By Mike Wooldridge
BBC world affairs correspondent
The government says the life of the unborn child must be paramount
Amnesty International has called on Nicaragua to repeal a law introduced last year criminalising abortion in all circumstances.
After a fact-finding mission, Amnesty says in
that the total ban on abortion "marks a grave departure from the government's commitment to improving social equality and has severe consequences for the protection of human rights for women and girls".
Amnesty points out that the ban allows no exceptions - even when continuing a pregnancy risks the life or health of the woman or girl or when the pregnancy is the result of rape.
The human rights group argues that banning so-called therapeutic abortions - undertaken in order to preserve the health of the mother - not only endangers lives but also puts medical professionals in an "unconscionable" position.
The Nicaraguan health ministry, contacted by the BBC, had no comment on Amnesty's report but the government has previously said that it is committed to reducing maternal mortality.
Accurate statistics of the impact of the ban in terms of avoidable deaths are hard to come by. One doctor said that of 95 women who died last year as a result of medical complications with their pregnancies, 13 could have been saved if they had been able to have therapeutic abortions.
And the difficulties now facing medical staff are very real, says Dr Andres Herrera Rodriguez of the University of Leon in Nicaragua.
Women's groups and doctors say the law is wrong
"Now you can't even teach about abortion because it would be dangerous. You need to be very careful because the law says you can be put in jail if someone says you are promoting abortion," he says.
"We need to be able to deal with people who have been sexually abused," he says.
"If a woman's life is at risk you need to do something to make sure she doesn't die. Our back is to the wall, I would say."
Most Nicaraguans are Catholics and the Roman Catholic Church was a key backer of the ban - arguing that abortion meant murder, even when mothers' wellbeing was in jeopardy.
And the Church and practically every parliamentarian agreed that the term "therapeutic" was being over-used to cover a wide range of terminations that were not actually medically justified.
Amnesty says officials have sent out private signals that doctors should continue to abide by their own medical code.
Nonetheless, Amnesty maintains that the total ban has "a chilling effect on the ability of medical professionals and health workers to provide medically indicated treatment".
One woman told us about her sister's ectopic pregnancy - discovered three weeks after the ban went into effect.
"We were very afraid. But she was able to have an abortion. Fortunately some doctors still act on medical principles."
Law 'hits poor'
It is indeed clear that, despite the ban, there are still some abortions taking place. A 22-year-old woman told us what happened when she recently wanted an abortion.
"I talked to a doctor and she indicated that there was a way to do it in your home using some medicine," she said.
The law targets the poor, says the director of Ixchen clinic
"I was between two places - my future and the risk of going to jail. But I own my body."
Amnesty argues in its report that the effects of the new law are most marked among women and girls living in poverty.
Each day at the Ixchen women's centre in Managua the seats around the open courtyard, where people wait to be seen, are filled with many women enduring hardship - in making ends meet and often in their relationships too.
The centre's director, Maria Lourdes, says the total ban on abortion is a big problem and she sees it as an expression of the weakness in the human rights system in Nicaragua.
"Women have no right to decide for themselves," she says.
"The lives of women are secondary."
For some Nicaraguans, the issue is a touchstone of the legacy of the Sandinista revolution, which has just marked its 30th anniversary.
Ahead of the 2006 elections that brought the Sandinistas back to power after a lengthy spell in opposition, they backed calls from the Roman Catholic church for the end to therapeutic abortions.
This was "playing politics with the lives of women and girls", says Patricia Orozco. She fought on the side of the Sandinistas and is today a radio journalist and activist.
I asked her whether she felt there had been a betrayal of the revolution she took part in.
"We see our comrades in the revolution all changed, many of the women in particular."
At the University of Leon, Dr Herrera said that 30 years ago when the revolution took place he dreamed that there would be freedom for women.
"I have been working with women for many years. It has been very hard for women - especially now."