Building Responsive, Local Family Planning Systems in Guatemala
By Robin Brazier and Paulina Garbero Muralles
Since its inception in 2009, Guatemala’s National Contraceptive Security Commission (CNAA)—a governance body made up of government, international development, and civil society institutions—has been helping to improve access to family planning services and commodities, especially among the country’s rural and Indigenous communities. In 2014, the CNAA began establishing a network of contraceptive security subcommittees, tasked with coordinating and monitoring the quality and availability of family planning supplies and services at the local level. The effort, supported by Health and Education Policy Plus (HEP+) helped decentralize the CNAA, bringing commodity security accountability and locally led solutions directly to the communities it serves.
Subcommittees conduct periodic assessments of contraceptive supply levels at local health centers, informing the central CNAA of supply shortages or other issues that could affect family planning services. Subcommittees advocate for culturally relevant health services and have built alliances to combat misinformation about family planning, which is particularly prominent in the rural Western Highlands. They have created strategic partnerships with the Ministry of Health and nongovernmental organizations to teach healthcare personnel how to insert long-term contraceptive methods and use specialized medical equipment. Working alongside local organizations, subcommittees have leveraged community events to disseminate accurate family planning information; conducted family planning awareness campaigns using local media and social networks; and generally, promoted the use of available family planning services, including bringing providers into communities without family planning clinics to provide services.
“Through the subcommittees we can carry out [contraceptive supply] analyses, where we have identified the shortage or oversupply of some methods and we have taken actions to improve this situation within the services, especially in areas of difficult access.”
– Yaquelin Chaclán, coordinator of the subcommittee in Quiché
Overcoming Family Planning Challenges During a Pandemic
The subcommittees’ community engagement activities have also proved crucial during the COVID-19 pandemic. As the virus spread across Guatemala, public hospitals paused their outpatient services, family planning consultations decreased, and the number of unplanned pregnancies rose. In response, subcommittees analyzed contraceptive demand data from local health area directorates and presented suggestions to increase demand. These suggestions empowered each directorate to make informed decisions about their service provision strategy during the pandemic and served as the foundation for advocacy campaigns designed to encourage community members to continue using family planning services. Subcommittees also worked with public hospitals to provide needed family planning services while outpatient procedures and consultations were being cancelled.
At the public hospital in Quiché—a remote department in Guatemala’s Western Highlands—the local subcommittee helped establish a family planning clinic within the hospital’s maternity ward to better reach visitors. The Quiché subcommittee promoted these services during community engagement visits, focusing increasingly on promoting the use of voluntary surgical contraception and long-term postpartum contraception methods.
The steps taken by subcommittees across Guatemala helped mitigate the negative effects of the pandemic and increase family planning uptake during the health crisis. In the departments of Huehuetenango and Quetzaltenango, the number of new family planning service users increased by 55 percent. Specifically, in 2021, the regional hospitals in those two departments saw an increase in the use of subdermal implants, quarterly injectables, oral contraceptives, and condoms.
The Way Forward
Since the formation of the first contraceptive subcommittees, created with HEP+ support, Guatemala’s Ministry of Health has expanded the effort, setting up subcommittees on its own in five additional health areas. This decentralization of contraceptive security in Guatemala has made it possible to better meet the specific family planning needs in each region, provide contextualized solutions to family planning challenges, and improve access to culturally relevant family planning services that inform, advise, and offer a variety of methods. Having the decentralized health infrastructure already in place also allowed the country to maintain essential services when the COVID-19 pandemic hit. This year, as HEP+ comes to a close, the project will continue providing capacity building support to the subcommittees to ensure their ongoing sustainability and ability to secure contraceptive services for all Guatemalans.
On January 25, HP+ hosted a virtual watch party that featured a short film—“Why Policy Matters: Strengthening Family Planning Services for Guatemala's Indigenous People”—about Guatemala's National Contraceptive Security Commission (CNAA) and its network of local, multisector subcommittees. The virtual watch part for the “Why Policy Matters” short film featured representatives from the Reproductive Health Program of the Ministry of Health, the CNAA’s Observatory on Reproductive Health, and a community-based logistics coordinator for medicine and had 145 people in attendance, including high-level representation from USAID.