Access as a Factor in Differential Contraceptive Use between Mayans and Ladinos in Guatemala
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Author(s): Seiber E, Bertrand J T
Previous studies consistently have demonstrated that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladrino counterparts (e.g., 50 percent versus 13 percent in the 1998 DHS). Most researchers and practitioners have attributed this to social, economic, and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 kilometers from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering FP services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to the injectable. Otherwise, the FP supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8 percent of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM -- which was the nearest facility for only 7 percent of the respondents in this study -- was the source of supply for 48 percent of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users.
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