NicaNotes: Making it to the Manger: Why are Women in Nicaragua More Likely to Survive Childbirth Than Women in the U.S.?

By Becca Renk

Becca Renk is originally from the U.S. but has lived and worked in Nicaragua since 2001 with the Jubilee House Community and its project the Center for Development in Central America.

In Nicaragua, all prenatal, childbirth and post-natal care are offered countrywide free of charge including premature births, c-sections, neonatal ICU stays and even fetal surgeries. (Photo: Jennifer Aist)

It wasn’t quite a manger, but after I was born, my parents wrapped me in swaddling clothes and laid me in a dresser drawer lined with a blanket. They had a crib prepared for me at home, but home was a log cabin in the woods more than an hour away on a bumpy road. So, when my mom and I were released from the hospital, they brought me to an upstairs room they had rented from the widow Mrs. Long in Sandpoint, Idaho. They had gone into town to wait there until it was time to go to the hospital, and we would also spend the next couple of days there until my mom and I were well enough to make the journey.

In 1977 with CB radios as their only form of communication in the mountains, it was dangerous for my mom to make the trip to the hospital while in labor, and even more dangerous to give birth out in the wilds of North Idaho.

Today, it remains true that pregnancy and childbirth can be dangerous – but 80 percent of maternal deaths are entirely preventable.  Nicaragua, where I now live, has proven this over the past 15 years: despite being one of the poorest countries in the Western Hemisphere, it has managed to reduce maternal mortality by 70 percent and infant mortality rates by 56 percent.

Through the country’s universal free healthcare system, all prenatal, childbirth and post-natal care in Nicaragua is offered countrywide free of charge – premature births, c-sections, neonatal ICU stays and, incredibly, even fetal surgeries are all free. Home births, previously common especially in rural areas, are now nearly unheard-of – 97% of all births are in hospitals. Lay midwives who once attended home births have now been incorporated into the healthcare system to provide prenatal and in-hospital birth support.

In Nicaragua, 25 hospitals have been built new and 46 remodeled since 2007 to make giving birth in 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 parents who still live far from hospitals, a network of 181 maternity waiting homes around the country provide space for nearly 70,000 women per year to stay near a hospital for the last two weeks of their pregnancy. Food, housing and vocational training are provided free of charge; women rest and are checked by medical staff regularly and, when they go into labor, they give birth safely in the hospital next door.

More than four decades after my mother went to stay in town with Mrs. Long in her self-made maternity waiting home, the situation for women in rural Idaho hasn’t improved…in fact, it has gotten worse.

There has been only one maternity-related death in Ciudad Sandino over the past three years. (Photo: Becca Renk)

There has been only one maternity-related death in Ciudad Sandino over the past three years. (Photo: Becca Renk)

Today, Nicaraguans are less likely to die during pregnancy than Idahoans, although both places have significant rural populations: Nicaragua had 31.4 deaths compared to Idaho’s maternal mortality rate of 40.1 deaths per 100,000 births in 2021, up from 13.6 in 2019. What is behind this sudden leap in maternal mortality?

In March of this year, the hospital where I was born – Bonner General Hospital – announced it would stop attending births. The hospital said that it simply can’t find doctors willing to staff an obstetrics unit in Idaho – doctors are worried that providing routine care for a miscarriage or ectopic pregnancy could violate Idaho’s strict abortion laws, causing them to lose their license or even go to prison.

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. To put it simply, there are women and babies who will die.

Unfortunately, while Idaho’s case is extreme, it is not alone: according to a Centers for Disease Control and Prevention report, maternal mortality rates increased by 40% in 2021 across the U.S.

How is it that a third world country like Nicaragua has better maternity care than the richest country in the world? The answer is that the Nicaraguan government has the political will to provide that care. Over the past 15 years eradicating maternal and infant mortality has been a top priority that is carefully followed up on at all levels.

Recently the director of the local hospital where I live in Ciudad Sandino, Nicaragua told me a story about a young pregnant woman with preeclampsia from our city of 200,000 people. This woman went to the local free health clinic with a headache and when the staff took her blood pressure it was very high. Over the next few hours, several dozen healthcare workers from local lay workers right up to the Minister of Health herself followed up to save the life of this young mother and her baby, with the hospital director personally going to the patient’s home to transport her to the maternity hospital in Managua for specialized care.

For Nicaragua’s healthcare system, a pregnant woman or her baby dying was an unacceptable outcome, and healthcare workers took every possible measure to prevent that.  The result of this is that there has been only one pregnancy-related death in Ciudad Sandino over the past three years – nationwide, only 37 women died last year in a country of just over 7 million people. Each death was investigated and the details are available to the public.

Meanwhile, this past July, Idaho with its 1.9 million people became the only state in the nation with no legal requirement or specialized committee to review maternal deaths related to pregnancy.

As winter falls on Idaho with its icy roads, heavy snowfalls and treacherously long journeys to the hospital, I pray that there is a legion of Mrs. Longs who can rent rooms near the hospital to expecting families. Or better yet, that Idahoans begin to follow Nicaragua’s example of maternity waiting homes. Because if nothing changes, too many mothers in Idaho won’t live to lay their new babies in a manger.


By Nan McCurdy

Nationwide Campaign to Vaccinate 400,000
On Nov. 27 the Ministry of Health started the second national vaccination campaign, with the goal of applying 425,831 doses by December 22. Children and adults will be protected against severe forms of tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis b, viral meningitis, bacterial meningitis, human papilloma virus, viral pneumonia, bacterial pneumonia, measles, rotavirus diarrhea, rubella, influenza and Covid-19. The campaign also includes the vaccination of 100,000 dogs against rabies. See photos:   (La Primerisima, 26 November, 2023)

Rehabilitation Pool at Aldo Chavarría Hospital
On November 23, the hydrotherapy pool of the Aldo Chavarría National Referral Hospital, Managua, was inaugurated. The pool will enable more than 6,000 sessions every year for patients with cerebral palsy, muscle stiffness, lower back pain, diseases of the nervous system, those who have suffered brain trauma, or stroke, who are treated at this health unit. (La Primerisima, 22 November 2023)

Zero Usury Helped Half a Million Women since 2007
The Zero Usury Program has helped 544,000 women since 2007, with 1.69 million loans. Leonor Corea, director of the program, said that the government continues to support women with small and medium-sized businesses through financing that has maintained its annual interest rate of 5% on the balance. Corea explained, “This year we have served 136,000 women with 141,800 loans. The amount loaned has increased substantially to a maximum of US$1,400. Initial credits are for US$280 and, as they advance, as their business evolves, they can opt for a loan for a higher amount.” She said that the participants in Zero Usury receive training from different state institutions to expand their technical capacity and better develop their enterprises. (La Primerisima, 21 November 2023)

Thousands of Children Improve Nutritional Status
The Ministry of Health reported that 122,398 children with acute malnutrition are being monitored to improve their nutritional status. Currently, the National Plan for Follow-up on the Nutritional Status of Children between birth and six years of age is moving forward and, so far, 1,349,340 care sessions have been provided. The report states that 801,764 house-to-house and school visits were made to children under 6 years of age, who were dewormed and received Vitamin A, Zinc and micronutrients; 176,126 pregnant women received counseling on the benefits of exclusive breastfeeding up to six months of age and continued breastfeeding up to 2 years of age. Similarly, 111,989 members of the Community Network have been trained and certified to identify children with nutritional problems and to promote healthy lifestyles. See photos:
(La Primerisima, 27 November 2023)

Millions Bring Electricity to Every Corner 
Investments in the electricity sector to expand the grid to provide coverage nationwide exceed US$50 million to date while the total invested in the energy sector exceeds US$4 billion, stated the president of the Electricity Transmission Company (ENATREL), Salvador Mansell. The national coverage is currently 99.36%, which improves the quality of life of thousands of Nicaraguan families who dreamed of having electricity in their homes. Mansell announced that, in the South Caribbean region, US$100 million has been allocated to modernize the La Gateada substation. He added that there is a 10-year maintenance plan to rehabilitate the energy networks, reduce losses and continue installing energy service in more remote communities. (La Primerisima, 26 November 2023)

Nicaragua World Leader in Renewable Energy
On November 27 the specialized portal on growth data for the region, Latinometrics, highlighted the progress made by Nicaragua in electric energy. “Surpassing Norway and Sweden, Nicaragua shines in renewable energies. They will literally lead most of the world in clean energy,” reports the Latinometrics portal. “What we have yet to talk about, because we only learned about it when we looked at the numbers from a different perspective, is the commendable growth Nicaragua had from 2000 to 2020 in its share of electricity coming from clean sources. In a span of two decades, Nicaragua more than tripled the previous figure, from 21% to 70%.” Nicaragua “now ranks higher than countries like Norway and Sweden and has joined the list of Latin American countries with more than half of their electricity coming from renewables. “According to the World Bank, Nicaragua is a renewable energy paradise due to its rich geothermal resources, abundant wind and sun, and diverse water sources.”  (La Primerisima, 27 November 2023)

New Biogas Plant Inaugurated
The Nicaragua Water and Sewage Company and the National Electricity Transmission Company inaugurated the biogas electricity generating plant, located at Lake Xolotlán Wastewater Treatment Plant in Managua. The new US$2.44 million-dollar plant financed by the General Budget with support from the German Development Bank (KFW), has a capacity to contribute 1 MW of electricity to the national grid. (Nicaragua News, 27 November 2023)

Nicaragua Qualifies for the U23 Baseball World Cup in China
Nicaragua’s U23 baseball team won by knockout (15-5) against the Dominican Republic, getting its pass to the Baseball World Cup to be held in China in 2024.

Nicaragua also beat Argentina 13-0 and Puerto Rico 2-0. Nicaragua is currently hosting the 12-team Americas Qualifying Tournament for the Under-23 Baseball World Cup. The games have been held in the brand-new Roberto Clemente Stadium in Masaya as well as the six-year-old Soberanía Stadium in Managua. The tournament ends on Nov. 30. (Canal 13, 28 November 2023)

Formidable Economic Achievements Recognized by IMF
The IMF mission, led by Alina Carare, visited Managua from November 6-17 to conduct the 2023 Article IV Consultation, concluding with an excellent assessment of Nicaragua’s economic performance. Mission members met with Finance Minister Iván Acosta, Central Bank President Ovidio Reyes, other senior officials, representatives of the free trade zone, banks and others. The report stated, “The economic outlook is favorable and risks are balanced. Real GDP growth could be higher than expected due to a more sustained recovery in domestic demand, including investment and stronger-than-expected remittance inflows.” However, “a deterioration in the terms of trade or a sharper global slowdown could lead to lower export and remittance growth. Economic performance and social outcomes are vulnerable to natural disasters, given Nicaragua’s high exposure … to the effects of climate change. On the political front, there is a risk that international sanctions could deepen, negatively affecting the economic outlook.”  The Fund’s report argues that “Nicaragua’s economy has remained resilient to multiple shocks thanks to sound economic policies, sizable buffers, and multilateral support. After a very strong rebound in 2021, economic growth has been stable thanks to private consumption and export performance since 2022. Real GDP is expected to grow by 4% in 2023, inflation is expected to decelerate, and the government’s fiscal position shows a small surplus and ample deposits.”  (La Primerisima, 22 November 2023)

Assembly Amends Constitution and Judiciary Law
On November 23, the National Assembly approved amendments to Nicaragua’s Constitution and the Judicial Power Law, which, among other aspects, eliminated the fixed percentage of 4% of the national budget for the Supreme Court (CSJ). According to the reform initiative, the budget prepared by the CSJ will be a proposal to be reviewed and approved by the Treasury. This institution and the Comptroller’s Office will be empowered to supervise its execution and the accountability of the authorities of this branch of government. For more information:  (La Primerisima, 23 November 2023)

Nicaragua Reaffirms Rejection of Neocolonialism
On November 21, the Government of Nicaragua reaffirmed its strong solidarity with the Palestinian people which it said face the neocolonial forces of Israel. It also demanded an immediate ceasefire, an end to war crimes, the construction of peace and the peaceful coexistence of the Palestinian and Israeli states. During the third meeting of the organizing committee of the Forum of Campaigners Against Modern Practices of Neocolonialism, commitment to the elimination and eradication of the colonial occupation still experienced by many peoples in Asia, Africa and the Caribbean was also confirmed. The Forum is an informal association of political parties and social forces. During the virtual meeting chaired by Dmitry Medvedev, former Russian President and current Deputy Chairman of the Security Council of the Russian Federation, the Nicaraguan government expressed its “solidarity with the Russian Federation and its people in their struggle against neo-fascism that has developed in in Ukraine under the mandate and directives of the US and Europe.” Nicaragua stated its firm disposition to “continue cooperating with the Security Council of the Russian Federation in the working groups to counteract the color revolutions that the US and Europe continue to attempt against governments and peoples, threatening stability and peace.” (La Primerisima, 21 November 2023)