title: Humanizing access to modern contraceptive methods in national hospitals in Guatemala, Central America.
abstract: BACKGROUND
  The overall situation in Guatemala, Central America, regarding programs caring for women's reproductive health has been lagging behind for some decades. Since the year 2000, 56% of Guatemalan families have lived below the poverty line. Guatemala has one of the highest fertility rates (lifetime births per woman) in Latin America and the Caribbean countries, comparable to those observed in less developed countries in Africa. Considering the lack of sex education, poor access to effective contraceptive methods and issues of unwanted pregnancy, Guatemalan women engage in illegal and unsafe abortions, which often causes harm and sometimes death. A key strategy designed to improve women's health is through free and informed access to contraceptive methods that are effective and accepted by Guatemalan women.
  
  
  METHODS
  From July 1, 2003, to December 31, 2006, specially hired trained facilitators visited 22 public hospitals for 1 week to train corresponding physician staff in postabortion counseling, enabling them to assist patients to select and use an effective contraceptive method. To monitor the progress achieved, the trained facilitators returned 4 weeks later. The main purpose of the training was to focus in strengthening the understanding and technical capacity of the hospital staff to implement postabortion contraceptive counseling and to enable women to obtain an effective contraceptive method prior to hospital discharge.
  
  
  RESULTS
  Out of 22 hospitals, 21 managed to improve their record for counseling patients admitted for postabortion complications, from 31% to 96%. Furthermore, the percentage of women being discharged from the hospital with an effective contraceptive method rose from 20% to 64% from 2003 to 2006.
  
  
  CONCLUSIONS
  The successful results obtained during this study to meet postabortion demands by Guatemalan women point out to the urgent need for the government to expand this initiative within the national health system, including health centers nationwide. This is one of the worldwide recommendations previously made by the World Health Organization.
authors.affiliation: Epidemiologic Research Center in Sexual and Reproductive Health, Hospital General San Juan de Dios, Sótano, Guatemala. ciesar@concyt.gob.gt
authors.forename: Edgar
authors.initials: E
authors.lastname: Kestler
authors.forename: Beatriz
authors.initials: B
authors.lastname: Barrios
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Hernández
authors.forename: Vinicio
authors.initials: V
authors.lastname: del Valle
authors.forename: Alejandro
authors.initials: A
authors.lastname: Silva
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D003270:Contraceptive Agents; D003273:Contraceptive Devices; D005260:Female; D006166:Guatemala; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans
chemical_list: D003270:Contraceptive Agents