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My Trip to Nicaragua
“It is much more important to have a friend than a dollar.” That
excellent soundbite came from the Nicaraguan Country Representative
of UNFPA, Tomas Jiménez, during a discussion of 34 Million
Friends. Tomas heads the cooperation program in Nicaragua, and
like every UNFPA representative I have met, he is intelligent,
dedicated, and effective in communicating UNFPA’s commitment
to working in partnership with governments to promote a human rights
based approach to reproductive health. Tomas acknowledges that
the dollars are important, too: without dollars, there are no programs.
UNFPA invited me to visit some programs in Nicaragua so I could
report back to you how UNFPA focuses its efforts and invests its
(your) money. In two days my brain and heart were assaulted with
information and images that will never leave me.
First, some background. Nicaragua is a beautiful but strained
country with beautiful but strained people. The last century brought
Nicaragua years of political instability, civil war, a horrendous
earthquake, and hurricane Mitch. Nicaragua has one of the highest
population growth rates in Latin America, one of the highest fertility
rates, one of the highest teenage pregnancy rates and one of the
highest maternal mortality rates. There is also a high rate of
unmet demand for modern contraception methods, and as a result
sterilization is a default method. There is a lot of work to be
done. With all that said, Nicaraguans are anything but beaten.
They are energetically and creatively determined to control the
forces they can control and be prepared for those they cannot.
Second, some of the programs. (In selecting these, I am leaving
out equally important and effective ones.) I’ll start in
a place that may surprise some of you—our visit to the Sergeant’s
School of the National Army. The commander of the school, a Lieutenant
Colonel, knew exactly what he wanted: healthy soldiers. So part
of the training curriculum for the sergeants is a very frank, very
comprehensive course in reproductive health and reproductive rights.
As the Colonel said, men who are embarrassed to talk about issues
of sex and reproductive health openly, will, if they become sick,
try to hide their illness and illness will spread.
The Colonel sees
his responsibility for education in concentric circles, starting
with his circle of soldiers, spreading to a
circle of their families, and finally to the communities around
them. The school trains about 2,000 men each year. The colonel’s
program seems to be working: sexually transmitted disease has
been limited to four cases in each of the past two years.
Another group we visited was working at the policy level—three
women elected to Parliament, all members of the Sandinista political
party. Women fought alongside men in the civil war, and that changed
their position in society. One of the most respected individuals
in the country is Violeta Chamorro, who in 1990 won the presidency
in the first democratically held election in six decades. The three
women who met with us held the equivalent positions of committee
chairs in the house or senate. They discussed their initiatives
for empowerment of women, equal opportunity, reduction of family
violence, and reproductive health. They are sponsoring legislation
on family law and equal rights. They are impressive and tough!
I have saved the worst and best for last. We traveled inland to
Matagalpa, a coffee growing center once reasonably prosperous but
now impoverished due to the collapsed coffee market. Some growers
are not even bothering to harvest their beans. The result is no
work. Children are suffering from malnutrition.
In Matagalpa we visited the Casa Materna, which provides free
care for near-term pregnant women who are at risk because they
are too young or too old, already have had many pregnancies (the
record is 24), or because they live in such isolated areas that
if they need help in labor they would be unable to get it because
of lack of transportation. After delivery, the Casa takes care
of them for at least eight days or until they are strong enough
to return to their homes. They are also given family planning information
and contraceptives if they want them.
The Casa is equipped for 20 women, but because they never turn
away anyone at risk, capacity is sometimes extended to 40, and
the women share the available beds. The women pay nothing. Their
level of poverty is so profound that even the most modest charge
would make it impossible for them to come to the Casa.
The highly-respected senora who runs the Casa shared her story
with me. After marrying, she lived in isolation on a coffee plantation.
She delivered eight babies alone, cutting the umbilical cords herself.
Her husband was never present for a birth and no one else lived
close by. She went to her mother and told her that she was afraid
of being so isolated, but her mother responded that her place was
with her husband. So she returned to the plantation and had more
babies. She says, “I am not like that now!” and I believe
her!
We also spoke to Elsa, a 23 year-old who was having her third
child at the Casa. She had managed to get to the fourth grade and
wanted to continue, but her family was too poor, so she had to
leave school to work. Her husband raised subsistence food for them
now that he no longer had work in the coffee fincas. She wanted
to work, but knew there was none available. Her dream was to see
her children educated.
UNFPA has been able to partner with a great variety of efforts
in Nicaragua to improve the quality of lives and in particular
women’s lives. Words are inadequate to describe the spirit
of the Nicaraguan people and the challenges they face. I wish everyone
could have this face-top-face experience. The world would work
better.
-- Lois Abraham
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