Ethnic inequality in Guatemalan women's use of modern reproductive health care.

CONTEXT 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. CONCLUSION 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.