Invisible Threads: Addressing the Root Causes of Migration from Guatemala by Investing in Women and Girls

In recent years, a growing proportion of migrants at the US southern border have come from Guatemala, El Salvador, and Honduras. This surge of migrants has prompted the US government to seek to address the root causes of migration from the region. As this strategy is further elaborated, a deeper look at human lives in the context of the forces shaping migration is warranted.

This report focuses on factors that are driving migration from Guatemala—and in particular, the lives of women and girls in the context of these factors. The status, health, and well-being of women and girls are intertwined with many of the challenges driving migration from Guatemala, yet they face persistent inequality in education, the labor force, health care, and family life. Limited investment in sexual and reproductive health, in particular, has stalled meaningful progress in the realization of rights and opportunities for women and girls. Data and stories in this report demonstrate how a deeper understanding of the intersecting challenges and opportunities facing women and girls will strengthen policies and programs designed to address the root causes migration.

Download the report (English)

Download the report (Spanish)

Download the executive summary

Download the executive summary (Spanish)

Barriers to Family Planning: Challenges in Access Around the World

Created with research support from Stanback Fellow Theiija Balasubramanian

Safe and voluntary family planning is an essential health service and a basic human right. Family planning is a cornerstone of gender equality and is critical to the health and well-being of individuals, families, and communities. And yet, physical, educational, social, and legal barriers prevent millions of people globally from accessing quality family planning services every year. By identifying the barriers, effective evidence-based solutions can be implemented to ensure that everyone, everywhere has access to person-centered family planning services.

Explore this page to learn more about some of the barriers that exist around the world that prevent individuals from accessing the family planning services they deserve.

Read our brief report to understand some of the barriers to family planning services that people experience worldwide.


Download the brief here.

 

Watch this animation for an overview of why family planning is important and the types of barriers to family planning services experienced by people around the world.

 

Interact with this map to learn about specific examples of some of the barriers that prevent people from accessing family planning services. Hover over a highlighted country to read about one of the barriers that exists there.

1Guttmacher Institute. (2020, November). Induced Abortion in Indonesia. Guttmacher Institute. https://www.guttmacher.org/fact-sheet/induced-abortion-indonesia

2Bhatt, N., Bhatt, B., Neupane, B., Karki, A., Bhatta, T., Thapa, J., Basnet, L. B., & Budhathoki, S. S. (2021). Perceptions of family planning services and its key barriers among adolescents and young people in Eastern Nepal: A qualitative study. PloS one, 16(5), e0252184. https://doi.org/10.1371/journal.pone.0252184

3Jourdan, D. (2021, December). The journey towards comprehensive sexuality education: Global report. In 4th IAAH MENA Region adolescent health conference: Adolescent care, Leaving no one behind. Paris, France: UNESCO.

4Che, Y., Dusabe-Richards, E., Wu, S., Jiang, Y., Dong, X., Li, J., Zhang, W. H., Temmerman, M., Tolhurst, R., & INPAC group (2017). A qualitative exploration of perceptions and experiences of contraceptive use, abortion and post-abortion family planning services (PAFP) in three provinces in China. BMC women’s health, 17(1), 113. https://doi.org/10.1186/s12905-017-0458-z

5Government of India Ministry of Health and Family Welfare Statistics Division Rural Health Statistics. (2019). https://main.mohfw.gov.in/sites/default/files/Final%20RHS%202018-19_0.pdf

6Mustafa, G., Azmat, S. K., Hameed, W., Ali, S., Ishaque, M., Hussain, W., Ahmed, A., & Munroe, E. (2015). Family Planning Knowledge, Attitudes, and Practices among Married Men and Women in Rural Areas of Pakistan: Findings from a Qualitative Need Assessment Study. International journal of reproductive medicine, 2015, 190520. https://doi.org/10.1155/2015/190520

7DeGraw, E., E. Rottach, and S. Parveen (2019). Male engagement in family planning: Understanding policy implementation barriers and enablers in Bangladesh. Health Policy Plus. http://www.healthpolicyplus.com/pubs.cfm?get=18497

8Alomair, N., Alageel, S., Davies, N., & Bailey, J. V. (2021). Barriers to sexual and reproductive wellbeing among Saudi women: A qualitative study. Sexuality Research and Social Policy. https://doi.org/10.1007/s13178-021-00616-4

9Gueye, A., Speizer, I. S., Corroon, M., & Okigbo, C. C. (2015, December). Belief in Family Planning Myths at the Individual and Community Levels and Modern Contraceptive Use in Urban Africa. International perspectives on sexual and reproductive health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858446/#R

10Habte, A., Dessu, S., Bogale, B., & Lemma, L. (2022). Disparities in sexual and reproductive health services utilization among urban and rural adolescents in southern Ethiopia, 2020: A comparative cross-sectional study. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-12634-x

11Solo, J., & Festin, M. (2019). Provider bias in family planning services: a review of its meaning and manifestations. Global Health: Science and Practice, 7(3), 371-385. https://doi.org/10.9745/GHSP-D-19-00130

12Adelekan, A., Omoregie, P., & Edoni, E. (2014). Male involvement in family planning: Challenges and way forward. International Journal of Population Research, 2014, 1–9. https://doi.org/10.1155/2014/416457

13Solo, J., & Festin, M. (2019). Provider bias in family planning services: a review of its meaning and manifestations. Global Health: Science and Practice, 7(3), 371-385. https://doi.org/10.9745/GHSP-D-19-00130

14Daff, B. M., Seck, C., Belkhayat, H., & Sutton, P. (2014). Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services. Global Health: Science and Practice, 2(2), 245-252. doi:10.9745/GHSP-D-13-00171

15chrumpf, L. A., Stephens, M. J., Nsarko, N. E., Akosah, E., Baumgartner, J. N., Ohemeng-Dapaah, S., & Watt, M. H. (2020). Side effect concerns and their impact on women’s uptake of modern family planning methods in rural Ghana: a mixed methods study. BMC women’s health, 20(1), 1-8. doi: 10.1186/s12905-020-0885-0

16Silumbwe, A., Nkole, T., Munakampe, M. N., Milford, C., Cordero, J. P., Kriel, Y., ... & Steyn, P. S. (2018). Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia. BMC health services research, 18(1), 1-11.

17Potasse, M. A., & Yaya, S. (2021, February 2). Understanding perceived access barriers to contraception through an African feminist lens: a qualitative study in Uganda. BMC Public Health.

18Speizer, I. S., Hotchkiss, D. R., Magnani, R. J., Hubbard, B., & Nelson, K. (2000). Do service providers in Tanzania unnecessarily restrict clients' access to contraceptive methods?. International Family Planning Perspectives, 13-42.

19Ministerio de Salud Pública y Asistencia Social - MSPAS/Guatemala, Instituto Nacional de Estadística - INE/Guatemala, Secretaría de Planificación y Programación del la Presidencia - Segeplán/Guatemala, and ICF International. 2017. Encuesta nacional de salud materno infantil 2014-2015: informe final. Rockville, Maryland, USA: MSPAS, INE, Segeplán and ICF International. http://dhsprogram.com/pubs/pdf/FR318/FR318.pdf

20Bahamondes, L., Fernandes, A., & Monteiro, I. (2017). Barriers to implementing and consolidating a family planning program that would meet Brazilian needs. Revista Brasileira de Ginecologia e Obstetrícia, 39, 373-375.

21Irons, R. (2021). Venezuelan women’s perception of sexual and reproductive health services in Lima, Peru. Revista Peruana de Medicina Experimental y Salud Pública, 38, 248-253.

22Ranji, U., Long, M., Salganicoff, A., Silow-Carroll, S., Rosenzweig, C., Rodin, D., & Kellenberg, R. (2019). Beyond the Numbers: Access to reproductive health care for low-income women in five communities. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/report/beyond-the-numbers-access-to-reproductive-health-care-for-low-income-women-in-five-communities/

23Hulme, J., Dunn, S., Guilbert, E., Soon, J., & Norman, W. (2015). Barriers and facilitators to family planning access in Canada. Healthcare policy = Politiques de sante, 10(3), 48–63.

24Dansereau, E., Schaefer, A., Hernández, B., Nelson, J., Palmisano, E., Ríos-Zertuche, D., Woldeab, A., Zúñiga, M. P., Iriarte, E. M., Mokdad, A. H., & El Bcheraoui, C. (2017, October 17). Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents. Reproductive health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646150/

25Jourdan, D. (2021, December). The journey towards comprehensive sexuality education: Global report. In 4th IAAH MENA Region adolescent health conference: Adolescent care, Leaving no one behind. Paris, France: UNESCO.

26Gele, A. A., Musse, F. K., Shrestha, M., & Qureshi, S. (2020). Barriers and facilitators to contraceptive use among Somali immigrant women in Oslo: A qualitative study. PloS one, 15(3), e0229916. https://doi.org/10.1371/journal.pone.0229916

27Väisänen, H., Koponen, P., Gissler, M., & Kontula, O. (2018). Contraceptive use among migrant women with a history of induced abortion in Finland. The European Journal of Contraception & Reproductive Health Care, 23(4), 274-281.

World Population

The subject of population touches upon a wide variety of human interests from reproductive rights to economic development to a sustainable world.  For a quick overview, see Why Population Matters. Every two years, the UN’s Population Division publishes its “World Population Prospects” report: Click here for a summary of the latest findings and trends.

All Methods for All: Funding comprehensive contraceptive programs for everyon

Due to interlocking systems of structural oppression such as racism, bias, and discrimination, many people who desire contraceptive information and services are not able to obtain them. In 2018, about 73 million people in the United States were of reproductive age, and about 63 percent did not desire to become pregnant. Researchers estimate that nearly all women will use a method of contraception to achieve their reproductive desires and manage their reproductive health during their reproductive life course. Of these contraception users, about one-third will require public assistance to access contraception-related information and services. Regardless of insurance status and income, barriers in access to contraception persist. The need for contraception among people with the ability to give birth highlights how these services are essential for sexual and reproductive health and well-being and are of great public health importance.

All Methods for All: Funding comprehensive contraceptive programs for everyone

The Economic Costs of Abortion Restrictions

Access to sexual and reproductive healthcare services, including abortion, is critical for the health and well-being of people everywhere. In addition to underpinning people’s health and rights, there is a growing body of evidence that demonstrates the importance of such access in economic terms. The advancement of sexual and reproductive health and rights has helped people overcome barriers to earning better wages and has granted greater access to participation in the workforce. However, abortion restrictions enacted at the state-level threaten decades of progress made regarding the well-being of many individuals and families in the United States.

The Economic Costs of Abortion Restrictions

The State of Reproductive Health and Rights: A 50-State Report Card

For a decade now, the Population Institute has released a 50-state report card on reproductive health and rights showing how opponents of reproductive rights are creating a United States where there is a deep divide between those who have access to reproductive health care and those who do not. In the ten years of the report card, the U.S. overall grade has dropped from a C- to an F, and the number of failing states has grown dramatically — from nine the first year to 25 this year.

Find out if your state is making the grade.

Click here to read more about this Report Card

2021 National Press Release

The State of Reproductive Health and Rights: A 50-State Report Card

Beyond Roe: The Floor, Not the Ceiling

With recent changes to the makeup for the U.S. Supreme Court, there is a concern that Roe v. Wade will be overturned. The Supreme Court is set to review Mississippi’s 15-week abortion ban, which is a direct challenge to Roe and the nearly 50 years of precedent that the landmark decision has established. But the Supreme Court does not have to officially overturn Roe for people to be unable to exercise their right to abortion. The “Beyond Roe” series makes the broader point that abortion rights have already been significantly undermined, and it documents how, to what extent, and who are disproportionately impacted by abortion restrictions, namely Black, Indigenous, and people of color (BIPOC), low-income people, and young people. Protecting and expanding upon the legal right to abortion established by Roe is vital, especially now. But in the midst of this struggle, it is important to recognize that Roe is not and has never been enough to ensure that everyone has access to abortion who needs it.

Individually, each abortion restriction is harmful; when working in tandem with other restrictive policies, the barriers to accessing abortion can become insurmountable and deepen existing inequalities — even under Roe. To learn more, please explore the “Beyond Roe” series here:

All of these anti-abortion laws interact with one another to create a suite of hostile policies that severely undermine abortion rights. While individually these policies create barriers that limit a person’s access to abortion services, they also work in tandem to make it virtually impossible to obtain abortion care in some regions of the country. Restrictive abortion laws and policies can be broken down into several categories, including:

Gestational Age Bans

Gestational age bans restrict abortion after a specific point in pregnancy. The efforts to pass early gestational age bans have been viewed by many to be an attempt to bring a case before the Supreme Court to directly challenge Roe and point to Mississippi’s 15-week as an example.

Insurance Coverage Bans

Insurance coverage plays a major role in affordable and equitable access to abortion care. Some state governments have passed bans on abortion coverage in public employees’ insurance policies, as well as have laws restricting abortion coverage in all private health insurance plans. Some states also restrict abortion coverage in plans offered through the health insurance exchanges established under the Affordable Care Act. The Hyde Amendment, a federal-level policy, also plays a role in denying coverage for abortion care. It prohibits the use of federal funds for abortions except in cases of life endangerment, rape, or incest. This restriction denies abortion coverage to many of those enrolled in Medicaid, the nation’s primary health insurance program for low-income individuals and families. Other individuals impacted by the Hyde Amendment include people insured by Indian Health Service, Medicare, the Children’s Health Insurance Program, the military’s TRICARE program, federal prisons, immigration detention centers, the Peace Corps, and the Federal Employees Health Benefits Program.

Method Bans or Restrictions

These laws ban methods of abortion care, including the safest and most common method of abortion care in the second trimester: dilation and evacuation (D&E) procedures. Other restrictions include those around telemedicine and the provision of medication abortion, a safe, nonsurgical abortion practice that can expand access to abortion, particularly for individuals in rural areas and regions with few abortion providers.

Other Medically Unnecessary Requirements

Medically unnecessary requirements are often touted as protecting pregnant people’s health, but in reality, they place additional burdens of cost and time on people seeking abortion care. These types of requirements can include mandatory counseling that incorporates medically misleading information, mandatory waiting periods, and forced ultrasounds.

Parental Involvement Laws

Parental involvement laws require parental notification, consent, or judicial approval for minors seeking abortion care. These laws often delay or prevent young people’s access to abortion services and disproportionately affect immigrant youth.

Religious Refusals

Religious refusal laws allow most health care workers to deny patients access to certain types of health care services if that worker deems it contrary to their personal beliefs.

SB 8

Texas’ Senate Bill 8 (SB 8) is one of the nation’s most restrictive abortion laws. It bans abortion as early as six weeks into pregnancy, two weeks after a missed period, with no exceptions in cases of rape or incest. This law is in effect despite being unconstitutional and was designed to be immune to judicial review. SB 8 is currently serving as a template for lawmakers in other states to implement similar bans.

TRAP Laws

Targeted restrictions on abortion providers—known as TRAP laws— impose medically unnecessary requirements on providers and clinics under the guise of protecting pregnant people’s health. The enactment of these regulations has become unnecessarily burdensome on providers and clinics, forcing some of them to stop providing care.

Trigger Bans

Many states have passed laws to restrict the legal status of abortion should the Supreme Court overturn Roe. These “trigger bans” are designed to take effect immediately upon a Supreme Court decision, without the need for further state-level legislation.

Individually, these laws are harmful; but when working in tandem with other restrictive policies, the barriers to accessing abortion can become insurmountable and deepen existing inequalities — even under Roe.

Click here to access the full Beyond Roe brief

Beyond Roe: Gestational Age Bans

Beyond Roe: Insurance Coverage Restrictions

Beyond Roe: Method Bans

Beyond Roe: More Medically Unnecessary Requirements

Beyond Roe: Parental Involvement Laws

Beyond Roe: Religious Refusals

Beyond Roe: SB 8

Beyond Roe: TRAP Laws

Beyond Roe: Trigger Provisions

The Shadow Pandemic: Addressing gender-based violence during the COVID-19 pandemic

Significant progress has been made in improving the lives of health services — have been overwhelmed, shifted priorities, or women and girls around the world in recent years. More girls are enrolled in primary and secondary education, the practice of female genital mutilation/cutting (FGM/C) has seen an overall decline, and millions of child marriages have been averted worldwide. The COVID-19 pandemic, however, stands to threaten years of progress.

The Shadow Pandemic: Addressing gender-based violence during the COVID-19 pandemic

Separate Policies, Similar Harm: The Global Gag Rule and the Helms Amendment

As the world’s number one global health donor, the U.S. has an obligation to support the provision of equitable, accessible health care globally. However, there are two major policies that currently interfere with and disrupt essential health care services: the “global gag rule” (GGR), and the Helms Amendment. These policies have devastating impacts on safe abortion access (and beyond) for millions of people in low- and middle-income countries, primarily harming people of color. While the harm they cause is similar, these policies do have distinct differences.

Separate Policies, Similar Harm: The Global Gag Rule and the Helms Amendment

The State of Reproductive Health and Rights: A 50-State Report Card

While most Americans are aware of the national political debate over birth control and abortion, many are unaware of the status of reproductive health and rights in their own state. In the interest of an informed public debate, the Population Institute released it’s 2020 50 State Report Card on Reproductive Health and Rights that gives an overview of what’s happening in the 50 States and the District of Columbia.

Find out if your state is making the grade.

Click here to read more about this Report Card

2020 National Press Release

The State of Reproductive Health and Rights: A 50-State Report Card