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But then why is Guatemala's birth rate higher than that of other Central American countries?
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I can't speak to a comparison to other countries, but I can give you some information about birth rates and family planning in Guatemala that may be useful. These are some of the highlights from a 2003 report issued by the Center for Reproductive Rights. You can get the report online through their website. It's an extensive report (100 pages) but not at all difficult to read. It gives lots of background on how birth rates and maternal and child health in Guatemala are related to the government's provision of health care, human rights in Guatemala and domestic law, and recommendations for protecting the right to family planning. Here are a few things that might help in understand the birthrate:
* 43% of the Guatemalan population is below 15 years of age
* annual population growth rate in 1999 was 2.68%
* 75% of Guatemalans live in poverty and 58% in extreme poverty
* life expectancy is 66.5 years (70 years for women, 63.8 years for men); this is one of the lowest life expectancies in Latin America; the highest rates of mortality are from preventable illness, violence and accidents
* almost 60% of Guatemalans (mostly indigenous women) do not have access to health services -- this is the lowest coverage rate in Latin America
* almost 1/3 of people who do use public health systems live 2 hours from the nearest facility
* 25% of the system's medical equipment does not operate reliably and 15% is inoperable; 37% of the facilities are in very poor condition and 28% are closed
* delivery of health services and education is complicated by the diversity of languages in the country; there are 21 Mayan languages in Guatemala and Guatemala has more languages than other Latin American countries; in the indigenous population approximately 1/3 of the people speak only a Mayan language but very few health care providers speak those same languages
* maternal mortality rate is 190/100,000 births; infant mortality is 45 per 1,000 births
* fertility rates vary widely -- from 3.8 among urban mestizo women to 6.8 among rural indigenous women; the overall fertility rate is 5.0
* 38% of married or cohabiting women use some for of contraception and only 26% use a modern method
* although 69% of women know of a family planning method, only 15% use one; while 61% of women in relationships do not want to have more children, only 38% use contraception
* complications from abortion are the second most common cause of death among women in Guatemala
* the average Guatemalan attends 3.2 years of school and in predominantly indigenous areas the figure is lower
* only 50% of girls in rural areas have attended school at all
* the government invests 1.7% of GDP in education, one of the lowest rates in Latin America
* investment in health (including investments for woater, sanitation and environment) usually "hovered below only 1.5% of GNP in recent years, and has never exceedd 2.2% of the GNP"
* "The reality of Guatemalan women's lives is characterized by pervasive discrimination in the economic, political, educational, and health spheres, as well as within the family. For example, patriarchal attitudes among males make it extremely difficult for women to access reproductive health and family planning services without their partner's approval."
* "Despite the great need of its citizens, the Guatemalan government largely has failed to provide even basic health information and services to much of the population. The government has failed to create and fund programs providing health care at local levels and has failed to involve the communities in such programs. In addition it has not adequately leveraged the provision of health information and education as a means of both enabling and exercise of human rights and promoting good health."
* "The current unwritten policy of the Ministry of Public Health and Social Services with respect to family planning is to provide available methods only at the request of the client. There is no department-wide policy regarding the provision of family planning information, except in the context of post-partum care in public facilities. As a result of the lack of a department-wide policy addressing family planning for all women of reproductive age, the availability and quality of counseling in both natural and modern methods of family planning is often deficient and largely depends upon the education and attitudes of the particular providers."
* a 1993 law to address reproductive health and gender equality was vetoed by the president
* A 1998 draft of a national reproductive health policy was "suddenly shelved for political reasons"