Guatemala has the second lowest level of contraceptive use of any country in Latin America, despite an active private family planning program for over 30 years. Previous analyses identify correlates of contraceptive use but fail to address the fundamental question: Why does Guatemala differ so markedly from the rest of Spanish-speaking Latin America in the acceptance of family planning? This case study explores political and historical factors at the macrolevel that have shaped the evolution of family planning in Guatemala. These include the anti-imperialistic leftist movements of the 1960s and 1970s; the large percentage of the population that is indigenous; the civil unrest that peaked in the 1980s and paralyzed social programs, especially in the western highlands; and the powerful alliance between the government and the Catholic Church. Although none of these factors is unique to Guatemala, the convergence of the four in a single country explains why Guatemala lags far behind its Latin American neighbors in the acceptance of family planning. However, recent events give reason for guarded optimism that Guatemala is advancing toward greater acceptance of family planning.
