F O C U S

Appreciating the Complexity and Dignity of People’s Lives:Integrating Population-Health-Environment Research in Petén, GuatemalaLiza Grandia

From 1997-1999, a team of researchers developed a new

environmental module for Guatemala’s Demographic

and Health Survey (DHS) that analyzed the rapidly

changing population-environment dynamics in Petén, a

frontier region in the northern part of the country.

Anthropologist Liza Grandia (1) presents the context and

history of the module’s development; (2) discusses the les-

sons learned; (3) describes programs based on the survey

that reduced Petén’s total fertility rate from 6.8 to 5.8

children per woman in just four years; and (4) concludes

that integrated research is an important part of respecting

the humanity of the poor.1

Issue 10 November 2005

on population, environment, and security

At the heart of ancient Mayan civilization, thePetén region of northern Guatemala washome to millions of people at the height of

the late Classic period (600-900 AD). Then, follow-ing a political and demographic decline, Petén’s once-great cities like Tikal and Yaxhá faded into the forests.Today, the ruins of stone temples peeking out of thedense tropical canopy serve as reminders of the ebband flow of civilization—and how quickly things canchange on our fragile planet.

Once again, Petén has emerged as one of LatinAmerica’s most dynamic and endangered frontiers.Before 1960, the largely isolated region had only15,000 inhabitants, whose “enclave” economy wasbased on extracting non-timber forest products(Schwartz, 1990). Petén’s skyrocketing growth canbe traced to Guatemala’s military dictatorship,which, after gaining power following the 1954 CIA-orchestrated coup, encouraged colonization of theregion. While the planners envisioned only 150,000settlers by 2000, new roads and agrarian pressuresspurred uncontrolled migration by poor peasants,and today, the population surpasses 500,000(Grandia & Fort, 1999).

The migrants—ladinos (mestizos) from theOriente, Guatemala’s arid eastern ranchlands, andQ’eqchi’ Maya from south of Petén—settled alongdirt roads that timber and oil companies blazed intothe northern forests. Given the poor quality of Petén’ssoil, cattle ranchers bought up or seized the migrants’land, and thus pushed the agricultural frontier furthernorth (Grandia, 2004). By the 1990s, more than halfof Petén’s forests—approximately one and a half mil-lion hectares—had been lost.

To stem the tide, in 1991 the Guatemalan gov-ernment created the 1.6 million-hectare MayaBiosphere Reserve, the largest protected tropical for-est north of the Amazon and twice the size ofYellowstone. When created, thousands of subsis-

tence farmers already lived in the reserve, mostly inthe buffer zone. But by 1998, a government-spon-sored census found 87,100 people—and the num-ber was growing quickly (Grunberg & Ramos,1998). In addition, absentee cattle ranchers clearedthousands of hectares of Laguna del Tigre NationalPark and other parts of the reserve with impunity.

In the early 1990s, USAID/Guatemala support-ed the establishment of several Petén-based conser-vation projects, including ProPetén, formerly theGuatemalan branch of Conservation Internationaland now an independent NGO.2 Initially, ProPeténworked to develop economic alternatives to slash-and-burn farming, such as sustainable forestry, eco-tourism, and harvesting non-timber forest products,to mitigate the impacts of settlements inside thereserve’s Multiple Use Zone, an 848,400-hectareregion where residents are permitted to extract forestproducts and raise some crops.

By the mid-1990s, however, ProPetén’s local lead-ership realized that conservation efforts must alsoaddress population growth, which was estimated at10 percent annually (see Graph 1). Ecotourism, forexample, can encourage conservation, but it onlyemploys a limited number of people. Even withoutfurther immigration, the male population of thereserve (a proxy for the amount of farmlandrequired) is expected to double within twenty years(Grandia, 2000). Aside from one private gynecolo-gist, no NGO or government agency offered familyplanning services in Petén, even though both womenand men expressed interest in them. Although popu-lation is not traditionally part of the conservationagenda, ProPetén’s leadership felt the organizationshould address the need for family planning servicesin order to help alleviate future pressures on naturalresources and improve family health in general.3

ProPetén got involved in population because, at thetime, no one else was willing to do it.

INTRODUCTION

2

Issue 10 November 2005

Agronomist EricMena explainshomemade, plant-based pesticidesto Q'eqchi' farm-ers and their wives(Photo: ErickaMoerkerken)

Piggybacking on theDemographic and Health SurveyFor safety and budgetary reasons, Guatemala’s 1987and 1995 Demographic and Health Surveys(DHS)4 excluded Petén, so the region lacked thebaseline fertility data needed to build stakeholdersupport for a major population-environment initia-tive. Known for its methodological rigor andrespected by donors and policymakers, USAID’sDHS was selected as the best instrument to collectfertility and contraceptive data in the region. Inaddition, these surveys explore linkages betweenmaternal-child health and fertility indicators, onthe one hand, and on the other, women’s economicstatus, education, and other social factors. Strictstandardization criteria in DHS questionnairesenable international policymakers to compare dataon regional and international scales. Now compris-ing more than 200 surveys in 75 countries, theDHS program exerts tremendous influence oninternational and national health policy.

The idea to integrate environmental questionsinto the Petén DHS arose synergistically. LuisFlores, then vice president of Guatemala, expressedconcern to the sponsors of the 1995 DHS reportabout its omission of Petén. In response,USAID/Washington staff allocated $90,000 of seedfunding for Macro International, Inc., to carry out aseparate survey of Petén; ProPetén suggested that abonus module exploring linkages among popula-tion, migration, and natural resource managementcould be added with little additional cost. ProPetén

also provided staff time and travel resources tomobilize financial and institutional supportfor the survey, which involved extensivefundraising and consultation with localgovernment agencies and NGOs.5

In the spring of 1998, theGuatemalan government, UnitedNations Population Fund, andUSAID/Guatemala’s health and edu-cation office unexpectedly announcedthat together they would sponsor asmaller, interim DHS to evaluate themidterm fulfillment of Guatemala’s PeaceAccords. Signed in December 1996 afternearly four decades of civil war, the peaceaccords set ambitious goals, such as lowering infantand maternal mortality by 50 percent within fouryears. At that time, the Petén DHS had been on thepolitical table for more than a year, and local andnational politicians were growing concerned at thedelay. In response, USAID/Guatemala agreed to funda complete Petén DHS as part of the interim survey.6

And so, the integrated Petén survey was “piggy-backed” upon Guatemala’s 1998 interim DHS.

Public workshops with NGOs and governmentalorganizations working in Petén helped MacroInternational, Inc., prioritize six thematic areas forthe new integrated survey, which sampled 1,000+households. After receiving training in land andenvironmental concepts, the regular DHS interviewteam surveyed male heads-of-household in March-April 1999 in their mother tongue (either Spanish

3

Liza Grandia (B.A., Yale University) is a doctoral candidate in anthropology at theUniversity of California, Berkeley. She is currently writing her dissertation about lowland fron-tier settlement processes among Q’eqchi’ Maya villages in Guatemala and Belize. After start-ing as a volunteer with ProPetén in 1993 and 1995, Liza returned to Petén in 1997 with aFulbright grant to create the Remedios program described in this paper. In 2002 she becameone of ProPetén’s founding board members, establishing the organization as an independentGuatemalan NGO dedicated to the conservation of the natural and cultural patrimony ofPetén. Having completed her term as president of ProPetén’s board (2003-2005), she remainsan emeritus member.

or Q’eqchi’, the main Mayan language in Petén),asking 81 questions on these themes:7

• Migration;• Agriculture;• Wage labor and non-timber forest products;• Land extension and tenure, with special cate-

gories for protected areas;• Conservation/environmental opinions; and• Population perceptions.

Putting the “E” in DHS: LessonsLearned From the Survey ProcessWhile multidisciplinary research like the integratedDHS offers many benefits, the devil is in the details.The lessons learned while conducting the DHS, list-ed below, might help future integrated surveys.

1. Explore other population-health-environmentconnections beyond linking family planning toconservation initiatives.8 The survey, for example,produced the most accurate land data for Petén indecades, which indicated that landlessness—one-

The Maya Biosphere Reserve (solid line) in Petén, Guatemala, encompassesboth core areas and multiple use zones. The dotted line marks the boundaryof the buffer zone. Source: Forest cover from LANDSAT images 2001; population data from Census 2002, Instituto Nacional de Estadistica deGuatemala. Map courtesy of Edwin Castellanos and Jorge Roldan, GIS andRemote Sensing Laboratory, Universidad del Valle de Guatemala.

4

FOCUS on population, environment, and security

third of farmers reported they had to either rent orborrow land—was more serious than anyone envi-sioned. The 2004 agricultural census confirmedthese conclusions, demonstrating that though pri-marily a health survey, the DHS could also providea “back door” for collecting preliminary data onthorny issues such as land distribution.9 Other rel-evant health-population-environment themesmight include:

a. Relationship of family size to land inheri-tance patterns;

b. Speculatory pressures on land markets, espe-cially those arising from (re)concentration ofland ownership;

c. Environmental justice issues, like use of pesti-cides and other occupational work hazards;

d. Traditional medicine versus governmenthealth services;

e. Links between nutrition and agriculturaldiversity (anthropometry);

f. Women’s work in natural resource management;g. Life-cycle approaches to migration analysis;h. Future perceptions, including views on envi-

ronmental sustainability, the impact of popu-lation growth, and aspirations for their chil-dren and grandchildren; and

i. Relationships between infectious diseases andforms of environmental degradation such asdeforestation.

2. Tailor integrated surveys to the local context,due to the nature of environmental problems. Forexample, measurements of farm size and agricultur-al harvests can be particularly idiosyncratic [seeSchwartz (1990) on the peculiarities of Petén meas-urements]. However, environmental data may pres-ent fewer opportunities for standardization thanhealth data, which could make it difficult to com-pare results across countries or regions.

3. Hire bilingual local people as enumerators—atleast for the pilot survey. If, for budgetary reasons,the regular DHS survey staff must be employed, theschedule must include additional time for trainingand debriefing. Data entry workers must also betrained, as they may encounter difficulties in coding“other” responses.

600,000

500,000

400,000

300,000

200,000

100,000

0

1700 1725 1750 1775 1800 1825 1850 1875 1900 1925 1950 1975 2000

POPU

LATI

ON

5

Issue 10 November 2005

Graph 1. Petén's Population Growth, 1714-1998

Petén has grownby around 10%annually since1960. Roughly2/3 of that growthhas been from in-migration and 1/3from natural repro-duction. Sources:Schwartz (1990);Grandia (2000);Grunberg &Ramos (1998);SEGEPLAN et al.(1993).

6

FOCUS on population, environment, and security

4. Take into account logistical problems present-ed by remote, environmentally sensitive areas; forexample, schedule fieldwork according to the vari-able road conditions during the rainy season.

5. Consider the highly gendered division of laborin rural areas, where men do most of the farming.If the survey focuses on agriculture, then it shouldbe carried out consistently with men (or viceversa, if women are primarily responsible for sub-sistence agriculture). If men are surveyed, thenestablish a coding plan for correlating the malesurvey with the female health survey. Surveyingmen does have a practical advantage: a differentteam of local enumerators can survey men whilefemale enumerators survey women for the regularDHS. Also, the survey could be combined easilyand cost-effectively with a male reproductivehealth survey.

6. Utilize enumerators’ downtime for qualita-tive research (e.g., recording life histories of key

informants) that could provide nuance to informa-tion gleaned from the standard closed-ended ques-tionnaire. This opportunity is not unique to anintegrated DHS, however, and could offer benefitsfor all surveys.

7. Budget extra time for preparing data tables andexploring interesting, unexpected patterns. Stan-dardized data processing of regular health indicators(e.g., total fertility rate, infant mortality, birth atten-dants) can produce preliminary reports withinmonths. Processing data from an experimental envi-ronmental module may be more difficult, however,since some of the potential correlations betweenhealth and environmental variables may not beimmediately apparent.

8. Disseminate results widely to expand awarenessand interest in DHS data among new constituen-cies. These surveys are one of the best sources fornot only health data, but also for other socioeco-nomic indicators. By adding new variables, thismultisectoral data analysis will interest professionalsoutside the traditional health sector.

The cost of expanding the DHS to include envi-ronmental data need not be prohibitive. Even ifdeveloping a separate environmental module is tooexpensive, adding a few such questions to the gen-

From the 1998/99 Petén DHS Indigenous Ladino

Total Fertility Rate (children per woman) 8.6 6.1

Ideal Family Size (children per woman) 4.4 3.7

Percentage of women who do not want more children 37.4% 42.0%

Percentage of women who would be “happy” aboutanother pregnancy

24.2% 14.3%

Percentage of women who would be “sad” about anotherpregnancy

59.8% 48.8%

Table 1

The integrated DHS has been a critical part ofdeveloping ProPetén’s programs linking health

and population with the environment.

7

Issue 10 November 2005

eral household questionnaire could be productive.For example, cross-country analysis of existingenvironmental indicators (e.g., water collection andsanitation) gathered in previous surveys mightprove valuable.10 Other ways to make integratedsurvey modules more cost effective include partner-ing with local research institutions and individuals(NGOs, universities, independent researchers, andgraduate students), which could produce additionalbenefits such as building local research capacity andgenerating interest in the data.

Survey Results: Impact on Healthand Family PlanningWhile most health experts predicted that fertility inPetén was high, no one expected the survey to revealthat the total fertility rate was 6.8 children perwoman, rising to more than 9.0 children in ruralindigenous areas. These shocking numbers catalyzedGuatemala’s Ministry of Health to work withProPetén’s new population and environment pro-gram, Remedios, to train government health work-ers to provide reproductive healthcare across theregion. The results also inspired APROFAM,Guatemala’s leading NGO provider of reproductivehealth care (and International Planned Parenthoodaffiliate), to invest its own resources in opening thefirst reproductive health clinic in Petén, along withrural extension programs.11

The survey found that Petén’s teenage pregnancyrate was the highest in the country, with 37 percentof adolescents aged 15-19 already mothers, com-pared to 22 percent nationally. This discoveryspurred the establishment of adolescent sexual edu-cation programs now run by Tan Uxil, an NGOthat ProPetén helped Family Planning InternationalAssistance start in 2002.12 In addition, ProPeténand its partners established an inter-institutionalReproductive Health Commission, whose collabo-rative projects address cervical cancer (the mostcommon cause of death in women in Petén),domestic violence, emergency contraception, andfamily planning education.

By 2002, only four years later, the nationalDHS revealed that Petén’s total fertility rate haddropped from 6.8 to 5.8 children per woman(Klein & Hidalgo, 2003). Contraceptive use for all

methods increased from 23.5 percent to33.9 percent, while use of modernmethods increased from 19.8 per-cent to 28.2 percent. The per-centage of women who haveheard about or used a contra-ceptive method increasedeven more dramatically, from77.2 percent to 93.9 percent,surpassing the national aver-age of 91.5 percent. By 2002,91.9 percent of Petén resi-dents were aware of AIDS,surpassing the national averageof 85.6 percent. Most significant-ly, these improvements occurred in aprimarily rural area, where 60 percent ofthe population are farmers.

ProPetén’s Remedios Program:Phase OneFrom its start in 1997, ProPetén’s Remedios pro-gram has sought to respond to constantly shiftingconservation threats by making population-health-environment connections in the local context.ProPetén builds alliances, catalyzing and nurturingprojects as long as necessary before passing them onto capable partners in the health field. ThenProPetén seeks new ways to connect population-health-environment issues or fill niches overlookedby other organizations.

The integrated DHS has been a critical part ofdeveloping ProPetén’s programs linking health andpopulation with the environment. In addition to

At the mobile edu-cation center,women demon-strate how to usea condom (Photo:Ericka Moerkerken)

Contrary to the idea that frontier settlers havelarge families to claim more land, the PeténDHS showed that women in families with secureland tenure were happier about the possibilityof another pregnancy than women in familieswithout land.

8

FOCUS on population, environment, and security

helping establish APROFAM and Tan Uxil in Petén,over the past five years, Remedios has successfully ini-tiated a number of other programs based on the inte-grated DHS data:

• Trained 90 midwives and health promoters fromremote communities inside the Maya BiosphereReserve to become community-based distribu-tors of contraceptives for APROFAM; lined upcontinuing training with Concern America, anetwork of primary health promoters in Petén.13

• Initiated a network of traditional healers todocument and exchange knowledge of medici-nal plants; an indigenous partner organization,the BioItzá, is continuing these efforts to revi-talize Itzá Maya medicinal plant traditions. Inaddition, the Ministry of Health invitedProPetén to help sensitize their staff to the rolesof traditional healers.14

• Launched the first organic agriculture and domes-tic-animal breeding programs in Petén in five key-stone communities inside the Maya BiosphereReserve, in response to the alarming data on pesti-cide use discovered by the Petén DHS. Since2000, ProPetén has been working with HeiferInternational to systematize and scale up thisprizewinning program. ProPetén also trainedmore than 80 agricultural extensionists, using acurriculum—planned in conjunction withGuatemala’s national university—that rangesfrom family planning to organic mulches.15

• Worked with the Ministry of Health to train 220public health workers, stock 60 health centerswith educational materials on the nationalInformation, Education, and Communication(IEC) strategy, and equip 30 government clinicsto improve reproductive healthcare, such as IUDinsertions and cervical cancer screening.16

ProPetén’s Remedios Program:Phase TwoNow that strong family planning services have beenestablished in Petén, the Remedios program is turn-ing its attention to educating the public, with sup-port from USAID/Washington (2004-5).17

DHS data revealed that the indigenous groups inPetén, mainly Q’eqchi’ Maya, suffered from lowerlevels of knowledge and access to good reproductivehealthcare (see Table 1).

The Remedios program is addressing theseinequities with two bilingual projects:18

• Like an old-time medicine show, the traveling“Mobile Biosphere” brings integrated agriculture,health, and family planning education to commu-nities in and around the Maya Biosphere Reserve.19

• Launched in August 2005, the year-long radiosoap opera “Entre Dos Caminos,” broadcast inboth Q’eqchi’ and Spanish, integrates familyplanning, agrarian issues, conservation themes,and women’s issues. While the program isextremely popular, its immediate future is endan-gered by recent USAID budget cuts.

Also on the horizon may be a new education pro-gram for men (e.g., soldiers, transportation work-ers, evangelical preachers, park guards, and forestworkers) based on in-depth ethnographic researchthat identifies the best way to reach them. If it pro-ceeds, ProPetén would begin with a small butstrategic pilot project directed at evangelicalpreachers, who can block or facilitate other people’sinterest in family planning.

The Power of InterdisciplinaryResearchWhile there are many reasons for interdisciplinaryresearch, the few listed below demonstrate itspower to challenge received wisdom and broadenthe population and reproductive health fields, inaddition to providing important information fordeveloping programs.

The specter of Chayanov: People—donors, NGOstaff, interested observers, journalists—tend to

Rather than reducing the many facets of humanbehavior into limited sectors, we can improve our

understanding of the complexities of people’sproblems through integrated research.

9

assume that farmers want large families for addition-al labor, as Aleksandr Chayanov (1986) brilliantlyshowed in 1920s Russia. Yet, Guatemala’s rural laborsituation today is quite different. Severelyinequitable land distribution and few off-farmemployment opportunities may lead Guatemala’srural people to want fewer children, not more.Indeed, the Petén DHS reported that desired fertili-ty was 4.0 children per woman, significantly lessthan the actual fertility of 6.8. Farmers had nogreater preference for male children than urban fam-ilies. Contrary to the idea that frontier settlers havelarge families to claim more land, the Petén DHSshowed that women in families with secure landtenure were happier about the possibility of anotherpregnancy than women in families without land.Without integrated background research, serviceproviders may mistakenly assume that rural areas areless fertile grounds for family planning services.

Cairo linkages: Integrated research reminds us ofthe importance of improving reproductive health byenhancing women’s education and economicempowerment, as widely discussed at the 1994 UNConference on Population and Development inCairo. Indeed, the integrated Petén DHS showedmany linkages between women’s status and fertilitypreferences (see Grandia et al., 2001, chap. 7).

Knowledge/Attitudes/Practice (KAP): The assump-tion that more and better information will changeattitudes and behavior underlies much of themethodology in the reproductive health field. TheKAP hypothesis does not seem to fit as well in theenvironmental field, where poor people degraderesources out of need, rather than greed, regardless oftheir environmental knowledge. Nonetheless, envi-ronmental education also has an impact on behavior.Cross-fertilization with the compelling debates in theenvironmental field could perhaps help facilitate pos-itive reproductive health change as well.

Qualitative research: Integrated research often callsfor qualitative data and analysis, which can helpmove reproductive health programs beyond the lim-itations of “objective metric measures.” As Schwartz(2004) has argued, some projects may have failed

quantitatively but succeeded in other ways, bybuilding community capacity, for example.Likewise, other projects might achieve short-termnumerical goals, but fall into oblivion once theorganizing institution moves on.

“Studying up”: Integrated research may also chal-lenge project managers and policymakers to broadenthe focus beyond project subjects (e.g., family plan-ning users and subsistence farmers) to consider thepower of outside forces—such as corporations andthe government—that influence subjects’ behavior.Researchers can no longer assume that communitiesare isolated from the world, as Nader (1972) arguedin her prescient call for “studying up.” Today, avibrant anthropology looks at the dynamic relation-ships between the poor and the powerful. In the fam-ily planning field a similar shift has occurred, from aprimary focus on user behavior to a broader concernabout quality of services and products.

Policy: If for no other reason, integrated DHSresearch can be powerful because the DHS is aknown and proven research mechanism and policy-makers pay attention to DHS findings. Even smallinterventions with policymakers, like a demographictraining held in conjunction with the Futures Groupfor representatives of government ministries inPetén, have had rippling impacts. The national parkservice was so impressed by the software that they

Issue 10 November 2005

School childrenflock to the MobileBiosphere when itarrives in their vil-lage in northernPetén (Photo:Ericka Moerkerken)

10

FOCUS on population, environment, and security

launched their own two-year demographic researchproject, which provides detailed population projec-tions and their relationship to natural resource use.

ConclusionThis morning, thousands of poor settlers got up inthe dark, with only the light of a homemadekerosene candle, to prepare for a long walk to theirfarms. Their wives rose even earlier to light thehearth and pat out corn tortillas, which were proba-bly eaten with salt and chili because they had noother food for breakfast.

Perhaps a man just spent the last of his money onbus fare to the hospital to find out that his wife hascancer, possibly caused by a dangerous pesticideexported to Guatemala by a U.S.-based corporation(see Grandia, 2001). A mother watches over a childsick with malaria from mosquitoes bred by increaseddeforestation and settlement. A girl stays home fromschool because she has no shoes; her family’s corncrop failed in last year’s drought, which many believewas due to the massive deforestation of Petén.

A thousand interrelated tragedies occur every dayin the lives of Petén’s rural setters. Yet, in some cor-

ners of Petén, life may be getting a little easier.Couples can now decide the number and spacing oftheir children. Or a village might get a new school,because the education department has used demo-graphic data to build schools where the population isgrowing fastest. A traditional healer hangs a diplomaon her wall, with renewed faith in her work becauseshe has met other people like her and no longer feelsostracized as a “witch.” A farmer treats his tomatocrop with an organic pesticide made of chili peppers,garlic, and certain forest leaves, and he thinks abouthow to spend the $30 he saved from spending on astore-bought chemical. His wife and their breastfeed-ing baby are healthier, too, because she no longer hasto wash pesticide-laden clothes.

Having witnessed scenes like these, I know thatDHS reports and projects matter, often in ways thatcan never be fully evaluated by metrics. Rather thanreducing the many facets of human behavior into lim-ited sectors, we can improve our understanding of thecomplexities of people’s problems through integratedresearch. We can move beyond bandages to developbetter, more holistic projects that not only seek toameliorate poverty but also work for justice anddemonstrate respect for the dignity of people’s lives. •

Chayanov, Aleksandr V. (1986). The theory of peas-ant economy. Madison: University of WisconsinPress. (Original work published 1925).

Grandia, Liza. (2000). “Cuantas personas quiere quevivan en Petén?” In Facultad Latinoamericana deCiencias Sociales (Eds.), Nuevas perspectivas dedesarrollo sostenible en Petén (pages 137-56).Guatemala City: Facultad Latinoamericana deCiencias Sociales (FLACSO).

Grandia, Liza. (2001). “Exportaciones venenosas:El uso de pesticidas en Petén.” In II encuentropor el desarrollo sosenible de Petén, “Los Retos dela Economía Rural.” Flores, Petén, Guatemala:FLACSO.

Grandia, Liza. (2004, March 6). Fronteras de progre-so o desarrollo de pobreza: Dinámicas fonterizas dela migración Q’eqchi’ hacía las tierras bajas dePetén, Izabal, y Belice en el contexto de la global-ización corporativa. Fourth Inaugural Lecture,Centro Universitario del Petén (CUDEP),Universidad de San Carlos, Santa Elena, Petén.

Grandia, Liza, & M. Fort. (1999). “Population andenvironment in the Petén, Guatemala.” In

Nations, James D. (Ed.), Thirteen ways of look-ing at a tropical forest: Guatemala’s MayaBiosphere Reserve (pages 85-91). Washington,D.C.: Conservation International.

Grandia, Liza, Norman B. Schwartz, AmilcarCorzo, Oscar Obando, & Luis H. Ochoa.(2001). Salud, migración y recursos naturales enPetén: Resultados del módulo ambiental en laencuesta de salud materno infantil 1999.Guatemala City: Macro Internacional Inc.,USAID, Instituto Nacional de Estadística.

Grunberg, Georg, & Víctor Hugo Ramos. (1998).Base de datos sobre población, tierras y medioambiente en la Reserva de la Biósfera Maya,Petén-Guatemala. Guatemala: CARE, Centrode Monitoreo del Consejo Nacional de AreasProtegidas (CEMEC-CONAP).

Klein, Robert, & Edgar Hidalgo. (2003, October).Encuesta nacional de salud materno infantil 2002.Guatemala City: Ministerio de Salud Pública yAsistencia Social, Instituto Nacional de Estadística,Universidad del Valle, y Centers for DiseaseControl (among other collaborating agencies).

Nader, L. (1972). “Up the anthropologist:Perspectives gained from studying up.” InHymes, D. H. (Ed.), Reinventing anthropology.New York: Pantheon Books.

Schwartz, Norman B. (1990). Forest society: Asocial history of Petén, Guatemala. Philadelphia:University of Pennsylvania Press.

Schwartz, Norman B. (2004). Project failure andclient satisfaction: The use of indicators in local-leveldevelopment projects. Unpublished manuscript.

Schwartz, Norman B., & Liza Grandia. (2000,March). Some paradoxes of NGO-donor relationsas seen through a multidisciplinary research proj-ect in Petén, Guatemala. Panel paper presentedat the annual meeting of the Society forApplied Anthropology, San Francisco, CA.

Secretaria General del Consejo Nacional dePlanificación Económica (SEGEPLAN), Agrarund Hydrotechnik GMBH (AHT), & Asesoríay Promoción Económica, S.A. (APESA).(1993). Plan de desarrollo integrado de Petén(Volumen I: Diagnostico General de Petén).Guatemala: Authors.

References

11

Issue 10 November 2005

1. Special thanks to Aaron Tukey, NormanSchwartz, Ericka Moerkerken, Tom Outlaw,Meaghan Parker, and Jennifer Kaczor for reviewingdrafts of this essay. I would also like to especiallyacknowledge Norman Schwartz, my organizingcolleague and co-author of the Petén DHS report(Grandia et al., 2001), as well as Oscar Obandoand Amilcar Corzo, our Guatemalan co-authors.

2. After 10 years as Conservation International’sGuatemalan branch, ProPetén separated from its par-ent organization and became an independent NGOin June 2002. For more information about ProPetén’swork, please see http://www.propeten.org.

3. Managers who understood the importanceof integrated population-environment projectswere critical to both the success of the DHS sur-vey and the programs based on it. In particular, Iacknowledge the support and influence of CarlosSoza, ProPetén’s late executive director; JimNations, then Conservation International’s vicepresident for Mesoamerica; and NormanSchwartz, ProPetén’s advisor.

4. DHS Surveys provide large sample data for awide range of monitoring and impact evaluationindicators in the areas of population, health, andnutrition. DHS is now part of a broader USAIDprogram called MEASURE. Since its inception,the DHS program has been managed by MacroInternational, Inc., a for-profit USAID contractorlocated in Calverton, Maryland. For more informa-tion, see http://www.measuredhs.com/

5. This included presentations before Petén’sgovernor’s council (composed of municipal mayors,regional ministry representatives, and NGO dele-gates) in July 1997 and March 1998, which result-ed in an official resolution calling for the survey.For a detailed account of the survey development

process, see Schwartz and Grandia (2000).6. In recognition of our voluntary work on the

module’s conceptual design and efforts to generatepolitical and financial support for the project,Macro International, Inc., hired Norman Schwartzand me to design the questionnaire and analyze thesurvey results.

7. See http://www.measuredhs.com for thesurvey results.

8. See, for example, two reports by PopulationAction International, “Plan and Conserve” and“Planting Seeds, Meeting Needs”(available athttp://www.populationaction.org/issues/environment/index.htm).

9. The integrated DHS can also provide a meansto collect integrated data for planning. Recognizingits comprehensiveness, the Petén governor’s regionalplanning council passed a resolution in 2002 recom-mending that all the mayors and government repre-sentatives use the integrated DHS as a basis formunicipal project and development planning.

10. Thanks to Vinod Mishra for this suggestionat a meeting following my presentation at theWoodrow Wilson Center on October 12, 2004.

11. See http://www.aprofam.org.gt/ for moreinformation.

12. See http://www.tanuxil.org/ for moreinformation.

13. Supported by the Summit Foundation (seehttp://www.summitfdn.org/foundation/index.html).

14. Supported by International DevelopmentResearch Centre, Cabot Foundation, and a medium-sized grant from the Global Environment Facility.

15. Supported by Heifer International and theToyota Foundation.

16. Supported by the Compton Foundation(see http://www.comptonfoundation.org/).

17. The second phase of the Remedios programis being led by University of Michigan Population-Environment Fellow Ericka Moerkerken;ProPetén’s executive director, Rosa María Chan;and their multiethnic staff.

18. See http://www.propeten.org/projects.htm#remedios for more information on these projects.

19. This project seeks to build a “critical mass”of family planning users. A 2000 baseline study ofcontraceptive prevalence rates (before the mini-pharmacies were established) showed that averagecontraceptive use rates belie wide variations in ruralareas. Some villages have high rates of contraceptiveuse, while others have virtually no knowledge thatmethods even exist. Moreover, in rural areas wheresecrets are hard to keep, building a “critical mass” offamily planners can encourage hesitant couples totry a contraceptive method. When a couple hearsthat their cousin, or their cousin’s cousin, has tried amethod without any complications, they are morelikely to try it themselves. The key to building criti-cal mass is a successful multiplier. For example, avillage called El Cruce a Dos Aguadas, the largestcommunity in the Multiple Use Zone of the MayaBiosphere Reserve, had an estimated contraceptiveprevalence rate of less than 5 percent (close to zeroamong Q’eqchi’ families). The training of bilingualmultipliers in that village dramatically increased useof contraception: use of temporary methods is nowestimated at 40 to 50 percent.

Woodrow Wilson International Center for ScholarsLee H. Hamilton, President and Director

Board of TrusteesJoseph B. Gildenhorn, Chair; David A. Metzner, Vice Chair; Public Members:James H. Billington, Librarian of Congress; John W. Carlin, Archivist of theUnited States; Bruce Cole, Chair, National Endowment for the Humanities;Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services;Condoleezza Rice, Secretary, U.S. Department of State; Lawrence M. Small,Secretary, Smithsonian Institution; Margaret Spellings, Secretary, U.S.Department of Education. Private Citizen Members: Carol Cartwright, Robert B.Cook, Donald E. Garcia, Bruce S. Gelb, Charles L. Glazer, Tamala L.Longaberger, Ignacio E. Sanchez

Notes

The University of MichiganPopulation Fellows Programs

This publication is made possible throughsupport provided by the Office ofPopulation, U.S. Agency for InternationalDevelopment, and the University ofMichigan, under the terms of Grant No.HRN-A-00-00-00001. The opinionsexpressed herein are those of the authorsand do not necessarily reflect the views ofthe U.S. Agency for InternationalDevelopment, the University of Michigan,or the Woodrow Wilson Center.

The Environmental Change and Security Program (ECSP) promotes dialogue onthe connections among environmental, health, and population dynamics and their links to conflict,human insecurity, and foreign policy.

ECSP focuses on four core topics:

Population, Health, and Environment Initiative explores the linkages amongreproductive health, infectious disease, and natural resource management, within the contextof foreign policy and global security.

Environment and Security Initiative brings policymakers, practitioners, and schol-ars from around the world to address the public on the “disarmament policy of the future”—environmental security.

Water: Navigating Peace Initiative examines water’s potential to spur conflict andcooperation, its role in economic development, and its relationship to health and disease.

China Environment Forum creates programming, publications, and study tours toencourage dialogue among U.S. and Chinese scholars, policymakers, and nongovernmentalorganizations on environmental and energy challenges in China.

The Program publishes two annual journals—the Environmental Change and Security ProgramReport and the China Environment Series—which are read by more than 7,000 policymakers,practitioners, journalists, and interested citizens. ECSP News, the Program’s e-newsletter, deliversnews, summaries, and invites to thousands of email recipients every month. ECSP also publishesFocus, a series of papers on population, environment, and security (formerly known as PECSNews) as well as original research and occasional reports. To subscribe, please contactecsp@wilsoncenter.org.

One Woodrow Wilson Plaza1300 Pennsylvania Avenue, NWWashington, DC 20004-3027Tel: 202-691-4185Fax: 202-691-4001ecsp@wilsoncenter.orgwww.wilsoncenter.org/ecsp

EditorMeaghan Parker

Production and DesignLianne Hepler

Cover PhotographAimee Centivany, Courtesy of Photoshare

StaffGeoffrey Dabelko, DirectorNelia Forest, Program AssistantJennifer Wisnewski Kaczor, Program AssociateMeaghan E. Parker, Writer/EditorJennifer L. Turner, Senior Program AssociateAlison Williams, Editorial AssistantCharlotte Youngblood, Program Assistant

Presorted First Class Mail

Postage and Fees Paid

Smithsonian Institution

G-94

Printed on recycled paper.

ONE WOODROW WILSON PLAZA

1300 PENNSYLVANIA AVENUE, NW

WASHINGTON, DC 20004-3027

SMITHSONIAN INSTITUTIONOFFICIAL BUSINESSPENALTY FOR PRIVATE USE, $300