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Jessica Malter
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IN GUATEMALA, INEQUALITY PERSISTS IN USE OF REPRODUCTIVE HEALTH SERVICES

For Indigenous Women, Language a Major Barrier to Obtaining Pregnancy-Related Services and Contraceptives

Health disparities between ladina and indigenous women in Guatemala are among the largest in Latin America. Now, a new study on the use of pregnancy-related services and modern contraceptives finds that while the difference between indigenous women and ladinas, Spanish-speaking women of mixed Spanish and indigenous heritage, in use of prenatal care was small (74% and 86%, respectively), deliveries to indigenous women were far less likely to occur in an institution than those to ladinas (36% vs. 73%), and indigenous women who wanted to avoid pregnancy were far less likely than their ladina counterparts to use modern contraceptives (49% vs. 72%). The study, "Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care," by Kanako Ishida, of the Division of Reproductive Health at the Centers for Disease Control and Prevention, et al., used Demographic and Health Survey data to examine whether differences in language, socioeconomic status and residence translate to lower use by indigenous women of institutional prenatal care, institutional delivery, and modern contraceptives for birth spacing.

When the differences in service use were broken down, the researchers found that lack of fluency in Spanish accounted for the largest portion of the ethnic difference in use of institutional delivery and use of modern contraceptives. Even among indigenous women alone, the differences in service use by Spanish fluency were striking. Some 55% of births to indigenous women who spoke Spanish occurred in a health facility, compared with 19% of those to non-Spanish speakers. And among indigenous women who wanted to delay their next birth, 60% of those who spoke Spanish were using a modern contraceptive method, compared with 36% of those who did not speak Spanish.

Among both ethnic groups, the use of institutional prenatal care, institutional delivery and modern contraceptives rose with schooling, household wealth and urbanization. However, of these other factors, household wealth accounted for a larger portion of the ethnic differences in service use than did education or urbanization. The authors also note that indigenous women's preference for traditional midwives and their distrust of ladino-run government health facilities may further explain disparities in use of public services.

Despite the high rates of prenatal care among all women, child mortality rates among indigenous families are the highest in Central America, and high rates of maternal mortality and morbidity persist in rural and indigenous areas of the country. To help improve maternal and child health among indigenous populations, Ishida et al. recommend increasing the number of facility health care personnel who speak the local Mayan language. Noting the high rate of institutional prenatal care by indigenous women, they suggest further integration of prenatal care, institutional delivery and family planning services to encourage women to use the full range of available services. Furthermore, training traditional midwives to refer pregnant indigenous women with obstetric risks to health facilities may help persuade such women to deliver in a facility.

The study, "Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care," is currently available online and will appear in the June 2012 issue of International Perspectives on Sexual and Reproductive Health.

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