Family Planning

Family Planning Among Indigenous Populations In Latin America
By Anne Terborgh, James E. Rosen, Roberto Santiso Gálvez, Willy Terceros, Jane T. Bertrand and Sheana E. Bull

Approximately 40 million people living in five Latin American countries—Bolivia, Ecuador, Guatemala, Mexico and Peru—retain the language and much of the culture of the ancient pre-Columbian civilizations of the Aztecs,Mayans and Incas. These indigenous people tend to be poor, rural residents with little education. Long an underserved population from a health care perspective, the indigenous population has also proved difficult to reach with family planning services. An examination of two promising projects—one in Guatemala and one in Bolivia—suggests several potentially useful strategies for reaching indigenouspeople, among them the use of community workers and traditional health practitioners to promote family planning, the provision of a mix of maternal and child health services along with family planning and the employment of bilingual and bicultural staff members. (International Family Planning Perspectives, 21:143–149 & 166, 1995)

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lthough fertility rates in Latin America have declined steadilyover the past 25 years and the level of modern contraceptive use among women in union has risen (from less than 10% before 1970 to the current level of 48%),1 these broad advances have been spread unevenly among ethnic and cultural groups. One segment of Latin American society relatively untouched by the contraceptive revolution is the indigenous population of the region. No single definition of“indigenous” exists, but most agree that the indigenous people of Latin America are descendants of the pre-Columbian inhabitants of the region who retain some or all of their own social, economic, cultural and political institutions. This group is enormously varied, though, speaking hundreds of different languages and ranging from members of small, isolated forest tribes to the millions ofQuechua-speaking descendants of the vast Inca empire of South America. The lack of a standard definition makes it difficult to consistently and accurately identify indigenous people. Multiple facAnne Terborgh is senior associate with Development Associates, Arlington, Va., USA. James E. Rosen is senior research associate with Population Action International, Washington, D. C., USA. Roberto Santiso Gálvez isexecutive director of the Asociación Pro-Bienestar de la Familia de Guatemala, Guatemala City. Willy Terceros is program director of the Fundación Ecuménica para el Desarrollo, Cochabamba, Bolivia. Jane T. Bertrand is a professor at the School of Public Health and Tropical Medicine, Tulane University, New Orleans, La., USA. Sheana E. Bull is faculty associate at Emory University School of PublicHealth, Atlanta, Ga., USA. The authors would like to thank the Demographic and Health Surveys staff at Macro International for their assistance in tabulating data by ethnic group.

tors unite ethnic groups, including race, culture, traditions and language.2 However, factors such as adherence to traditional values and cultural identification can be difficult to measure. In Latin America, wheregovernments do not commonly disaggregate statistical indicators by ethnicity, very little national information is available. Data gathered in surveys and special studies often rely on easily observable indicators, such as dress and language, to identify indigenous people. These, however, are less than adequate for identifying a population in various stages of transition and acculturation. Many indigenouspeople living in urban areas, for example, speak Spanish and even wear Western dress, but continue to observe traditional customs and maintain strong ties with their rural communities of origin. As can be seen in Table 1 (page 144), it has been estimated that more than 40 million of the 144 million people living in five countries in Latin America—Bolivia, Ecuador, Guatemala, Mexico, and Peru—...