In Paraguay, both IUDs and contraceptive pills come with "strings attached".

1 Family Health International, Durham, North Carolina, United States of America. Send correspondence to: Dawn S. Chin-Quee, Family Health International, 2224 E NC 54, Durham, NC 27713, United States of America; telephone: (919) 544-7040, ext. 473; fax: (919) 5447261; e-mail: [email protected] Despite government-sponsored efforts to develop, disseminate, and institutionalize national family planning guidelines, many providers in Latin America do not always comply with guideline recommendations, which are generally intended for public sector providers. The reasons for this noncompliance range from lack of knowledge of the guidelines to providers’ deeply held personal or cultural beliefs that run counter to the guideline recommendations.2 Providers have also been known to exhibit deliberate resistance to training. For example, one provider who attended a family planning training session in El Salvador reported that, even after four days of training, other providers in the session still believed the myth that the intrauterine device (IUD) is an abortifacient (1). Responding to community expectations on gender roles in order to avoid later problems with the husband of a female client has also been documented (2). Providers sometimes pick and choose which recommendations to follow. In Peru, for instance, there has been selective noncompliance with standards on voluntary surgical contraception (3, 4). Very few studies in Latin America have explicitly assessed provider adherence to national family planning guidelines. Many more instances of provider noncompliance with guidelines have been anecdotal, or they have been noted in the course of studies that examined related issues of family planning service delivery. Cumulatively, these accounts suggest that provider noncompliance constitutes a significant barrier to the provision of reproductive health and family planning services in Latin America.