6 de Febrero: Los que realmente queremos
This week I’d like to share a study that was published in the December 2009 issue of International Perspectives on Sexual and Reproductive Health. Doctoral candidate at the University of Texas at Austin Catherine B. McNamee brings us this study, titled, “Wanted and Unwanted Fertility in Bolivia: Does Ethnicity Matter?” You can access the PDF of the article here:
Early in her article, McNamee points out a well known fact—that indigenous women in Bolivia have a consistently higher fertility rate than mestiza (mixed-race) and white women in the country. (While in 2001 indigenous women had on average 5.0 children each, non-indigenous women had 3.6.) The question that the author then poses is simple, but as she points out, rarely addressed in studies of this type: do indigenous women have more children than mestiza and white women because they want to?
The answer, not surprisingly, is no. McNamee finds that the desired fertility rate for indigenous women is 2.7 children, 2.6 for mestiza and white women—which means that, while both groups are having more children than they want, indigenous women are having way more than they want (167).
One problem, clearly, is birth control use. Only 27% of indigenous women report using “modern” methods of birth control (which are more effective than traditional methods), compared with 61% of non-indigenous women (170). McNamee identifies a variety of factors that make using these contraceptive methods more difficult for indigenous women than for mestiza and white women.
A central obstacle to indigenous women’s use of modern methods is the real or perceived opposition of their male partners. McNamee notes that, “cultural barriers that inhibit indigenous couples from discussing family planning could contribute to…unwanted fertility” (173). Machismo also certainly plays a role. Many women state that their partners oppose their birth control use because they believe that, with their wives on the pill, they can sleep with other men without fearing pregnancy. Other women confess that they use methods without their partners’ knowledge. (This is why relatively confidential methods like Depo Provera are so popular here.)
In addition to unsupportive partners, McNamee finds that many indigenous women simply distrust birth control and Western medicine in general (167). This belief has a long and somewhat sordid history in Bolivia, and is not altogether unfounded. In 1971, the Peace Corps were famously expelled from the country due to allegations that the group was sterilizing women and inserting IUDS without women’s knowledge or consent. These policies were correctly identified as part of eugenic and imperialist attempts to limit low-income indigenous populations worldwide. Indigenous women in Bolivia also often suffer discrimination in Western health care facilities, where they are sometimes insulted or mistreated, and prevented from practicing the reproductive rituals that they prefer (taking home the placenta after birth, for example). For these reasons, women may be hesitant to visit health care centers or to use modern birth control methods.
Finally, McNamee notes that indigenous women are consistently poorer and more likely to live in rural areas than non-indigenous women, which obstructs their access to birth control methods (173).
McNamee makes a few key policy suggestions to help reduce unwanted pregnancies among indigenous populations that have not, to my knowledge, been attempted in any large-scale way in Bolivia. First of all, she makes the revolutionary suggestion to direct birth control information and services toward men, as well as women. Secondly, McNamee urges policymakers to increase access to birth control methods in rural areas and to promote culturally sensitive care, so that more women will feel comfortable visiting health posts and hospitals.
As McNamee notes, “women, regardless of ethnicity, should be able to control the number and timing of their births. The inability to control fertility is an incursion upon basic human rights”(167).
I would add to this that women should also be able to control how we time our births and how we understand and manage our fertility. Indigenous women’s hesitation to use Western birth control methods and facilities is complex and understandable. Perhaps a final and apt suggestion would be to promote non-Western proposals, from local midwife and yatiri communities, to decrease the gap between the number of children we want, and the number of children we have.