Health
 Guatemala
Project #2394

Family Planning for Guatemalans Living in Poverty

by WINGS
Vetted
Young mothers at WINGS
Young mothers at WINGS' mobile clinic

Life for Teenage Mothers in Guatemala

Adolescence should be a period of discovery and change, of transitioning from childhood to adulthood. In Guatemala the reality is unfortunately a different one, where young girls have to learn to be adults too early. Guatemala has one of the highest teenage pregnancy rates in Latin America, and is the only country in Central America where teenage pregnancy is on the rise. A shocking 58.1% of young women become pregnant for the first time before age 18. This can often be attributed to sociocultural norms, lack of sexual education, and little access to reproductive health services. Unmet need for family planning is the highest among this age group, with 25.6% of young women between 15 and 24 expressing an unmet need.

In a recent mobile clinic in San Francisco Zapotitlán, on the country’s Pacific coast, we met 21-year-old Fabiola. Born in San Francisco Zapotitlán, Fabiola is one of seven siblings. Her mother sold vegetables and fruit in the local market to provide for her children. While her mother was working, Fabiola was in charge of the house, taking care of her younger brothers and sisters, despite being a child herself. As in many Guatemalan families, nobody ever told Fabiola about birth control. When she was 18, Fabiola had her first child. She struggled because on top of looking out for her younger siblings, she now had her own baby to take care of. At 19, Fabiola had her second child. Today, Fabiola is 21 years old and has three children. Raising her three children has not been easy: “Being a mother is a beautiful thing, but sometimes I feel like I can barely manage. I can’t afford to provide my children with everything I’d like to give them, and when they get sick, I can’t sleep because I’m worried about their well-being”.  

Days before the mobile clinic, our Field Supervisor Mylin visited women in San Francisco Zapotitlán to talk about their family planning options and encourage them to attend our mobile clinic. Although Fabiola showed up, she was very scared about using birth control. In San Francisco as in many Guatemalan communities, birth control is highly stigmatized. While she was afraid that her community would judge her, Fabiola knew that she could not afford to have more children. After discussing which contraceptive options we could offer her, Fabiola chose the subdermal hormonal implant, which provides up to 5 years of protection. Fabiola said she is grateful to WINGS because now she does not have to worry about becoming pregnant again and she is ready to dedicate all her time to raising her three boys. “WINGS is one of the few organizations that has reached out to women in my community. Many of us do not have enough money to go to a big hospital and pay for expensive services. Once I told the nurses I did not have enough money for the implant, they gave it to me for free!”

Young mothers at WINGS’ clinic

It is not surprising that many teenagers end up being parents at a young age, just like Fabiola. There is little and often incorrect information available to them and very limited access to contraceptive methods or they cannot afford them. Young women face barriers many older women do not, such as biased health care providers who refuse to attend them, claiming adolescents are not old enough for this type of education or services. WINGS strives to be as youth-friendly as possible, training our staff and volunteer promoters on how to provide youth-friendly counseling and providing contraceptive methods free of charge to anyone age 15 to 19. Last year alone 3,429 young women and men came to WINGS for a short-acting or long-acting reversible contraceptive method.

During the same mobile clinic, we met Berta, a 19-year-old girl who carried her 10-month-old baby in her arms. Berta too had never learned about birth control – not even in school where teachers are legally required to provide sexual education.  When Berta was 5 years old, her mother passed away. She was raised by her aunts and her father. Her family is very religious, and she was not allowed to ask any questions related to sexuality. She was very surprised when she got pregnant, as was all her family. A friend of her late mother told Berta about the mobile clinic, so Berta came in to get a subdermal hormonal implant. Berta may want to have one other child in the future, but she is happy that she now gets to choose when she is ready for that.

It is through the support of our donors that we can provide reproductive health services to youth in Guatemala, free of cost, so that they can have a chance at a better future. Thank you so much for supporting WINGS in empowering young women in Guatemala to take control of their reproductive lives. 

21-year-old Fabiola and her youngest of 3 sons
21-year-old Fabiola and her youngest of 3 sons
Berta, 19, and her 10-month-old son
Berta, 19, and her 10-month-old son
Isabela, 18, breastfeeds at WINGS
Isabela, 18, breastfeeds at WINGS' mobile clinic
A young mother during a WINGS family planning talk
A young mother during a WINGS family planning talk

Guatemala is often known for its beautiful landscapes, travel spots, and rich Mayan history. However, Guatemala is also known for its struggles as a developing country, especially for its extremely high poverty rates. Seventy five percent of the indigenous population in Guatemala lives in poverty. Those who live in extreme poverty in this country live on $2 a day. Along with poverty, malnutrition is widespread. One in every two children under 5 years old is chronically malnourished. This makes Guatemala the country with the highest malnutrition rate in Latin America and the Caribbean, and fourth highest in the world.  Chronic malnutrition occurs over time and affects children cognitively, socially, and physically. Chronically malnourished children are very short for their age and their learning capabilities are lower than those of a healthy child. The first 1000 days of a child’s life are crucial in establishing good nutrition because after that, the effects of chronic malnutrition are irreversible.

But what do poverty and malnutrition have to do with family planning? Well, if a family has access to reproductive health services, they will get to choose how many children they have. They will most likely have fewer children than families who do not have access to family planning services. A family with fewer children will be more likely to meet the needs of each child financially. On the other hand, parents who have 11 children, for example, will find it far more challenging to properly feed them all. Many large families in this country do not have enough resources to pay for food, hence their children quickly become malnourished, and so the cycle goes on. To make matters worse, in Guatemala there is nearly a 30% unmet need for family planning. For indigenous women, it is even more challenging; 1 in 3 indigenous women have no access to health and family planning services. The average Guatemalan woman’s ideal number of children is 2, but they have 3.8 on average and 4.6 in indigenous communities. This makes Guatemala the country with the highest fertility rate in Latin America and the Caribbean.

Ana is from San Pablo la Laguna. At 46 years of age, she has been pregnant eight times and currently has five children. Ana is chronically malnourished and weighs less than 100 pounds; her body is not fit for pregnancy, resulting in three pregnancies ending in miscarriage.  Ana came to a WINGS clinic held at a partnering hospital in Santiago, extremely pale and clearly anemic. She had never used a contraceptive method before, simply because she could not afford one. Ana came to the hospital in hopes of getting a tubal ligation, even though she had no way of paying for it. Unquestionably, our staff was prepared to waive the operation costs so that Ana could receive the method of her choice. Because her health was quite unstable, it was a very delicate procedure, but Ana’s operation was successful. Even though our medical staff recommended that she stay in the hospital that night, Ana had no one to look after her children, so she went back to her village. WINGS’ staff is still in regular contact with Ana, to make sure that her health is better than the first time we saw her. Ana is now able to focus more on her own health and the health of her family, without being concerned about future unintended pregnancies.

Family planning positively impacts Guatemalans by enabling them to take ownership of their reproductive lives, providing them a path out of the cycle of poverty and malnutrition. Just in 2015, we provided reproductive health education, contraceptive methods, and family planning services to more than 21,310 people in Guatemala. Through WINGS stationary and partner clinics, we performed six times the number of tubal ligations and vasectomies projected for 2015. In the first three months of 2016, we have already provided family planning services to 3221people in Guatemala.  

It is through the support of donors like yourself that we can provide family planning services in Guatemala, to break the cycle of poverty and malnutrition. Thank you so much for your continued support and for standing with WINGS in bringing reproductive health services to the most vulnerable in Guatemala. 

Discussing the importance of family planning
Discussing the importance of family planning
Providing contraceptive methods in rural Guatemala
Providing contraceptive methods in rural Guatemala
Ana-Antoineta joined us in Morelia
Ana-Antoineta joined us in Morelia

In Guatemala, 58.1% of youth become pregnant for the first time before age 18, leading to one of the highest adolescent fertility rates in the region: 92.4 births per 1,000 girls between ages 15 and 19. All the more shocking is that over a quarter of young women between ages 15 and 24 express an unmet need for family planning. This means these young women do not want to have a child right now, but are not using contraception. 

We ask ourselves why, if these girls and young women do not want to have a child right now, are they not taking preventative measures as simple as taking birth control? Unfortunately, the reality in Guatemala is not that simple. Stigmas, misconceptions, and administrative barriers often impede young women and even men from not only learning about their sexual health, but buying and properly using any form of birth control. In fact, one of the biggest issues we see is that one too many healthcare providers do not treat youth with the respect they deserve. Rather, questions and doubts are dismissed and young women and men are turned away because ‘they are too young’ or ‘they need permission’. While WINGS has worked throughout the years to ensure the availability of accessible information, most recently through our networks of youth leaders, making services ‘youth-friendly’ remains the bigger challenge.

But we are happy to report, that we are overcoming that challenge: between March and December of this year, our local family planning promoters and mobile units saw a 234% increase in the number of not-in-school youth deciding to use birth control. 131 more young women and men chose to protect themselves from early pregnancies (and in many cases, sexually transmitted infections) in the past nine months. Among those 131 youth, was Ana-Antoineta from Morelia, a mountainous village in the Western Highlands accessible only by a muddy dirty road. At 19 years old, the mother of two was unable to learn about birth control, let alone receive any kind of health services in her rural community. Fortunately, WINGS’ Family Planning Promoter Enma who lives in nearby Vista Hermosa decided to organize a mobile clinic with our medical team. Our two nurses and driver made the bumpy journey, crossing an overflowing river during the midst of Guatemala’s rainy season, to provide highly effective long-acting reversible birth control to 18 women, as young as 19 year old Ana-Antoineta and her neighbor Delfina, a 16 year old mother of one.

We know in many cases that we are helping women prevent their second pregnancy which is equally as important as enabling girls to postpone the first pregnancy until they are mentally, physically, and emotionally ready to be mothers. Girls and young women who give birth at an early age are more likely to become multiparous earlier than their counterparts who become pregnant for the first time later in life. Not only do pregnancies at an early age and multiparity increase reproductive risks for these young mothers, but also, are major risk factors for developing cervical cancer, the leading cause of cancer-related deaths among Guatemalan women.   

Many young women like Ana-Antoineta do not have the opportunity to continue studying, earn a decent living, and perhaps build the future they once dreamed off, but instead are now making responsible decisions to invest in the futures of their children. Ana-Antoineta was so grateful for finally having access to family planning services that she has started talking to her family and friends about their options so that they have the freedom to plan their lives as they see fit.

So how do we make it easier for youth like Ana-Antoineta to learn about and decide on available family planning options? We make sure that everyone involved in the chain of services willingly creates a supportive environment for these often nervous young women and men. From your neighborhood promoter Enma and youth leader Alejandra who will offer you counselling and answer any of your questions in a kind receptive manner, to our mobile staff that will travel by whatever means necessary to make sure the service is available in your community, and to our entire team that has made the decision to provide all services to youth between ages 14 and 19 for free, we are committed to making sexual and reproductive health information as accessible and friendly as possible.

And it is only through the support of donors like yourself that we are able to carry out our work. So thank you for your continued support and for standing with WINGS in bringing sexual and reproductive health information and services to the most vulnerable in Guatemala.

Clinic attendees learning about the IUD
Clinic attendees learning about the IUD
Our mobile unit making the bumpy journey
Our mobile unit making the bumpy journey
Morelia
Morelia
Our youngest team members preparing snacks
Our youngest team members preparing snacks
Informational Talk
Informational Talk

Since January 2015, WINGS is proud to offer voluntary surgical contraception (tubal ligations for women and vasectomies for men) as one of our valued reproductive health services. We have seen an overwhelming need for these services throughout Guatemala with many women and men having wanted a permanent procedure for some time, but  unable to find affordable care. We are both surprised and encouraged by the number of men, 37 so far, who have chosen a vasectomy, as we anticipated performing 10 vasectomies throughout all of 2015. Our incredibly subsidized prices have allowed numerous men and women to access their contraceptive method of choice.

In spite of these initial successes, we know many barriers remain to acceptance and use of permanent contraception in Guatemala, especially for men. Besides cost, men confront misconceptions and stigmas about vasectomies such as they cause impotence and they are emasculating. It is a commonly held belief in Guatemala that the size of one's family reflects a man's worth, therefore, limiting the number of children a man could have undermines his worth. Secondly, male involvement in family planning is not only limited in Guatemala, but also a taboo. Family planning is believed to be a woman's issue and therefore, it is her responsibility to use a method.

Despite these barriers, 22 men came to our vasectomy clinic in Antigua this past month and underwent the quick procedure. Daniel was one of the first men to arrive, accompanied by his partner, Gaby. Daniel and Gaby live in Guatemala City, an hour away from our office, and had been interested in a vasectomy for a long time but unfortunately nearby services were always too expensive, over $150 in a country where 43.5% of the population survives on less than $450 per year. They planned to wait until they saved enough money for the procedure but luckily, Gaby heard about our clinic in Antigua, where we asked men for only a $ 6.50 donation for their procedure.

Gaby quickly let Daniel know so that he could take time off work and the couple arrived at our clinic grateful for the opportunity they were given. Daniel told us that he never had any children, but he and Gaby are parents to her 10-year-old daughter from a previous marriage.

Daniel and Gaby feel very happy with the family they now have and together made a decision not to have any more children. Daniel confessed that, although he considers himself an open-minded and progressive person who is not afraid to speak his mind, he decided not to share his plans about having a vasectomy with anyone until after the procedure.

“My family and friends think a man should have children. If they knew I was planning to do this, they would have tried to convince me to change my mind. But I feel that my parents and grandparents didn’t raise me to blindly follow society’s norms. I believe a man or a woman has a right to make their own decision about if and when they want to have children.”

Kevin, who arrived shortly after Daniel and Gaby, made the decision to have a vasectomy to make sure his wife Vivian can lead a long, healthy life.

Vivian had serious complications during her first pregnancy. For months her feet and face were severely swollen, she was extremely weak and was advised to rest. During labor Vivian lost consciousness twice and had to be revived by the attendings - she nearly died during delivery.

Luckily, Vivian made it through labor and she and the baby are now doing well. However, the attending doctor told the couple that if Vivian becomes pregnant again, she may face life-threatening complications during the pregnancy. Considering what his wife suffered while delivering their child, the couple wanted a real solution to preventing future pregnancies.  Tubal ligation was out of the question due to the high risk of complications for Vivian. Kevin didn’t want his wife to have to take hormones for years, and since they were both sure they didn’t want to have anymore children, he offered to have a vasectomy. The couple struggled to find affordable services in their area, but, having heard of WINGS’ clinic, they decided to call one of our team members to reserve an appointment for the procedure.

Post surgery, Kevin and Vivian shared how happy they are now that they don't have to worry about future pregnancies putting Vivian´s life at risk.

Later in the day, 50 year old Roger came to the clinic. A veterinarian by trade, he works for a large dairy company and spends much of his time organizing clinics to care for animals. Roger and his wife who have 3 children between 10 and 14 years of age decided their family size was just right and started looking into their contraceptive options.  

The day of the vasectomy clinic, Roger shared his thoughts about family planning with WINGS, “In Guatemala, the idea of men being involved in family planning is a huge taboo. The idea that ‘a man is no longer a man” after having a vasectomy is very common.” He believes that a lack of information is to blame for these misguided ideas.

Roger opposes the machismo culture in Guatemala which means women would undergo the operation, not the men. “Women are expected to do everything, men nothing...just lie on the sofa” he says.

Pleased with his decision to have a vasectomy, Roger believes he and his wife can provide for their children and offer them everything they need to have a head start in life.

We congratulate Daniel, Kevin, Roger, and all the men who have chosen to take an active role in the health and future of their families, setting an example for other men, and breaking down barriers to reproductive health in Guatemala.

Thank you for your support and for making reproductive rights a reality for all in Guatemala.

Daniel and Gaby
Daniel and Gaby

Links:

Youth Leaders in Training
Youth Leaders in Training

It is widely acknowledged in the world of sexual and reproductive health that young people require a separate, unique approach when it comes to delivering education and services. There are many barriers young people face concerning access, such as judgement from their communities, families, and/or health care providers, limited or incorrect knowledge, and cost of services/transportation. Some of their key concerns are privacy and confidentiality, followed by quick in and out service. So how do we provide youth friendly services?

First we look at the context. In Guatemala the statistics relating to youth vary from region to region and amongst different populations, such as indigenous versus non indigenous groups. Petén has the highest teenage pregnancy rate in all of Guatemala. Alta Verapaz faces the highest number of maternal deaths in adolescents, with 44% of adolescents giving birth before age 20, and 29% of those births unplanned. More astounding, nearly 50% of Guatemalan women give birth before age 20. And even though 83% of sexually active women between ages 15 to 19 have stated they do not intend on having children within 2 years, only 18% are using effective contraception. These different local situations within the same country necessitate strategies that are aware of the structural barriers and easily adaptable.

For WINGS, the strategy to ensuring adolescents have access to youth friendly services has been peer outreach with strong community support. In many rural, indigenous, and low-income communities throughout the country, few young women and men continue studying past middle school. Take the north for example, nearly 85% of adolescent girls do not complete junior high school which means their access to vital information regarding their health and their rights is extremely limited. Our Youth Leader projects in Alta Verapaz and Petén recognize the limited access to social and educational spaces and trains young women and men to be leaders in their communities who share knowledge about reproductive risk, rights and advocacy, gender inequality, and sexual identity with their peers. Youth leaders develop and offer informal talks to vulnerable peers in their communities, creating safe spaces for adolescents to address stigmatized topics, including sexual violence and ‘machista’ norms, in addition to helping their peers access our youth-friendly health promoters and mobile clinics for their specific sexual and reproductive health needs. These leaders become trusted and reliable sources of information who simultaneously build their self-esteem and become advocates for reproductive rights at the community level.

Using peer outreach this year we can reach 3,600 marginalized youth through informal talks and provide services to a minimum of 450 marginalized youth.

Early this year, WINGS hired its youngest staff members, a 17 year old and an 18 year old who are working as Assistants in the Sierra del Lacandón Park in Petén. Together Dalila and Hector support 20 youth leaders from 10 communities, promote family planning clinics, and seek new ways to engage young men and women to think about their health and their futures: “We see these young mothers and have to remember that they are still girls. Instead of toy dolls, they are now taking care of real dolls. They’re kids taking care of kids. That’s why our work is so important.”

For Dalila, this is more than just a job, it’s about her community’s wellbeing. As one of five siblings and one of the few to have stayed in her small community along the Mexican border, Daly as she’s known, has different plans. “I just started studying social work this year in Santa Elena [the provincial capital]. I want to understand the problems we face, at the root, and fix them.” Daly makes the arduous 8 hour journey to study every Saturday morning and travels daily on dirt roads between communities providing both informal and formal workshops, counselling, and support to youth leaders.

Our youth leaders and young staff members continue to awe us with their commitment to their communities and we are fortunate to have the opportunity to train more youth throughout the country. In June, we were invited by a local NGO Education for the Children Foundation to work with their high school and college scholarship students. Our team organized and led a dynamic activity during the Foundation’s Annual Sexual Education Congress on the topic of 'Responsible Parenthood'. It was a fantastic opportunity to work with a group of young men and women who all have overcome many difficulties to continue their education and break from the cycle of poverty.

WINGS is working hard to ensure young people in Guatemala have access to information and services about sexual and reproductive health that understand their needs and meet them. Moreover, we are increasingly moving towards linking sexual and reproductive health to livelihoods, in order to create long term sustainable change. We encourage our youth leaders and their peers to identify what they want for themselves, what is available within their communities, and what tools they need to fulfill their plans.

Youth Workshop in Coban
Youth Workshop in Coban
Activity with Education for the Children
Activity with Education for the Children
Youth participate in educational workshop
Youth participate in educational workshop
 

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Organization Information

WINGS

Location: Antigua, N/A - Guatemala
Website: http:/​/​www.wingsguate.org
Project Leader:
Sally Parmelee
Development Coordinator
Antigua, Guatemala
$36,123 raised of $40,000 goal
 
610 donations
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