Transcript See Rebecca s presentation here

Family Planning
& Reproductive
Health in Guatemala
Rebecca Braun
MPH Candidate 2006
Bixby Program Intern
Demographic Indicators
Population
14,655,189
% Population under 15
44
Annual growth rate %
2.7
Life expectancy at birth
66.0
Total fertility rate
5.0
Sources: World Population Data Sheet 2004, WHO Statistical Information
System, 1998/99 Demographic & Health Survey
The People of Guatemala...

56% live in poverty, 16% in extreme poverty

55% of the population live in rural areas
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41% of the population is indigenous,
speaking one of 22 Mayan languages

36 year Civil War ended in 1996: left 150,000
people dead and another 50,000 missing
WINGS / Asociación ALAS
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Created in 2001 to help impoverished Guatemalans,
particularly women, increase access to family
planning and reproductive health care
Works to address common obstacles such as
geographic isolation, lack of financial resources and
education, and cultural barriers
Seeks to mitigate these factors through education,
clinical outreach, research and subsidizing costs
Collaborates with public and private health care
organizations, utilizing existing infrastructures to
maximize access while not duplicating services
STIs in Guatemala
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Government estimates 50-75,000 people with
HIV/AIDS yet no data on other STIs
Found that no organization had even basic
information regarding the prevalence and
spread of STIs, nor was anyone seeking it
STIs are largely ignored as health issue

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Prevalence rates are not tracked
No coordinated or widespread effort to educate
public about risks & prevention
STI/HIV Prevalence Study
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Data Collection May – August 2005
~1200 women ages 18 - 49 in 8 communities
were interviewed & tested for 6 common STIs
Protocol:
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Advertise in week prior thru local health center
Study day: health education session, interview,
blood test, Papanicolau & STI test
Return with results one week later  provide
treatment for STIs, family planning methods,
referrals for cervical cancer follow-up as needed
STI/HIV Study: Interview
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Socio-Demographic Variables: education, literacy,
occupation, # people in household, marital status
Sexual History: age and contraceptive use at 1st
intercourse, where to get contraceptives
Risky Sexual Behaviors: multiple partners,
oral/anal sex, unprotected sex
Current Sexual Partner: does partners have sex
with others or have an STI
Knowledge of STIs: diseases & symptoms,
personal history, where did you seek STI care, STI
transmission & prevention
STI/HIV Study: Results
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Data analysis is STILL in process
STI rates lower than expected, highest were
Bacterial Vaginosis & HPV
Only 1 confirmed case of HIV
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Arranged care at clinic in capital
Once the need for further study has been
established, a strong case can be made to
develop a countrywide effort to diagnose and
treat sexually transmitted infections
Family Planning in Guatemala
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Family planning is acknowledged by the
Government as a basic human right!
However...
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Unmet need for family planning: 23.1%
Just 38% of women are currently using any
method and only 31% are using a modern method
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Much lower among indigenous populations (~16%)
50% have a child before age 18, 20% have 2+
At the current rate of increase, the population
will double every 23 years
FP Barrier Analysis
Based on model by ‘Food for the Hungry’
Target groups: Doers & Non-Doers
Methodology:
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Creation of questionnaires for women and men
Individual interviews
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100 women (50 doers, 50 non-doers)
100 men (50 doers, 50 non-doers)
Focus groups of 6 – 10 participants
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4 with women (separate for doers & non-doers)
4 with men (separate for doers & non-doers)
FP Barrier Analysis: Interview
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Demographics: # children, education, religion
Desired family size
Problems and benefits associated with
contraceptive use or non-use
Approval or disapproval of contraceptive use
Factors that make it easier or harder to use
contraceptives
Contraceptive efficacy
Method choice
Reasons for use or non-use (open ended)
FP Barrier Analysis: Results
Demographics
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Age
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Education
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~ 60% had no formal education
35% primary or secondary, 5% university
Religion
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Range 17 – 59, mean/median = 30
40% Catholic, 31% Evangelical, 27% no religion
Number of children
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Majority had between 1 and 7 children, with the
most common being 2 – 4
FP Barrier Analysis: Results
Methods
60
40
% of Men
% of Women
20
0
D
o
ep
V
Q
D
IU
ll
Pi
C
s
B
m
do
on
C
m
fe
lo
ic
C
A
FP Barrier Analysis: Results
Why do you use FP?
80
60
% of Men
% of Women
40
20
0
o
on
ld
hi
C
y
m
n
of
re
lth hild
ea
C
H
e
or
M
o
N
th
al
He e
y
s
M
U
to
ng
ni
sy
an
Ea
Pl
ily
m
al
ic
m
Fa
Ec
FP Barrier Analysis: Results
Why don’t you use FP?
60
40
% of Men
% of Women
20
0
al
on
rs
P e er
rtn y
P a ne
o
M nfo
o
I
N of s
r
ck ea
F
La
lth y
ea ph
H
a
gr
eo
G ion
ig
el
R
FP Barrier Analysis: Results
What makes FP hard to use?
Women
Men
Cost
21%
15%
Fear of Illness
27%
24%
Lack of Info
23%
29%
Geographic Isolation
10%
10%
Partner Disapproval
19%
0%
0%
33%
I Don’t Agree
FP Barrier Analysis: Results
Who disapproves of FP use?
Women
Men
Partner
25%
15%
Church
30%
40%
Family
34%
22%
FP Barrier Analysis: Results
Other Interesting Findings...
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The vast majority of both men and women
state family planning as a benefit of using
contraceptives but only women (10%)
mentioned that the use of contraceptives
could give a better life to their children
90% of women believed that contraceptives
always prevented pregnancy compared to
just 74% of men
71% of females and just 48% of males said
contraceptives are easy to remember to use
Program Development
For each program:
 Program Manual – background info, goals &
objectives, activities, program implementation
guide, evaluation plan, staffing & budget
 Educator’s Manual
 Visual Aids – flipcharts, trifolds, power points
 Training Materials
 Evaluation Materials
Family Planning Program
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Goal: To increase knowledge of and access
to family planning among men and women of
reproductive age with limited resources
Objectives:
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Provide information on family planning, including
anatomy/physiology, reproductive risks, benefits
of family planning and contraceptive methods
Provide access to family planning methods
Increase capacity of individuals and partner
organizations to provide family planning
information and contraceptive methods
Family Planning Program
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Program activities include:
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Educational talks that cover reproductive
anatomy, reproductive risks, family planning and
contraceptive methods
Trainings for staff and partner organizations
Providing methods through our own promoters
and to other NGOs, targeted at rural, indigenous
and low-income people
Subsidizing costs of surgical sterilization
Cervical Cancer in Guatemala
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1st leading cause of cancer-related death
among women of reproductive age, 2nd
leading cause of cancer-related death among
women of all ages
~ 5% of women in Guatemala have been
screened for cervical cancer in the past five
years, compared with 40 to 50% of women in
developed countries
Guatemalan women at high risk for HPV, Early
initiation of sexual relationships, History of
multiple sex partners, High parity
Cervical Cancer Program
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Goal: Reduce morbidity and mortality due to cervical
cancer among rural, indigenous and/or low-income
Guatemalan women through testing and treatment
Objectives:
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Increase awareness and knowledge about cervical cancer
and its prevention, treatment and risks as well as the
benefits of early detection
Increase access to cervical cancer screening and follow up
services
Increase knowledge of and access to family planning
services in order to reduce risk for cervical cancer
Cervical Cancer Program
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Program activities include:
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Educational talks that cover the detection,
treatment and prevention of cervical cancer,
including the relationship to family planning
Trainings for staff and partner organizations on
advances in cervical cancer detection and
treatment services
Pap Test clinics that provide services to women of
limited resources and often in rural areas, many of
whom have never had one in their lives
Follow-up treatment and counseling
Referrals for contraceptive methods
Reproductive Health Trainings
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Day 1
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Reproductive Risk
Family Planning
Cervical Cancer
Day 2:
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Reproductive Anatomy
Contraceptive Methods