Health
 Guatemala
Project #2394

Family Planning for Guatemalans Living in Poverty

by WINGS
Vetted
Medical Director Michelle gives talk
Medical Director Michelle gives talk

It’s common knowledge that family planning is an extremely taboo topic in Guatemala.  Equally as taboo are mental health issues, another topic not openly discussed.  In Guatemala, many people think depression, anxiety, and other disorders are “made up” and don’t take them seriously. Recently, these two areas of health crossed paths in what became a learning experience for WINGS staff.

Daniel is a 36-year-old, unmarried man, without children who walked into our Antigua clinic wanting a vasectomy. For most Guatemalans, his presence would be considered odd, as he hadn’t even had any kids yet. In Guatemala, it is not common for men to get vasectomies. In addition to the culture of machismo, there is a great deal of incorrect information about vasectomies; some men think they will not be able to have sex again, some think they won’t have an orgasm again, and others believe reproductive health and family planning should only be a woman’s responsibility.

Regardless, Daniel was certain about his decision, and he underwent a vasectomy with no complications. We spoke with Daniel later on, and learned more about how WINGS helped him with the decision to have a vasectomy, a decision he made when he was 18 years old. We were surprised that at such a young age, he made such a permanent choice for his life. When we asked why, he slowly, but bravely explained that at 17, he was diagnosed with bipolar disorder. He has lived with this disorder for nineteen years now, and it has been very challenging in many ways, especially in a society that is not accepting of people who have mental health issues. Daniel shared, “I don’t want to have children because the disease is genetic, and I could never forgive myself if my child were to suffer as much as I have. I don’t know how I would handle that situation.”  

Daniel mentioned that growing up sexual health was taught in a very conservative manner in school. And while his parents never discussed contraceptives with him, they did support his decision to get a vasectomy. His female friends congratulate him for being so responsible.  His male friends constantly ask him about the pain, which is their main concern. However, Daniel explains how smoothly the process went, and some friends have become more interested in a vasectomy as an option and more open to learning about the work WINGS does. 

Because WINGS offers vasectomies for $6, Daniel was able to undergo the procedure without worrying about being in debt. Our services are affordable so that all Guatemalans, no matter their income or financial situation, can feel empowered to take control of their reproductive health. For us, it is extremely important to engage men in reproductive health, and though it can sometimes be a challenge, we are already seeing changes. Just in 2016, 101 men have gotten a vasectomy at WINGS, and we are certain that our number of patients will continue to increase from year to year, as has been the case so far.

Thanks to your valuable support, we are able to provide affordable services for patients in need. Your contributions are helping us change lives, one person at a time!

Daniel and his two favorite girls
Daniel and his two favorite girls
Men at a talk with our Medical Director
Men at a talk with our Medical Director

In Guatemala, there is much pushback toward family planning. Many people believe it is a sin to use contraceptive methods, and it is commonly believed that a woman’s role in life is solely to have children. Sadly, given that Guatemala is a very patriarchal country, many men support and encourage these ideals. In fact, many women in this country cannot use a contraceptive method without asking for her partner’s permission.

At WINGS, we believe that family planning is also men’s responsibility. We are certain that including and educating them about why family planning is beneficial. We have many adolescent men in our Youth Program, many of which have become Youth Leaders, and are making change in their communities. Another program we have at WINGS is our permanent procedure program; we offer vasectomies and charge roughly $6 for this surgery. We are excited to see more and more men welcoming this decision into their lives.

Lucas, 30 years old, came to our Antigua clinic in July. We held a Vasectomy Clinic, where 15 men showed up. When men arrive at our clinic during a Vasectomy Clinic day, they first get signed up, and then our Medical Director Michelle Dubón gives a talk to explain how the procedure works, along with the risks and benefits it has. After each man gets a vasectomy, they go to a room where we provide them food and a place to recover.

Lucas has two children. He had his first child when he was only 20 years old. Lucas shares his experience; “I had my first child at 20 and he was unplanned. I knew that condoms existed, but I was too afraid to buy them or ask for them. Because of how taboo this topic is in Guatemala, I felt judged. Now, I’m not embarrassed to ask for a condom but I know young people definitely feel bad when they have to do that. “

When he was young, family planning and contraceptive use were not to be spoken of in his community and in the country in general. Lucas never got information from his parents or other family members, and when he tried to ask his teacher in school, the teacher would change the subject. Lucas explained to us: “I acquired information about sexual and reproductive health from other types of people who were probably not the best role models. I think it is very necessary to get this type of advice from someone who is trained to do so and who is knowledgeable”.  Lucas mentioned that despite technology being so advanced these days, and even though more people have phones and internet now than ever before, nobody seeks reproductive health information. When asked why he thought people didn’t take the initiative to learn about their own bodies; he said that from a very young age, boys and girls are taught to feel guilty if they ask any questions related to sex. Lucas thinks the consequences of this can be seen in the high rates of teen pregnancies. He mentioned that nobody takes the time to talk to teenagers and explain what the changes in their bodies mean. Lucas has already started to talk with his little boy and with his nephews about reproductive health, so that they will never feel embarrassed to ask him anything.

When asked why he decided to get a vasectomy, Lucas shared that he made this decision because not only women should do it; “Getting a vasectomy will make it easier for me and my wife. Even though there are contraceptive methods for my wife, I am happy she doesn’t have to use them anymore. We don’t want any more children, so this is the soundest decision.”  

His wife already had two C-sections and he thinks it’s unfair for her to undergo another surgery, even if it’s a simple procedure. Lucas’s family is very supportive of him, and many of his family members have gotten a vasectomy. However, his friends have given him a hard time about his decision. They think that after getting a vasectomy, a man won’t ejaculate, hence making him less manly. “There are so many myths! My friends have the idea that a vasectomy makes you less of a man, and their attitude is very disturbing. I do what I can to reduce their misunderstandings so that they will one day make the same decision I did.”

Lucas is grateful to WINGS because in Guatemala City, this procedure can be very expensive, and he is not financially stable enough to pay a huge amount of money. He tells us that even though he had to come from the city, WINGS made everything so easy; from the low price that he preferred without hesitation, to signing up in the clinic that morning, to hearing the doctor’s explanation, to the brief procedure, to the care he was provided afterward. Lucas shared his thoughts about WINGS’ work and he mentioned that WINGS is doing a huge service for communities in Guatemala, and that he wishes we could reach the entire country. Lucas voiced his faith in the organization; “I encourage you to keep on doing what you do. Go to as many communities as you can, reach out to all the teenagers and families who are lacking information. I know that you are going to change this country.” At WINGS, we are pleased to see that more and more men are becoming involved and supporting their families by taking control of their reproductive health. We are also pleased to know that we can count on your support to make these programs possible. Thank you so much for investing in family planning services in Guatemala.

 

 

Two men waiting in line for their vasectomies
Two men waiting in line for their vasectomies
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
 

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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
$37,747 raised of $40,000 goal
 
658 donations
$2,253 to go
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