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Analysis of a Family Planning Program in Guatemala

Analysis of a Family Planning Program in Guatemala

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Association of Schools of Public Health
Analysis of a Family Planning Program in GuatemalaAuthor(s): Donald W. MacCorquodaleReviewed work(s):Source:
Public Health Reports (1896-1970),
Vol. 85, No. 7 (Jul., 1970), pp. 570-574Published by:
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Analysis
of
a
Family
Planning
Program
in
Guatemala
DONALD W.MacCORQUODALE,M.D.
GUATEMALA,with 35
percenlt
ofthepop-
ulation of the Central Americancountries,is the second largest and most populous of theC.A. republics.Accordingtothe1964census,the population of this nation was 4,284,473; the1969 population was estimated at 5,126,000. Therate of population growth in Guatemala ap-proximates 3percent a year. It is the only oneof the CentralAmerican countries with an ap-preciable proportionof Indians, totaling about50 percent of itspopulation.The leadingmorning newspaper of Guate-mala, Prensa Libre,has consistently takentheeditorialpositionthatGuatemala'srate ofpop- ulation growthisaserious obstacletoeconomicdevelopmentand thatfamily planningisessential for thefuture well-being ofthecountry. On the otherhand, the leading eveningdaily, ElImp,arcial,hasjusta,sconsistentlytaken the poisitionthat family planningisun-necessary and couldconceiva.bly prove harmfulowing to the lowpopulation densityofthecountry-about102people per squaremile. Theclimateofthe countryhasneverbeenpartic-ularly propitiousfor alarge-scale family plan-ning program.Thehierarchyof the RomanCatholic ChurchinGuatemalaremained silent onthe issueuntilPope PaulVI madepublic h-is nowfamousencyclical,"HumanaeVitae." Thenthe Arch-bishop ofGuatemalapubliclymanifested hissupport o,fthe Pope's positionon artificialcon-traiceptionand urged thefaithful tofollowvhisdictates.Although somecabinetmembers of tlhepres-entgovernment ofGuatemala havepublicly ex-pressedconcern over laexplosiondemografica,none haveopenlysupported familyplanning.TheF'amilyWelfareAssociation ofGuatemala,aprivateorganizationinterested inprovidingfamilyplanningservices towomen of the lowverincomegroups, ha,dto wait 2years beforethepreviousgovernment of thecountry legallyap-provedtheassociation's cha,rterand bylaws.Despite thesefactors, theMinistry ofPublicHealthagreedtoallow theprovision ofcon-traceptive servicesandsuppliesin20 ofitshealthcentersduring thesecond half of 1967.Themunicipics, politicalandgeographicunitssimilar tocounties intheUnited States,inwhich thesehealthcenters arelocated (seecha,rt)differmarkedlyfromoneanotherinmanyre,spects, suchassizeandethnic composi-tion(table 1).Each healthcenterphysician wasallowedaminimumof4hoursperweektodevote exclu-sivelytofamilyplanning.He wasto receiveQ2(1quetzal=US$1)foreachnewpatientcaredforupto atotalof30newpatientsforany givenmonth.Sincethe clinicalhistorywasto betakenbyagraduatenurse,itseemed reasonabletoDr. MacCorquodaleiswith the U.S. AgencyforInternational Development,inBogotu, Colombia.He was formerly chief of the HumanResourcesDivision, USAID Mission to Guatemala.
570Public HealthReports
 
expect that the healithcenterphysiciancouldexamine and care for a minimum ofthree orfour patients per hour, or 48 to64piatientsamonth.There were reasonsto anticipatethat thefamily planning program. would reachacon-siderableniumberofwomeninthe childbearingages. A knowledge,attitude, and practice sur-
vey in Guate;malaCityin 1967by the University
of San Carlos School of Medicine revealedthat40.8 percent of the 1,348 women, married orliv-ing in consensual union, who were interviewedwere practicing some method of birth controlatthe timeoif the study,and an additional 40.1percent had used somemethod of contraceptionin the past. (1).Effectiveness of the new program wasex-pected to vary from one community to another.In view of the relationship of educationandurbanizationwithfertility, as reported else-whereinLatin America (2-5), those involvedin planning and implementingthe program ex-pected greater interestin family planning in thecommunitieswith more urban characteristics,particularly Escuintlaiand Puerto Barrios, aswell as inthosewith higher degrees of liteiracy.Thelimited interest of the Indian populationinotherhealthprograms led to tihe beliefthatTable1.Somecharacteristicsof 20muni-cipios with family planning services in1967
Popu-Percent Percent PercentMunicipio lation urban Indianilliter-ateMalacatan 4,237 174669Salama4, 43924 2372Cuilapa- 4,001 29357SanMarcos6,61153 1744Solola4,8971817 83Chimaltenanigo9,278 595460Zacapa 11,23037259Chiquimula14,69341 1361ElProgreso 3,37435 354Jalapa 10,309262364SanPedroCarcha3,874697 95Retalhuleu-14,702 391955Tiquisate -9,682156 60Antigua -13,90762729Mazatenango 19,535 6030 49Huehuetenango-- 10,171 40246Coatepeque 14,37333 3356Totonicopan-8,254179174Puerto Barrios-22,25269138Escuintla-24,98146853
SOURCE:
FamilyWelfareAssociationofGuatemala,August 1968.
therewouldbe less interestin areas witlhahighpercentageof Indians inthe population.Withina few months after the programwasiniti,ated, farfewerwomen weirereceiving con-traceptiveservices thanhad beenanticipated.Nosinglehe,althcen'ter was providingservicestoasmany a,s30womena month,and a fewhealth centerswere providingservicestoas fewas four orfive womenamonth.There was markeddisparityin thedegree ofsuccess ofthe familyplanningprogramin theparticipatingmunicipiosat theend of 1year.The followingtabulationliststhe 20healthcentersin order of effectivenessin familyplan-ning andthe peircentageof womenbetween15and 50 years ofage whowere initial acceptorsofthe contraceptiveservices.
MunicipioPercent
1. Malacatan-19. 92. Salama-19.13.Cuilapa-15.74. San Marcos-15.55. Solola-12.76.Chimaltenango-9.87. Zacapa-8. 78.Chiquimula-8.59.ElProgreso-8. 010. Jalapa-6.311. SanPedro Carcha-6.212. Retalhuleu-5. 613.Tiquisate-5.014. Antigua-4. 815.Mazatenango-4.716. Huehuetenango-4.717. Coatepeque-4.118. Totonicopan-3. 619.PuertoBarrios-1. 820.Escuintla---------------------1.4
Onemightwellexpectthattheattitudesoflocalcivilorreligiousaulthoritieswouldin-fluencethe degreeofacceptanceoffamily plan-ning.However,noinstancesofoppositionbycivilauthoritie'swere reportedbythepersonnelofthehealthcenters,and inonlyonecommu-nitywasactiveoppositionbyapriestencoun-tered.Thiscommunity,incidentally,enjoyedawell-above-averagedegreeofacceptance,al-thoughitwasnot the most successfulinreach-ingthe greatestnumberof womeninthechildbearing ages.Presumably,two factorsexertedconsiderableinfluenceon thedegreeofacceptanceof familyplanningservices;namely,thecharacteristicsof thepersons (ofthe healthcenters)offeringtheservice andofthose(ofthecommunities)receivingthe serviices.Becauseolf his essential
Vol. 85, No. 7, July1970571

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