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Dr. Mirna Montenegro Rangel Guatemala, October 2007

Improving Financial Sustainability in Guatemala: The Role of Advocacy and Policy in Contraceptive Security. Dr. Mirna Montenegro Rangel Guatemala, October 2007. Guatemala Political processes for adoption of law. Contents. Guatemala in Brief

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Dr. Mirna Montenegro Rangel Guatemala, October 2007

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  1. Improving Financial Sustainability in Guatemala: The Role of Advocacy and Policy in Contraceptive Security Dr. Mirna Montenegro Rangel Guatemala, October 2007 Guatemala Political processes for adoption of law

  2. Contents • Guatemala in Brief • Gaps between rural and urban, between indigenous and non-indigenous • Reproductive health indicators • Advancements in access to family planning services from 1990 to 2007 • Role of civil society • Law of Family Planning • Use of data and information • Lessons learned

  3. Comparison of Poverty Classification at the National Level 2000-2006 Total Poverty Extreme Poverty CAMPAÑA NACIONAL DE LA SOCIEDAD CIVIL POR LA SALUD REPRODUCTIVA

  4. Maternal Mortality Rates by Department of Residence 153 148 124 Source:Línea Basal de Mortalidad Materna para el año 2000. Guatemala, 2003 60 48 29 Guatemala Honduras Nicaragua El Salvador Mexico Costa Rica Reproductive Health in Guatemala Maternal Mortality Maternal mortality in comparison with other Latin American countries Assistance provided by relevant personnel according to place of residence or ethnic group Source: Guatemala. Encuesta Nacional de Salud Materno Infantil 2002.

  5. Total Fertility Rate2.7 points lower in 52 years

  6. Situation in 1990s • No legislative framework or enabling policies • Slowly declining fertility but increasing demand for FP - Unequal access to services - Weak public sector programs – 100% externally subsidized (MOH, IGSS) - NGOs dependent on donations, high pharmacy prices

  7. Situation Today: Guatemala on its way to financial sustainability • MOH partially financing contraceptive supplies and have expanded services 72% (2001 – 2005) • IGSS buying its own contraceptives • Major NGOs have achieved financial independence • Rapid decline in TFR during last 6 years • Increased in use of family planning, especially among lower income

  8. Percentage paid by MOH and total cost of contraceptives, by year

  9. How did Guatemala Get on the Road to Contraceptive Security? • Major effort by civil society and sympathetic politicians to improve RH services • Advocacy campaigns showing FP needs and inequalities • Advocacy programs focusing on adverse health impacts of limited RH/FP • Legal and legislative breakthroughs guaranteeing FP services

  10. Advocacy…Policy processes for adoption of laws

  11. Law approval process Legislative Branch, approval of decree 87-2005 by absolute majority (only 3 people voted against it) 16-11-05 Executive veto. Argument: Duplicity, unconstitutionality, lack of funding 21-12-05 Legislative rejects legality of veto. In a new vote orders publication of the Law 31-1-06 Constitutional Court supports the Executive veto 6-2-06 Public Opinion Congressional HR Committee with NGO support argues against Constitutional Court resolution 17-3-06 Constitutional Court decides in favor of Congress and NGO - Congress orders publication of the Law 6- 4-06 9-5-06 Family Planning Law published and in effect

  12. Information Use for AdvocacyUnmet Need of FP Need of FP services by women in union 15-49 years old, By ethnic group, urban/rural residence and level of education

  13. Information for the MediaFamily Planning Survey 96% agree that the Ministry of Health teaches and helps people with family planning 90% of the population feels favorably towards the Ministry of Health distributing methods of contraceptives to space out the number of pregnancies 94% feel that families with fewer children have a better quality of life

  14. Lessons Learned • The Power of Information • Created alliances; united on common issues; respectful of different stances. • Social support for the issues (to inform) • Alliances with Congress and Ministries of Health (on the issues) • Political analysis and constant monitoring

  15. Thank you for your attention!

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