Etelvina Alvarez was born and raised in Santo Tomas Milpas Atlas, a small town approximately one hour west of Guatemala City, the capital of Guatemala. She had 12 siblings growing up and shared that life was not easy. “I think the biggest challenge was when my dad couldn’t find work … and that was sometimes difficult for us because we didn’t have enough money to buy food,” Etelvina explained. Etelvina’s experience is not unique in a country where nearly 50 percent of children under five are chronically malnourished. She was forced to drop out of school at age 12 to work in a factory to help support the family. “It was a vegetable chopping plant,” Etelvina said, “We worked in the factory on different rotations … one week we would work 8 hours during the day, and the next we would work 8 hours during the night.” “We had to help our parents, and that’s why worked … We helped with the expenses at home for our younger siblings,” Etelvina explained.

At 17, Etelvina got married. “I was already pregnant, three months,” she added, “I knew nothing of family planning.” It was only after she had her first son that she learned about contraception. Poor access to contraceptive information and services is a common challenge in Guatemala where one in three indigenous women have no access to family planning services. The health clinic explained the basic family planning methods, but it was only when Etelvina was trained by WINGS, a local Guatemalan health care organization, that she fully understood her options. “At the health center they weren’t very open about what they taught us. They weren’t very clear so we wanted more,” she said. “[WINGS] taught me a lot, and that’s where I learned about family planning methods in the long-term.”

Etelvina used the family planning information and services she gained from WINGS to plan her three children, “between each child there’s a difference of 5 years,” she said with a smile. “I have only three children because I know that way I give them a good education, the good quality of life that they deserve. I can give them food and the necessary schooling to become professionals and do well in life.”

In addition to using the information she gained from WINGS to improve her own life, Etelvina was so motivated by the importance of reproductive health information she learned that she began working as a volunteer promoter with WINGS, running a small clinic out of her home and providing basic health information and services to hundreds of women and families in her community. “I get up around 6 in the morning because the women start coming at that time,” she said proudly. “Monday through Friday, Saturday and Sunday, I don’t have a schedule to take care of the women I help. Some of them work, some come in a 9 o’clock, 10 o’clock at night. I get out of bed and come in to take care of them because they need me.”

IMG_0558 Showing her contraceptive commodity educational kit she uses to explain the variety of options to patients.

Etelvina provides a whole range of basic health services, but contraceptives are one of her most in-demand services. “In the last nine years, I’ve seen a serious increase in people looking for family planning methods,” she said. “I think they look for me because they have heard they need more time between one pregnancy and another; they’ve realized they can give their children a better quality of life if they have less and more time between.” This desire for greater access to information and services is widespread in Guatemala where women report their ideal number of children as 2, and yet have 3.1 on average, and close to 4 in indigenous communities. Etelvina sees her outreach as critical to addressing this unmet need.

She is able to distribute the contraceptives at a deeply discounted rate because they are provided by WINGS, which purchases them from the United Nations Population Fund (UNFPA) for much less than market rate. “It has benefited all of us in the community because it helps the patients. They can get it at a cheaper price, because if they would go to the pharmacy, it’s much more expensive,” Etelvina explained. “The money they save by getting their family planning method here with me helps them buy more food for their children,” she added.


IMG_0679 Etelvina with her neighbor Sandra, a patient who receives family planning services, along with Sandra’s son outside their home in Santo Tomas Milpas Atlas.

When asked what would happen if WINGS was unable to provide her with the discounted contraceptives, Etelvina said, “That would be very unfortunate, because that would keep them from planning their families … and the problem is, there are no jobs, so that would definitely damage the community.” For Etelvina, providing access to contraception is about much more than health care, it’s about empowering women to control their lives and build better futures for themselves and their families: “They’ll be able educate them, feed them, dress them. It’s going to improve the quality of life that they can give to their children.”

IMG_0403 Etelvina with Adeli, a neighbor and family planning client, outside her home-based clinic.

“I was already pregnant, three months. I knew nothing of family planning.”

IMG_0595 Etelvina outside her home with the sign notifying community members she is a WINGS promoter who provides health services.

“I think they look for me because they have heard they need more time between one pregnancy and another; they’ve realized they can give their children a better quality of life if they have less and more time between.”