CENTRAL AMERICA: Families Downsizing

• by Danilo Valladares (guatemala city)
• Wednesday, July 27, 2011
• Inter Press Service

The countries of Central America have slammed on the demographic brakes by promoting sex education and access to family planning methods, in order to improve living conditions, which are marked by poverty and social inequality.

Other factors, like the high cost of living and soaring rates of violence and crime, especially in El Salvador, Guatemala and Honduras, have also acted as a disincentive to increasing family size. Aceituno belongs to the new generation of Central Americans who are choosing to have smaller families, in contrast to the situation over 10 years ago, when it was customary to have five or 10 children.

'I would really like to have another child, but schools are so expensive now, and besides you have to be so careful about the crime situation,' said the 33-year-old Guatemalan woman who says she is against repeating the life led by her parents, who had four daughters, and even less by her maternal and paternal grandparents, who had five and seven children, respectively.

Statistics confirm the trend. In Guatemala, the total fertility rate (the average number of children a woman will have in her lifetime) for women aged 15 to 49 dropped from five to 3.6 over the decade between 1998-1999 and 2008-2009, according to the National Survey on Maternal and Child Health (ENSMI) 2008-2009, carried out by the Health Ministry.

Over that decade, use of modern and traditional family planning methods by women with steady partners and aged 15 to 49 increased from 38.2 to 54.1 percent, according to the study, in this country of 14 million people.

These figures show that 'the population is accepting' advice on family planning offered by non-governmental organisations, women's and young people's groups and the government, Dalila de la Cruz, of the Family Welfare Association of Guatemala (APROFAM), told IPS.

'Economic conditions for families could improve, since they won't be sharing their income among 10 people, but among four. This means they will have more access to health, food and clothing,' she said.

De la Cruz said one success was the detailed regulation of the 2009 Guatemalan family planning law, which allowed sex education in primary schools and facilitated access to family planning methods via the Health Ministry, the Social Security Institute and other institutions.

But there are still great challenges to overcome. In 2009, 41,529 births were reported to girls aged 10 to 19, while in 2010 the number climbed to 45,048, according to the Health Ministry, which did not count pregnancies that did not reach term, nor home births attended by midwives.

Language is a difficulty in Guatemala, where in addition to Spanish, Garifuna and 22 Maya languages are spoken.

'In some cases, Maya women have been given contraceptive methods with an explanation in Spanish, which they did not understand. It's like not having access to the methods at all,' Griselda Lorenzo, of the National Alliance of Indigenous Women's Organisations for Reproductive Health (ALIANMISAR), told IPS.

Lorenzo said there is a need for information and access to more family planning methods, as these are ever more widely used in spite of the risks they sometimes pose. 'Many women use injections (like Depo-Provera) so that their husbands do not find out they are using contraceptives, because they face the risk of being beaten or abandoned for using birth control,' she said.

Half of the 43 million people in Central America — made up of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama — live below the poverty line.

Nicaragua, a country of 5.8 million people, is also making efforts to promote family planning. Its crude birth rate has in fact fallen from 46 to 24 live births per 1,000 population between 1970 and 2009, according to the United Nations Population Division.

Dr. Freddy Cárdenas, of the Nicaraguan Family Welfare Association (PROFAMILIA), told IPS his country 'has achieved a high level of contraceptive use, with a relatively well-balanced mix of methods.'

He said the Education Ministry included sex education in school curricula in 2009, and produced and published a sex education manual and a basic information guide for teachers.

'Sex education, as taught, focuses on family life and HIV/AIDS prevention, but it does not include specific information on pregnancy prevention, abortion and sexual diversity,' he complained.

Lack of sex education, and expanding the distribution of family planning methods to the entire population, remain challenges in this Central American country, Cárdenas said.

'Women who can plan how many children to have, and when, enjoy better health, have fewer unplanned pregnancies and are at a lower risk of having an abortion. They also have more educational and employment opportunities,' Cárdenas said.

In contrast, Costa Rica has been promoting family planning for decades. 'In the 1970s there was an intense campaign that had a powerful effect, with slogans like 'Have the number of children you can make happy',' Ana Caicedo of the Feminist Information and Action Centre (CEFEMINA) told IPS. 'During the campaign the Catholic Church, for instance, took a leading role, holding courses on family planning.'

Caicedo attributes the 'huge' fall in the birth rate in Costa Rica to the family planning movement. Today 'the country has a fertility rate that, in some years, is below the replacement rate, which means there would be a decline, not an increase, in the population if it were not for immigration.'

But this country of 4.6 million people also struggles to teach sex education in schools.

'The Education Ministry drew up guidelines for sex education, but they have never been used because of interference by the Catholic Church leadership,' she said.

In Caicedo's view, family planning 'is a matter of basic rights, of self-determination.'

Meanwhile, the populations of Honduras and El Salvador are also growing more slowly, and these countries are making similar efforts in family planning and sexual health, in pursuit of a better quality of life and preventing premature births, maternal mortality, HIV/AIDS, abortions and unwanted pregnancies.

The crude birth rate dropped from 47 to 27 births per 1,000 population between 1970 and 2009 in Honduras, and from 43 to 20 in El Salvador over the same period, according to U.N. figures.

However, concern for the improvement of sexual and reproductive health persists.

'Some components of sexuality are addressed with an emphasis on preventing teenage pregnancies and HIV/AIDS, but the only form of contraception advocated is abstinence,' María de la Paz, of El Salvador's Alliance for Sexual and Reproductive Health (ASSR), told IPS.

© Inter Press Service (2011) — All Rights ReservedOriginal source: Inter Press Service

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