Understanding Ethnic Variation in Pregnancy-Related Health Care in Rural Guatemala Dana A. Glei Office of Population Research and Department of Sociology Princeton University July … .. 1999 Acknowledgements: We would like to acknowledge support for this project from NICHD grants R01 HD31327 and P30HD32030. We would also like to thank Noreen Goldman, Marta Tienda, Anne Pebley, and Denise Roth for their comments and suggestions and Germán Rodríguez for his statistical advice.

numerous indicators of socioeconomic status, including land ownership, household consumption patterns, and possession of modern conveniences. A calendar-based approach was used to collect detailed information on pregnancy-related practices and complications for the last two live births that occurred since January, 1990 (n=3,350 births). Respondents were asked who they saw during each month of pregnancy. 3 Measures of ethnicity included self-reported ethnicity4; languages spoken; language used within the home; ethnicity of spouse/partner, parents, and siblings; and traditional indigenous dress (i.e. huipil and corte ) of the respondent as observed by the interviewer. Versions of the questionnaire were fielded in Spanish, K’iche’, and Kaqchikel. In addition, three community informants (the mayor, a woman in a leadership position, and another person not in a leadership position) provided information about the community and a listing of health providers and facilities within a 20-km radius of the community. These listings were consolidated to construct a census of health providers and facilities for each community. Subsequently, the following types of providers were randomly selected from each community and interviewed: 1) the head of the health post or center (HCP) nearest the community; 2) a medical doctor; 3) a midwife; and 4) two other providers, including non-biomedical practitioners, such as curers ( curanderos ), herbalists, spiritists, and others. (The provider surveys were not used for this paper.) The community and provider questionnaires were administered only in Spanish. Measures Outcomes. We include two outcomes measuring the type of care received during pregnancy and birth. Very few women saw only a nurse was seen for prenatal care (n=48), so we combined doctors and nurses into one category. Because HCP services are nearly free while doctors and nurses are often quite expensive, it is important to distinguish between these biomedical services. Thus, we classify providers of pregnancy care into three types: doctor or nurse, health center or post (HCP), and midwife, allowing for all 3 Respondents were asked, “Did you see someone during this pregnancy? IF SO, who? (PROBE: midwife, doctor, nurse) The term “provider” was purposefully not used, since it may influence the type of person that a woman reports. 4 Respondents were asked, “Do you consider yourself indigenous (natural or maya) or ladina?” In the department of Jalapa, it was found to be considered offensive to ask about ethnicity, so this question was omitted and all

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