‘Uno tiene que cuidar también de sí mismo’: Guatemalan Family Planning Decisions in the Context of Social Cognitive Theory and a Political Economy Approach

Understanding the persistent inequalities in family planning rates between indigenous and non-indigenous women in Guatemala requires localized explorations of the specific barriers faced by indigenous women. This thesis presents, across three papers, a novel framework for simultaneously considering proximal, intermediate and distal factors affecting family planning.Based on Social Cognitive Theory, elicitation interviews were carried out with 16 young women, aged 20 to 24, married or in union, from rural districts of Patzun, Chimaltenango in Guatemala. Content analysis was carried out using the constant-comparison method to identify the major themes raised by participants in terms of barriers to accessing and using family planning. Barriers not directly mentioned by participants were distinguished through the application of a political economy approach. The first paper presents this augmented elicitation interview methodology and the resulting family planning self-efficacy scale.In the second paper, a political economy approach contextualizes structural issues that affect current family planning decisions, including: social exclusion and repression of indigenous people dating back to colonial times and exacerbated by the recent civil war; gender inequity; the influence of the Catholic Church at the state level, and on individual beliefs; and the evolution of population politics at the global and national levels.The third, methodological, paper draws on this inter-cultural research to highlight recommendations for: early involvement of a local team in preparing research instruments, recruitment and conducting interviews; multilingual interviewing, transcription and team analysis; and inclusive reporting and dissemination.The combination of theoretical approaches extends the application of either perspective in isolation: Social Cognitive Theory incorporates more structural influences on individual decisions about family planning and the political economy perspective links impacts and interactions at the individual level. This approach may be useful for a more complete understanding of health issues both within and outside the realm of reproductive health.Ph.D