Unintended Pregnancy, Induced Abortion, and Unmet Need for Effective Contraception in Twenty-First Century Indigenous Mayan Populations of Guatemala

Abstract

Almost one-half of the Guatemalan population is of indigenous Mayan ancestry, and in some districts this ratio reaches above 90%. Guatemala had a broad national and international legal framework including the peace accord signed by the Guatemalan government in 1996; however, the legal and political mandates of this framework have not led to significant improvements in their health or in provisions of healthcare, and especially for the indigenous, and the rural and poor girls and women. Unmet needs for effective contraception are believed to have been reduced from 28 to 14% over the past decades, and the demand for modern contraceptive methods have increased from 45 to 66% during the same period. These figures need to be interpreted with caution, given that the definition used for effective modern contraceptives include the Lactational Amenorrhea Method (LAM), which is highly controversial and of very questionable effectiveness in the public health sector. The total fertility rate in the indigenous populations has decreased from 6.8 children per woman to 3.6 children per woman over the past four decades, but significant ethnic-based disparities between Mayans and non-Mayans still persist. In Guatemala, it is estimated that a total of 66 unintended pregnancies occur per 1000 women each year, and that more than one-third of all pregnancies are either unplanned or unintended. Overall, about 205 pregnancies are believed to occur per 1000 women in the reproductive age range of 15–49 years. It is estimated that approximately 65,000 abortions are performed each year in the same age range, which represents an annual rate of 24 abortions for every one thousand Guatemalan women of reproductive age. Eighty-two percent (82%) of poor rural indigenous adolescent girls and adult women seeking abortions are not seen or treated by qualified providers. Maternal morbidity and mortality secondary to induced abortion continues to be a very significant and preventable public health problem in Guatemala.