Instead of focusing solely on young women to improve family planning in rural indigenous communities in the Western Highlands of Guatemala, new Johns Hopkins Center for Communication Programs research suggests that a community-wide approach can successfully increase contraceptive use.
The CCP-led Breakthrough ACTION project in Guatemala saw family planning use rise from 45 percent to 54 percent in just over a year by using a far-reaching set of interventions that did not focus on women in isolation. The findings of the mixed-methods research will be presented at the International Conference on Family Planning in Bogotá, Colombia, from Nov. 3 to 6.
“We didn’t want to burden the woman with everything, in the way that many family planning projects do,” said CCP’s Rob Ainslie, who led the work in Guatemala. “She needs support from her husband, her mother-in-law, and her community.”
This project created a multi-layered support system, with the goal of reducing stunting in Guatemalan children living in Huehuetenango and Quiché. Local women trained as community facilitators conducted monthly home visits to provide women with tailored counseling, including the use of an interactive tablet application. At the same time, these facilitators established and led support groups for mothers, grandmothers and fathers.
The most surprising finding emerged in women’s motivations, researchers said.
The data show that the odds of using family planning increased 1.5 times among those who believed it protects the child’s health; 1.6 times among those who believed it promotes family well-being; and 2.2 times among those who believed that it saves money.
“When women recognize that family planning protects their child’s health, promotes the family’s well-being, and saves money, they are more likely to use it,” CCP’s Carmen Cronin, PhD, who was involved in the research. By spacing the birth of children, she said, the mother is healthier and so is the child, who can receive the benefit of more resources.
Married women in Guatemala’s Western Highlands typically live with their husbands’ families and are subject to their mothers-in-laws’ opinions and desires when it comes to how they behave. In working with mothers-in-law to help them understand the most up-to-date information on family planning and nutrition, the project was able to attack the issues from a variety of angles.
The impact on contraception use from June 2023 to September 2024 may have been even higher than the findings show. One reason many women don’t use family planning there is migration, Ainslie said. Many husbands migrate to the United States for work, often for extended periods, obviating the need for contraception.
“When a husband is away for a year or two, women often don’t use family planning,” Ainslie said. “But that doesn’t mean they don’t want to. It’s about understanding the context better.”
Cronin noted that the CCP approach – developed by lead researcher Maria Elena Figueroa – went “beyond reach,” meaning they didn’t just count participants, but truly understood how and why behaviors were changing. By using digital platforms and community-based data collection, researchers could make real-time adjustments to their approach.
“It’s not enough to count how many people our programs are reaching,” Cronin said. “We need to know whether we are meeting their needs, filling knowledge gaps, shifting beliefs, building their self-efficacy, and more.”
One key to success was that the community facilitators, who made monthly home visits to monitor family planning use, nutrition and more, were local women who were already trusted within their communities. “They’re known within their community,” Cronin said. “These are trusted messengers, and these can be sensitive health discussions.”
As global health experts continue to seek effective strategies for improving reproductive health, the Guatemala project could provide a blueprint for community-centered approaches that respect local contexts, empower women, and mobilize families and communities to improve health.
“Beyond Reach: What Monitoring Data Reveal About Family Planning Uptake in Breakthrough ACTION Guatemala’s Project Communities” was written by Carmen Cronin, Rob Ainslie, Maritza Méndez de Oliva, Claudia Nieves, Sean Maloney and María Elena Figueroa.
