Ipas works with Nicaragua's maternity homes to offer special care for pregnant young women and victims of sexual violence

Thursday, December 6, 2012

pregnant young womenTwo young pregnant women keep each other company at the Jinotega Maternity Home, where 60 percent of residents are under the age of 19.

Pregnant women staying at the Jinotega Maternity Home enjoy many benefits: care before and after childbirth, educational programs, and the camaraderie and emotional support of other pregnant young women facing similar hardships in this rural part of Nicaragua.

One thing many of these young women have in common is that they became pregnant as the result of rape. Girls and female adolescents make up the vast majority of sexual violence victims in Nicaragua. In fact, 84 percent of all the rape cases handled by the nation’s Institute for Legal Medicine between 2009 and 2011 were girls younger than 17. Girls younger than 13 were almost half of the total case load. In the very rural Department of Jinotega, the problem is even worse.

“In the Jinotega Maternity Home, the number of pregnant women under age 19 has doubled in the last three years, so that in 2011 they accounted for 60 percent of all women seen,” explains Ipas consultant Argentina Espinoza, who oversees Ipas’s work with the country’s maternity homes. Sexual violence is rampant and under-reported in this region, most perpetrators go unpunished, and the rates of adolescent pregnancy and maternal mortality are dramatically higher than the national average. And due to the country’s total ban on abortion, girls and adolescents who become pregnant from rape must carry their forced and unwanted pregnancies, often sinking them further into poverty.

Women’s rights advocates in Nicaragua are currently holding events to raise awareness of the country’s high rate of violence against women as part of the 16 Days of Activism Against Gender Violence. Each year, this international campaign begins on Nov. 25, the International Day for the Elimination of Violence Against Women, and ends on Dec. 10, International Human Rights Day, thereby symbolically linking violence against women and human rights.

Nicaragua is under increasing scrutiny and pressure to implement its laws addressing sexual violence. When Tracy Robinson, the rapporteur for women’s rights of the Inter-American Commission on Human Rights (IACHR), visited the country earlier this year, she addressed the problem head on: “Impunity for violence against women is a chronic problem in this country and the rest of the Americas,” she said. Only 24 percent of sexual violence cases reported to police reach the courts, and only 3.6 percent of assailants are punished for their crimes, a 2011 report found.

A need for specially tailored care

To Nicaragua’s credit, its Ministry of Health has established an internationally recognized National Maternity Homes Network, a system of community-operated centers providing temporary shelter for pregnant women from poor, rural communities located far away from health services. Ipas Central America began working with the Jinotega Maternity Home and others to train staff and community leaders on how to identify victims of violence and report the crimes to local authorities.

“Social tolerance of violence and the fear felt by victims make it difficult for women to report physical and sexual abuse,” Espinoza says. “If staff at maternity homes don’t ask pregnant girls and adolescents specific questions about the violence they have experienced and work to help them understand that their rights have been violated and how they can report the incidents, most victims avoid reporting their attackers due to fear and lack of information about how to navigate the legal system.”

So far more than 260 health advocates, midwives, representatives of local governments and personnel at maternity homes have participated in Ipas training workshops on the different types of violence against women, the consequences of this violence—especially for girls and young women—and the legal process for pursuing justice. In addition to the Jinotega Maternity Home, homes in the municipalities of Wiwilí, Bocay, and Ayapal are now beginning to screen women at the shelters for experiences with sexual violence and report these incidents.

“The project’s next phase will involve creating a strategy for differentiated care in maternity homes for girls and young women who have pregnancies resulting from rape,” Espinoza says. “Currently they receive care and counseling just like all other pregnant women, but these youth have special needs.”

Ipas also has collaborated with the Strategic Group for the Decriminalization of Therapeutic Abortion (Grupo Estratégico por la Despenalización del Aborto Terapéutico) on various activities in Jinotega to raise awareness of the terrible consequences of Nicaragua’s total ban on abortion. Under the ban, all women—including very young women and sexual violence victims—are forced to continue their pregnancies regardless of psychological or health risks. Pregnant adolescents under age 16 are four times more likely to die from pregnancy-related causes than older women.

Community involvement changes attitudes

With limited time and resources, maternity home workers can’t provide for all the needs of young women who have suffered violence. For that reason, Ipas has helped create 10 community advocacy networks in rural communities with high violence rates. The networks involve community leaders, local government officials, health-care workers, maternity home staff and others in a collaborative effort to identify and support sexual violence victims. Members of the networks accompany and support victims when they report incidents and during court proceedings.

“The project has opened the doors to addressing violence in rural areas, and has helped community leaders to recognize violence as a public health problem,” Espinoza says. And as the testimony of advocacy network participants reveals, the project is also changing attitudes about gender equality:

“Now I feel self-worth; we are at the same level as men, and not beneath them. It has helped me change from within, knowing that he must respect me; now I say what I think and what I feel, and I am not afraid; now I can contradict my husband.”

    ~ Member of the Ayapal community advocacy network

“The work I have been carrying out in the project has changed both my personal and professional life. I am more sensitive … I’m always seeing whether the appropriate procedure was performed in the services provided to the victims. Now I follow up with physicians to see what they did, how they treated her, where they referred her.”

    ~ Health worker from San Rafael del Norte

“This project has produced changes in my life, and now I feel stronger, starting with my home, my life with my husband.”

    ~ Member of the Ayapal community advocacy network