title: Ethnic inequality in Guatemalan women's use of modern reproductive health care.
abstract: BACKGROUND
  Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services.
  
  
  METHODS
  Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics.
  
  
  RESULTS
  The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage.
  
  
  CONCLUSIONS
  The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.
authors: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. kishida@cdc.gov
authors: Kanako
authors: K
authors: Ishida
authors: Paul
authors: P
authors: Stupp
authors: Reina
authors: R
authors: Turcios-Ruiz
authors: Daniel B
authors: DB
authors: William
authors: Evelyn
authors: E
authors: Espinoza
mesh_terms: D000293:Adolescent; D000328:Adult; D001723:Birth Rate / Q000208:ethnology; D003144:Communication Barriers; D003267:Contraception / Q000191:economics / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006166:Guatemala; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology*; D006801:Humans; D007197:Indians, Central American / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D011203:Poverty; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D034121:Reproductive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D012423:Rural Health; D055815:Young Adult