Contraceptive dynamics in Guatemala: 1978-1998

Context: Guatemala lags far behind other Central American countries in contraceptive prevalence, and levels of use differ markedly between Mayans and ladinos, the two main ethnic groups. Understanding the factors that influence contraceptive use is critical to the efforts of programs to increase prevalence. Methods: Data from four national-level surveys are used to examine trends in contraceptive use between 1978 and 1998. Results of multivariate analyses show the extent to which various factors, particularly ethnicity and access, influence contraceptive dynamics. Results: Between 1978 and 1998, the proportion of women using any contraceptive rose from 28% to 50% among ladinos, but only from 4% to 13% among Mayans. Female sterilization, the pill and rhythm have been the most widely used methods, although as of 1998, the injectable replaced the pill as the third most popular method among Mayans. The source of methods has shifted over time, but Mayans and ladinos have used similar sources at each survey. Dramatic changes in socioeconomic conditions among both ladinos and Mayans over these 20 years have been key determinants of contraceptive use; access to services is also a significant correlate of use among Mayans, once socioeconomic factors are controlled for. Conclusions: Mayans are a "hard-to-reach"population, but they are becoming more open to adopting family planning when services are accessible and provided in a culturally acceptable manner.