Understanding ethnic variation in pregnancy-related care in rural Guatemala

Objectives. This study examines the relatively low use of modern pregnancy- related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in ca re. Methods. The data for the analysis come from the Guatemalan Survey of Famil y Health-a population-based survey of rural women that contains detailed da ta on care received during pregnancy and delivery along with extensive back ground information. Binomial and multinomial logit models are used to ident ify the variables that affect the likelihood of receiving different types o f care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the obse rved ethnic differences. Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend th em by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly a ssociated with modern pregnancy-related care than are measures of access an d that the former variables explain more of the ethnic variation in care th an the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction w ith traditional midwifery care rather than to rely solely on the former. Conclusion. The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to m odern health facilities improves. Current efforts directed toward the train ing and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replac ement of midwives with biomedical providers.