Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care

Article excerpt

CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and Iadina women. To reduce these disparities, it is necessary to under stand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services.

METHODS: Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics.

RESULTS: The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among Iadina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage.

CONCLUSION: The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.

International Perspectives on Sexual and Reproductive Health, 2012,38(2)99-108, doi:10.1363/3809912

Guatemala lags behind most Latin American countries that have undergone demographic and epidemiological transitions in fertility and maternal and child mortality) Guatemala also has one of the highest levels of health inequality in Latin America: (2) Studies have consistently shown that indigenous women use reproductive health care services less frequently than "Iadinas," Spanish-speaking women of mixed Spanish and indigenous heritage. (3-6)

Although some suggest that indigenous women's socioeconomic and residential disadvantages are the most important factors in their underutilization of modern health care services, (3) others maintain that neither of these factors fully explains the ethnic disparity in women's use of pregnancy-related services (4) or contraceptives. (5), (6)According to qualitative research, indigenous people in Guatemala face discrimination at health care facilities that are staffed by predominantly ladino personnel; they distrust and avoid modern health care services; and they prefer traditional alternatives to institutional prenatal care and delivery. (7)

In this study, we used nationally representative data from Guatemala's most recent reproductive health survey, conducted in 2008-2009, to estimate the magnitude of ethnic inequality in the use of institutional prenatal care and delivery services, and in met demand for modern contraceptives among Guatemalan women. We also estimated the extent to which this inequality was attributable to: a language barrier; differences in education level, in household wealth or in residential characteristics; and unknown factors (residuals).

Reproductive Health Indicators and Disparities

A cross-national comparison of health indicators among Central America's four countries highlighted the poor reproductive, maternal and child health indicators in Guatemala. (1) Although the country's total fertility rate (TFR)--the number of lifetime births a woman would be expected to have at current age-specific rates--declined from 5.6 in 1987 to 4.4 in 2002, the IFR and wealth-related disparities in total fertility continued to be among the largest in Latin America. …