The social context of family planning policy in highland Chiapas, Mexico.

Abstract

This thesis focuses on the concept of informed choice in family planning and how numerical and systematic targeting aimed at raising the numbers of contraceptive acceptors fundamentally undermines this concept in highland Chiapas. The Government of Mexico’s policy aims within its Reproductive Health Programme (1995-2000) are to reduce the total fertility rate whilst promoting reproductive health services and family planning choices. Though Mexico has seen a decline in its total fertility rate attributed to increased contraceptive use in urban areas, in rural parts the rate remains high. Consequently, the rural poor, and in Chiapas overwhelmingly indigenous populations, have become a major target of the Reproductive Health Programme. Monthly targets are set for clinics and family planning services are offered systematically every time a woman attends a clinic for whatever reason. Amongst the factors which must be accounted for in assessing family planning provision in highland Chiapas are cultural differences between mestizo providers and the indigenous target groups as well as local economic and political conditions. Presently, the state of Chiapas is highly militarised and under the cloud of a low intensity war precipitated by the Zapatista uprising in 1994. The provision of any kind of health services is difficult under these situations, but more so what one considers the distrust sown between some indigenous communities and the government Who provide the health services. This thesis examines the practicalities of implementing a global policy at a local level and the constraints faced by both providers and intended recipients in the social context of Los Altos. Mindful of the care required in identification most people in this thesis (with the exception of a few well-known academics) appear under pseudonyms.