Celebrating Mothers…By Helping Them Survive

I gave birth to both of my daughters at home with an attending OB/GYN, a pediatrician, a nurse, my husband Paul as support, Kathleen as a doula, various other members of our community in the room, and in the case of my older daughter, also with the pet monkey Bella watching from outside the window. (“You told me it was just going to be two people,” the doctor chided me afterward, “You never mentioned the monkey!”)

At the time, in the early 2000s, it was common for Nicaraguan women to give birth at home. But unlike my neighbors, I had the privilege and resources to pay for prenatal care and to hire a doctor to attend the births. For most women, regular checkups were difficult to access, and impossible for women in rural areas who were far from health centers. Women were afraid to go to the hospital, and often opted to give birth at home with only a lay midwife and no emergency services if things went wrong. From 1990 to 2006, Nicaragua suffered under neoliberal governments which stripped the people of their basic rights – health care and education had essentially been privatized – and pregnant women in particular were affected.

Our younger daughter Orla was born in 2006, just a few months after Nicaragua had once again elected a Sandinista-led government, a government which has been re-elected in three subsequent elections. President Daniel Ortega declared health care and education free again immediately upon entering office over the 18 years of her life, we have seen how this government has set about restoring Nicaraguan’s rights with particular emphasis on women’s rights.

This week, Nicaragua celebrates its biggest holiday. Bigger than Christmas, or Easter, or even the Feast of the Immaculate Conception, it is a day when Nicaraguans celebrate the holiest of holies: their moms.

Mother’s Day in Nicaragua is on May 30 th and it is a mandatory paid holiday. All around the country right now, people are celebrating their moms with gifts, food, cake, and pinatas. At the Nueva Vida Clinic we are preparing chop suey for 100 people and the men on staff are organizing a program replete with dance numbers. But in Nicaragua, honoring mothers is not just lip service paid one day a year. Over the past 18 years, the Nicaraguan government has honored mothers every day in tangible ways, such as taking care of women during pregnancy, birth, and beyond.

Worldwide, pregnancy and childbirth can be dangerous, but 80% of maternal deaths are entirely preventable. Nicaragua has proven this: despite being one of the poorest countries in the Western Hemisphere, since 2007 it has managed to reduce maternal mortality by 79.8%, reduce neonatal mortality by 62.5% and reduce infant mortality rates by 58.6%.

Through the country’s universal free healthcare system, all prenatal, childbirth and post-natal care in Nicaragua is offered countrywide free of charge – c-sections, premature births, neonatal ICU stays and, incredibly, even fetal surgeries are all free. Nicaragua is the only Central American country offering this type of surgery free in the public health system.

Home births like mine and so many of my neighbors are now nearly unheard-of – 97% of all births are in hospitals. In rural communities where we work, lay midwives who once attended home births have now been incorporated into the healthcare system to provide prenatal care and in-hospital birth support.

In Nicaragua, 75 hospitals have been built new or remodeled since 2007 to make giving birth in a hospital a possibility even for rural families. Respect for Nicaragua’s diverse cultures has been incorporated into new hospital birthing facilities so that Indigenous women can safely give birth squatting or standing up, the way that women in their communities have traditionally given birth.

For those who still live far from hospitals, a network of 201 maternal wait homes around the country provide space for more than 72,000 women per year to stay near a hospital for the last two weeks of their pregnancy. Food, housing and vocational training is provided free of charge, women rest and are checked by medical staff regularly, and when they go in to labor they give birth safely in the hospital nearby.

Post-partum, Nicaraguan women and their babies receive free quality healthcare and working women are guaranteed full pay maternity benefits. Last month, the maternity leave law was increased from 84 days to 91 days of mandatory paid leave. Free daycare programs around the country provide care, meals and preschool for babies and children up to six years of age so their moms can work.

In fact, Nicaraguans today have much better access to perinatal care than my home state of Idaho. In March of 2023, the hospital where I was born – Bonner County General Hospital – stopped attending births. With this closure, the nearest hospital with perinatal care is now at least an hour away. But many families in rural North Idaho are low-income, lacking health insurance, and with limited access to reliable transport. For these families, the journey to the hospital might be as long as three hours in good weather and longer in a north Idaho winter…there are women and babies who are dying.

Unfortunately, while Idaho’s case is extreme, it is not alone: according to a Centers for Disease Control and Prevention report, maternal mortality rates in 2021 increased by 40 percent over the previous year across the U.S., and outcomes are uneven, with Black women disproportionately dying during pregnancy.

How is it that a Third World country like Nicaragua has better maternity care than one of the richest countries in the world?

The answer is that the Nicaraguan government has the political will to provide that care. Over the past 18 years, eradicating maternal and infant mortality has been a top priority that is carefully followed up on at all levels.

Recently I was at the local public hospital where I live in Ciudad Sandino, just outside Managua. The director was ordering exams for a 19-year-old woman who was pregnant and very close to her due date. She had just returned from the United States, where she had been working but couldn’t afford to see a doctor. She’d had no bloodwork, no ultrasounds, no prenatal care at all. She had returned to Nicaragua where she could give birth safely for free without incurring debt, but she was returning as a high-risk pregnancy due to lack of care. The hospital director personally ensured that she was transferred to the maternity hospital in Managua for specialized care.

For Nicaragua’s healthcare system, a pregnant woman or her baby dying is an unacceptable outcome, and healthcare workers at all levels take every possible measure to prevent that.

The result of this is that no pregnant women have died in Ciudad Sandino over the past three years – nationwide, only 21 pregnant women died last year. Simply put, Nicaragua is taking every step possible to ensure that pregnant women survive to celebrate Mother’s Day.

— Becca

Becca recently participated in a webinar, "Nicaraguan Programs of Maternal & Child Health: A Cross-National Comparison," with Magda Lanuza, and Jameela Alexander.    You can watch the webinar recording here:  https://youtu.be/WQBVlvhTIm0?si=qAkVgInwQ3or6axt

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