Objective This study investigated ethnic differentials in the use of pregnancy-related care and aimed to identify whether the differences persist when geographical access to services is equal. This study was based in the north-eastern Ch'orti area of Guatemala, an area characterised by a mixed ladino (of Spanish descent) and Maya (Ch'orti) culture.

Methods Data from a household survey carried out in 2001 in the town of Jocotán, and a previous survey carried out in 1994 in two nearby indigenous villages (aldeas), were used in this study. Logistic regression was used to explore the data. Unlike the Demographic and Health Survey (DHS) (1998–1999) that classifies ethnic groups according to dress and language, this study introduced an alternative approach based on self-identification.

Results The results showed significant differences and a gradient in the use of modern pregnancy care services among self-identified ethnic groups within the same town, after controlling for socioeconomic and cultural indicators. Women of ‘mixed’ ethnicity had an intermediate behaviour between ladino and indigenous women. Women in the nearby aldeas almost solely relied on the traditional birth attendant for pregnancy-related care. The DHS data did not permit the detection of ethnic diversity in the use of pregnancy care for this region.

Conclusions Differences in the use of modern pregnancy care exist even among self-identified ethnic groups with no outward markers of ethnicity and persist when access to services is equal. For the majority of the population, living in indigenous villages, pregnancy care remains traditional. This ethnic diversity highlights the importance of further extending affordable, high-quality and culturally adapted maternal health care services in Guatemala