Introduction
As a controversial topic, abortion has received tremendous attention from the human rights perspective. Governments that have continuously prevented populations from accessing safe and legal abortions have created an environment of distrust and confusion. Whether criminalized or not, abortions will happen in unsafe ways, causing women of different ages and social statuses, both psychological and physical pain. The case of Nicaragua has shown to be particularly challenging as the country’s leaders are adhering to the patriarchal worldview that does not consider the rights and the health of women, and the importance of their well-being to the country’s social and economic status.
What some fail to consider is that modern medicine can be of high importance for facilitating safe and effective abortions that would preserve the health of women while alleviating the burden of unwanted and even forced pregnancies. The unsafe abortions that occur in cases when the procedure is banned legally can cause significant healthcare challenges, which suggests that there is no way of preventing abortions. Because of this, it is imperative to consider the positive impact of scientific advancements in the sphere of abortion procedures. Since modern medicine has become effective enough to guarantee the safety of women undergoing the procedure, governmental laws that limit abortion altogether are only punitive and restrict human rights.
Understanding the Problem
When conducted in safe conditions and legally, abortions represent highly effective procedures that do not lead to many complications overall. Data from around the world suggests that abortion has the same level of safety as standard medical procedures, including childbirth. The training and technologies required for carrying out abortions are extremely straightforward for the majority of healthcare settings, and all necessary management techniques of minor risks can be performed by medical staff easily. According to the evidence-based guidelines developed by the World Health Organization, the majority of abortion cases are possible to conduct by a wide range of healthcare providers or even a primary care level. Therefore, the general view of abortions is that modern healthcare can ensure the safety of the procedure, with the likelihood of complications being very low.
Today, abortions do not present any significant challenges from the scientific perspective. However, as in the case of Nicaragua, more than a half of abortions that occur every year are considered unsafe for women. Unsafe abortions are defined as such that are carried out by inappropriately trained personnel and implement non-recommended methods. According to Ganatra, in cases when the legal status of abortion is considered, the rate of unsafe procedures is in countries with restrictive laws, with the majority of them being present in developing countries. Such a way of approaching the issue is ineffective when modern medicine has offered multiple methods of terminating pregnancies safely, which is why Nicaragua and other countries with restrictive laws on the procedure must reconsider their standpoint on the issue.
Because of some developing countries establishing restrictive laws on carrying out abortions, there is currently ongoing work related to improving the main results of both medical and surgical abortions. It is imperative to focus on the latest developments aimed at improving the completeness of the procedures targeted at terminating a pregnancy and reducing the complications associated with it. A specific focus should be placed on improving access to safe abortions, considering its benefit for preserving the core principles of human rights. When considering the case of Nicaragua and its government’s restrictions on carrying out abortions, the impact of recent scientific advancements should be considered because it can guarantee the safety and well-being of the country’s female population.
Recent developments in both medical and surgical abortion show that prohibiting the procedure on a legislative level does more harm than good. From the medical abortion standpoint, the earliest can women take medication to facilitate abortion; the higher is the likelihood of positive outcomes and the absence of complications. Because of this, it is recommended to urgently minimize delays in administering medication, so women that want to receive an abortion can do it as early as possible to maximize efficacy. Also, early at gestation, there is a lower likelihood of pain and bleeding associated with the procedure.
One of the recent advancements in medical methods of abortion is the development of a clinical protocol, a very early medical abortion (VEMA), which occurs at gestations of earlier than six weeks. The rate of incomplete abortions in women that have VEMA is significantly lower compared to those having medical abortions after six weeks. Besides, VEMA protocols have been shown to decrease the risks of ectopic pregnancies while also allowing detection as early as possible and facilitating an early intervention that could save women’s lives.
When it comes to the scientific developments associated with second-trimester abortions, researchers have advanced the implementation of dilation and evacuation, which is a safe procedure with an increased level of efficacy and safety when performed by skilled and highly trained healthcare providers. However, the beneficial results of the procedure rely predominantly on the medication being used, which means that it can be performed by a wide range of healthcare professionals. As a result of this advancement, it is possible to provide abortion care to women in their second-trimester pregnancies, thus contributing to expanding the availability of safe healthcare at this particular gestational stage. Thus, medical abortions have become safe ways of terminating pregnancies, which is a significant advancement that can save the lives of women who would have sought unsafe and illegal ways.
Surgical abortions have also advanced, with WHO recommending using vacuum aspiration in the first trimester. This procedure is safe and can be carried out by a trained midwife or nurse, which broadens the spectrum of its application at healthcare facilities. When implementing surgical abortions, it has also been recommended to apply perioperative antibiotic prophylaxis as a way of reducing infections after the operation. While additional studies associated with effective antibiotic regimens remain to be done, the scientific advancements listed in this section clearly show that abortions are safe when carried out appropriately. Limiting or ultimately preventing the access of women to the procedure is not only an attack on their health but also shows the disregard of higher-standing powers of their rights and freedoms to choose the future that would be favorable.
To summarize the exploration of the medical perspective on abortion, it should be mentioned that modern technologies have made the procedure extremely safe for women who do not experience complications if abortions were carried out in safe conditions. If countries that have restrictive laws regarding the procedure consider changing their policies, they must prepare their healthcare providers through training, work toward removing the stigma associated with abortions, and improve access to affordable and effective contraception. As science made abortions available and safe, it is crucial that the public gets appropriate education on the procedure and is aware of its consequences, benefits, and disadvantages. In any context of the situation, abortion will present a choice for women, and they will have to use sound judgment and logic to make the decision that would benefit their lives and health on a long-term basis.
The Criminalization Issue
Despite the significant progress associated with carrying out abortions safely and effectively, governments have continuously failed to guarantee women access to the service, making it illegal. In Nicaragua, abortion is considered entirely unlawful, without any exceptions to the rule, even in instances when pregnancies cause a significant threat to the lives of women or have been the result of rape. The problem is significant because it has caused abortions to go underground, with healthcare providers having to choose between following the law and helping women in need of medical intervention. The human rights aspect of the problem is particularly challenging because the law does not make any exclusions for women whose lives and dignity may be under threat. There is always a high risk of them being prosecuted for seeking out and undergoing illegal abortions, which contributes to social stigma.
Both medical and surgical abortions are illegal in Nicaragua, and the government does not consider any changes and modifications to the law. Such a radical attitude toward criminalizing the procedure has stemmed from the long history of female oppression and the machismo culture, which institutionalizes the prevalence of the male gender over the female. Furthermore, the criminalization of abortion in the country has not been challenged educationally, with schools failing to inform younger generations on safe sex and the precautions they should take. As suggested by a Planned Parenthood Global report, 93% of childhood pregnancies in the country were the consequences of rape, with 80% of pregnant teens having no prior sex education. While criminalizing abortions, the government does not implement any safeguarding measures for protecting younger people from being subjected to unsafe sexual relationships.
Altogether, the criminalization of abortion in developing countries such as Nicaragua is ineffective because they have no reasonable justification for being enacted. While there is nothing that is being done to prevent unwanted pregnancies, especially among younger women and those who have been victims of rape, the legal punishment for it does not stop women from seeking underground options. Therefore, there is an ongoing circle of mistreatment of women and the misinformation of the country’s population that remains to be unresolved, even with the availability of modern and safe procedures of pregnancy termination.
Abortion Laws as Weapons Against Women’s Human Rights
Even though the overall trends across the globe tend to be more progressive, some countries in which right-wing ideologues have taken over have prevented women from having control over their lives and bodies. The Abortion law that continues to be in effect today puts the lives of women at risk, thus contributing to the significant issue within the human rights framework, which suggests that health is a fundamental human right. According to Dr. Tedros Adhanom Ghebreyesus, WHP Director-General, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” For World Health Organization, health has been placed at the forefront of the organization’s work, with the right to health suggesting that every person should have access to the services they need, regardless of the location and the time they need them, without experiencing financial pressure.
The state of affairs in Nicaragua concerning the abortion law is an attack on the human rights of women due to the adverse health consequences for the population seeking illegal and unsafe abortions. The legislation has a negative impact on the health of women, resulting in preventative deaths of women as well as the embryo or fetus that they were carrying. The law places healthcare providers at risk of being put into the prison if they carry out the procedure, even in cases when there were women’s lives at stake. It also requires physicians to report women and girls to police for suspected abortions, thus breaching the duty of confidentiality toward their patients and placing them in a conflict between medical ethics and law. The right to health is disregarded by the provisions of Nicaragua’s legislation, pointing to the prevalence of the government over the lives and decisions of its citizens.
The right to freedom of choice is also under attack in Nicaragua’s abortion ban. Freedom of choice represents the right of an individual to be a free agent in his or her interhuman relationships, make his or her own decisions, be free from the arbitrary authority of others, as well as be able to choose how to use services or property without being subjected to external coercion. Women and girls who are the primary subjects of the law cannot choose their course of action when it comes to their health and has to comply with the requirement that violates their freedom of choice. The pro-choice movement, which advocates for allowing women to decide when and with whom to start a family, is based on the fundamental right of freedom of choice. By enacting the abortion ban, the government of Nicaragua disregards the right of women to choose their reproduction path, showing that the decision of the state regarding the issue has more value than the decision of separate women on whether to have a child at a particular point in their lives.
A Path Toward Safe and Legal Abortions
Countries that restrict access to abortions have shown to have higher rates of unsafe and illegal abortions compared to countries that have established liberal laws. Allowing women to have abortions does not lead to them having the procedure more times or more frequently but rather makes it safer, thus decreasing the high expenses associated with treating complications and trying to save the lives of women who got unsafe abortions. Evidence shows that countries that have made abortions legal after they were banned, such as Romania, Nepal, and South Africa, witnessed a notable decline in the mortality and morbidity of women who undergo abortions.
The stigma associated with abortion should be eliminated as it represents the core factor behind unsafe procedures being implemented around the world. The stigma leads to women having to seek abortion options that are both unsafe and illegal when there are scientific advancements available in other countries that could have been beneficial. Delays in abortions due to the absence of available services lead to pregnancies in advanced gestations, making it complicated to perform the procedure safely and at no risk to mothers. Furthermore, stigma goes beyond affecting mothers but also healthcare providers who must deal with the low morale, decreased respect from others in the medical field, as well as ostracism for proving abortion services to women in need. In addition, qualified healthcare workers and those who are trained may be deterred from carrying out abortion care because of the increased levels of criticism. Overall, to facilitate safe and advanced abortions that would not put the lives of women into a threat, strategies are required to eliminate the stigma associated with the procedure. In countries such as Nicaragua, this need is high on the agenda.
With the availability of advanced medicine that can both prevent pregnancies and facilitate abortions at the early stages of gestation, the population must have access to effective contraception methods. Modern pharmacology has made it possible to provide both affordable and readily available birth control products, and governments must ensure that the population has access to them. This recommendation goes together with the need for disseminating reliable information about contraception as a part of the strategy to prevent the occurrence of unwanted pregnancies. If the government of Nicaragua wants women not to have abortions and is willing to consider changing the policy to allow them in some cases, it is imperative to make emergency contraception available in cases when regular methods fail or were not used initially.
This could be a step forward in the direction of making abortions legal, overcoming the social stigma associated with it, as well as helping women gain control over their lives and bodies. According to Cameron, recent evidence shows that while the numbers of women of reproductive age who live in developing countries having unwanted pregnancies due to the absence of contraception have declined, they remain at around 314 million worldwide. These women account for approximately 84% of all unplanned or unwanted pregnancies in developing regions. Therefore, since modern medicine has allowed the population to have affordable and reliable contraceptive methods, they should be accessible for everyone in both developing and developed countries.
On the path to having safe and legal abortions that rely on advanced medicine and the expertise of healthcare specialists, contraceptive counseling is a step that can work in any social or political context. Since the fertility of women can resume soon after having an abortion, such counseling is imperative for ensuring that women do not have pregnancies that they have not planned or wanted. For example, the latest advances in contraceptive medicine have allowed to implementation of “most-effective long-acting reversible methods of contraception (LARC) such as the implant and intrauterine contraception, which can be used safely and immediately after an abortion.” Furthermore, for those women who have a combination medical abortion, the LARC implant can be administered during the procedure, which makes it easier for healthcare providers to provide preventative care. Besides, for women that want to use LARC, receiving it at the time of the procedure is linked to a lower likelihood of unintended pregnancies.
The interplay between technologies and law presents high importance in the current exploration of abortions. To make the procedure available in countries like Nicaragua, the global community must urge the government to repeal its penal code that criminalizes abortions and develops legislation that protects women’s human rights, as well as their health and dignity. Nicaraguan women must have adequate access to reproductive healthcare as well as contraception products to be in control of their lives and bodies. Moreover, the law should allow physicians to carry out their responsibilities and duties per medical ethics, particularly in terms of preserving medical confidentiality.
Conclusions and Recommendations
With the wide availability of advanced technologies that make abortions safe and effective, there is no logical reasoning that prevents women from having them if needed. In Nicaragua, the abortion ban presents a challenge to human rights and the attack on the dignity of women as well as their physical and psychological well-being. Instead of giving girls and women prison sentences for seeking abortions or punishing medical staff for having them, the government should focus on sex education, the provision of affordable and accessible contraception and emergency medicine, as well as the fostering of a social environment in which women will be supported and value for their role in society.
The exploration of the latest trends in healthcare has illustrated that the process of abortion is an extremely safe procedure when conducted by skilled providers and inappropriate environments. Because of this, Nicaragua must liberalize abortion laws to ensure that the procedure poses to risk to the lives of women. It is essential to implement health legislation that will support the carrying out of the law, increase the presence of trained providers, as well as work toward removing the social stigma associated with abortion. The matter of allowing abortions goes beyond the matters of health and safety but touches upon the freedom principle of human rights. Women should have the right to prevent unintended pregnancies or terminate them because they must have some control over their lives and bodies and be able to prevent associated complications that could follow up unsafe pregnancies.
The legal policy established in Nicaragua has been shown to violate the human right to health as well as freedom of choice. The right to health means that each person is entitled to have control over their health and body, including being granted access to reproductive and sexual information as well as related services, free of discrimination, oppression, and violence. The freedom of choice, in the current case, pertains to the ability of women to make informed and sound decisions about whether they are ready to have a child and can be responsible mothers. It is high time for the oppressive legislation established in Nicaragua to be terminated. What is occurring in the country is highly concerning as women continue putting themselves at risk when seeking out illegal and unsafe methods of terminating their pregnancies. Modern medicine has offered a range of methods that allow women to undergo abortion and preventative methods safely, and it is high time for Nicaragua to reach the expected level of medical and social advancement that would make the population safe and secure in the choices they make and the healthcare procedures they undertake.
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