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NICARAGUA: Controversy Over Pregnancy-Related Death Toll

José Adán Silva

MANAGUA, Apr 21 2010 (IPS) - Non-governmental organisations in Nicaragua are questioning data on the maternal mortality rate released by the government, which is claiming a historic decline in the indicator, and they warn that the reduction target that the country has committed itself to by 2015 is still out of reach.

Miriam Chávez, the Health Ministry’s head of nursing, reported that Nicaragua had achieved a reduction of the maternal mortality rate to 90 per 100,000 live births in 2009, by means of a campaign sending health brigades to work among the poor.

Health Ministry statistics indicate that in 2007, the first year of the administration of leftwing President Daniel Ortega who took office that January, there were 107 maternal deaths per 100,000 live births, and that in 2008 the number was 94.

The health authorities forecast that by the end of 2010, the maternal mortality rate will be reduced by up to 25 percent, giving a rate of 70 maternal deaths per 100,000 live births.

In 2006, the year before Ortega began his second term – he previously governed from 1985 to 1990 – the maternal mortality rate was 140 per 100,000 live births.

Chávez attributed the achievement to government health promotion measures, like sending medical brigades to the most isolated and vulnerable parts of the country, creating 72 maternity homes and training the nursing personnel of the Local Comprehensive Healthcare System.

She told IPS that her office has already trained 394 obstetric nurses to care for women during pregnancy and labour in the poorest rural areas and those furthest away from the towns. “By the end of this year, we will have 500 trained obstetric nurses,” she said.

Nicaragua is one of the poorest countries in Latin America, with 47 percent of the population living on less than two dollars a day.

This Central American country has a population of 5.7 million, of whom more than one million are living in extreme poverty, with incomes of less than one dollar a day, according to official statistics from the National Institute for Development Information (INIDE).

In 2000, the United Nations member countries adopted the eight Millennium Development Goals (MDGs), to be met by 2015.

The eight MDGs, with quantifiable targets, seek to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and women’s empowerment, reduce child mortality, improve maternal health, combat HIV/Aids, malaria and other major diseases, ensure environmental sustainability and develop a global partnership for development.

On the basis of this platform, each country has its own national goals. Nicaragua committed itself to reducing the maternal mortality rate from the 1999 level of 90 per 100,000 live births, down to 27 in 2015.

According to Francis Bustos, an independent clinical pathology researcher, the official figure announced this month “seems hard to believe.”

“The government’s figures contrast with the World Health Organisation’s (WHO) global health statistics for 2009, which say Nicaragua’s maternal mortality rate is 170 per 100,000 live births, higher than the 1999 average for the Americas,” said Bustos.

In her view, the true figure may be higher than the official statistics indicate. “Every year, the Health Ministry records approximately 400 cases of ectopic pregnancy, one of the main causes of maternal deaths,” she said.

“And if we consider the approval of the law banning therapeutic abortions , which forces many families to avoid the health system, it would imply a possible increase in maternal deaths” that are not being registered, she said.

Passage of the 2006 law made Nicaragua one of the few countries in the world where abortion is illegal under all circumstances, even in cases where the mother’s life is in danger or the fetus is deformed.

In contrast, Débora Grandison, Special Ombudsperson for Women, endorsed the official statistics and said the government has made efforts to improve maternal health indicators.

“I think there has been an improvement, making a small difference in the figures, perhaps, but representing a great effort. Access to healthcare and treatment for women has improved, but there is still much to be achieved” in terms of the fifth MDG – reducing by three-fourths the number of maternal mortality cases – she said.

Juanita Jiménez, of the non-governmental Autonomous Women’s Movement, rejected the maternal mortality figures reported by the government.

“Ever since they stopped posting up-to-date data on the Ministry’s web page and started handling the figures as if they were state secrets, I lost all faith in the official information,” she told IPS.

In Jiménez’s view, the low mortality rate announced by the government is an attempt to counteract international disapproval of the banning of abortion in any circumstances.

“There has been strong international pressure to reinstate therapeutic abortion, and one way or another the government is seeking to improve its image (with these new data),” the activist complained.

Fátima Millón, of the Central American organisation Network of Women against Violence (RMCV), expressed doubts about the new official maternal mortality statistics.

“The government generally tells lies, hides and manipulates figures when it doesn’t want them to become public knowledge, so I doubt that it’s true,” she told IPS.

Millón accepts figures provided by the New York-based international organisation Human Rights Watch, which estimated this year that in Nicaragua, 170 women die per 100,000 live births.