New analysis from Ipas Central America underscores lost opportunities to prevent women's deaths

"¿En cuánto valoramos la vida de una mujer?" How much do our societies value the life of a woman?

This is the challenging question posed by a new report from Ipas Central America, which analyzes data on the pregnancy-related deaths of Nicaraguan women in the first three years of the 21st century. Suggesting a grim answer to that question, evidence documented in the report shows that many of these deaths could have been prevented through better education and increased access to reproductive-health care including contraceptive methods, therapeutic abortion and emergency obstetric care.

In preparing A summary of analysis of maternal mortality in Nicaragua 2000-2002, researchers delved into data available in official records on the 445 women reported to have died in those years from causes related to pregnancy.

Nicaragua's total population is 5.5 million, and the World Health Organization estimates that the maternal mortality ratio is 230, which means that 230 women die from pregnancy-related causes for every 100,000 live births.

The new report examines the incidence of maternal mortality in Nicaragua with respect to cause, time and place of death, yielding significant findings. For example:

• More than one in five of the women who died from pregnancy-related causes were between the ages of 15 and 19.
• The majority of the women (72%) were from rural areas, where factors such as poverty, malnutrition, limited education and limited access to necessary health services increase the level of risk associated with pregnancy.
• While the majority of the women were not using contraceptive methods when they became pregnant, 96 women, or about one in five, died from pregnancies that resulted from contraceptive method failure. Sixty percent of these women were using oral contraceptives.
• The number of deaths that occurred in the women's homes decreased from 60% in 1998 to an average of 35% in 2000 to 2002, indicating an increase in the number of women dying after having reached a health center or hospital.
• Only 4% of the deaths were recorded as resulting from unsafe abortion; however, a significant number of deaths from unsafe abortion may have been incorrectly attributed to suicide, sepsis or hemorrhage.

"Our analysis points to the need to improve the quality of emergency obstetric care. Maternal deaths have not decreased and increasingly women are dying in hospitals and health centers and not in their homes or communities," said Karen Padilla, one of the report's authors.

"Also, many of these women became pregnant due to contraceptive method failure, indicating that we must ensure better counseling and access to modern contraceptives. No woman should face the risk of dying from an unwanted pregnancy."

Padilla and co-author Heathe Luz McNaughton propose several actions for prevention and intervention. These include providing better sexual education, counseling and access to modern contraceptive methods, including emergency contraception, in order to reduce the incidence of unwanted pregnancy and, correspondingly, the rate of maternal mortality.

Further, the authors suggest the need for more research on the relationship between unwanted pregnancy and death due to suicide and violence in order to specifically address this issue in maternal mortality prevention efforts.

In addition, the report notes, improving the quality of prenatal care is a critical step toward identifying risky pregnancies as early as possible. Women who are recognized as candidates for therapeutic abortion may then be provided with the knowledge necessary to make informed choices about their pregnancy.

The report, which is in Spanish, is available for free from the Ipas website.

For more information, contact media@ipas.org