While Guatemalan women increasingly want smaller families, their levels of contraceptive knowledge and use remain low, especially among the country’s poor and rural populations. Two new studies published in International Family Planning Perspectives outline urgent next steps for health care providers to help women get the contraceptive information they need to avoid becoming one of the 65,000 Guatemalan women who have an unsafe abortion each year, and the even larger number who have an unplanned birth.

According to “Induced Abortion and Unintended Pregnancy in Guatemala,” by Susheela Singh of the Guttmacher Institute et al., abortion is prevalent in Guatemala although it is legal only to save a woman’s life. National estimates, available for the first time, show that about one in three pregnancies are unintended and that one abortion occurs for every six births. More than 20,000 women are hospitalized each year for treatment of complications of unsafe abortion. Among women having abortions, those who are poor, rural or indigenous are considered by health professionals to be more likely to experience health complications, and less likely to obtain care when they do so, compared to socio-economically advantaged women.

Internal migration, which is common in Guatemala, poses a particular challenge for health care providers. Families on the move lack regular access to clinics and are unlikely to see the same health care provider more than once, thus limiting the follow-up care and counseling they receive. Language may also act as a significant barrier as migrants who speak local languages are not reached by health care interventions launched solely in Spanish.

A recent national survey of Guatemalan migrants found that people moving from rural areas often arrive in cities with less information about contraceptives than nonmigrants who have spent their entire lives in urban areas In “Internal Migration and Contraceptive Knowledge and Use in Guatemala,” authors David P. Lindstrom of Brown University and Coralia Herrera Hernández of El Colegio de Mexico, Mexico City, analyze findings from Ladino and Mayan men and women to determine the relationships between moving to an urban area and a woman’s likelihood of using modern contraceptives. The researchers interviewed men and women living in poor to middle-class urban neighborhoods—including urban natives, migrants who had recently moved from rural areas to cities and migrants who had spent a significant amount of time in cities—and people who had never lived in urban areas. The analysis finds that over time, the negative association between being a rural-to-urban migrant and possessing information about modern contraceptives fades, suggesting that as rural women adapt to new environments, they also gain knowledge of contraception.

This change does not occur for Mayan migrants who, years after moving to an urban area, remain unfamiliar with modern methods of contraception such as the IUD and birth control pill. Interventions designed to educate women about modern contraception should include migrant women, particularly Mayan women who currently face a high risk of unintended pregnancy.

Getting information about contraception to migrants as soon as they arrive in a city means designing culturally appropriate interventions that take into account the many languages spoken by Guatemalan women and informing women of their full range of options for avoiding unintended pregnancies.

These studies appear in the September 2006 issue of International Family Planning Perspectives. Also in this issue:

“Before First Sex: Gender Differences in Emotional Relationships and Physical Behaviors Among Adolescents in the Philippines,” by Ushma D. Upadhyay of Johns Hopkins University et al.

“Maternal and Social Factors Associated with Abortion in India: A Population-Based Study,” by Saseendran Pallikadavath and R. William Stones of the University of Southampton, United Kingdom.

“Sexual Initiation, Substance Use, and Sexual Behavior and Knowledge Among Vocational Students in Northern Thailand,” by Alice Liu of Stanford University et al.