In reply to emily.

Hi Emily --

I just came across your blog from a post on a listserv for parents with children adopted from Guatemala -- I look forward to reading more! Just thought I'd comment on your birth control musings. I'm a midwife, and work in the South Bronx, so spend a lot of time thinking about some of the same issues you do in terms of presenting family planning options. I'm not nearly as opposed to hormonal contraception as you seem to be -- the pill, for instance, is arguably a medication that should be offered to *all* women (who don't have any medical contraindications) for the prevention of ovarian cancer, regardless of their FP needs. And the most recent evidence around Depo is reassuring about the bone loss issues. Still, it is a difficult balancing act, to determine what level of information people are capable of processing. I'd say that *on the whole* the misconceptions about various birth control methods, at least in this country, lean heavily toward a overestimation of increased risk of the method, and underappreciation of the risks of pregnancy. It sounds to me like what you're doing is helping to correct those misperceptions.

However, I think it would ALSO be worth exploring the use of natural family planning with your Guatemalan women. NFP can actually be very simple to use in some of it's various permutations. In fact, at the Contraceptive Technology conference I went to in March, there was a company with a product called "cyclebeads" -- a sort of fertility rosary that could easily be duplicated with local materials. Not sure if you've already investigated that line of thinking, but thought I'd put it out there if you haven't. I'm sure others have written about NFP in indigenous communities, although I don't have any specific references for you at the moment.

cheers!
Esme