title: "Siempre me critican": barriers to reproductive health in Ocotal, Nicaragua.
abstract: 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.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America, Dabney.evans@emory.edu.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Luffy
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America, Dabney.evans@emory.edu.
authors.forename: Dabney P
authors.initials: DP
authors.lastname: Evans
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America, Dabney.evans@emory.edu.
authors.forename: Roger W
authors.initials: RW
authors.lastname: Rochat
mesh_terms: D000024:Abortion, Illegal; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D007398:Interpersonal Relations; D009527:Nicaragua; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D046269:Reproductive Rights; D012927:Social Control, Informal; D014505:Urban Population; D014754:Violence; D014930:Women / Q000523:psychology*