A new study of couples in Bolivia finds that indigenous and nonindigenous women have nearly the same rate of wanted births, a finding that dispels the myth that indigenous women have higher birthrates simply because they desire larger families than nonindigenous women. The study finds that the difference in the total birthrates of indigenous and nonindigenous women is due almost entirely to a higher rate of unwanted births among indigenous women. This disparity is likely driven by indigenous women’s poor access to contraceptive services and higher rate of unmet need for contraception, concludes the author, Catherine McNamee of the University of Texas at Austin.

The study also looked at the role of men’s attitudes and couple dynamics to determine whether these factors contribute to the disparity between the two groups in rates of unwanted births. McNamee finds that while partners in indigenous couples are more likely than those in nonindigenous couples to respond separately that they do not want another child, indigenous women are still less likely than nonindigenous women to discuss family planning with their partner and thus are less accurate at predicting their partner’s support for using family planning. Since the indigenous women who think their partner does not approve of family planning or who are not sure of their partner’s attitude are much less likely to use a contraceptive method, McNamee concludes that these factors negatively influence indigenous women’s contraceptive use.

Promisingly, though, the study finds that vast majorities of both indigenous and nonindigenous couples approve of family planning. Nevertheless, 44% of indigenous women, compared with 26% of nonindigenous women, say they do not want a child in the near future but are not using any method of contraception. The author therefore recommends that family planning clinics encourage indigenous couples to communicate more about contraceptive use and family planning so that they can achieve their smaller desired family sizes. Further, involving men in visits to family planning clinics could be helpful because, as McNamee observes, indigenous men are more likely than women to know about a variety of modern contraceptives and to speak Spanish, which is used more often than local languages by clinic staff.

Since McNamee did not find a significant cultural power dynamic to be at work among indigenous couples, she concludes that access to clinics (which are less numerous in the rural areas where the majority of indigenous women live) is likely more important in the disparity in rates of unwanted births between indigenous and nonindigenous women. Poverty and the remote locations of many clinics may also obstruct indigenous women’s access to a variety of contraceptives, as may experiences with or fears of language barriers and culturally insensitive policies at family planning clinics. Family planning programs and policies, she concludes, should take greater note of the needs of indigenous couples and target them in a culturally appropriate way.

The study, "Wanted and Unwanted Fertility in Bolivia: Does Ethnicity Matter?" appears in the December 2009 issue of International Perspectives on Sexual and Reproductive Health.

Also in the December 2009 issue of International Perspectives on Sexual and Reproductive Health:

The Influence of Wives’ and Husbands’ Education Levels on Contraceptive Method Choice in Nepal, 1996–2006 by Bina Gubhaju;

Social Exclusion and Early or Unwanted Sexual Initiation Among Poor Urban Females in Ethiopia by Annabel Erulkar and Abebaw Ferede;

Perceptions of Policymakers in Nigeria Toward Unsafe Abortion and Maternal Mortality by Friday E. Okonofua et al.;

Stalled Decline in Fertility in Ecuador by Kanako Ishida et al.