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For the Nicaraguan rich, a problematic pregnancy need not be a death sentence. You can fly to Miami or bribe a discreet private clinic in Managua. But in this wretchedly poor country most young women do not have money. Their choice is to go through with a pregnancy that may kill them, or attempt a DIY termination that may kill them.

As a result of the blanket ban enacted last November at least 82 women have died, according to advocacy groups. "This new law intentionally denies women access to health services essential to saving their lives, and is thus inconsistent with Nicaragua's obligations under international human rights law," says Human Rights Watch.
Nicaragua is famous for its misfortunes: the Somoza dictatorship, the civil war, the impoverishment, the natural disasters. Pro-choice groups say article 143 of the new penal code should be added to that list since it bucks the international trend towards greater abortion access and drags women back to the dark ages.

The anti-abortion camp, in contrast, is euphoric. The new law, it says, is a beacon in the fight to protect the unborn. It is time to celebrate. "Now it is all penalised. And Catholics agree that is should be this way," says Roberto González, 50, a Franciscan priest in Managua. "The population sees the church as behind the law - behind the pressure that succeeded in getting the government to change the law."

Abortion has long been illegal in Nicaragua but there had been exceptions for "therapeutic" reasons if three doctors agreed there was a risk to the woman's life. Those exceptions were no longer necessary, said the Nicaraguan Pro-Life Association, because medical advances obviated the need to terminate pregnancies. "The conditions that justified therapeutic abortion now have medical solutions," says a spokesman. Pope Benedict XVI welcomed the ban but added that women should not suffer or die as a result. "In this regard, it is essential to increase the assistance of the state and of society itself to women who have serious problems during pregnancy."

In an attempt to clarify matters, the health ministry issued protocols last December that said doctors should respond to most obstetric emergencies, including ectopic pregnancies and post-abortion care. To terminate an ectopic pregnancy is legal, it turns out, because since the foetus is not in the womb the procedure would not be an abortion. But such is the climate of fear and confusion that the protocols are widely ignored and misunderstood.

Women who become pregnant after being raped, or whose lives are endangered by their pregnancy, are banned from having abortions in just three countries around the world: Nicaragua, Chile and El Salvador. These countries refuse to take into account a woman's age or her ability to care for a child and will prosecute any woman who has an abortion.

In 2006, a UN committee report stated that one of the main causes of maternal mortality in Chile was women turning to illegal abortions and asked the government to stop imprisoning women who sought them.