Nicaragua's decision to ban all types of abortion, including those ruled necessary to save the life of the mother, is drawing criticism from human rights and women's groups for causing unnecessary deaths and denying unrelated health services to women. The law, promoted by the Catholic Church and passed by the national assembly in October 2006, has the support of the left-wing government. It makes the country one of only four in the world where abortion is illegal in all cases.
According to Nicaragua's health ministry, there have been 82 maternal deaths since the law came into effect in November 2006. Enforcement is strong and a great deal of publicity has been given to the sentence - up to six years' imprisonment - that doctors can receive for performing abortions.
Of course, those who can afford private (and secret) procedures can easily obtain them, as is the case throughout Latin America. This means that the law mainly affects the poorest. "Women with money suffer the same circumstances. The difference is that they can pay a doctor, and, like they say, money talks. But poor women need the services of the state, and that's where the doors are closed," said Martha Flores, a social worker from the barrios of the capital, Managua.
It is little surprise, then, that more than 80 per cent of the reported maternal deaths have occurred in poor rural areas. One doctor who admitted to performing abortions, and who spoke only on condition of anonymity, said: "The price has risen, so what happened? It's turned into a business, that's all that happened when they passed the law. On the other hand, the poor class, we are killing the women. Simple."
The US-based NGO, Human Rights Watch, argues that the effect of the law goes beyond the issue of abortion. HRW researcher, Angela Heimburger, claims that some doctors in Nicaragua are now afraid to provide even legal health services to pregnant women for fear of being prosecuted. "We've talked to a lot of doctors who have witnessed cases of unnecessary deaths, especially involving miscarriage, because women were not treated immediately."
The government does not keep official statistics on the effects of the law, so the actual number of deaths directly resulting from its introduction is hard to ascertain.
Women's rights groups are currently suing the government over the legislation, saying it violates a fundamental right to life. If the case is turned down in Nicaragua's Supreme Court, it could move to the International Court of Justice in The Hague. But neither court is as influential in Nicaragua as the Catholic Church.
Roughly 85 per cent of Nicaraguans are Catholic, and, as a result, the religious values of the people are important to the government. Even President Daniel Ortega, a man with an unimpeachable leftist background, supports the abortion law.
A close friend of Venezuelan president Hugo Chávez, Ortega spent years in prison under the dictator Somoza, whom he eventually overthrew in 1979 with his Sandinista guerrilla revolution.
Ortega and his government spent the 1980s under attack from the US-sponsored Contra forces and eventually lost power. A Marxist atheist for most of his life, he returned to the Church and changed his mind on the abortion issue shortly before being re-elected in 2006.
According to official Catholic doctrine, abortion is always the intentional taking of a life and is therefore never permitted. The duty of any doctor is to save the mother and the baby, no matter how unlikely the survival of both may be; the life of the mother is considered no more valuable than that of the unborn child.
Father Henry Moreno, a leader in the pro-life movement in Managua, believes "the protocol of the ministry of health is to save both lives . . . if during the process one dies, there is no crime, no sin, no excommunication". But, "if you intentionally interrupt the process that's when it's a sin and that should never be condoned".
There are a few dissenting voices within the Church, with some, such as the theologian Christopher Kaczor, arguing that in certain cases the foetus could be considered an unintentional material aggressor whose life may be taken, unintentionally, in an attempt to save the mother.
HRW's report, Over Their Dead Bodies, argues that the problem is not so much one of the legal application of a strict interpretation of Church doctrine, but the climate of fear created among doctors.
The challenge is to find room for compromise without directly stepping on the toes of the Church. Even with the Sandinistas back in power, a Nicaraguan government cannot afford to lose the support of the Catholic Church and those who follow its teachings.