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Compared to women in other countries in Latin America, Nicaraguan women are more likely to die giving birth. Nicaragua has made progress in reducing its maternal mortality ratio (MMR), a measurement of maternal deaths, from 202 deaths per 100,000 live births in 2000 down to 150 deaths per 100,000 live births in 2015. Despite this improvement in overall maternal mortality, the high percentage of adolescents giving birth annually poses challenges for the future of the government’s maternal and child health efforts. Approximately one-quarter of all births annually are to girls between the age of 15 and 19 years, and one-half of all women in Nicaragua have delivered a baby before reaching the age of 20. Although Nicaragua’s annual gross national income (GNI) per capita of US$1940 makes it a lower-middle-income country under World Bank criteria, there is considerable income inequality, and nearly 30% of the population lives in poverty. Many of the country’s youngest mothers live in rural and peri-urban areas and are among the poorest of the poor, with limited or no formal education. Once they become pregnant, adolescents who are still in school are dismissed or drop out on their own, further limiting their economic prospects and those of their children. With women who bear a child during adolescence likely to have higher fertility than those who wait until their 20s to have their first child, girls in Nicaragua who become pregnant face a greater risk of maternal mortality over the long term. To address the connected challenges of adolescent pregnancy and maternal mortality, Nicaragua must consider legal, social, and health sector reforms to meet the needs of the country’s most vulnerable mothers and their children.

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