In a family-planning clinic in downtown Guatemala City, Ana Coj awaits an injection she hopes will give her a radically different life from the one her mother has. With regular contraceptive injections, Ms. Coj says she plans to have just three children and space them two years apart. Her mother had eight.
"My mother gets sick a lot and has a lot of pain, and having so many children so close together is what has affected her health," says Coj, who at 18 already has a 10-month-old baby girl of her own. "I don't want that to happen to me."
In a nation with the highest fertility rate in Latin America and one of the lowest rates of contraceptive use, many here hope a new law will allow more women the opportunity to make their own choices about family planning. In the face of stern Catholic Church opposition, the president signed into law last week Guatemala's first official reproductive health policy.
The Social Development and Population Law, which covers a broad range of issues, will institutionalize the sporadic and largely underfunded reproductive health programs of the past.
"This law would make support of reproductive health programs a policy of the state, and, as such, one that would have to be respected and continued in future administrations," says Hector Colindres, who heads up the Health Ministry's reproductive health program, launched in January.
Mr. Colindres says the law will enable congress to assign funds specifically for the program, which currently subsists largely on ever-dwindling foreign aid.
The Catholic Church asked the president to veto the law. Similar initiatives in the past had been blocked by church opposition. "Our fear is that this law could be manipulated to promote abortions," says Nery Rodenas, the director of the local church's human rights office. The church said it will be watching carefully to see if that happens.
But supporters of the law, who point out that abortion is illegal in Guatemala, argue that this law will protect the right to life - the right to life of the nation's women, who have an average of five children.
"The fertility rate is a brutal attack on the health of women," says Telma Duarte executive director of the private Association for Family Well Being. Ms. Duarte points to United Nations' statistics showing that the maternal mortality rate in Guatemala is the fifth highest in Latin America. She adds that this statistic is widely recognized to be under-registered, according to some studies, by as much as 60 percent.
Duarte says giving birth at very young ages, the number of births, and close spacing of births all contribute to the high maternal mortality rate. UN statistics show that in Latin America, only in Haiti is contraceptive use less prevalent than in Guatemala. With a 2.6 percent annual population growth, Guatemala is one of the fastest growing countries in the region.
The new law will not only bolster reproductive health programs, but also make reproductive health education obligatory in the nation's schools.
"Guatemala is a very conservative country, and so it has been very difficult for the state to give information on reproductive health to the public," says Zulema Paz de Rodriguez, president of the congressional women's committee that drafted the law. "We made the best of efforts to work with the church and incorporate their suggestions into the law, but we cannot halt something that is necessary for the nation's development and a law that is well received by Guatemalan society."
Guatemala is not only a predominantly Catholic country, but a nation in which nearly half the population is Maya, a culture that is also traditionally against contraception.
"The Maya society doesn't accept family planning," says Gloria Tecún, vice-secretary of the president's secretariat for women's affairs. "Many Maya see contraceptives as a way for the rest of society to do away with the Mayas, because we have always been blamed for the underdevelopment of the country."
But advocates of family planning also point out that most women, including indigenous women, have more children than they want. Among indigenous women, the fertility rate jumps to an average of 6.2 children. Many say this reflects the fact that the indigenous population is the most marginalized sector of society with the lowest levels of education.
Ana Coj, a Maya herself, can't read or write, having never gone to school. But relatives told her about the free contraceptives, she says, and the injection that would enable her to have only as many children as she wants.
Nonetheless, she says she doesn't feel she is doing anything radical or controversial.
"I want to have the shots so that my children won't suffer, and so I won't suffer," she says, adding that her mother never took contraceptives, "because she didn't know they existed."