Guatemala has the second lowest level of contraceptive use of any country in Latin America, despite an active private family planning program for over 30 years. Previous analyses identify correlates of contraceptive use but fail to address the fundamental question: Why does Guatemala differ so markedly from the rest of Spanish-speaking Latin America in the acceptance of family planning? This case study explores political and historical factors at the macrolevel that have shaped the evolution of family planning in Guatemala. These include the anti-imperialistic leftist movements of the 1960s and 1970s; the large percentage of the population that is indigenous; the civil unrest that peaked in the 1980s and paralyzed social programs, especially in the western highlands; and the powerful alliance between the government and the Catholic Church. Although none of these factors is unique to Guatemala, the convergence of the four in a single country explains why Guatemala lags far behind its Latin American neighbors in the acceptance of family planning. However, recent events give reason for guarded optimism that Guatemala is advancing toward greater acceptance of family planning.
Key words: family planning, contraception, Catholic Church, Guatemala, Maya
Over the past three decades the contraceptive revolution has taken hold firmly in the majority of Latin American countries. Birth rates have dropped from an average of 6 per woman in the 1960s to 2.7 as of 2002. Contraceptive use has edged up steadily, to the point where a number of Latin countries have a contraceptive prevalence level approaching or exceeding that of the United States (76%). This list includes Costa Rica (80%), Brazil (76%), Colombia (76%), Peru (68%), and Mexico (69%) (Population Reference Bureau 2002). By contrast, Guatemala has not kept pace with other Latin American countries, even its neighbors in Central America, despite the efforts of an active family planning association for over 30 years (see Figure 1). As we entered the new millennium, Guatemala's contraceptive prevalence of 38 percent (INE et al. 1999:42) was the second lowest in Latin America, trailed only by Haiti at 28 percent (Population Reference Bureau 2002).
Family planning began in Guatemala as it did in many Latin American countries-as a response of a group of concerned physicians, nurses, sociologists, and social workers to unwanted pregnancy. In Guatemala, the most alarming sign of this trend was clandestine abortion, which resulted in serious health problems and in some cases death to women, many of whom were high parity, low income, and desperate to prevent another birth (Early 1982:79; Martinez 1963; Santiso 1964, 1966). This interest in the health and welfare of individual women and their families coincided with burgeoning awareness of rapid population growth in developing countries worldwide (Hall 1973:420; Harkavy 1995:29-71; Piotrow 1973:3-11). In 1964 this small group of concerned health professionals organized as an affiliate of the International Planned Parenthood Federation (IPPF) under the name of the Asociacion ProBienestar de la Familiar (The Association of Family Well-being [APROFAM]). The first APROFAM clinic opened in Guatemala City in 1965. Ironically, as of 1970 Guatemala was one of six Latin American countries considered most progressive in terms of family planning, based on having an official family planning program whose goals were phrased in both health and demographic terms (Hall 1973:420). However, the situation has changed markedly in the past three decades.
This paper explores why family planning has met with far less success in Guatemala than in the rest of Spanish-speaking Latin America. Social scientists often study determinants of reproductive health behavior using multivariate analysis of national surveys such as the Demographic and Health Surveys (DHS). Such analyses exist for Guatemala (Bertrand, Seiber, and Escudero 2001:116), …