CONTRACEPTIVE PRACTICES OF MAYAN WOMEN IN SAN JUAN LA LAGUNA

ALEX IS M. TRAN, DO D E P A R T M E N T O F O B S T E T R I C S A N D G Y N E C O L O G Y

A L B A N Y M E D I C A L C E N T E R

A L B A N Y , N Y

U N I T E D S T A T E S O F A M E R I C A

A N D

TARANEH SH IRAZIAN, MDD I R E C T O R O F G L O B A L H E A L T H

D E P A R T M E N T O F O B / G Y N A N D R E P R O D U C T I V E S C I E N C E S

M O U N T S I N A I S C H O O L O F M E D I C I N E

N E W Y O R K , N Y

U N I T E D S T A T E S O F A M E R I C A

F O R P R E S E N T A T I O N A T T H E F I G O W O R L D C O N G R E S S 2 0 1 2 I N

R O M E , I T A L Y

OUTLINE

Background and Objectives

Methods

Results

Conclusions

Areas for ontinued development

References

BACKGROUND AND OBJECTIVES

In many parts of the developing world, as many as one in six women die of maternal causes.

High fertility rates often accompany high maternal mortality rates.

Among Latin American countries, Guatemala ranks among the highest in fertility rates.

WHO reports Guatemala’s 120 (110-114) maternal mortality index of 100,000 births.

Mayan women have shown consistently lower rates of contraceptive use than Ladrino counterparts.

Our objective: To understand contraceptive practices among the Mayan population of San Juan La Laguna including attitudes, knowledge and cultural barriers contributing to the high fertility rates in this Guatemalan highland region.

METHODS

194 surveys were verbally administered to the Mayan women of San Juan La Laguna. Surveys were both administered in Spanish and Tzutuhil. Interviewers consisted of a US medical provider, community partner and local health providers who had fluency in both languages and were available for questions. The survey consisted of 26 questions and examined general demographics, contraceptive options, and access to contraception.

RESULTS

194 surveys were returned. Demographic data revealed:

● 95% of cohort resided in San Juan her entire

life.

● 73% with no formal or limited education .

● 57% with ≥ 3 pregnancies; 33% with > 5

● Mode for age 19-24 years

● 54% delivered her first child between ages 15-19.

● 42% of pregnancies were unplanned.

● 64% reported never having tried

contraception.

PREVALENCE OF CONTRACEPTION UTILIZATION

72% of women surveyed reported no

current contraceptive use (Figure 1).

Among the 24% who reported contraceptive

use: Depo-Provera (13%),oral contraceptives

(3.6%). (Figure 1)

PREVALENCE OF CONTRACEPTIVE CHOICES

Among recipients, contraceptive knowledge

(30%) and timing of the next baby (22%)

were the most common concerns in

contraceptive decision-making. (Figure 2)

57.7

13.9

13.2

8.2

4.13.6

2.1 2.1 lack of awareness orunderstanding

lack of financial means

religious or cultural beliefs

no response

difficulty in seeking a providerof contraceptive services

lack of access to provider orcenter

social pressures

partner considerations

Figure 2. Response to access to contraception questions

CONCLUSIONS

Contraception utilization among the Mayan women of San Juan La Laguna appears limited. The majority reported no current contraceptive use and cited lack of awareness of options as the most common barrier to access. These results suggest the need for educational outreach in family planning. Ultimately, family planning initiatives carry wider implications on total fertility and maternal mortality rates among Mayan communities, residing in the Guatemalan Highlands.

AREAS OF DEVELOPMENT

Contraception initiation and utilization carry potential to avert unwanted pregnancies and potential related maternal mortalities.

Guttmacher Institute reports the following:

• In 2012, an estimated 291,000 women in developing countries will die from pregnancy-related causes; of these, 104,000 pregnancies will have been unintended.

• The number of unintended pregnancies could be decreased by two-thirds, from 80 million to 26 million, resulting in 26 million fewer abortions, 21 million fewer unplanned births and seven million fewer miscarriages if contraception needs were met.

• The number of pregnancy-related deaths may be reduced by 79,000 if unmet needs of contraception were employed.

REFERENCES

1. Diamond-Smith N, Potts M. A Woman Cannot Die from a Pregnancy She Does\ Not Have. Intl Perspectives on Sex Repro Health.Vol 37, No. 3, Sept 2011, 155-156.

2. Seiber EE et al, Access as a factor in differential contraceptive use between Mayans and ladinos in Guatemala, Health Policy Plan. 2002 Jun;17(2):167-77

3.Ramakrishn U et al, Fertility behavior and reproductive outcomes among young Guatemalan adults, Food Nutr Bull. 2005 Jun; 26(two Suppl 1):S68-77

4.Lindstrom DP, Migration and the diffusion of modern contraceptive knowledge and use in rural Guatemala, Stud Fam Plan. 2005 Dec;36(4):277-88. occupation, and assets. Food Nutr Bull. 2005 Jun;26(2 Suppl 1):S25-45

Website: http://apps.who.int/ghodata?vid=240. Accessed October 8, 2012

Website: http://www.guttmacher.org/pubs/FB-Costs-Benefits-Contraceptives.html