JEFFREY BROWN: Now, the second of Ray Suarez’s global health reports from the Central American nation of Guatemala.
Tonight, Ray looks at the many obstacles to family planning in that traditional society.
RAY SUAREZ: Every day, Evelyn Roquel travels the rugged countryside of Guatemala’s highlands teaching women about birth control. In a population where the fertility rate is the highest in Latin America, it’s a daunting task.
Evelyn works for Women’s International Network for Guatemalan Solutions, called WINGS. Not surprisingly, the highest fertility rates are in the hardest-to-reach areas of the country, places reached mainly by boat, like the villages that surround Lake Atitlan.
EVELYN ROQUEL, Women’s International Network for Guatemalan Solutions (through translator): I travel to very far-off places. I typically go to places several times over and over again. When I first come to a community, I am met with a lot of resistance, but I keep coming.
RAY SUAREZ: Here, populations are overwhelmingly Mayan and overwhelmingly religious. Women typically have eight, nine, 10 children.
EVELYN ROQUEL (through translator): The culture and mind-set here makes birth control very difficult to discuss. It’s so embedded that the number of children is what God gives you; it’s out of your hand. So, for most women, this is a very new theme, which breaks with their traditional cultural values.
RAY SUAREZ: On this day, Evelyn is greeted by a huge crowd of women in San Marcos. It’s a scene that plays out again and again as Evelyn travels throughout the region.
Most of the women here have no idea what birth-control methods are available to them, much less how to obtain them. But they are experts on their own lives. When Evelyn shows the crowd a picture of a pregnant woman with an infant on her back and a toddler in her hands, the reaction is immediate. They know women in that situation. Some of them have lived it themselves.
Family planning isn’t always a question of fewer pregnancies. Better spaced childbirth is better for their health and their children.
Evelyn Roquel says they’re brave just to show up.
EVELYN ROQUEL (through translator): In these communities, it’s the men who make the decisions about family planning. These women here, most do not have the support of their husbands. Many times, they come to me and say their husbands will accuse them of sleeping around and being prostitutes if they use birth control.
RAY SUAREZ: In fact, it’s such a sensitive subject that Evelyn’s own safety is at risk. She requires women who ask for treatment or just for more information to sign a document proving they’re voluntary participants. Those who are illiterate provide fingerprints.
EVELYN ROQUEL (through translator): I am Catholic and Mayan myself. I sing in my church choir. But I believe that giving a woman the ability to decide the number of children she wants is critical. It’s vital for her health.
RAY SUAREZ: The United States government seems to agree. The Obama administration recently announced it wants to make family planning a top priority for global-health funding.
Dr. Rajiv Shah is the administrator for USAID.
DR. RAJIV SHAH, United States Agency for International Development: Family planning has been underinvested in and is absolutely critical to the safety, security and stability of many of the countries we work in around the world.
There’s so much data that shows us that as total fertility rates go down in countries, the health and welfare of children, families and, frankly, of the community overall goes up.
RAY SUAREZ: Health officials say family planning saves lives.
In the towns and villages strung along the shoreline of Guatemala’s Lake Atitlan, you will find some of the Western Hemisphere’s largest indigenous communities and the hemisphere’s highest rates of maternal mortality, death in childbirth. But when you talk to women about their lives, it’s easy to understand why so many continue to risk early death with eight, nine, 10 pregnancies.
Concepcion Ramirez Riyanda’s mother, Maria, died while giving birth to her 11th child. At the time, Concepcion was 19 years old and was given the responsibility of raising her seven younger siblings. Concepcion’s now husband, Diego Chichom Ramirez, says the family was devastated.
DIEGO CHICHOM RAMIREZ (through translator): When Maria, their mother died, the family disintegrated and was torn apart.
RAY SUAREZ: But even with this firsthand tragedy, Concepcion defers to her husband about any family planning. Diego refuses birth-control interventions.
DIEGO CHICHOM RAMIREZ (through translator): We will follow God’s will. We believe this is natural law. And we have heard too many stories about birth control, like injections and pills that cause cancer.
RAY SUAREZ: Stories about the dangers of birth control are often linked to religion, where family-planning methods such as monthly pills, tubal ligation, and IUDs have long been against church teachings.
Oscar Julio Vian Morales is Guatemala’s archbishop.
OSCAR JULIO VIAN MORALES, Archbishop of Guatemala (through translator): The problem is the kind of birth control methods that are used, like forcing families to sterilization for life. Foreign governments should not insist on less children but on more education, more health services and work.
RAY SUAREZ: For their part, health officials say family planning is one strategy to help turn around Guatemala’s dire health needs. Years ago, more children meant more hands to work the land. But generation after generation, farms are divided into smaller and smaller plots. There’s less food to harvest.
And with big families comes more mouths to feed. Nearly half the population of Guatemala suffers from chronic malnutrition.
DR. RAJIV SHAH: You know, if you look at Guatemala, 46 percent of children are stunted. And that means if you just put them against a wall and draw a line, they are, on average, significantly shorter than they should be for their age. And that is reflective of certain — a certain type of chronic nutritional deficiency.
RAY SUAREZ: At Hospitalito Atitlan, a small private hospital funded largely by international donations, malnutrition is a common sight. This 4-year-old weighs only 18 pounds, and she’s lost one pound since August.
Andres Botran is a former secretary of nutrition for the previous Guatemalan government.
ANDRES BOTRAN, former Guatemalan secretary of food security: Malnourished children have 12 points less of I.Q. than a normal child. We will have a great majority of the population with diminished mental capacities. That is a risk not only for economic development, health, et cetera, et cetera, but the viability of our democracy.
RAY SUAREZ: Even if women want birth control, getting contraceptives to remote areas poses a logistical challenge. So, mobile units are dispatched by the Guatemalan family-planning association, APROFAM.
The group transforms local office space into operating rooms, offering tubal ligations and slow-release hormone implants.
Dr. Lisbeth Contreras is one of the gynecologists for APROFAM.
DR. LISBETH CONTRERAS, APROFAM (through translator): We cover the whole country, but it’s difficult. There is a huge demand. These are bad financial times in Guatemala. And it’s hard for families who have many children.
RAY SUAREZ: Forty-three-year-old Dora Ileana Orellana came with her daughter-in-law, Julia Maria, to the clinic. Dora has a child the same age as her grandson, less than 2 years old, her seventh child.
DORA ILEANA ORELLANA (through translator): My body can’t hold children anymore. I’m too weak. Already, I have headaches. My bones hurt. And I’m worn out from housework.
RAY SUAREZ: Both grandmother and daughter-in-law receive Jadelle, a hormone implant in the upper arm which acts much like birth control pills.
DORA ILEANA ORELLANA (through translator): My mother had 13 children. But times are harder now. Everything is really expensive. And sometimes I’m in trouble because I have no money to feed my family.
RAY SUAREZ: Over 40 percent of Guatemala’s population is younger than 15. Family-planning advocates realize they must target the young.
Here, in a community outside Antigua, school-age children become voluntary peer educators, steering their classmates away from early parenthood. This program is also run by WINGS.
Janeen Simon, the executive director of WINGS, says schools are a platform for both genders.
JANEEN SIMON, Women’s International Network for Guatemalan Solutions: It’s important for the kids to be comfortable talking about the topic amongst their peers of both sexes.
This is a very machista society here, where the men, the boys are brought up to believe that they have rights over the girls or the women. And I think that helps also if — if they’re learning together and they can see that — the power that the girls have through their — through their education and their intelligence and their wisdom.
RAY SUAREZ: Programs like these are likely to gain traction from the administration’s Global Health Initiative. But with strong opposition from Congress on the overall levels of foreign aid, any future funding remains unclear.