The FAM Project: New family planning options in Guatemala
Guatemala is a focus country of the Institute for Reproductive Health’s (IRH) Fertility Awareness-Based Methods (FAM) Project, a U.S. Agency for International Development (USAID) funded initiative. The purpose of the FAM Project is to facilitate and document the scale up of FAM services in select focus countries, and to continue supporting increased access to and use of FAM worldwide.
The goal of the FAM Project in Guatemala is to provide couples with sustainable access to FAM by integrating the Standard Days Method® (SDM) and Lactational Amenorrhea Method (LAM) into ongoing family planning services provided by the Ministry of Health (MOH) and non-governmental organizations (NGOs). Additionally, the methods will be offered at the community level by community health workers and socially marketed in the private sector. Under the FAM Project, the Guatemala country program will also explore the feasibility of including the TwoDay Method® (TDM) in the MOH norms, assess where it can be integrated and begin integration where appropriate.
Recent FAM Project accomplishments in Guatemala
  • IRH worked in four departments with Calidad en Salud/URC to provide training and support to the country’s largest service providers, the MOH’s NGO Network Extension de Cobertura and APROFAM, to build capacity among community health workers and promoters on SDM and LAM.
  • The SDM and LAM are featured in a nationally-televised commercial about family planning methods developed by Alianzas/RTI in collaboration with family planning partners, including IRH, as a follow-up to a birth-spacing commercial launched previously. 
  • IRH has had increased commitment from a number of organizations, especially the MOH, after the Strategic Planning Follow-up Meeting with ExpandNet and other partners held in June 2009.  As a result, a resource team of 13 individuals and IRH was formed to ensure the integration of FAM within their organizations and within the national family planning strategy. 
The FAM Project: Expanding access to family planning in Guatemala
In Guatemala, IRH is partnering with the MOH, APROFAM and IGSS to scale up the SDM and strengthen their family planning programs in at least three departments, including USAID priority health areas: Sololá, Quetzaltenango and San Marcos.  The scaling up process is guided by the World Health Organization’s ExpandNet model for scaling up reproductive health innovations.
IRH is developing in-country capacity for providing training and technical assistance among private and public sector organizations by coordinating with local NGOs to train trainers and providers and by providing follow-up support.  Additionally, IRH is working to increase awareness of FAM through an IEC campaign that includes print and radio.
The FAM Project addresses unmet need for family planning in Guatemala 
The 2002 Guatemala National Health Survey (ENSMI 2002) indicates that contraceptive prevalence is 43% among married women, age 15-49, and that 28% of married women have an unmet need for family planning.  Although recent studies show that unmet need has decreased slightly, it still remains high in rural areas.
Coincidentally, it is in rural areas and with married couples that the SDM has its highest demand.  The estimated current use of natural methods in Guatemala suggests that up to 20% of women of reproductive age may be interested in using the SDM.  As a result, the SDM could reach as much as 10-15% of the method mix, meaning an increase in contraceptive prevalence rate (CPR) and a decrease in unmet need.
Following the research-to-practice-to-scale model in Guatemala
IRH began work in Guatemala in 2002 at the request of the MOH and the Guatemalan Social Security Institute (IGSS), which sought to expand contraceptive choice by integrating fertility awareness-based methods into the method mix. IRH’s initial efforts sought to build evidence in fertility awareness-based methods to guide their introduction and eventual scale-up in Guatemala and elsewhere.
Studies were conducted on both SDM and TDM, as well as on best practices for offering these methodsFor this research, IRH pursued a diversified strategy including work with the public and private sectors, NGOs, international organizations and faith-based groups. Research and technical assistance activities were conducted in Quetzaltenango, Chimaltenango, Santa Rosa, Sololá, Totonicapán and San Marcos.
Building partnerships to expand choice
Several key partners support FAM, including: 
  • The main family planning providers in the country: MOH, IGSS, APROFAM, and the Guatemalan OB/GYN Association (AGOG)  
  • NGOs that provide technical support to the MOH and APROFAM through training, community outreach, and M&E: AMIGAS, APROVIME, WINGS and members of the MOH NGO Network Extension de Cobertura
  • Cooperating Agencies and donors: Calidad en Salud/URC, Population Council/Guatemala, HPI, Deliver Project, PAHO, and UNFPA
The next steps for IRH include following up with partners to ensure that FAM reaches the community level and that the necessary resources (IEC materials, reporting forms and CycleBeads®) are available to providers and potential SDM and LAM users.
Contact the FAM Project in Guatemala or IRH Headquarters
IRH/Guatemala Country Representative, Karina Arriaza at
IRH Country Manager for Guatemala, Elizabeth Salazar at