In reply to esme.

Good questions Esme,
We are not health care providers. My husband is and architect and I've got a liberal arts degree with a concentration in Spanish literature; definitely NOT health care providers. We work in conjunction with the Guatemala's Ministry of Health, which I think is more sustainable anyway. I've occassionally wished I had more medical experience and qualifications, but I think they really just need educators at the moment. I mentioned this in the above post, but the ministry of health has been working fairly hard to extend services and qualified personnel. The problem is that people here are not used to having medical assistance. In lots of areas they don't understand it, or are frightened by it, and distrust it. So we're here to help the Ministry of Health and the healthcare providers extend their services by educating the people on what the health center will provide for them. We also educate them on WHEN they should and should not seek medical assistance because this is a very basic thing that few people are very certain of here.
A lot of the time when we do health talks I go discuss things with the nurses first so we can get their messages to the people, let them know what is provided for them through the health center and what exactly the nurses can do here. There are two nurses working in our village at the health post, one is an asst. the other the equivalent of an RN. The RN is qualified to put in the copper T, but does not have the equipment. She's encouraged me to send women who are interested into the puesto to talk to her. She can either borrow the equipment from the central office in Huehuetenango and do a little copper T campaign, calling in the local women who want them to come and get them over a period of a few days or a week. Or she can request to have someone from Huehue come up and run the copper T campaign. If someone didn't want to wait he or she could go to Huehue for the T or for either a male or female operation to stop having children. All their medical expenses are free, but the trip is not, and the operations require an overnight in the capital. People here are more day-to-day rather than long-term thinkers, and these expenses feel astronomical to them. So we've talked to them about how, while it feels expensive, taking such measures will help them economically by not adding so many children to the family, to clothe and feed and educate. They are just beginning to grasp these concepts, as they're all very new ways of thinking to them. But it's one of those things, even if they're intimidated by or a little frightened of, I can tell they understand what I'm saying and the ideas I'm trying to share. And that's very important to me.
As far as pregnancy is concerned, women are most frequently attended by local midwives (we also work with the health center on an education series for the midwives to provide better services/recognize danger signs/practice basic hygiene etc.). Between 98% and 99% of births here take place in the home. Huehue is a long way from here, which makes it expensive for them to rent a car--about 2000Q for people who make 30Q a day when they have work. There is a center two hours from our village that can provide a C-section, though sometimes the women are taken all the way to the capital, Huehue, which is about 3-4 hours in a private vehicle; it's better equiped in general. Last week our ambulance arrived so getting them to hospital is about to get much easier and less cost-prohibitive for the infirm! Pretty exciting.
But again, the women are most comfortable doing it the way they've always done it, in-home with a midwife. For the majority of pregnancies that's ok, as long as they get the hygiene issues taken care of. But we're working on improving this from all angles, working with the families and the midwives.
It's great to talk to you about these things. I often say, what strikes me all the time here is not how different it is from the US, but how so many problems are just a matter of degrees. The US has the same problems with better infrastructure. Unfortunately the better infrastructure sometimes just masks the problems so many Americans are unaware of their existence and therefore do not work for change. Teenage girls in South Bronx are probably not terribly different from teenage girls here. I imagine both groups have a very limited view of what their education could do for their future as well as plenty of negative body image issues, lack of body knowledge, as well lack of self-esteem for never being taught they matter. Babies, here just as there, are sometimes had and treasured as a thing to love and be loved by, even when the mother is only 13 or 14 years old, because that love is not coming from anywhere else. Though it has its usefulness when used properly, birth control won't change any of these issues.
As for Taking Charge of Your Fertility, don't hesitate to recommend it as a planning method also if you feel you've found a good candidate for it. We are so happy with its effectiveness, and it also feels like when/if we decide, "Ok, it's time to have kids" things will all be in pretty good working order, no waiting for a cycle to regulate after getting off hormones. We're both ridiculously analytical and want to know STUFF so her book was a great read for both of us. Also I have a dear friend who has a strong family history of breast cancer from both sides of her family; she's nearly guaranteed to get it at some point. She uses it with barrier methods just to stay away from hormones and she's single. She loves it as well. Not a good choice for anyone who just doesn't want to get pregnant and wants to forget about their cycle entirely, but some people just don't want to get pregnant and are ok with their periods.
Also, Toni Weschler came out with a new book for girls/young women called Cycle Savvy. I haven't gotten my hands on a copy yet, but I'd really like to read it. I might end up getting it for my throng of beautiful little nieces when the time is right (some of them are getting to be not-so-little anymore). I have a lot of respect for the work that woman has done. Likewise, I commend you for the work you're doing state-side.
I'd love to hear them if you have more comments or questions. You know where to find us.

Best,
Emily