Advertisement

Overcoming Barriers to Reducing Adolescent Pregnancy and Improving Maternal Health in Nicaragua

  • Katherine E. Bliss
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

Compared to women in other countries in Latin America, Nicaraguan women are more likely to die giving birth. Nicaragua has made progress in reducing its maternal mortality ratio (MMR), a measurement of maternal deaths, from 202 deaths per 100,000 live births in 2000 down to 150 deaths per 100,000 live births in 2015. Despite this improvement in overall maternal mortality, the high percentage of adolescents giving birth annually poses challenges for the future of the government’s maternal and child health efforts. Approximately one-quarter of all births annually are to girls between the age of 15 and 19 years, and one-half of all women in Nicaragua have delivered a baby before reaching the age of 20. Although Nicaragua’s annual gross national income (GNI) per capita of US$1940 makes it a lower-middle-income country under World Bank criteria, there is considerable income inequality, and nearly 30% of the population lives in poverty. Many of the country’s youngest mothers live in rural and peri-urban areas and are among the poorest of the poor, with limited or no formal education. Once they become pregnant, adolescents who are still in school are dismissed or drop out on their own, further limiting their economic prospects and those of their children. With women who bear a child during adolescence likely to have higher fertility than those who wait until their 20s to have their first child, girls in Nicaragua who become pregnant face a greater risk of maternal mortality over the long term. To address the connected challenges of adolescent pregnancy and maternal mortality, Nicaragua must consider legal, social, and health sector reforms to meet the needs of the country’s most vulnerable mothers and their children.

Keywords

Indigenous women Maternal health Maternal mortality ratio Adolescent pregnancy Maternal mortality Teenage pregnancy Infant mortality Pregnancy disease Pregnancy Central America Fertility Nicaragua Poverty Family planning Contraception Sexual violence Rape Child welfare Casas maternas Miskito 

References

  1. Altamirano, A., Pacheco C., Huelva L., Sáenz, M., López, A. (2016). Embarazo adolescente en Nicaragua: Causas y consecuencias económicas y sociales del embarazo adolescente en Nicaragua. Serie de documentos de trabajo Número 7. FUNIDES. Retrieved April 21, 2017, from http://funides.com/embarazo-adolescente-en-nicaragua/.
  2. Amnesty International. (2009). The total abortion ban in Nicaragua: women’s lives and health endangered, medical professionals criminalized. London: Amnesty International Publications. Retrieved May 3, 2017, from http://www.amnestyussa.org/sites/default/files/pdfs/nicaragua_abortion_ban_report__english.pdf.
  3. Amnistía Internacional. (2010). Escucha sus voces y actúa: no más violación y violencia sexual contra niñas en Nicaragua. Editorial Amnistía Internacional (EDAI). Retrieved May 4, 2017, from https://doc.es.amnesty.org/cgi-bin/ai/BRSCGI/NO%20MÁS%20VIOLACIÓN%20Y%20VIOLENCIA%20SEXUAL%20CONTRA%20NIÑAS%20EN%20NICARAGUA?CMD=VEROBJ&MLKOB=29281302222.
  4. Bárcenas, J. (2015). Reformas presupuestarias: un balance después de la crisis. InQué sucedió con las casas maternas, los subsidios a las viviendas de interés social, y el bono productivo alimentario? Managua: Instituto de Estudios Estratégicos y Políticas Públicas.Google Scholar
  5. CODENI. (2005). Así piensan y actúan los abusadores y explotadores sexuales: una visión masculina de la violencia sexual. Managua: CODENI. Retrieved April 3, 2017, from http://www.poderjudicial.gob.ni/genero/documentos/11_asi_piensan_y_actuan.pdf.
  6. CODENI. (2017a). Situación de los embarazos en las adolescentes. Retrieved April 3, 2017, from http://www.codeni.org.ni/situacion-los-embarazos-las-adolescentes/.
  7. CODENI. (2017b). Violencia sexual. Retrieved April 3, 2017, from http://www.codeni.org.ni/proteccion-especial/violencia-intrafamiliar/violencia-sexual/.
  8. Conde-Agudelo, A., Belizán, J. M., & Lammers, C. (2005). Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 192, 342–349.  https://doi.org/10.1016/j.ajog.2004.10.593 CrossRefPubMedGoogle Scholar
  9. Cortez, R., García Prado, A., Kok, H., Largaespada, C. (2008). Las casas maternas en Nicaragua. Washington, DC: Banco Mundial and Banco Interamericano de Desarrollo (BID). Retrieved April 3, 2017, from http://siteresources.worldbank.org/INTLACREGTOPGENDERINSPA/Resources/Cuaderno4casas_maternas.pdf.
  10. El Nuevo Diario. (2016). Capacitarán a 500 bachilleres en salud ya 700 parteras. El nuevo diario. Retrieved April 3, 2017, from http://www.elnuevodiario.com.ni/nacionales/381419-capacitaran-500-bachilleres-salud-700-parteras/.
  11. Guttmacher Institute. (2006). Early childbearing in Nicaragua: A continuing challenge. In Brief, 2006 Series, No. 3. Retrieved May 4, 2017, from https://www.guttmacher.org/sites/default/files/report_pdf/rib_nicaragua2006-09en_0.pdf.
  12. Hernández, M. (2007). Mortalidad materna en adolescentes y mortalidad infantil en hijos de madres adolescentes en Nicaragua. Organización Panamericana de la Salud (OPS). Retrieved May 4, 2017, from http://www.paho.org/nic/index.php?option=com_docman&task=doc_view&gid=234&Itemid=235.
  13. Howe, C. (2007). Gender, sexuality, and revolution: Making histories and cultural politics in Nicaragua, 1979–2001. In W. E. French & K. E. Bliss (Eds.), Gender, sexuality and power in post-independence Latin America (pp. 230–260). Lanham, MD: Rowman and Littlefield.Google Scholar
  14. Lancaster, R. (1992). Life is hard: Machismo, danger, and the intimacy of power in Nicaragua. Berkeley, CA: University of California Press.Google Scholar
  15. Law Library of Congress. (2007). Nicaragua: children’s rights: international and national laws and practices. Retrieved April 3, 2017, from http://www.loc.gov/law/help/child-rights/pdfs/childrensrights-nicaragua.pdf.
  16. Meuwissen, L., Gorter, A., & Knottnerus, A. (2006). Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: A quasi-experimental intervention study. Journal of Adolescent Health, 38, 56e1–56e9.CrossRefGoogle Scholar
  17. Ministerio de Salud, Dirección General de Extensión y Calidad de la Atención. (2012). Estrategia Nacional Casasa Maternas Porla reducción de la mortalidad materna y perinatal. Retrieved May 3, 2017, from http://www.minsa.gob.ni/index.php/repository/Descargas-MINSA/Dirección-General-de-Servicios-de-Salud/Estrategia-Nacional-de-Casa-Materna/.
  18. Organización Indigena Wangki Tagni Mairin Asla tajanka tah upla, FIMI, CADPI, Alianza de Mujeres Indigenas de Centroamerica y Mexico, ONU Mujeres. (2012). Estudio de caso: Violencia contra mujeres Miskitus. Comunidades del Wangki. Retrieved May 4, 2017, from http://www.fimi-iiwf.org/archivos/84fa5f31561e5fed22bf79a917110fb4.pdf.
  19. Organization of American States (OAS). (2007). Red hemisférica de intercambio de información para la asistencia mutua en materia penal y extradición. Código Penal de la República de Nicaragua. Retrieved May 4, 2017, from https://www.oas.org/juridico/mla/sp/nic/sp_nic-int-text-cp.html.
  20. Pan American Health Organization (PAHO). (2012). Health in the Americas, 2012. Country volume: Nicaragua. Retrieved April 3, 2017, from http://www.paho.org/salud-en-las-americas-2012/index.php?option=com_docman&task=doc_view&gid=140&Itemid=.
  21. Pan American Health Organization/World Health Organization (PAHO/WHO). (2017). Zika- epidemiological report Nicaragua. PAHO/WHO. Retrieved May 2, 2017, from http://www2.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=35217&Itemid=270&lang=en.
  22. Quintanilla, M. (2014). Adolescent pregnancy in Nicaragua: More than just an issue about adolescent women. Unpublished manuscript. Retrieved May 3, 2017, from http://www.academia.edu/7415620/Más_allá_de_las_adolescentes_otras_dimensiones_del_embarazo_adolescente_en_Nicaragua.
  23. Red de empresarias de Nicaragua (REN). (2017). Lo que debe ser penoso. Retrieved May 5, 2017, from https://ren.org.ni/lanzamiento-campana-lo-que-debe-ser-penoso/.
  24. Schwartz, D. A. (2017). Autopsy and postmortem studies are concordant. Pathology of Zika virus infection is neurotropic in fetuses and infants with microcephaly following transplacental transmission. Archives of Pathology & Laboratory Medicine, 141(1), 68–72. Retrieved from http://www.archivesofpathology.org/doi/full/10.5858/arpa.2016-0343-OA.CrossRefGoogle Scholar
  25. UNICEF. (2013). Casas maternas: Refugios de vida. Nicaragua. Retrieved May 3, 2017, from http://en.unicef.org.ni/prensa/37/.
  26. USAID and Catholic Relief Services (CRS). (2014). An innovative approach to involving men in maternal and newborn health care: Program experiences in the Department of Matagalpa, Nicaragua. Operations Research Brief. Retrieved from https://www.usaid.gov/sites/default/files/documents/1864/CRSORBrief.pdf.
  27. Velázquez, U. (2016). País gasta US$5,1 millones en atender a madres adolescentes. Diario metro. Retrieved April 17, 2017, from http://diariometro.com.ni/nacionales/101465-pais-gasta-us51-millones-en-atender-a-madres-adolescentes/.
  28. World Bank. (2017a). Adolescent fertility rate (births per 1,000 women ages 15–10). Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama. Retrieved May 4, 2017, from http://data.worldbank.org/indicator/SP.ADO.TFRT?locations=BZ-CR-GT-SV-HN-NI-PA&view=chart.
  29. World Bank. (2017b). Maternal mortality ratio (modeled estimate, per 100,000 live births). Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama. Retrieved May 2, 2017, from http://data.worldbank.org/indicator/SH.STA.MMRT?locations=BZ-CR-SV-GT-HN-NI-PA&view=chart.
  30. World Bank. (2017c). Nicaragua: Poverty headcount ratio at national poverty lines (% of population). Retrieved April 10, 2017, from http://data.worldbank.org/indicator/SI.POV.NAHC?locations=NI.
  31. World Health Organization, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group. (2015). Maternal mortality in 1990–2015: Nicaragua. Retrieved April 3, 2017, from http://www.who.int/gho/maternal_health/countries/nic.pdf.
  32. Zeka, A., Kahn, H.S. (2014). A quiet inquisition. Documentary film. Film website. Retrieved May 6, 2017, from https://www.facebook.com/aquietinquisitionthefilm/.
  33. Zelaya, E., Marín, F., García, J., Berglund, S., Liljestrand, J., & Persson, L. (1997). Gender and social differences in adolescent sexuality and reproduction in Nicaragua. Journal of Adolescent Health, 21, 39–46.  https://doi.org/10.1016/S1054-139x(96)00277-7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Principal, Girasol Global Policy ConsultingDallasUSA
  2. 2.Formerly Global Health Policy Center, Center for Strategic and International StudiesWashington, DCUSA

Personalised recommendations