Access as a factor in differential contraceptive use between Mayans and ladinos in Guatemala

Previous studies have demonstrated consistently that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladino counterparts (e.g. 50% versus 13% in the 1998 Demographic and Health Survey - DHS). Most researchers and practitioners have attributed this to social, economic and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 km from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering family planning services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to injectables. Otherwise, the family planning supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8% of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM - which was the nearest facility for only 7% of the respondents in this study - was the source of supply for 48% of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users.