Context: A key challenge of the 1990s is increasing the acceptance of family planning in hard-to-reach populations. The Mayan populations in Guatemala lag far behind the nation's primary ethnic group in terms of health indicators and contraceptive use.
Methods: An intervention project was conducted in 1993-1996 in the predominantly Mayan department of El Quiché to increase knowledge about and use of contraceptives, and to improve attitudes toward birthspacing. The effect of the intervention was assessed using program-based data (routine service statistics from the leading family planning organization) and population-based data (a 1992 baseline and a 1996 follow-up survey conducted in eight municipalities).
Results: Knowledge of at least one method and positive attitudes toward birthspacing increased dramatically over the period between surveys. For example, while only 42% of Mayan women in 1992 knew of a modern method, 95% of those interviewed in 1996 did so; moreover, the proportion who responded that birthspacing was "good" more than doubled over the period (from 43% in 1992 to 88% in 1996). Current contraceptive use similarly rose from 5% to 18% in the period between surveys. The number of volunteer promoters, who are able to reach Maya-Quiché women in remote rural areas, increased notably—from 79 in 1993 to 144 in 1995. The study design could not rule out confounding factors. However, logistic regression revealed that program-related variables (i.e., contact with the private family planning clinic and exposure to birthspacing messages in the mass media) and previous reproductive experience (i.e., having experienced a mistimed pregnancy) were important predictors of contraceptive use, once social and demographic factors were controlled for.
Conclusions: The three-percentage-point annual increase in prevalence among Mayan Guatemalans achieved during this intervention demonstrates that the pace of contraceptive adoption can be accelerated in this hard-to-reach population. However, the process requires an influx of resources and a long-term commitment on the part of program administrators and donors.