Damiris Castro, expecting her third child at age 22, rests while on her first night at a casa materna in Jinotega. Throughout the country, the Red Nacional de Casas Maternas (Maternity Homes National Network) offers rural mothers medical checkups, food, education and a temporary place to stay near a hospital where they can give birth safely. * After working on an assignment on Costa Rica earlier this year, I took a personal trip for a few days to northern Nicaragua to learn more about issues of maternal health, adolescent pregnancy and reproductive rights among rural women. The story, with the help of reporter Kristy Heim and editor Kathy Treisch, published in late November in Pacific Northwest Magazine. (Thank you ladies, for all of the time and support.) I visited several of the country’s casas maternas, which offer rural mothers medical checkups, food, education and a temporary place to stay near a hospital where they can give birth safely. Many in northern Nicaragua live a considerable distance from a health care center. If these women have complications at home, instead of a casa materna, they may have to travel hours by boat, bus or by foot to reach medical attention. They may not be able to reach help in time. The casas maternas offer a relatively inexpensive but effective way to help rural women have babies safely. The homes were created to address the lack of health services in rural parts of the country, especially when women couldn't leave their communities during the conflicts of war. Mostly women spearhead these efforts, and almost all of their staffs are Nicaraguan. Casas Maternas national coordinator Francisca del Carmen Espinoza Ortiz, 61, has helped establish 79 maternity homes around Nicaragua. The United Nations Population Fund honored her work in 2009, and last year, under her supervision, the casas maternas admitted 14,700 women. They work on a shoestring budget. The Ministry of Health provides all medical care and an average of about 75 cents a day to each woman for basic nutrition. However, it takes about $5 a day to fully provide for each mother, Espinoza said. Volunteers and employees bring food from home. Mothers may need to sleep two to a bed or on pads on the floor. Espinoza believes that prevention and education are essential to changing women’s lives, but they do not have the financial resources to carry out the programs. Adolescent pregnancy rates are also high — some of the highest outside Africa. And on average, rural women here have more pregnancies than women in developed countries, making their risk of dying in pregnancy or childbirth over the course of their lives seven times greater than it is in the United States. And in rural Nicaragua, where husbands are typically in charge of family decisions, women generally don't have the choice or the ability to plan when to start having a family or when to stop. Husbands sometimes object to their wives being seen by male medical professionals or taking birth control. And, a 2006 law criminalized abortion in all circumstances, even to save the life of the mother. Rape and domestic violence are prevalent; one in three women is abused. In some cases, girls give birth as early as 9, and women have children well into their 40s. As an outsider, it’s obvious to see how Espinoza and her colleagues do a lot of work with minimal resources. But, what was also apparent was how much women believe in the importance of helping one another. Margaritia Quintanilla, Nicaragua program leader for the Seattle-based health organization PATH, learned these lessons from her mother and grandmother. She works to improve the welfare of women, introduce health technology and build bridges between that work and supporters here in the Northwest. Efforts to improve rural women's health will not work unless they address the underlying issues of inequality, says Quintanilla. Quintanilla, who has three daughters of her own, says being able to decide, "by themselves, about their lives, about their bodies," is a right they need to have. Having opportunities and the ability to do what they want — to study, to get married or not — that, she says, "is huge." Each day, around the globe, an estimated 1,000 women die from pregnancy or childbirth-related complications, many of them preventable. Kitty Madden, a volunteer social worker at Casa Materna Mary Ann Jackman, says it's important for women in developed countries to turn their attention to parts of the globe where the challenges are greater. "What affects any woman of the world affects all of us," she said. Here's the link to The Seattle Times story - It takes more than villages to keep mothers safe HOW YOU CAN HELP: Red Nacional de Casas Maternas: casamaterna.jinotega@yahoo.es Mothers at Risk: www.mothersatrisk.org PATH: www.path.org Casa Materna Mary Ann Jackman: www.casamaterna.org *