McNaughton Heathe Luz, Mitchell Ellen M H, Blandon Marta Maria
Ipas Central America, Managua, Nicaragua.
Reprod Health Matters. 2004 Nov;12(24 Suppl):18-26. doi: 10.1016/s0968-8080(04)24005-8.
Nicaragua's Penal Code permits "therapeutic abortion" without defining the circumstances that warrant it. In the absence of a legally clear definition, therapeutic abortion is variously considered legal only to save the woman's life or also to protect the health of the woman, and in cases of fetal malformation and rape. This paper presents a study of the theory and practice of therapeutic abortion in Nicaragua within this ambiguous legal framework. Through case studies, a review of records and a confidential enquiry into maternal deaths, it shows how ambiguity in the law leads to inconsistent access to legal abortions. Providers based decisions on whether to do an abortion on women's contraceptive behaviour, length of pregnancy, compliance with medical advice, assessment of women's credibility and other criteria tangential to protecting women's health. The Nicaraguan Society of Obstetrics and Gynecology aimed to clarify the law by developing a consensus among its members on the definition and indications for therapeutic abortion. If the law designates doctors as the gatekeepers to legal abortion, safeguards are needed to ensure that their decisions are based on those indications, and are consistent and objective. In all cases, women should be the ultimate arbiters of decisions about their reproductive lives, to guarantee their human right to life and health.
尼加拉瓜《刑法典》允许“治疗性堕胎”，却未明确规定准予施行治疗性堕胎的情形。由于缺乏明确的法律定义，治疗性堕胎在不同情况下被认为只有在挽救妇女生命时才合法，或者在保护妇女健康、胎儿畸形及强奸案件中也合法。本文呈现了在这一模糊的法律框架下对尼加拉瓜治疗性堕胎的理论与实践的一项研究。通过案例研究、记录审查以及对孕产妇死亡情况的秘密调查，研究表明法律上的模糊性如何导致合法堕胎的获取情况不一致。医疗服务提供者依据妇女的避孕行为、怀孕时长、是否遵循医嘱、对妇女可信度的评估以及其他与保护妇女健康无关的标准来决定是否为妇女实施堕胎。尼加拉瓜妇产科学会旨在通过其成员就治疗性堕胎的定义和指征达成共识来澄清法律。如果法律将医生指定为合法堕胎的把关人，那么就需要保障措施以确保他们的决定基于那些指征，并且是一致和客观的。在所有情况下，妇女都应该是其生育生活相关决定的最终仲裁者，以保障她们的生命权和健康权。
