For about one-third of my life (soon to reach 75 years of age) I have lived in Guatemala, a country that deserves a much better government than it has ever had. It is a beautiful, agricultural country, and yet some 50% of its children under 5 suffer from chronic malnutrition[i], which results in both growth stunting and cognitive impairment (a loss of as many as 15 IQ points)[ii] [iii]. The consequences of this are devastating and normally life-long unless the infant receives proper nutrients during the first 1,000 days (9 months in the womb and the first 2 years of life). With over half of the population living in remote, rural villages, it is a very challenging age group to reach; clearly it must be done through their mothers, helping the mothers know what proper practices are such as 6 months of exclusive breastfeeding, and then careful introduction of appropriate foods, using only potable water. Many non-profit organizations in Guatemala, including ALDEA (www.aldeaguatemala.org) work in a focused way to reduce chronic malnutrition, including through the introduction of clean water systems, latrines, and improved stoves that use one-third of the firewood of open stoves and vent the smoke outside the home. It is a long, staff-intensive process, but clearly one worth investing in.
One of the most important components of reducing chronic malnutrition is providing education about and access to effective contraceptive methods. There are many obstacles to widespread use of contraceptives, including poverty, lack of awareness, geographic isolation, machismo[iv], the Catholic and many Evangelical churches, and largely unfounded fear of side effects. The results of these obstacles are that an estimated one-third of pregnancies end in abortions (virtually all abortions are illegal here) and the birth of many unplanned children[v]. Due to the obstacles, fewer than 40% of sexually active people are using any modern form of contraception, and Guatemala has the highest birthrate in Latin America, 3.6 children per woman, and over 5 children per woman among indigenous communities, which comprise one-half of the population.
The importance of working simultaneously on the reduction of chronic malnutrition and the provision of contraceptives is fairly obvious, and yet I am aware of only one NGO (ALDEA) focusing on both issues. Most NGOs work on the nutrition part, which is much less controversial, or solely on family planning education and provision of methods (www.wingsguate.org).
UNICEF guidelines stipulate that a woman needs 3 years between pregnancies in order to fully recover so that she can bear a proper birth weight baby, and yet she is naturally protected against another pregnancy for only 6 months of exclusive breast-feeding. What is needed for the other 2.5 years or more is of course contraception. A critical time in which to educate and open the mind is talking to the pregnant mother prior to giving birth, when she and her husband are most receptive to the idea. Another factor is that very few male/female partnerships actually converse about how many children they wish to have and can afford, and when they want them. Sadly, for many it is the passive “Lo que Dios mande”, “whatever God sends,” which normally is too many. Adolescents begin their risky sex lives too soon, so that by the time a girl is 18, 20% have two or more children, and by 19 one-half of the girls have at least one child – all of which is before their young and malnourished bodies are ready.
Although access to contraceptives is legal in Guatemala, and the government is supposed to provide the temporary methods (condoms, injections and pills) free of charge, the national government has never made providing access to contraceptives a priority. If and when it does, the results will be startling (as they have been in Mexico over the last 20 years, where their birthrate is now down below replacement level!). At that point, the population will also begin to see reductions in the hideously high rates of chronic malnutrition (which currently in the world are exceeded only by Afghanistan, Yemen and East Timor.) Until then, it is up to the dedicated non-profits to carry the load, and hopefully more and more of them will merge the two missions.
[i] World Bank, Nutrition at A Glance in Guatemala, http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Guatemala.pdf
[ii] The Lancet, Series on Maternal & Child Nutrition, http://www.thelancet.com/series/maternal-and-child-nutrition
[iii] Effects of health and nutrition on cognitive and behavioural development in children in the first three years of life. Part 1: Low birthweight, breastfeeding, and protein-energy malnutrition, http://archive.unu.edu/unupress/food/V201e/ch07.htm
[iv] Merriam Webster, Definition of Machismo, http://www.merriam-webster.com/dictionary/machismo
[v] Induced Abortion and Unintended Pregnancy in Guatemala https://www.guttmacher.org/pubs/journals/3213606.html