Misinformation, mistrust, and mistreatment: family planning among Bolivian market women.

ABSTRACT

PIP: Ethnographic data were used to examine fertility control in 1993 among Aymara urban women in Bolivia. Data were gathered from in-depth interviews on family planning (FP) with 30 women, from similar interviews with eight men, from 38 other household interviews, and from FP service clients. Most of the Bolivian population is composed of members of the Aymara or Quechua indigenous groups. About 50% of total population is urban. Interview responses indicated that most women wanted to control their fertility so that they could improve their economic situation by selling items in the market. Cultural norms and beliefs were compatible with fertility control and women's work. Women were expected to control reproduction through rhythm or a form of abstinence. Barriers to fertility control included a lack of communication about sexual and contraceptive matters with friends, family, or spouses. This pattern of silence was handed down from their mothers. Almost 66% of the 30 women had never received information on menstruation or reproduction when growing up. The message was that sexuality was dangerous and shameful. Almost 33% engaged in a living arrangement with a sexual partner at the age of 14-16 years, and the remaining had done so by 17-20 years. Marriage occurred accidentally or by force (25%). Voluntary cohabitation occurred in about 50% of cases. After sexual contact occurred, parents strongly urged marriage. Women eventually learned about contraception through women's clubs, clinics, church groups, husbands, or friends. When fertility control failed, women resorted to extreme abstinence, abortion, infanticide, or modern methods. Modern methods were viewed as dangerous and with harmful side effects; modern medicine was viewed similarly. Contraceptive use could be associated with promiscuity. Women feared being touched by health personnel. Although abortion was illegal, women conveyed a desire to end an unwanted pregnancy or acted with systematic neglect to end an unwanted birth. Recommendations were made for providing culturally sensitive services which involved men.