“Siempre me critican”: Barriers to reproductive health in Ocotal, Nicaragua

Objective. To identify perceived barriers to accessing reproductive health care according
to the women of Ocotal, Nicaragua; describe their understanding of their reproductive rights;
and document their opinions about Nicaragua’s total ban on abortion.
Methods. From May to June 2014, three focus group discussions were held in Spanish
with 17 women from two different neighborhoods (barrios) in the city of Ocotal, Nicaragua. A
semi-structured discussion guide with open-ended questions was employed to elucidate local
perspectives regarding the focus group discussions themes.
Results. Serious obstacles including 1) violence against women, 2) machismo, 3) criticism
from others, and 4) lack of communication and education limit women’s ability to make
their own reproductive health decisions. Women had a pervasive lack of knowledge about
reproductive rights and the international human rights documents that define them. In
addition, due to religious and cultural ideologies, most women supported the country’s total
ban on abortion in most circumstances, with the possible exception of rape.
Conclusions. Both men and women in Ocotal should be encouraged to participate in
community-level programs designed to reduce the impact of the following obstacles to
receiving reproductive health care: 1) violence against women and machismo; 2) insufficient,
non-standardized sexual education and information about reproductive rights; and 3) poor
communication within families and the community at large. Any future public health
campaigns to address women’s reproductive health needs in Ocotal should implement these
types of programs, at the neighborhood level, to reduce stigma surrounding sexual health and
activity.