Abstract

In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or “modern ”) health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.

An erratum to this article is available at http://dx.doi.org/10.2307/2061760.

References

Adams, R.N. (
1952
).
Un Análisis de las Creencias y Prácticas Médicas en un Pueblo Indígeno de Guatemala
.
Guatemala
:
Editorial del Ministerio de Educación Pública
.
Adams, R.N. (
1956
).
La Ladinización en Guatemala
.
Guatemala City
:
Seminario de Integración Social Guatemalteca
.
Annis, S. (
1981
).
Physical Access and Utilization of Health Services in Rural Guatemala
.
Social Science and Medicine
,
15D
,
515
23
.
Barry, T. (
1989
).
Guatemala: A Country Guide
.
Albuquerque
:
Inter-Hemispheric Education Resources Center
.
Bossert, T.J. and E. Del Cid Peralta. 1987. “Guatemala: Health Sector Assessment.” Report prepared for the U.S. Agency for International Development.
Burleigh, E., Dandano, C., & Cruz, J.R. (
1990
).
Colors, Humors and Evil Eye: Indigenous Classification and Treatment of Childhood Diarrhea in Highland Guatemala
.
Medical Anthropology
,
12
,
419
41
. 10.1080/01459740.1990.9966035
Cosminsky, S. (
1982
).
Childbirth and Change: A Guatemalan Study
. In MacCormack, C.P. (Ed.),
Ethnography of Fertility and Birth
(pp.
205
29
).
New York
:
Academic Press
.
Cosminsky, S. (
1987
).
Women and Health Care on a Guatemalan Plantation
.
Social Science and Medicine
,
25
,
1163
73
. 10.1016/0277-9536(87)90358-3
Cosminsky, S., & Scrimshaw, M. (
1980
).
Medical Pluralism on a Guatemalan Plantation
.
Social Science and Medicine
,
14B
,
267
78
.
Das Gupta, M. (
1990
).
Death Clustering, Mothers’ Education and the Determinants of Child Mortality in Rural Punjab, India
.
Population Studies
,
44
,
489
505
. 10.1080/0032472031000144866
Delgado, H., Valverde, V., & Hurtado, E. (
1986
).
United Nations Population Division
Effects of Health and Nutrition Interventions on Infant and Child Mortality in Rural Guatemala
Determinants of Mortality Change and Differentials in Developing Countries
(pp.
145
170
).
New York
:
United Nations
.
DHS Newsletter
. (
1991
).
Calverton, MD
:
Macro International Inc
.
Entwisle, B., Casterline, J.B., & Sayed, H.A.-A. (
1989
).
Villages as Contexts for Contraceptive Behavior in Rural Egypt
.
American Sociological Review
,
54
,
1019
34
. 10.2307/2095721
Gertler, P., & van der Gaag, J. (
1990
).
The Willingness to Pay for Medical Care: Evidence from Two Developing Countries
.
Baltimore
:
Johns Hopkins University Press
.
Goldman, N., & Pebley, A.R. (
1994
).
Health Cards, Maternal Reports, and the Measurement of Immunization Coverage in Guatemala
.
Social Science and Medicine
,
38
,
1075
89
. 10.1016/0277-9536(94)90225-9
Goldman, N., & Pebley, A.R. (
1994
).
Childhood Immunization and Pregnancy-Related Services in Guatemala
.
Health Transition Review
,
4
,
29
44
.
Hausman, J.A. (
1978
).
Specification Tests in Econometrics
.
Econometrica
,
46
,
1251
71
. 10.2307/1913827
Hawkins, J. (
1984
).
Inverse Images: The Meaning of Culture, Ethnicity, and Family in Post-Colonial Guatemala
.
Albuquerque
:
University of New Mexico Press
.
Hurtado, E. and A. Esquivel. 1986. Guatemala. Guatemala City: INCAP Publication No. C-242.
Kleinman, A. (
1978
).
Concepts and a Model for the Comparison of Medical Systems as Cultural Systems
.
Social Science and Medicine
,
12
,
85
93
.
Krotki, K. 1988. “Trends in Geographical and Socio-Economic Differentials in Early Age Mortality.” Mimeographed document, Centro Latinoamericano de Demografía.
Logan, M.H. (
1973
).
Humoral Medicine in Guatemala and Peasant Acceptance of Modern Medicine
.
Human Organization
,
32
,
385
95
.
Longford, N.T. (
1988
).
VARCL: Software for Variance Component Analysis of Data with Hierarchically Nested Random Effects (Maximum Likelihood)
.
Princeton
:
Educational Testing Service
.
Longford, N.T. (
1993
).
Random Coefficient Models
.
Oxford, UK
:
Clarendon Press
.
Mason, W.M., Wong, G.Y., & Entwisle, B. (
1984
).
Contextual Analysis through the Multilevel Linear Model
. In Leinhardt, S. (Ed.),
Sociological Methodology 1983–4
(pp.
72
103
).
San Francisco
:
Jossey-Bass
.
Melville, M., & Lykes, M.B. (
1992
).
Guatemalan Indian Children and the Sociocultural Effects of Government-Sponsored Terrorism
.
Social Science and Medicine
,
34
,
533
48
. 10.1016/0277-9536(92)90209-9
Encuesta Nacional de Salud Materno Infantil 1987
. (
1989
).
Guatemala
:
MSPAS and INCAP
.
Parra, P.A. (
1991
). La Mujer Rural, las Comadronas y el Sistema Mexicano de Salud.
Estudios Demográficos y Urbanos
,
6
,
69
88
.
Payer, L. (
1988
).
Medicine and Culture
.
New York
:
Henry Holt
.
Prosser, R., Rabash, J., & Goldstein, H.I. (
1991
).
Data Analysis with ML3
.
London
:
Institute of Education
.
Quezada, R.A., Peidra, C.H., Delgado, G.V., Aguilar, E.C., & Cordova, J.H. (
1988
).
La Práctica Medica Tradicional
.
Quito
:
IDICSA, Universidad de Cuenca
.
Rodríguez, G., & Goldman, N. (
1995
).
An Assessment of Estimation Procedures for Multilevel Models with Binary Responses
.
Journal of The Royal Statistical Society
,
158
,
73
89
. 10.2307/2983404
Rosenthal, C. 1987. “Santa Maria de Jesús: Medical Choice in a Highland Guatemalan Town.” Doctoral dissertation, Department of Anthropology, Harvard University.
Rosenzweig, M.R., & Schultz, T.P. (
1983
).
Estimating a Household Production Function: Heterogeneity, the Demand for Health Inputs, and Their Effects on Birth Weight
.
Journal of Political Economy
,
91
,
723
46
. 10.1086/261179
Rosenzweig, M.R., & Wolpin, K.I. (
1986
).
Evaluating the Effects of Optimally Distributed Public Programs: Child Health and Family Planning Interventions
.
American Economic Review
,
76
,
470
82
.
Análisis de la Mujer y Situación del Niño
. (
1991
).
Guatemala City
:
Secretaría General del Consejo Nacional de Planificación Económica and UNICEF
.
Self, S.G., & Liang, K.-Y. (
1987
).
Asymptotic Properties of Maximum Likelihood Estimators and Likelihood Ratio Tests under Nonstandard Conditions
.
Journal of the American Statistical Association
,
82
,
605
10
. 10.2307/2289471
Tedlock, B. (
1987
).
An Interpretive Solution to the Problem of Humoral Medicine in Latin America
.
Social Science and Medicine
,
28
,
925
37
.
Tedlock, B. (
1992
).
Time and the Highland Maya
.
Albuquerque
:
University of New Mexico Press
.
Tienda, M. (
1991
).
Poor People and Poor Places: Deciphering Neighborhood Effects on Poverty Outcomes
. In Haber, J. (Ed.),
Macro-Micro Linkages in Sociology
(pp.
244
62
).
Newbury Park, CA
:
Sage
.
Tsui, A.O. (
1985
).
Community Effects on Contraceptive Use
. In Casterline, J. (Ed.),
The Collection and Analysis of Community Data
(pp.
77
99
).
Voorburg
:
International Statistical Institute
.
Vielman, L., & Hurtado, E. (
1986
).
lnforme Final de la Investigación Etnográfica sobre Algunos Aspectos de Salud y Nutrición Realizada en la Colonia Juarez Guanagazapa
.
Guatemala
:
Instituto de Nutrición de Centro América y Panamá
.
Villatoro, E. and E. Hurtado. 1986. “Informe Final de la Investigación Etnografica sobre Algunos Aspectos de Salud y Nutrición en una Comunidad de Huehuetenango.” Report prepared for the Guatemalan Ministry of Public Health and Social Assistance. von Hoegen, M. 1986. Concentración Geográfica de Servicios en Guatemala. Guatemala: Asociación de Investigación y Estudios Sociales.
Warren, C., Monteith, R.S., Johnson, J.T., Santiso, R., Guerra, F., & Oberle, M.W. (
1987
).
Use of Maternal-Child Health Services and Contraception in Guatemala and Panama
.
Journal of Biosocial Sciences
,
19
,
229
43
. 10.1017/S0021932000016825
Warren, K. (
1989
).
The Symbolism of Subordination: Indian Identity in a Guatemalan Town
.
Austin
:
University of Texas Press
.
Wilk, R.R. (
1991
).
Household Ecology: Economic Change and Domestic Life among the Kekchi Maya in Belize
.
Tucson
:
University of Arizona Press
.
Woods, C.M. (
1977
).
Alternative Curing Strategies in a Changing Medical Situation
.
Medical Anthropology
,
3
,
25
54
. 10.1080/01459740.1977.9965823
Young, J.C. (
1981
).
Medical Choice in a Mexican Village
.
New Brunswick
:
Rutgers University Press
.