Contraceptive Dynamics in Guatemala: 1978-1998
Bertrand, Jane T., Seiber, Eric, Escudero, Gabriela, International Family Planning Perspectives
Context: Guatemala lags far behind other Central American countries in contraceptive prevalence, and levels of use differ markedly between Mayans and ladinos, the two main ethnic groups. Understanding the factors that influence contraceptive use is critical to the efforts of programs to increase prevalence.
Methods: Data from four national-level surveys are used to examine trends in contraceptive use between 1978 and 1998. Results of multivariate analyses show the extent to which various factors, particularly ethnicity and access, influence contraceptive dynamics.
Results: Between 1978 and 1998, the proportion of women using any contraceptive rose from 28% to 50% among ladinos, but only from 4% to 13% among Mayans. Female sterilization, the pill and rhythm have been the most widely used methods, although as of 1998, the injectable replaced the pill as the third most popular method among Mayans. The source of methods has shifted overtime, but Mayans and ladinos have used similar sources at each survey Dramatic changes in socioeconomic conditions among both ladinos and Mayans over these 20 years have been key determinants of contraceptive use; access to services is also a significant correlate of use among Mayans, once socioeconomic factors are controlled for.
Conclusions: Mayans are a "hard-to-reach" population, but they are becoming more open to adopting family planning when services are accessible and provided in a culturally acceptable manner.
Latin America has made remarkable strides regarding contraceptive use and fertility decline in the past three decades. Thirty years ago, the total fertility rate for the region was around 6.0 lifetime births per woman; by 1999, it had dropped to 2.9. This same dramatic decline has not occurred in Guatemala, where the total fertility rate remains at 5.1, the highest in Central America. The contraceptive prevalence rate (including all methods) of 38% among 15-49-year-old women in union lags far behind those of neighboring countries, which range from 47% to 75%. 
The population of Guatemala totals 12.3 million and is divided roughly in half between the Spanish-speaking and economically dominant ladinos and the less-affluent, more rural Mayan (indigenous) populations. The latter consist of some 22 major groups, who remain linguistically and culturally isolated from ladino society as well as from each other. On every major health, economic and social indicator, the Mayans fare far worse than the ladino population. Low levels of education and residence in rural areas have made it difficult for the Mayan groups to integrate into the mainstream of Guatemala society.
Moreover, decades of political and economic oppression have resulted in widespread discrimination against Mayans and, in turn, their distrust of the ladino population.  As descendants of one of the greatest civilizations in the Western Hemisphere, the Mayans remain fiercely proud of their heritage and suspect those who wish to change their ways in the name of progress. During the peak of the civil unrest in Guatemala during the 1980s, whole villages were massacred and many Mayans were forced to leave the country, further reinforcing Mayans' distrust of outsiders. In the eyes of many Mayans, the promotion of family planning (interpreted as not having children or as killing babies) reflects similar genocidal motives. 
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 1965, the first family planning clinic opened in Guatemala City, under the auspices of the recently established International Planned Parenthood Federation affiliate, the Asociacion Pro Bienestar de la Familia Guatemalteca (APROFAM). In the early 1970s, the Ministry of Health established the Integrated Office of Information, Education and Training, and promised to provide family planning services through some 450 facilities throughout the country However, from 1970 to 1999, the government never fully embraced family planning, although it continued to accept funding from the U. …