Leanny Yasmina López Santiago was 20 years old when she was admitted to the Ernesto Sequeira Blanco Regional Hospital in Bluefields to give birth to her first child. Four days later, she died following childbirth. Her family reported that, despite the complications that arose, the doctors insisted on performing a vaginal delivery before deciding to perform a cesarean section.
The young woman’s death, which occurred on November 17, 2023, was not merely etched in her family’s memory. It also became part of the official statistics from the Ministry of Health (or Minsa, its acronym in Spanish), which show that from that year through 2025, 83.5% of maternal deaths in Nicaragua occurred in hospitals, and that the leading causes have remained unchanged over the past decade.
Nicaragua continues to be one of the most dangerous countries in Central America for women to give birth. Although Minsa claims to have reduced maternal deaths to just 16 cases in 2025—the lowest figure recorded in the last six years—the World Health Organization (WHO) ranks the country as having the third-highest maternal mortality rate in the region, with 60 deaths per 100,000 live births.
Variations in the Methodology for Recording Maternal Deaths
The figures from the Ministry of Health and the WHO’s estimates are not contradictory; rather, they are based on different methodologies. While the ministry counts deaths reported by the national health system, the international organization calculates the maternal mortality ratio using statistical models that adjust national records to account for possible underreporting and facilitate comparisons between countries.
Under this methodology, Nicaragua has one of the highest rates in the region. While Costa Rica records 24 maternal deaths per 100,000 live births, Panama reports 37, El Salvador 39, and Honduras 47. Only Guatemala, with a rate of 94, and Belize, with 67, have higher rates than Nicaragua.
Maternal mortality includes the deaths of women during pregnancy, childbirth, or the puerperium (postpartum period), a period of approximately six weeks following birth during which a woman’s body recovers from pregnancy and childbirth.
In this context, Nicaragua’s ranking reflects that, despite the reduction in maternal deaths by 2025, the risk of dying from causes related to childbirth remains one of the highest in Central America.
The Official Version
Based on official records from the Ministry of Health (Minsa), the Sandinista government presented this reduction as one of the main achievements of its healthcare system, both in publications on the ministry’s website and during the First National Symposium on Perinatal Nursing Care, held in June 2026.
At that event, the national director of nursing, Janeth Vega, reported that maternal deaths decreased from 21 cases in 2024 to 16 in 2025, equivalent to a year-over-year reduction of 23.8%. The official attributed this result to “the strengthening of perinatal care and the addition of more than 160 specialist nurses in hospital units.”
The figures presented by the Minsa official are consistent with the 2023–2025 Maternal Mortality Map, prepared by the government agency, which shows a sustained reduction in deaths over the past six years, with 45 cases reported in 2020, 37 in 2021, 37 in 2022, 30 in 2023, 21 in 2024, and 16 in 2025.
Risks Persist in Nicaragua’s Hospital System
According to official data, the decline in maternal deaths did not alter the causes that continue to claim the lives of Nicaraguan women during pregnancy, childbirth, and the postpartum period.
The Ministry of Health’s (Minsa) maternal mortality maps show that, although the number of deaths decreased between 2020 and 2025, the leading causes of death remained virtually unchanged. Hemorrhage associated with pregnancy, childbirth, and the postpartum period remained the leading cause throughout the entire period analyzed. Official records attribute 25 deaths to this complication in 2020, 15 in 2021, 17 in 2022, 14 in 2023, and ten in both 2024 and 2025.
Hypertensive disorders of pregnancy ranked second, with nine deaths in 2020; seven in 2021 and 2022; five in 2023 and 2024; and one in 2025.
The third complication recorded by the state agency is uterine rupture during labor, an obstetric emergency in which the uterus tears while a woman is giving birth, causing life-threatening bleeding.
Official records show five deaths from uterine rupture in 2020, two in 2021, four in 2022, three in 2023, and one in 2024. In 2025, for the first time during the period analyzed, the Ministry of Health (Minsa) recorded no deaths from this cause.
What the Data Reveals
According to José Antonio Delgado Alvarado, a gynecologist with a master’s degree in public health, although there are risk factors associated with childbirth, proper monitoring of labor allows for the identification of warning signs and timely intervention. For this reason, he believes that each case should be analyzed as an indicator of the quality of obstetric care.
For Delgado, official data show that the reduction in deaths has not been accompanied by changes in the complications that cause them. Although the total number of maternal deaths decreased during the period analyzed, hemorrhage accounted for an increasingly large proportion of cases. In 2020, it accounted for 55.6% of the deaths recorded by the Ministry of Health that year, and by 2025, that proportion had risen to 62.5%.
“It’s one thing to report lower maternal mortality rates, and another to say that even with lower numbers, the underlying causes of maternal mortality remain the same. So, something isn’t working in the system,” Delgado noted.
The persistence of the same complications is not the only pattern shown by the Minsa maps. The records also show that deaths continue to be concentrated in certain regions of the country and primarily affect the same age group, despite the reduction in the number of deaths.
Dying in the Hospital, Not at Home
The World Health Organization maintains that care provided by trained health personnel before, during, and after childbirth can save the lives of both the mother and the newborn. However, official maps from the Ministry of Health show that between 2023 and 2025, eight out of every ten maternal deaths in Nicaragua occurred precisely within a health facility.
According to data from 2023 to 2025, 83.5% of the country’s maternal deaths occurred in a hospital (56 out of 67 total cases during that period), compared to 74.7% between 2020 and 2022 and 76% between 2016 and 2018.
“How can this be explained if there are more hospitals? The Ministry of Health has announced the construction of more than 80 new hospitals, but precisely in the year it reports the lowest number of maternal deaths, the percentage of women who die within a healthcare facility is the highest of the period,” the specialist questioned.
In his view, this data is particularly concerning because postpartum hemorrhage occurs when the patient is already under medical care.
“If a woman dies from this cause inside the hospital—where staff have the greatest control over her clinical progress—that indicates a failure in obstetric monitoring,” he stated.
Beyond the Numbers
According to the United Nations and the World Health Organization (WHO), no woman should die from preventable causes related to pregnancy or childbirth. The Global Strategy for Women’s, Children’s, and Adolescents’ Health (2016–2030) sets the goal of ending preventable maternal deaths, while the WHO warns that most of these deaths can be prevented through timely, high-quality care during pregnancy, childbirth, and the postpartum period.
Official records from the Ministry of Health show that Nicaragua has managed to reduce the number of maternal deaths in recent years. However, the same data reveal that the leading causes of death remain virtually unchanged and that most of these deaths continue to occur in hospitals—a trend that contrasts with the international goal of preventing women from continuing to die from preventable complications.