Family planning in Nicaragua: contraception is available, but there is a deficit in knowledge

How many children do we want to have? How will we provide food for our family? It was normal for Esmeralda Álvarez Bermúdez that she had little say in her family and in Nicaraguan society. Since becoming involved in a women’s organisation supported by SWISSAID, her silence is a thing of the past.

“My entire life has changed.” Esmeralda Álvarez Bermúdez doesn’t even know where she should begin to tell her story. This activist in a women’s group as well as baker, farmer, mother of three and wife is amazed at how much she has benefitted from her commitment to La Dariana, the women’s cooperative supported by SWISSAID.

Taking joint decisions

“I’m no longer the same person. I’ve learned to voice my opinion, to discuss with my husband and to contribute arguments. I’ve managed to improve our nutritional situation, my self-esteem and also my health.” Incidentally, her relationship with her husband has also improved. “We now make joint decisions about our life, for example, about the size of our family. We have to consider the future and how many children we can provide an education, food and medical care for.”

For the 43-year-old, family planning (see box below) is now a closed subject. As the mother of two adult daughters, however, the topic is still current, “I always say to my daughters that they should get to know a man very well before they rely on him. I talk to them about their rights as women. They should plan their pregnancies and not leave them to chance.”

Parents are influential in childhood, and later the husband

In Nicaragua, women’s rights are a challenge. In fact, the country has a strong women’s movement, according to SWISSAID office manager Lucía Aguirre. “But you don’t notice much of that in rural areas. During their childhood girls must obey their parents, and when they are grown up they have to play a subordinate role to the husband.” They could play an active role in the church or on parents’ committees at best. “Unless there is a women’s organisation in the local community. Then, usually plenty of things change.”

La Dariana women’s organisation

This was exactly the case for Esmeralda Álvarez Bermúdez. 180 families live in her village of Dulce Nombre in the undulating hinterland of Matagalpa. This is where, in the heart of Nicaragua’s coffee-growing area, a few years ago the women founded the women’s cooperative La Dariana with the assistance of SWISSAID. At the outset the focus was on agriculture. “It’s important for the women to have agricultural training”, explains Lucía Aguirre. If they manage to make their fields productive, they can sell their surplus harvest at market, thus boosting the tight family income – and then, their self-esteem not only increases, but also their acceptance in society.

A spectrum of women’s issues

The early successes of working together means that trust in the organisation is growing as well as their joint strength. The focus was rapidly no longer only on combating pests, seeds and marketing, but also on women’s rights, domestic violence and sexuality. The women attend workshops and discuss family planning and different contraceptives, pregnancy and the menopause as well as sexually transmitted diseases.

Family planning also concerns the men

By now most of the women were using one method of contraception or another. Esmeralda Álvarez Bermúdez and her husband, for example, use condoms. But there are still women who lack the confidence to insist on using the condom, “Most men here don’t like condoms. They claim the condom is against God’s will and call it the ‘sack’ or ‘hood’ and laugh about it”, says the farmer. Convincing the men that they have to accept responsibility for family planning, their own health and their partner’s health, remains a challenge.

A lack of education and self-confidence

Obtaining contraceptives in Dulce Nombre, however, does not pose a problem. The men and women can purchase condoms or the pill in a small pharmacy. The three-monthly contraceptive injection is also popular as well as the IUD and other contraceptive methods associated with minor surgical procedures. If the state’s mobile clinic stops on the village square, La Dariana encourages the women – and increasingly also the men – to attend for free check-ups. If it is necessary to go for an examination in the provincial capital Darío, the organisation offers support and subsidises travel expenses. Esmeralda has personally experienced how worthwhile this can be, “My smear test was positive. Fortunately, our cooperative has an emergency fund for such cases and I was able to rely on this to pay for treatment and the check-ups afterwards. I have now made a full recovery.”

Project code: NC 02/12/16

Project duration: Until 2015

Project costs: 52,773 Swiss francs

Number of beneficiaries: 130 families

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Contraception and family planning in Nicaragua: Education is essential

Medical healthcare was markedly improved for the population under the ruling Sandinista government. For example, in the area of women’s health there was an increase in preventive examinations for pregnant women, medically assisted births as well as post-natal check-ups. Family planning consultations are also attended more frequently today. Yet preventive campaigns and free healthcare are in contrast with a restrictive ban on abortion and increasing shortages of material resources and staff. This especially applies for the peripheral regions where SWISSAID is active.

In comparison with other states in Central America – and Latin America in general – Nicaragua has the highest teenage pregnancy rate. Young women aged between 15 and 19 account for approximately a quarter of all births in the country, and in rural areas the rate is as high as a third. According to the Nicaraguan Society of Obstetricians and Gynaecology, the risk of complications during birth is higher for women below the age of 20 than for women aged between 20 and 35. This is another reason why the country struggles with a high maternal mortality rate that is around 100 deaths per 100,000 healthy births.

Nicaraguans are traditionally heavily influenced by their peers and frequently know too little and have a low decision-making ability in regard to family planning and using contraception. In a new study conducted in a clinic in Managua, one third of expectant mothers responded that their pregnancy was unwanted. 30 per cent of them fell pregnant, despite their preference not to have another child and despite using contraception.

The statistics show how important it is to know how to use contraception correctly. Once a woman falls pregnant, the law is tough: since 2006, there has been a total ban on abortion in Nicaragua. Abortions are also subject to prosecution, if the mother’s life or health is at risk or the pregnancy is a result of a rape case. If women or healthcare personnel contravene the law, they can face several years in prison.