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Download?Doi=10.1.1.43 1.8235&Rep=Rep1&Type=Pdf This master’s paper will demonstrate the attainment of the following four competencies: Evidence-based Approaches to Public Health. Analyze quantitative and qualitative data using biostatistics, informatics, computer-based programming and software, as appropriate. Evidence-based Approaches to Public Health. Interpret results of data analysis for public health research, policy or practice. Substantive Knowledge. Critically analyze determinants of health among infants, children, adolescents, women, mothers, and families, including biological, behavioral, socioeconomic, demographic, cultural, and healthcare systems influences across the life course. Research. Contribute to public health evidence by applying rigorous research methods to address problems relevant to the health of MCH populations. Ethnicity and Reproductive Autonomy: A Study of the Relationship Between Indigenous Self-Identification and Current Use of a Modern Contraceptive Method in the Huehuetenango Department of Northwestern Guatemala By Kay Schaffer A paper presented to the faculty of The University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Public Health in the Department of Maternal and Child Health. Chapel Hill, North Carolina April 23, 2020 Approved By: _______________________________________ Ilene Speizer, PhD (First Reader) ________________________________________ Deborah L Billings, PhD (Second Reader) 2 Abstract Objectives: Indigenous women in Guatemala have lower rates of contraceptive use than non-indigenous women. This study explores the relationship between indigenous self- identification and current use of a modern contraceptive method among women of reproductive age in the Huehuetenango Department of Guatemala. Methods: Data from the 2014-2015 Demographic and Health Surveys (DHS) for Guatemala were used to examine contraceptive use among varying populations of women. Descriptive and multivariate logistic regression analyses are performed to examine the association of demographic and social factors on modern contraceptive use. Results: There is a negative association between indigenous self-identification and modern contraceptive use. Women who were married and those who were an older age were significantly more likely to be modern contraception users. Conclusions: Understanding the contraceptive needs that indigenous women have throughout their lives will allow family planning programs to better serve this target population. 3 Table of Contents Abstract........................................................................................................................... 2 Table of Contents............................................................................................................ 3 Problem Statement.......................................................................................................... 5 The “Contraceptive Revolution” in Latin America ............................................................. 5 The “Delayed Contraceptive Revolution” in Guatemala ..................................................... 6 Rationale for the “Delayed Contraceptive Revolution” in Guatemala................................ 7 Literature Review ........................................................................................................... 9 Hypothesis .................................................................................................................... 13 Methods ........................................................................................................................ 13 Data ..................................................................................................................................... 13 Data Analysis ...................................................................................................................... 17 Results .......................................................................................................................... 17 Discussion .................................................................................................................... 28 Limitations .................................................................................................................... 32 Conclusion .................................................................................................................... 33 References .................................................................................................................... 34 Acknowledgements ....................................................................................................... 38 4 Acronym List CDC- Centers for Disease Control and Prevention CPR- Contraceptive prevalence rate DHS- Demographic and Health Surveys IUD- Intrauterine Device LAC- Latin America and the Caribbean SRH- Sexual and reproductive health TFR- Total fertility rate WHO- World Health Organization 5 Problem Statement The US Centers for Disease Control and Prevention (CDC) has heralded family planning as one of the top ten greatest public health achievements of the 20th century.1 Improving access to contraception has demonstrated economic and social benefits for families, as well as improving health outcomes for women, such as decreased maternal mortality and morbidity.2 Family planning also allows women to practice birth spacing by delaying a subsequent pregnancy so the body has time to heal and recover, and to limit the number of children that they have. The World Health Organization (WHO) currently recommends that women wait at least 24 months after a live birth before becoming pregnant again in order to have the best health outcomes for mothers and newborns.3 Furthermore, with unsafe abortion accounting for anywhere from 4.7-13.2% of all maternal deaths annually from 2010-2014,4 providing access to contraception to decrease the number of unintended pregnancies is an intervention that stands to reduce maternal mortality and morbidity globally. The “Contraceptive Revolution” in Latin America Roberto Santiso-Galvez and Jane Bertrand (2004) describe the transformation of sexual and reproductive health (SRH) in Latin America and the Caribbean (LAC) over the past 50 years as a “contraceptive revolution.”5 In 2019, LAC had a contraceptive prevalence rate (CPR) * of 58%, which was the second highest regional CPR in the world.6 Although measuring SRH indicators at the regional level provides valuable insight, rates and other data that summarize these indicators over large diverse *CPR is the percentage of women aged 15-49 years old who are currently using, or whose sexual partner is currently using, at least one method of contraception.41 6 geographic areas make it difficult to understand the reality at the country or local level. There have also been significant demographic changes in the total fertility rate (TFR)† in LAC, which has dropped from 6 children in the 1960s to 2.2 children in 2015.7 The maternal mortality ratio has also decreased from 96 maternal deaths per 100,000 live births in 2000 to 74 maternal deaths per 100,000 live births in 2017.8 The “Delayed Contraceptive Revolution” in Guatemala Through the tireless efforts of activists, local non-governmental organizations, and the international community, SRH outcomes in Guatemala have dramatically improved. However, the “contraceptive revolution” experienced by many other countries in LAC has been “delayed” in Guatemala5 as SRH outcomes still lag behind many countries in LAC. Despite following regional trends, the CPR in Guatemala is one of the lowest in LAC with 60.6% in 2014.9 Furthermore, the CPR in Guatemala decreased to 52% in 2019 when looking solely at use of modern contraceptive methods,9 which was well below the regional average of 70% in 2019.10 Modern contraceptive methods are highly effective if used correctly and can help prevent unwanted pregnancy in both the short and long term depending on the method of choice.11 The WHO considers the following to be modern contraceptive methods: hormonal birth control pills, contraceptive implants, injectable contraception, the contraceptive ring, intrauterine device (IUD), condoms, male sterilization (vasectomy), female sterilization (tubal ligation), emergency contraception, lactation amenorrhea, standard days method, basal body temperature method, two day method, and symptom thermal method.11 † TFR is the average number of children a woman will have in her lifetime.7 7 The TFR in Guatemala has declined from 7 children per woman in 1960 to 3 children per woman in 2017, yet remains higher than the regional average of 2.2 children per woman in 2017.12 Additionally, it is estimated that 55% of unmarried women and 26% of married women in Guatemala have an unmet need for family planning.‡13 Furthermore, while the maternal mortality ratio has decreased from 161 maternal deaths per 100,000 live births in 2000 to 95 maternal deaths per 100,000 live births in 2017 in Guatemala, it remains one of the highest in LAC.8 Rationale for the “Delayed Contraceptive Revolution” in Guatemala Santiso-Galvez and Bertrand attribute this “delay” to numerous historical events and sociocultural factors that have affected the acceptability of contraception among Guatemalans, including the rise of leftist movements in Latin America during the 1960s and 1970s and resulting civil unrest, the ethnic composition of the Guatemalan population, and religious opposition to family planning.5 One of the most influential events was the Guatemalan Civil War from
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