than respecting human rights and the secular nature of the state, and thus speaking up about sexuality and reproduction in what these religious lobbyists consider an “undue” manner.

The struggle that took place in Cairo was incredibly arduous. Nicaragua headed up Central America’s representation of the Vatican’s interests on that occasion, and two figures were particularly influential: Education Minister Humberto Belli and his adviser on values, Élida de Solórzano. I still recall with amazement how in one international preparatory meeting for Cairo, held a year earlier in Mexico, both publicly called the international director of the United Nations Population Fund an “abortionist.”
It was two years after Cairo that Nicaragua drafted its first population policy document. While it states that people have the right to information and to use family planning methods—without saying which ones—it, like the 1997 document, emphasizes that all must be done in the framework of moral values, family values and the values of Nicaragua’s eminently Catholic society. According to statistics, while 64% of Nicaragua’s population is Catholic, only 30% declare themselves practicing Catholics.

Just how secular is the Nicaraguan state?

Article 14 of Nicaragua’s Constitution establishes a secular state with no official religion. Article 68 establishes that “no one can elude observance of the laws or impede others from exercising their rights and fulfilling their duties by invoking religious beliefs or dispositions.” Many events have clearly shown that these constitutional dispositions are not being fulfilled in Nicaragua, but I’m only going to refer to some of those most directly linked to the population’s health, especially women’s health.

The most recent such event is the Education Ministry’s publication, with UN Population Fund support, of a manual titled “Education for life.” The state planned to distribute the manual to teachers around the country as a tool to help them sexually educate their students over the course of the student’s stay in the school. The controversy generated by religious sectors around this document has been so intense that President Bolaños had to withdraw it from circulation until consensus could be reached. The President’s insistence that the manual must “reflect our values, our customs, our philosophy of life and the Christian nature of its ethical and moral principles,” is just one more factor obliging us to reflect on whether a secular state exists in our country. I’ll say more about this publication after mentioning several earlier examples that also question the state’s secular nature.

A similar but less known precedent of a public document censured under religious criteria was a document presented by the Ministry of Health the last day of January 2002, only weeks after the Bolaños government—touted as the government of the “new era”—took office. It was originally titled “For a national sexual and reproductive health program in the health sector reform” and established what would be done in all the ministry’s structures to address the major sexual and reproductive health problems affecting Nicaragua’s population. UN agencies and Nicaraguan state institutions also jointly drafted this document, and again society’s organizations were not consulted. But when we finally looked at it, we could see that it contained a good number of positive aspects that could be applied.

Reproductive health yes, sexual rights no

In less than a month, however, the Ministry withdrew the document and recalled all previously distributed copies. A World Bank-financed Health Ministry official then took it to the Bishop’s Conference for consultation. The document disappeared for months, but another text finally appeared just recently, now called “National reproductive health program.” For starters, the word “sexual” had been cut, as had any reference to sexual and reproductive rights in the introduction. A few other changes had also been made. Like the original, the “revised” document does not recognize these rights; it speaks only of reproductive health.
The document contains an assessment of the national health situation, principally women’s health, and laudably aims to organize health care to deal with the extremely serious problems that the document itself recognizes. For example, it rightly states that maternal mortality is “high” in Nicaragua, although it provides no precise statistics. Another official document released at the same time, the famous “Enhanced Economic Growth and Poverty Reduction Strategy,” puts the maternal mortality rate at 148 per 100,000 live births, one of the highest rates in Latin America. But since we are in a country where no statistic is serious enough to be remotely reliable, an epidemiological bulletin posted on the Ministry of Health’s web page claims this same rate as 93 per 100,000, while UNICEF uses the figure of 250 per 100,000.

The reproductive health document profiles the women most likely to die as a result of pregnancy or childbirth: they are young, with little or no education, poor or extremely poor and live on the outskirts of cities or in rural areas. Beyond any figures, experience tells us that the prime cause of maternal mortality at a national level is post-delivery hemorrhaging, particularly in the rural areas where women give birth at home, attended by other women with inadequate training. In hospitals, the prime causes of maternal death are complications resulting from abortions practiced in clandestine conditions and eclampsia: high blood pressure with convulsions linked to parturition or postpartum.

The document does contain some statistics, particularly dealing with female adolescents: for example, it states that 27% of all female Nicaraguan adolescents are either pregnant or have already given birth, which is the highest adolescent fecundity rate in all Latin America. For every 1,000 female adolescents between 15 and 19 years old, 139 are pregnant. And 30% of the maternal mortality victims are under 19 years old. All this demonstrates the vulnerability of young Nicaraguan women with respect to health care. It also means that our adolescents are getting pregnant, dying or aborting in complete abandonment.

In a study we did in 1998 in five Nicaraguan hospitals, we found that 150 women had been admitted due to abortion or miscarriage, 32% of whom were under 19. The issue of teenage pregnancy is in vogue now in Nicaragua, but no state institution wants to talk about teenage abortion. Reality, however, shows us that female adolescents who have sought abortions in clandestine, unsafe conditions are filling the hospital wards. The director of the Bertha Calderón women’s hospital recently called abortion the “silent killer” and reported that it was keeping half the obstetric beds filled. The doctor believes this is because “girls don’t talk to their mom and dad and instead seek advice in the streets, so they end up getting pregnant and aborting.” He complains that the hospital budget is largely being spent to save the life of young girls who have had an abortion. The majority of Nicaragua’s male gynecologists share this regrettable vision and as often happens grab hold of the problem by its tail: the problem only becomes visible when the girl comes to the hospital dying from a botched clandestine abortion.

It is important to remember that Nicaragua’s annual health budget for 2003 is the equivalent of only US$22 per person. And this is only theoretical, because 83% of this budget goes to the paltry salary line and the rest to purchasing fuel, equipment, medicines, personnel uniforms and food and the repair and maintenance of the installations and equipment. If in a situation of such shortages, this particular hospital is spending thousands of dollars treating complications from teenage abortions, some economist should do us the favor of explaining how to curtail the economic damage to the budget caused by abortions carried out in unsafe and clandestine conditions. Perhaps the economic route is the only way to introduce some measure of rationality into such a vital and sensitive issue.

Who can take responsibility for sexual education?

One can only hope that the adolescents who find themselves in hospital following an unsafe abortion—those who don’t die before reaching one—have a family they can talk to so they don’t have to keep finding their information on the streets. But it turns out that women head 39% of Nicaraguan households because the father is far away or absent altogether or perhaps the daughter doesn’t even know him or he refused to acknowledge her. The fact is that the state must assume responsibilities that many families either cannot or don’t know how to assume. Despite the “American dream family” reflected in Belli’s literature, most Nicaraguan families are not nuclear but are made up of enormously varied combinations of people. Even when both the mother and father are present, very few educate or offer information to their sons and daughters on sexuality, because they never received it themselves and don’t know how to do it. That, once again, is why formation and information must be the state’s responsibility. How many Nicaraguan families discuss sex with their sons and daughters; how many explain the risks of a sexual relationship and how to prevent those risks? As long as families don’t address these issues, the state has to take responsibility for sexual education and information. The data on maternal mortality and teenage pregnancies reflect the results of our population’s absolute sexual ignorance.

One also reads in the document that Nicaragua’s fecundity rate is one of the highest in the world. Nicaragua doubles its population every 20 years. In another 20 years, we’ll have a population of at least 10 million at the rate we’re going. Yet we can be sure that the country will not have doubled its access to education and health care much less narrowed the gap between the huge number of Nicaraguans who are extremely poor and the few who are extremely rich. That gap means that we have one of the greatest social differences in the world and a minimal middle class. According to the latest Human Development Report by the United Nations Development Program, 82.5% of Nicaragua’s population survived on the equivalent of only US$1 a day over the past four years.

The government document also reports that 45% of women who now have or who have died of cervical cancer range between 20 and 35 years old, an alarming figure not found in other countries. This type of cancer is more frequently found among women over 40 years old, and death is generally even later. The document states that the Ministry of Health only does the Papanicolaou test to detect this type of cancer—which costs about US$3—on 10% of the country’s female population, an incredibly low rate that means we don’t know the real situation of the vast majority of Nicaraguan women of fertile age (14-45 years old).

How AIDS-free are we really?

The document also talks about the AIDS epidemic. Since the eighties, the message sent to the Nicaraguan population, which it has happily believed, is that for some unknown mysterious reason Nicaragua does not have as many AIDS cases as other countries. In fact, Nicaragua has reported the fewest AIDS cases of any country in Latin America, but that doesn’t mean other cases don’t exist, just that they haven’t been reported. There is reason to suspect that there are many, many more unreported cases. Do Nicaraguans tend to practice safe sex? Do Nicaraguan men use condoms? Have Nicaraguan women learned how to say no when they fear having a risky relation? Do men have a clue how to respect women’s desires, to understand what “no” means? Is Nicaragua free of rape, both within and outside of marriage? Is there sex education? Are barrier methods of contraception commonly used? Do we know how to avoid propagating AIDS intravenously? Do we avoid sharing needles? One can imagine the answers. In the end, are we risk free or is it just that we don’t have enough evidence to know how many HIV-positive people there are in the country?
How many cases have been reported? The Ministry of Health currently has 1,060 registered cases. Based on population estimates, the international agencies calculate that at least 10,200 people were infected in Nicaragua two years ago. Multiply each of those by the conservative figure of 10 people to whom the virus could possibly have been transmitted since then, and we are already talking about 100,000 people, each of whom could in turn be transmitting it to another 10 people. Even Nicaragua’s very low reported epidemic began to rise in the past year; the Ministry of Health admitted that in just one year we had gone from a supposed prevalence of only 1.8-1.9 for every 100,000 people to a prevalence of 3.2. This means that in another year we could reach 5. And when the prevalence of an epidemic hits 5, it has reached a point of acute progress that is no longer controllable. The African countries reached this prevalence rate a decade ago.

Nicaragua has allowed itself the luxury of wasting time since 1987, when a peasant became the country’s first detected carrier. It pleased us to say that there’s no danger in Nicaragua, no problem, no AIDS. We enjoyed proposing moral values as substitutes for condoms and counseling sexual abstinence, self-control and self-discipline as safer methods than massive information campaigns on and distribution of condoms. Now such luxury is behind us; we know we have little time before reaching that catastrophic prevalence 5, when the pandemic can no longer be controlled. And why can’t it be? Because a country doesn’t change overnight, because we’re still avoiding sweeping educational campaigns, because condoms aren’t being distributed massively, because people still aren’t being taught what safe sex means, because statistics aren’t being gathered and studies aren’t being done.

Most people who have already died from AIDS in Nicaragua were detected in the final phase of the illness; so late that nothing could be done for them. And most of them died alone, isolated, abandoned, rejected. The little that is known on the subject is that hospitals tend to release such patients so they can die with their families, but often the families don’t even visit them in the hospitals much less welcome them when they get out. Often when they die, their neighbors don’t even pass on the sidewalk in front of the house because fear and ignorance prevail.
The state bought medications for just 18 carriers of the virus, and then only after they filed charges with the Inter-American Commission of Human Rights. The IACHR accepted their suit, found in their favor and ordered the state of Nicaragua to purchase the medicines for them. The state complied, but only bought enough for three months. But antiretro-virals—the medicines used to combat AIDS—cause a rebound effect if they stop being used. It’s better to use nothing than to use them for three months and then stop. The Ministry of Health strongly resented the patients going outside the country to tell what was happening inside, but what other option is there? I belong to CONISIDA, the Nicaraguan AIDS Commission, which is the highest-level state and civil society decision-making body on the disease, so I know that not a single cent was programmed to treat AIDS patients and buy medicines for 2003.

Faithful wives bear the brunt

According to the official assessment, women make up 23% of those affected by AIDS in Nicaragua. But this statistic changes among affected 15 to 19 year olds, where 44% are women. So once again female adolescents are vulnerable, with nearly twice the rate corresponding to adult women. This indicates that children between 11 and 13 are being infected as the virus only reveals itself when they reach 15-19. Not even this huge number of adolescent girls with AIDS has merited special attention from either the health or education ministries.

Effectively protecting oneself from AIDS is complicated, but we know that conjugal fidelity and self-control are not enough. In the past three years, women from Chinandega have represented the geographic population sector most affected by AIDS. And we’re not looking at sexual workers exposed daily to unprotected relations; we’re talking about homemakers infected by their husbands. Interestingly, the profile of the majority of not just these cases but others in the same period is of married women faithful to husbands who in turn had some sexual contact with another man. This demonstrates that prescribing fidelity for woman is no solution, because even if a woman is totally faithful, she could still be having unsafe relations with her own husband.
Only 14 children under the age of 10 have been reported with AIDS, and they acquired it through vertical transmission: their mothers infected them during pregnancy or at birth. It is expected that the number of infected children will increase given the fecundity of infected women—99% of them are of fertile age. In fact, these women have already given birth to 700 children, and it can be calculated with absolute certainty that 40% were born HIV-positive. It is not out of line to recall the propaganda issued during the Alemán government by Health Minister Mariángeles Argüello—today a fugitive from justice for acts of corruption—because the ministry was providing AIDS treatment to three pregnant women to avoid vertical transmission to their children. It was tragic to learn that once they had given birth and it had been ascertained that the babies were AIDS-free, the treatment for the mothers was suspended.

Domestic violence is an unaddressed public health problem

The reproductive health program document also talks about domestic violence. In 1996, at the height of the electoral campaign, the Chamorro government issued a ministerial decree recognizing domestic violence as a public health problem. This decree stands alongside Law 230, which established that it is also a crime and that sentences will be set to punish it. With these two instruments, it could be supposed that the Ministry of Health would deal with the health problems generated by intra-family violence against women and children, but seven years later, the decree still has not gone beyond discourse.

Domestic violence is a genuine epidemic in Nicaragua. According to ENDESA, an official demographic and health survey, 29% of the 16,000 women interviewed nationally declared that they had been the victims of violence at some point in their life, and of those, 37% were hit by their partners while pregnant. In 53% of the child sexual abuse cases, the aggressor was a family member and in another 27% a person well known within the family circle. Given all this data, we can better understand the need for, in fact the absolute urgency of, a massive public sex education policy in Nicaragua.

The first sign of state responsibility
brings out the big opposition guns

It was all of this evidence that triggered the publication of the Education Ministry’s manual “Education for life” mentioned earlier. It was conceived with 11 chapters: self-esteem, human rights, self-respect, the human body, emotions, feelings, affection, love, sexual relations, prevention of sexually transmitted diseases, and prevention of pregnancy. One of its main objectives was to prevent the risks and undesired consequences of sexual relations.

Most of the manual is geared to help young people learn to separate sex from love. . Due to lack of reflection on such an important issue, young women frequently give “proof of their love” when all they are doing is giving sex to a young man who loves nothing and no one other than sex. Nonetheless, these women believe they are giving love to someone who wants it, that they are exchanging love. Educating around that fundamental distinction would help resolve many of the health problems that crop up daily in Nicaragua.

The manual’s contents were discussed with officials of the health, family, education and defense ministries, the Youth Secretariat, the Women’s Institute and a number of other institutions. On the cover appear the names of some forty national officials who were consulted, people it would be hard to think of as libertine, lacking ethics, promiscuous, or in favor of homosexual marriages and abortion. But powerful groups and individuals opposed to the manual are using all these labels against them, raising such a fuss they succeeded in getting it withdrawn.

The manual was the first sign of the state’s intelligence and responsibility in response to such a dramatic panorama with respect to sexual and reproductive health. Nonetheless, just as we were finally feeling hope from seeing the state take this great step, the religious sectors, both Catholic and Protestant, suddenly cropped up again, opposing any such progress. These symbolically powerful groups succeeded in imposing their viewpoints with no legal or constitutional backing.

Among those most belligerently opposed to the manual are the Catholic hierarchy and certain individuals heading Catholic groups. Right up there in front is Élida de Solórzano, who has recently formed a women’s NGO called ANIMU (Nicaraguan Women’s Association). Since 1993, she has represented the Nicaraguan government in all UN conferences on population and development, in all their preparatory stages and in all evaluations of their results. She was in pre-Cairo (1993), New York (1994), Cairo (1994), Cairo+5 in New York and The Hague (1999) and will surely also participate in the Cairo+10 evaluation in 2004. She will do so under cover of Nicaragua’s National Economic and Social Planning Council (CONPES, the civil society consultative body to the presidency), to which she and Humberto Belli were very recently admitted as civil society representatives. Élida de Solórzano also represented the government—displacing health, education and planning ministers—in all stages of the UN conferences on women: pre-Beijing (1994), New York (1995), Beijing (1995-1996) and Beijing+5 in New York (2001); and she will almost certainly be going to Beijing+10 in 2006.

Humberto Belli’s stance on the manual leaned toward ultra-Liberal thinking: for him the problem isn’t the manual’s content as much as that the state has usurped the right to educate around values that only the family should transmit. He thinks that the manual’s content belongs in the private sphere, the sphere of civil rights, and that it is up to parents to educate their children according to their own values, without the state having any responsibility in the issue. This idea would perhaps be valid if we were living in a very developed society where education is massive, and where people have their own criteria and are very guarded about the state interfering in their private lives. But in Nicaragua, where the state has never been involved in education for life, it is rather strange for a former education minister to be questioning why the state has to educate.

Two of the most belligerent opponents of the manual from the Protestant side are Reverend Roberto Rojas and his wife, Elizabeth de Rojas, leaders of the Assemblies of God, the Protestant denomination with the largest following in Nicaragua. This couple created what they call an Evangelical Alliance and have repeated on numerous occasions that “37,000 children are murdered annually in the women’s centers.” They have taken this figure from the population and development document drafted during the Chamorro government, where one reads that 37,000 clandestine abortions are performed in Nicaragua every year. Quite apart from irresponsibly blaming women’s health centers rather than back-alley abortionists or the system that encourages their proliferation, they are quoting a very conservative figure. The University of León puts the number of high-risk abortions much closer to 80,000.

The false alarm against tetanus vaccinations

This whole amalgam of opposition was led by a nongovernmental organization called Nicaraguan Association for Life (ANPROVIDA), founded by Rafael Cabrera, a doctor who achieved notoriety in 1995 when he managed to get the national tetanus vaccination campaign suspended by irresponsibly claiming, without proof, that the vaccines contained a substance that would sterilize women. Cardinal Obando received that information with alarm, and publicized it in his Sunday homily. The Pan-American Health Organization, which had provided the vaccine, got the US Federal Drug Administration, Mexico’s health ministry and other international bodies to analyze the bottles of vaccine. Although all declared that they contained no sterilizing substance, Cabrera presented the cardinal with a laboratory report he had distorted. In the end, the Ministry of Health had to bend to the pressure and suspend the vaccination campaign. By the time it was finally reactivated the damage had been done.

Effective vaccination campaigns were the best face of Nicaragua’s public health in the nineties because they had been inherited from the Sandinista health system in the eighties, when the Nicaraguan population’s immunization level was higher than anywhere else in Latin America. Dr. Cabrera’s stunt severely undermined trust in these campaigns. The Ministry of Health had to recognize that the controversy caused a major drop in vaccinations, especially among women, with some priests even continuing to recommend to families, above all rural ones, that they only vaccinate the men, just in case. But of course, rural women die of tetanus with greater frequency than any other sector, particularly right after delivery when the placenta is extracted without enough asepsis. So can it really be said that ANPROVIDA is pro-life?

The Penal Code: Another violation

Another violation of the constitutional principle of the secular state can be appreciated in the case of Nicaragua’s Penal Code, which, although reformed on various occasions, has been around for 130 years. A new code has now been drafted and approved in general by the National Assembly; the final step is its article-by-article debate and passage. Article 146 of the new code retains the legality of therapeutic abortion from the old law, but a new legal concept appears in article 148 that I think requires a more detailed explanation.

In 1999, Argentina’s President Carlos Menem was in the apogee of his relations with the Vatican, which had just decorated him with the Order of Saint Gregory the Great, the same order that Élida de Solórzano, then-Minister of the Family Max Padilla and Vivian Pellas would receive two years later. It is the order that the Vatican bestows on laymen and laywomen it views as notable defenders of human rights, especially belligerent opponents of abortion.
In 1999, Menem was the Vatican’s most militant crusader in the Cairo+5 process, which involved revising the original document five years after the Cairo conference. In this process, the pro-life groups tried to substantially modify Cairo’s progressive agreements, and Menem was the most active Latin American President in opposing all mention of reproductive and sexual rights. After receiving the order, he began to establish in his country what had been a central Vatican agenda point for nearly ten years: the granting of rights to the unborn. The objective is to have fetuses recognized as persons, granting them rights from the moment of conception. But this sets up an evident contradiction: the Constitutions of all countries in the world grant rights only to persons already born and these “new” rights would conflict with the rights of many of these people, especially women.

To establish its agenda, the Vatican is exploiting the state reform process imposed by the international financing agencies in Latin America to adjust our states to the neoliberal model. This reform shrinks the state into a “facilitating” role, modifying the national legal corpus to that end. This process has provided the Vatican an extraordinary opportunity to introduce legislative changes granting rights to the unborn in Latin American countries. A first proposal for promoting that is symbolic: that the states establish March 25 as the Day of the Unborn; the date is the liturgical celebration of the announcement of the Incarnation to the Virgin Mary. President Menem duly installed this festivity in Argentina in 1999. His partner in crime, Arnoldo Alemán, since both ended up prisoners for major acts of corruption, was also his partner in this adventure: he established the same festivity in Nicaragua the following year.

It’s not just a festivity

Article 148 in Nicaragua’s new Penal Code is titled “on injury to the as yet unborn” and establishes punishments for doctors who cause physical or psychological injury to the fetus during the nine months of gestation. These punishments include five years in prison, eight years of absolute prohibition from practicing medicine and eight years closure for the clinic or consulting center involved. The Nicaraguan medical class has yet to react; it seems they haven’t thought through the grave consequences of this article: with one article continuing to authorize therapeutic abortion and punishments being established two articles later for injury to the unborn, which article will prevail?
Article 148, still pending approval, is another expression of religious incursion into the legislation of a secular state. Something similar already exists in Colombia’s new penal code, and the day of the unborn has been decreed in Bolivia, the Dominican Republic, Guatemala and Costa Rica, as well as Argentina and Nicaragua. A group of Nicaraguan politicians from the Conservative Party, known as ALCON, has tried to go even further by proposing to reform article 23 of the Constitution, which establishes that the state respects “life,” by tacking on “from its conception to its natural end.”
These are just a few examples. The Nicaraguan state is officially secular, but many public officials and powerful sectors of our society seem unwilling to respect this constitutional principal. Because of this, we have to continue reflecting and acting so that the principles of a secular state will one day become a reality. Only by studying, reading, being informed and documenting what is going on will we be able effectively to contribute our opinions to this debate. The gravity of the country’s health situation and the lives of thousands and thousands of women and girls require that we add our wise Catholic and non-Catholic voices to this debate and effort.

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