Abstract
This chapter analyzes the perceptions and practices of contraceptive counseling among health service providers to the indigenous population of the Chiapas Highlands, Mexico. The objective is to describe and analyze how contraceptive counseling aimed at the indigenous population is provided, and the perceptions about delivery among health workers involved, highlighting the cultural relevance and acceptability of their services, and whether it fits within a human rights framework. The methodology is based on qualitative techniques including in-depth interviews with key informants, together with participant observation performed by indigenous simulated users. The first section describes the background and conceptual reference that guide the analysis, including the legal framework for family planning counseling and the landscape of contraceptive use among indigenous populations in the state of Chiapas and Mexico. Our findings show a key paradox in the representations and practices of health providers: while they consider that the contraceptive services are antagonistic to the indigenous cultures and values, and recognize the lack of availability of resources, contraceptive counseling competencies, and barriers to the access to services, at the same time the providers emphasized the need to persuade the population to use contraceptive services, an idea that seems inextricably linked to contraception being viewed as an important medium to reach public health goals and not as a value in itself. The chapter concludes by identifying windows of opportunity to implement intercultural adaptations and specific recommendations to improve access to and coverage of contraceptive and family planning services among the indigenous population of the Chiapas Highlands.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
The specific action programs are defined as “the guiding instruments that have been developed through consensus, with strategies based on best practice and scientific evidence available, to define the direction that all institutions and levels of government should follow to move forward collectively and harmoniously towards confronting the primary health challenges” (SSA 2008:7).
- 2.
Total fertility rate (TFT) refers to the total number of children who would be born per woman (or per 1000 women) if she/they were to pass through the childbearing years bearing children according to a current schedule of age-specific fertility rates.
- 3.
In 2014 the TFT in Chiapas was 2.90 births per women, while the national average was 2.26, and the lowest rate, Mexico City, was 1.47 (INEGI 2014).
- 4.
In 2014, 40.4% of women from Chiapas reported using FP, while the national average was 51.6%, and the highest rate of FP, Chihuahua, was 59.3% (INEGI 2014).
- 5.
In Chiapas, 10% of women of reproductive age had no knowledge of FP. At the national level only 1.3% of women of reproductive age had no knowledge of contraception, and in locales such as the state of Sonora, only 0.3% had no knowledge (INEGI 2014).
- 6.
In Chiapas 14.7% of women of reproductive age utilized some form of contraception during their first sexual encounter, while the national average was 34%, and the state with the highest use of contraceptive methods at first sexual encounter for women was the Federal District (Mexico City) at 48.2% (INEGI 2014).
- 7.
Aldama, Amatenango del Valle, Chalchihuitán, Chanal, Chenalhó, Huixtán, Larraínzar, Mitontic, Oxchuc, Pantelhó, San Cristóbal de Las Casas, San Juan Cancuc, San Juan Chamula, Santiago El Pinar, Tenejapa, Teopisca, Zinacantán, Amatán, El Bosque, Huitiupán, Pueblo Nuevo Solistahuacán, Simojovel, San Andrés Duraznal, Sabanilla, Salto de Agua, Tila, Tumbalá, Yajalón, Chilón y Sitalá
- 8.
Unmet need consisted of the number of married or partnered women of reproductive age who wished to limit of space out births and were not using any kind of contraceptive method out of the total number of women of reproductive age.
- 9.
In the manuscript we do not list the specific locations so as to preserve confidentiality.
- 10.
Aldama, Chalchihuitán, Chamula, Chenalhó, Mitontic, Oxchuc, Pantelhó, San Andrés Larrainzar, San Juan Cancuc, Santiago el Pinar, Tenejapa, and Zinacantan. We did not work in Chanal or Amatenango del Valle given that we did not have collaborators or local contacts in these municipalities.
- 11.
Altamirano, Las Rosas, San Cristóbal de Las Casas, and Teopisca
References
Banco Interamericano de Desarrollo. (2013). México SM2015: Censo y encuesta de línea base por hogares, Informe final. Iniciativa Salud Mesoamérica 2015.
Campbell, O., & Graham, W. (2006). Strategies for reducing maternal mortality: Getting on with what words. The lancet maternal survival series. Lancet, 368(9543), 1284–1299.
Castro, R. (2000). La vida en la adversidad: el significado de la salud y la reproducción en la pobreza. Mexico: CRIM-UNAM.
CONEVAL. (2014). Pobreza en México. México: Consejo Nacional de Evaluación de la Política de Desarrollo Social.
Declaración de Moisés Gandhi. 1997. Por una Salud en Manos del Pueblo. Región Autónoma Tzotz-Choj, Chiapas. Retrieved January 7, 2017, from http://www.cedoz.org/site/content.php?doc=500&cat=83.
Donabedian, A. (1988). Los espacios de la salud: aspectos fundamentales de la organización de la atención médica. Mexico: Fondo de Cultura Económica.
Frenk, J. (1994). La salud de la población: hacia una nueva salud pública. La salud de la población: hacia una nueva salud pública. Mexico: Fondo de Cultura Económica.
Freyermuth, G. (2003). Las mujeres de humo. Morir en Chenalhó. Género, etnia y generación, factores constitutivos del riesgo durante la maternidad. Mexico: CIESAS, Porrúa.
Ibáñez, M., Heredia-Pi, I., Meneses, S., Pelcastre, B., & González Block, M. A. (2015). Labour and delivery services use: Indigenous women’s preference and the health sector response in the Chiapas Highlands of Mexico. International Journal for Equity in Health, 14(156), 1–10.
INEGI. (2014). Encuesta Nacional de Dinámica Demográfica 2014. Instituto Nacional Estadística y Geografía. Principales resultados. Retrieved May 12, 2016, from http://www.inegi.org.mx/est/contenidos/proyectos/encuestas/hogares/especiales/enadid/enadid2014/doc/resultados_enadid14.pdf.
INEGI. (2015). Encuesta Intercensal 2015. México: Instituto Nacional de Geografía y Estadística.
ISECH. (2014). Guía de consejería anticonceptiva con pertinencia cultural. Chiapas: Instituto de Salud del Estado de Chiapas/Salud Mesoamérica.
Kirsch, J., & Arana, M. (1999). Informed consent for family planning for poor women in Chiapas, Mexico. Lancet, 354, 419–420.
Ley General de Salud. 2016. Retrieved July 28, 2016, from http://www.diputados.gob.mx/LeyesBiblio/pdf/142.pdf.
Loewenberg, S. (2010). The plight of Mexico’s indigenous women. Lancet, 375, 1680–1682.
Meneses, S. (2004). Semiótica de la otredad. La diferencia como diagnosis. Etnografía de los encuentros médicos interétnicos en Los Altos de Chiapas. Tesis para obtener el grado de maestro en antropología social. San Cristóbal de Las Casas, Chiapas: Centro de Investigaciones y Estudios Superiores en Antropología Social, Sureste.
Nazar, A., Halperin, D., & Salvatierra, B. (1996). Efectos de las prácticas anticonceptivas sobre la fecundidad en la región fronteriza de Chiapas, México. Salud Pública México, 38, 13–19.
Nazar, A., Salvatierra, B., Morales, M., Rodríguez, M. (2011). Estudio cualitativo de barreras de demanda y oferta con enfoque a nivel local y comunitario y cambio de comportamiento en municipios prioritarios de Chiapas, México. Banco Interamericano de Desarrollo (unpublished).
OIT. (2008). Clasificación Internacional de Ocupaciones. Organización Internacional del trabajo. Retrieved June 4, 2016, from http://www.ilo.org/public/english/bureau/stat/isco/isco08/index.htm.
OMS. (2014). Informe Mundial del Estado de las Parteras en el Mundo, 2014, Conferencia Internacional de Matronas, Organización Mundial de la Salud. Retrieved February 20, 2016, from https://www.unfpa.org/sites/default/files/pub-pdf/SoWMy2014_complete-Spanish.pdf.
OPS. (2012). Plan de acción para acelerar la reducción de la mortalidad materna y la morbilidad materna grave: estrategia de monitoreo y evaluación (p. 1593). Montevideo: Publicación Científica.
ONU. (2015). Objetivos del desarrollo sostenible. Nueva York: Organización de las Naciones Unidas. Retrieved January 7. 2017, from http://www.un.org/sustainabledevelopment/es/.
Palma, C., & Suárez, M. (1994). Planificación familiar. Diferencias regionales en la práctica anticonceptiva. Demos, 7, 39–40.
PHR. (1999). Health care held hostage: Human rights violations and violations of medical neutrality in Chiapas, Mexico. Boston: Physicians for Human Rights.
PNUD. (2010). Objetivos de desarrollo del milenio. Programa de las Naciones Unidas para el Desarrollo. Retrieved July 28, 2016, from http://www.undp.org/spanish/mdg/goal5.shtml.
SSA. (2008). Programa de acción específico 2007–2012: Planificación Familiar y Anticoncepción, México. Retrieved January 7, 2017, from http://www.spps.gob.mx/planificacion-familiar-y-anticoncepcion.
SSA. (2014). Programa de acción específico Planificación Familiar y Anticoncepción 2013–2018. Mexico: Secretaría de Salud. Retrieved January 7, 2017, from http://cnegsr.salud.gob.mx/contenidos/descargas/PlanFam/PlanificacionFamiliaryAnticoncepcion.pdf.
Sesia, P. (2009). El potencial del programa Oportunidades para promover una maternidad segura y abatir la muerte materna en México: una propuesta de política pública para regiones indígenas de alto rezago social. In G. Freyermuth & P. Sesia (Eds.), La muerte materna. Acciones y estrategias hacia una maternidad segura. Mexico: Comité Promotor por una Maternidad sin Riesgos en México/CIESAS.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Meneses-Navarro, S., Meléndez-Navarro, D., Meza-Palmeros, A. (2018). Contraceptive Counseling and Family Planning Services in the Chiapas Highlands: Challenges and Opportunities for Improving Access for the Indigenous Population. In: Schwartz, D. (eds) Maternal Death and Pregnancy-Related Morbidity Among Indigenous Women of Mexico and Central America. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-319-71538-4_14
Download citation
DOI: https://doi.org/10.1007/978-3-319-71538-4_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-71537-7
Online ISBN: 978-3-319-71538-4
eBook Packages: MedicineMedicine (R0)