Contraceptive use and intent in Guatemala

Abstract Guatemala is characterized by low contraceptive use rates and one of the highest fertility rates in the Western Hemisphere. These rates are particularly extreme for the poorest segment of the population and for the indigenous population. However, notable increases in contraceptive use have occurred within the past ten years, indicating that Guatemala may be on the precipice of significant demographic change. The purpose of this research is to enhance understanding of the modern contraceptive revolution in Guatemala through identification of the segments of the Guatemalan population at most need for contraceptive and family planning services. Using the most recently available survey data, the 2002 Reproductive Health Survey data set (RHS), classification trees are used to determine the women with greatest need for reproductive health services. The results highlight the persistent marginalization of the poor and the indigenous and provide further insight into the impact of education, place of residence and couple characteristics on contraceptive use and intent. (ProQuest: ... denotes formula omitted.) 1. Introduction Much of Latin America has recently experienced a rapid decline in fertility accelerated by an increase in contraceptive use (PRB 2007). An increasing number of countries in both Central and South America are characterized by below replacement total fertility rates (TFR) and contraceptive prevalence rates (CPR) matching those of more developed countries (De Broe and Hinde 2006; PRB 2007; Rosero-Bixby, Martin, and Martin-Garcia 2008). However, a closer look at country and regional family planning behavior in Latin America reveals exceptional subgroups with unusually high TFR and correspondingly low CPR. Once a leader in family planning, and despite recent strides in contraceptive expansion and fertility decline, Guatemala has the highest TFR in Latin America and one of the lowest CPRs in the Western Hemisphere (Santiso-Galvez and Bertrand 2004; De Broe and Hinde 2006; PRB 2007). In a context where maternal and infant mortality rates are high, poverty is rampant, and malnutrition is common, empowering women with the knowledge and resources to plan their own families is vital. However, Guatemala's low CPR and high TFR suggest that the ability of women to freely determine the timing and number of births may be limited. The goal of this research is to identify the Guatemalan women with the greatest need for contraceptive services using the most recently3 collected data. The results of the analysis aim to provide information helpful to monitoring Guatemala's evolving contraceptive needs and documenting the fertility transition in a contemporary less developed country. Differing from related research, this study incorporates flexible modeling techniques, the most recent data, and includes an alternative approach to ethnic classification. The results of the research therefore contribute to an improved general understanding of contraceptive dynamics in one of the fastest growing and most impoverished countries in Latin America. 2. Contraceptive dynamics in Guatemala Concern about the reproductive health of poor Guatemalan women motivated the 1964 development of the Asociacion ProBienestar de la Familia (Federation of Family Well-being [APROFAM]) (Santiso-Galvez and Bertrand 2004). Supported by the International Planned Parenthood Association, APROFAM began building reproductive health clinics the following year. Shortly after the first clinic was established, Guatemala was identified, in terms of women's health, as one of only a handful of forward-thinking Latin American countries (Hall 1973; Santiso-Galvez and Bertrand 2004). However, the combined impact of the civil war (1960-1996) with other socio-demographic factors caused significant stagnation in the country-wide adoption of family planning. Guatemala's unstable and, at times, violent social and political climate are theorized to be the root causes of the "delayed contraceptive revolution" and have resulted in a limited supply and demand for contraception (Santiso-Galvez and Bertrand 2004; De Broe and Hinde 2006). …