Planificación Familiar

A few days ago I asked Dominga (one of the head health promoters we have been helping with fluoride treatments in schools) about her thoughts on family planning.

She told me that after she had her first 3 children, her husband came to her and told her to figure out a way for them not to get pregnant for awhile.

So Dominga asked the women in her neighborhood what they thought about using birth control pills or the birth control shot (Depo-Provera) to space pregnancies and avoid having too many children. The women scolded her and told her that if she used birth control she would be murdering her future children and denying them the right to a life God had planned for them. Dominga said she felt very ashamed at the women’s reply, so she went to a priest, who taught her about natural family planning methods.

Natural family planning requires a couple to refrain from engaging in sexual intercourse on the days when the woman is most fertile. This form of birth control requires the participation and cooperation of both the man and the woman, which is unfortunately the reason why this method failed for Dominga.

Because this method of family planning confines sexual activity to only specific days of the month, each time Dominga’s husband wanted to have sex on the wrong day and Dominga told him, “not today,” an argument would ensue. Her husband accused her of having an affair. He would say, “if you don’t want to have sex with me, it must be because you have been out having sex with your lover.” Inevitably these arguments would end with her husband saying, “I am the the man and you are the woman. I tell you when we have sex, you don’t get to decide.”

Dominga stopped her attempts at family planning to avoid these fights with her husband, and soon they ended up with 9 children.

Dominga’s children are between the ages of 7 and 24. She told me that now, looking back on her decisions, she wishes she had planned her pregnancies and used birth control because it is has been and continues to be very difficult to care for all 9 children, to feed them all and make sure they get an education. “People say it’s a sin to use family planning,” said Dominga, “but I think it’s a sin to bring more children into the world if you can’t take care of them the way they deserve.” She told me that her life as a parent has been very difficult, and the struggle to provide for the children has been a constant stress and worry for her and her husband.

Dominga’s story made me wonder whether a family planning project might be helpful in the rural communities served by the health promoters. I asked her what she thought about starting such a project and she suggested home visits. Public group talks would make people uncomfortable, she said, and would prevent them from asking questions for fear that their neighbors might gossip about them. She also told me she thought it would be important to have an outsider do the educating. “People do not want to hear these things from their neighbors,” she said. She explained that there is not wide community acceptance of birth control and family planning, and that there is a certain taboo associated with talking openly or publicly about the subject. She said that if there were a project, a large part of the project would have to focus on how to change community conceptions of birth control and making it more permissible for people to discuss such things.

“How would you do it?” I asked her. Her idea was to ask each of the health promoters to come up with a list of couples in their community who have less than 4 children, and schedule an appointment for a home visit to each family to discuss family planning. “It’s important to do it with the man and the woman together,” she explained, “because women here cannot make any decisions without their husbands’ consent.” The man would have to be educated as well, and the home visit would be focused on planning together as a couple.

“What about language?” I asked. Most women in the rural communities speak limited Spanish, so I asked her if I would need to learn Kaqchikel to avoid the problem of having an interpreter spread gossip after helping me with each private home visit. “It’s not necessary for you to learn Kaqchikel,” she said, “just bring an outside health promoter from a different community to translate for you.”

I’ve thought about that a lot, the role of language in giving a community ownership over their own health. I’ve decided that bringing an interpreter with me would serve the positive purpose of training each health promoter to do these visits on their own in the future.

Given Dominga’s overwhelmingly positive response to the idea of a family planning initiative, I was excited to talk to Vicente (the head health promoter who coordinates all of the health promoter trainings and activities) about my talk with Dominga.

He was supportive of the idea, but uncomfortable about including anything but natural family planning methods in the educational home visits. It’s my opinion that it is a person’s right to be taught about all the available options and their right to choose what’s best for themselves. I also understand, however, that the health promoter system operates under the umbrella of the Catholic parish programs and is thus obligated to adhere to Catholic ideology. I mentioned to Vicente that Dr. Tun (the attending physician at the parish clinic) prescribes the pill to patients in some cases, so there must be a multi-layered understanding of artificial birth control at least at the clinic. Vicente suggested that we talk to Dr. Tun and see what he thinks about the idea of comprehensive family planning education through home visits. I’ll let you know what comes of my investigation…