WINGS Reproductive Healthcare for Every Guatemalan

Comalapa - September 2008

WINGS has been working with University of Maine Associate Professor of Geography Brad Dearden since early 2007 to design and implement a study of attitudes and practices related to family planning in Comalapa, Chimaltenango.  Comalapa represents a typical community where WINGS works – it is a small urban area with approximately 35,000 inhabitants (including surrounding villages); 93% of the population is of the Kaqchikel Maya ethnic group; and the majority of families are low-income.

The study was designed to assess fertility patterns in Comalapa and to gain an accurate understanding of knowledge, attitudes, and practices with regard to family planning methods.  In mid-2007, a team of researchers, including Dearden, four local interviewers, and two University of Maine students, was assembled to carry out the research.  The team interviewed 410 men and women of reproductive age (15-49) in Comalapa based on a random sampling of households in the target area.  Participants were asked about their age, occupation, ethnic background, religion, level of education, sexual history, knowledge about family planning, attitudes toward family planning, and use of family planning methods.

The report, published last month, provides strong evidence of the need for better education about family planning and reproductive health and improved access to quality family planning services.  The following results are of particular interest:

• The average female respondent had already had at least 4 pregnancies;
• 93% of women who reported having had sexual experience had been pregnant at least once;  
• Approximately two thirds of women had been pregnant by age 21;
• The age at first pregnancy was strongly correlated with education level – women with no schooling reported having had their first pregnancy four years before women with secondary school education;
• 42% of women between the ages of 45 and 49 reported having had seven or more pregnancies;
• Catholic women reported 34% more pregnancies on average than Evangelical women.

Awareness of birth control methods was shockingly low among the survey respondents – 41% had no knowledge of any birth control methods.  Again, this result was highly correlated with education levels, with more educated men and women reporting much greater awareness of birth control methods.  Use of birth control was also low.  Fifty five percent of sexually-active respondents had never used birth control, and only 35% reported currently using a method, even though 80% reported that they did not plan on getting pregnant in the next 12 months.  The most common reasons cited for not using a birth control method were religion and fears about negative impacts on the body.  These results highlight the importance of increasing the dialogue with religious groups about family planning and providing accurate information to both men and women about safety and potential side effects of birth control methods in order to dispel common myths about negative health outcomes.

The Comalapa study points to some continuing challenges for WINGS’ work.  Nearly 70% of people interviewed said that they did not plan to use a family planning method in the future or did not know why they would use a method.  Nonetheless, the potential for impact through greater education about family planning and broader access to services was clearly indicated by the fact that 80% of people reported that it was good health practice to delay first pregnancies, space births, and limit total pregnancies.  The average respondent reported that he or she would ideally like to have between two and four children.

There is a long way to go before family planning is fully accepted in Guatemalan society and men and women are able to effectively control their reproductive lives according to their individual desires.  Lack of education, religion, machismo, and misconceptions about the safety of birth control methods all pose significant challenges.  WINGS’ programs will continue to address these issues in order to put reproductive health options in the hands of all Guatemalans, regardless of age, income level, ethnic background, or geographic location.

For more information about the Comalapa study, download the full report and appendix.