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

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

5. Total Fertility Rate 2.7 points lower in 52 years

6. Situation in 1990s No legislative framework or enabling policies No legislative framework or enabling policies Slowly declining fertility but increasing demand for FP 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) MOH partially financing contraceptive supplies and have expanded services 72% (2001 – 2005) IGSS buying its own contraceptives IGSS buying its own contraceptives Major NGOs have achieved financial independence Major NGOs have achieved financial independence Rapid decline in TFR during last 6 years Rapid decline in TFR during last 6 years Increased in use of family planning, especially among lower income Increased in use of family planning, especially among lower income

8. YEAR % paid by MOH Amount paid by MOH TOTAL TOTALCOST 20025$20,868$417,354 2003 200320$192,657$963,286 2004 200430$301,723$1,005,744 2005 200540$339,736$849,340 2006 200645$406,840$904,090 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 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 Legal and legislative breakthroughs guaranteeing FP services

10. Advocacy… Policy processes for adoption of laws

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

13. Information Use for Advocacy Unmet 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

14. Information for the Media Family 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

15. Lessons Learned The Power of Information 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) Alliances with Congress and Ministries of Health (on the issues) Political analysis and constant monitoring Political analysis and constant monitoring

16. Thank you for your attention!