When a girl’s decision involves the community: the realities of adolescent Maya girls' lives in rural indigenous Guatemala

Abstract

Abstract

Adolescent Maya girls are among the most vulnerable, marginalized sub-populations in Guatemala, a country that is largely young, indigenous and poor. Adolescent Maya girls have limited access to secondary schooling, opportunities to work or earn an income, and sexual and reproductive health information and services. This article explores the extent to which adolescent Maya girls are able to adopt what they have learned in a community-based skills-building and sex education programme in isolated rural, indigenous Guatemalan communities. This is presented through an interview between the authors, who met and worked together in the Population Council's programme Abriendo Oportunidades (Opening Opportunities) for girls aged 8–19 years. The interview discusses what can be done so that indigenous adolescents not only obtain the sexual health information they need, but develop the skills to make decisions, communicate with their peers and parents, and exercise their rights. Much culturally and linguistically sensitive work must be done, using a community-based participatory approach, so that young people who do want to use condoms for protection or contraceptive methods not only have access to the methods, but the support of their families and communities, and government-sponsored sex education programmes, to use them.

Résumé

Les adolescentes mayas sont parmi les sous-populations les plus vulnérables et marginalisées du Guatemala, un pays où la majorité de la population est jeune, autochtone et pauvre. Les adolescentes mayas ont un accès limité à l'enseignement secondaire, aux possibilités de travail ou de revenu, et à l'information et aux services de santé sexuelle et génésique. L'article analyse dans quelle mesure les adolescentes mayas peuvent appliquer ce qu'elles ont appris dans un programme communautaire de renforcement des capacités et d'éducation sexuelle dans des villages autochtones isolés du Guatemala rural. Ces conclusions sont présentées dans un entretien entre les auteurs, qui se sont rencontrés et ont travaillé dans le programme du Population Council Abriendo Oportunidades (Élargir les possibilités) pour les filles âgées de 8 à 19 ans. L'entretien aborde les mesures pouvant être prises pour que les adolescentes autochtones obtiennent l'information de santé sexuelle dont elles ont besoin, mais acquièrent aussi les compétences requises pour prendre des décisions, communiquer avec leurs pairs et leurs parents, et exercer leurs droits. Beaucoup de travail culturellement et linguistiquement sensible doit être accompli, par une méthode participative à assise communautaire, pour que les jeunes qui veulent utiliser le préservatif pour la protection ou la contraception aient accès aux méthodes, mais aussi au soutien de leur famille et communauté, et des programmes d'éducation sexuelle parrainés par les autorités, pour les utiliser.

Resumen

Las adolescentes mayas constituyen una de las subpoblaciones más vulnerables y marginadas de Guatemala, un país en su mayoría joven, indígena y pobre. Las adolescentes mayas tienen limitado acceso a enseñanza secundaria, oportunidades para trabajar o ganar ingresos e información y servicios de salud sexual y reproductiva. En este artículo se explora hasta qué punto las adolescentes mayas pueden adoptar lo que aprendieron en un programa comunitario de desarrollo de habilidades y educación sexual en aisladas comunidades indígenas rurales de Guatemala. Esto se presenta en una entrevista entre los autores, quienes se conocieron y trabajaron conjuntamente en el programa del Population Council “Abriendo Oportunidades” para niñas de 8 a 19 años de edad. Durante la entrevista se examina qué se puede hacer para que las adolescentes indígenas no solo obtengan la información sobre salud sexual que necesitan, sino también desarrollen habilidades para tomar decisiones, comunicarse con sus pares y padres y ejercer sus derechos. Se debe realizar mucho trabajo cultural y lingüisticamente sensible, utilizando un enfoque participativo comunitario, de manera que cada joven que desee usar condones para protegerse u otros métodos anticonceptivos no solo tenga acceso a los métodos, sino también el apoyo de su familia y comunidad, así como programas de educación sexual auspiciados por el gobierno, para poder usarlos.

Key Words:

• adolescents and young people
• norms and values
• community-based programmes and interventions
• sexuality education
• Guatemala

Adolescent Maya girls are among the most vulnerable, marginalized sub-populations in Guatemala, a country that is largely young, indigenous and poor, where 70% of the population are under the age of 30 and 83% of the indigenous population live in poverty.¹ Pressure to marry early and bear children is the norm, especially for indigenous adolescents. Nearly 40% of indigenous girls enter a consensual or formal union before the age of 18, almost twice the percentage of non-indigenous girls who marry by that age,² not least because they have more limited access to secondary schooling and sexual and reproductive health information and few opportunities for economic prosperity.

The situation for adolescent Maya girls comes as no surprise when understood within the history of this post-conflict nation. The second half of the 20^th century in Guatemala was marked by a 36-year long civil war that escalated to genocide and resulted in the disappearance and death of over 200,000 people.³ But the history of racism and ethnic tension in Guatemala did not begin during the civil war. Indigenous populations, along with their language and culture, have been marginalized and persecuted since the Spanish conquest in the 16th century. Indigenous Maya live as second-class citizens and have historically been excluded from the mainstream Guatemalan economy and participation in political life.

Maya girls and women carry the dual burden of discrimination based on their ethnic background and their sex. Traditional Maya gender roles have men occupying most public roles and women tending to the home, food preparation and childrearing, placing them in a position subordinate not only to Maya men but to the state and ladinos (Guatemalans of Spanish descent) as well.⁴ Moreover, sexual violence against women has a long history in Guatemala. During the civil war it is estimated that approximately 90% of rapes were of Maya women.⁴ Indeed, as David Carey argues, since the Conquest violence against Maya women has been normalized by Guatemalan society.⁵

The relevance of Maya women's historically subordinate position and vulnerability to violence cannot be overstated when it comes to addressing sexual and reproductive health issues. Not only have access to contraceptive methods and health information been limited for women and adolescent girls, but also their power to make autonomous decisions, not only about using contraception but also about much more in their lives. This means that sexual and reproductive health work in rural Guatemalan communities is never just about sexual and reproductive health; it must also confront cycles of oppression that have marginalized Maya cultural, language and women for centuries.

A programme aimed at increasing Maya girls' personal and social resources

For anyone seeking to provide information about sexual and reproductive health to adolescent Maya girls and boys, working within the context of this history is crucial. In 2004, the Population Council and a group of Guatemalan NGOs in Patzun, Chimaltenango, Coban, Quetzaltenango and Totonicapan launched a programme in Guatemala called Abriendo Oportunidades (Opening Opportunities), whose goal is to increase Maya girls' personal and social resources or assets, including a safe place to regularly meet with peers, increased support networks, access to positive female role models, and a training programme to increase knowledge and skills, including in the area of adolescent sexual and reproductive health.

The programme focuses on building a base of critical life and leadership skills, which girls tend not to receive at home or in school. The activities take place in a local school or community centre in “clubs” that girls can join. There are two clubs per community: one for girls aged 8–12 and another for girls aged 13–19. In the past, clubs were often begun in towns where local partner organizations already had connections, but increasingly, community leaders are approaching the Population Council to start a club in their community after hearing about the programme in a neighbouring town.

Abriendo Oportunidades clubs are led by girl leaders, or lideresas, ages 15–24, who are selected through an interview process to lead a club in their own community. Twice a year they attend a week-long intensive training to learn how to teach the standardized Abriendo Oportunidades curriculum, including lessons on personal empowerment, finance education, gender violence prevention and sexual and reproductive health. These lideresas then return to their communities to replicate the lessons with the participants of their local girls' club. A slightly older “mentor” (also young indigenous women trained and supported by the programme) makes regular visits to the community to help negotiate with mothers and leaders, maintain attendance and give overall support to the lideresa. To be a mentor, a young woman must have served as a lideresa for at least two years and finished high school. To date the programme has reached more than 5,000 indigenous girls between the ages of 8–19 in approximately 50 towns in the Western Highlands and Alta Verapaz.

As a Population Council intern in 2011–12, Heather Wehr worked with Silvia Tum, who has worked with Abriendo Oportunidades in various capacities since 2004. She began as a lideresa, then served as a mentor to other Abriendo Oportunidades girl leaders and for the past two years she has worked on various Population Council studies with rural adolescents, and is an advocate of sexual and reproductive health education for indigenous girls and young women.

The following interview, with Heather (first author) asking the questions and Silvia (second author) responding, began as conversations we had together, attempting to reflect on our distinct experiences with Abriendo Oportunidades. We decided to record these conversations in an interview format in order to share what emerged. The interview opens below with us talking about the various programmes Silvia has participated in. We then go on to talk about what can be done to address the realities of sex, contraception and parental involvement in rural, indigenous Guatemala.

Interview with Silvia Tum

Q: Can you tell me about the experiences you had with sex education prior to getting involved with Abriendo Oportunidades?

In my case, they didn't teach me anything at school. My family taught me a little, but only about my period; my mother and cousin talked to me about it. My friends and I talked about getting our periods for the first time, but only that and nothing else. In my school there was not much information at all.

Q: And during your time as a lideresa and mentor with Abriendo Oportunidades?

When I first entered the programme, we started learning more because they gave us different trainings and there was a section about sexual and reproductive health. We mostly learned about the body – getting to know my body, my rights and methods of family planning. Afterwards as a mentor, I was interested in learning more because I had to teach it to other adolescent girls. It was then that I started looking for more information for myself too. As a lideresa I learned from what they taught us in [Abriendo Oportunidades], and as a mentor I learned from the modules and guides in order to lead the workshops.

Between my time as a lideresa and becoming a mentor, I participated in a scholarship programme called Liderando (Leading) and that's where I learned even more. That programme focused only on sexual education and HIV. I felt further empowered with the sexual and reproductive health information because we were in a mixed group of boys and girls. It was there that I lost the fear and shame I had felt to talk about these things. In Abriendo Oportunidades I did learn a lot, but it was a group of women where we got to know ourselves and talked about the same topics (as Liderando), but interacting with men was different. It opened up my mind. It was a part of the process I went through to learn more about sexual and reproductive health.

Q: Thinking about who you know — classmates, young people that you know from being a mentor or from focus groups you facilitated — what is it that young people do know about sexual and reproductive health?

Well, it depends. I know a lot of young people that work in the sexual and reproductive health field and young people who don't. Young people who aren't working in the field have very limited knowledge. They don't completely know their own bodies and they don't know how to take care of them. They only know the bare minimum. For example, I think they know more about sex, but they don't even know the precautions to take; they only know the minimum. In the case of men, they might know more about a woman's body out of pure curiosity, but not about their own bodies. They are interested in the parts of a woman's body and what happens in a woman's body, but never their own. I have guy friends who are ashamed to talk about these sorts of things.

It's the opposite case with young people who work in the sexual and repropductive health field. I have friends that know a lot. They know their rights, what precautions to take, body parts and methods of contraception.

Q: Now, thinking about the lideresas, do you think they learned the information that you taught them?

I think learning sexual and repropductive health information isn't just a one-time thing. It's not just a year or two, but a lengthy process. I have been in the programme for eight years and I am still learning. The lideresas who have only been in the programme for a year or two haven't had the chance to keep learning. If they finish their year as a lideresa and there is no follow up or continuation, then their knowledge is cut short.

The more you repeat the lessons, the more the lideresas will learn, because you can't learn everything in one workshop. I feel that way because every time I participate in a workshop I learn new things. I may have already heard them once, but I didn't learn them that first time. When adolescent women are in a workshop they might not be interested, but afterwards they realize they need to learn. The lideresas have been through various workshops, but they still need much more than one workshop to learn.

Q: From your experiences with Liderando and Abriendo Oportunidades, what do you think works best? Or, which programmes are working well and which aspects of the programmes are working?

The first time I learned about sexual and reproductive health was in Abriendo Oportunidades and it was good to begin with a group of only women. If I had started learning about it in a mixed group of boys and girls, it would have been very intense and shocking. So it was good to start the learning process with only women, and with topics like self-esteem and communication. Little by little we began talking about sexual and reproductive health and I think that was good.

In Abriendo Oportunidades I took my first steps; I see it like that. I began my learning in Abriendo Oportunidades, so that's where it all started for me. Afterwards the other programmes strengthened that knowledge even more and cleared up my doubts. Liderando was a scholarship specifically for sexual and reproductive health issues and Abriendo Oportunidades provides more than just sexual and reproductive health information, but what Abriendo is missing is to go more in depth into sex education material. But how I see it is that Abriendo Oportunidades opened the door for me and the other programmes came as reinforcement.

Q: So you think programmes should start slowly with girls separately and afterwards empower more…?

I think it's important to start with groups of only girls. For adolescent girls who haven't had any prior sexual and reproductive health education, it's very overwhelming to start right away with a mixed group. It will be a shock to interact with boys, so it's more difficult. Starting with girls only first puts the process on the right track.

Q: The next thing I want to talk about is whether there is part of what young people learn from sex education that they actually apply to their lives?

I think that they put sexual and reproductive health information into practice the least. According to what lideresas and club participants tell us, the greatest change in their lives through Abriendo Oportunidades is how they interact with their parents. So that means they are using the lessons on communication, negotiation and self-esteem. I think that's what they put into practice the most because they start sayng, “Now my dad gives me permission to do this or that, now I talk to him, now I value myself, now I love myself. I accept myself for who I am.” Those topics are put into practice, but sexual and reproductive health and rights are what they use the least.

Q: But within the sexual and reproductive health lessons, which aspects?

They might use information on how to take care of their body – the lessons about hygiene and accepting your body. They take those things into consideration.

Q: What do they definitely not put into practice?

They don't practice protecting themselves during sex. Young adolescent girls don't exercise the right to decide when they do or don't want to have sex. Adolescents don't do those things because it still involves a lot of influence from our parents, friends, or even our boyfriends when we can't negotiate with them. I think these things still need more emphasis.

Q: So do the majority of adolescents use contraception? Even if it's a natural method?

I don't think so.

Q: Nobody?

There might be some, but not many. Since we were born our parents raised us and taught us how to behave ourselves in life and it's part of our culture. It's not easy for a project or NGO to come in and change adolescents from one year to the other, or one month to the next, because it's not like that.

In the case of contraception, it's going to be hard for a young woman to say, “Yes I am going to use a method.” It's very, very hard for adolescent girls to make that decision because machismo still exists in the communities. If the girl has decided to use protection, but her partner hasn't, the girl can't do anything. It is very difficult, even though maybe some adolescents think about using contraception. They might say, “Yes, I want to use contraceptives when I have a partner or when I want to get married. One day when I want to have sex, I am going to use a method.” They might say it but in the moment it's still very difficult to make the decision because there are parents, the community and other people. She is closed off and can't decide for herself. I think that's what is missing – reinforcing how to make decisions for yourself, because it doesn't only depend on the young woman. Even if she wants to make her own decisions, they include other people.

Q: A lot of people say that the main problem with sexual and reproductive health issues is that there isn't access to contraception. But let's say that there will be better access and there are methods in the community– do you think something will change or will there still need to be work done with the community?

I think that culture is a very strong issue in the communities. It's not easy to say, “Look, here are the methods,” even though that influences a lot. For example, if adolescents want to access condoms in the community, they aren't going to find them. And if they go to a place where they do have them, they won't sell them to the adolescent Maya girl; they don't give them condoms because they are young, because they are girls, and because they are indigenous. But I think if there were access, it would still be difficult because of embarrassment and what parents would say. It's not only about empowering and changing the mentality of adolescent girls, but their parents as well. How much do parents accept that their daughters use contraceptives and protect themselves? There are many people that don't believe in sexually transmitted diseases. That also makes many young adolescent girls not believe in them and not get contraceptives. Even if there is access, I think that you have to work very hard from both angles – equally with adolescent girls and with the community. Changing someone's mentality is very difficult because we have been raised to think a certain way. But, access would help to show that there are contraceptives available and then the community could begin familiarizing itself and think: “Yes, it's good that adolescents use contraceptives and protect themselves.”

Q: Well, we talked about the content of the sexual and reproductive health education workshops, what is missing then?

Follow-up, not only about lessons but also to have someone accompany the lideresas that need it. What is missing is trust. Many times the relationship between lideresas and mentors is seen as a professional relationship, but not like a friend or a person to trust. It's rare that a lideresa approaches her mentor and says to her, “Listen, this is what is happening to me” or from the other side, definitely not, because the mentor knows it's a working relationship with the lideresa. It's very important that there be people available who lideresas can trust so that they can approach them and ask questions.

Recommendations for adolescent programmers, policy makers and researchers

Silvia brings up a variety of important observations about adolescent sexual and reproductive health programmes, as well as more building-block programmes like Abriendo Oportunidades. Further analysis of long-term interventions for adolescents, working with boys, and her suggestion for an ecological approach that involves the entire community, form a call for action to public health officials, policy makers and researchers.

Abriendo Oportunidades is not only a sexual and reproductive health intervention, but a building-block programme that attempts to equip young women with strategies to have more information and better control of their lives. It targets girls before they become sexually active and while they are still in school. As discussed in the introduction, Maya women have historically been subordinate to men. The same goes for adolescent Maya girls, but to an even greater extent because as minors they have less access to governmental benefits. For example, it would be more difficult for a Maya girl to access health care without permission and support from her parents. Due to this oppression, the empowerment element of adolescent programmes becomes key if there are any hopes for young indigenous women making their own decisions. Silvia points out that Abriendo Oportunidades seems to be working well for supporting household negotiations with fathers. Many lideresas and programme participants are able to negotiate with their fathers to get permission to go to club meetings, travel outside the community for trainings, or even to go back to school. However, while communication skills are being developed when it comes to these topics, negotiation about contraceptives and romantic partners needs to be addressed further.

Public health and adolescent programmers need to keep these things in mind when designing and implementing programmes. Silvia argues for a life-cycle approach – one that accompanies youth before, throughout and beyond adolescence (ages 8–24). Liderando worked well for her because it was a logical next step towards completing her leadership development as a sexual and reproductive health and HIV advocate. She was older and thus ready to interact with her adolescent male peers, and also ready to face the issues of sexually active teens. In order to achieve this staged, long-term accompaniment, adolescent programmers should not only think about extending the length of their interventions, but about feeding programmes into one another. Collaboration is key – in this case not only for inter-organizational relationships, but for the lives of the adolescent girls these programmes wish to serve. As Silvia explained, when sexual and reproductive health information is presented in one or two workshops, young women do not absorb it and their knowledge is “cut short”. In practice the life-cycle approach is harder to achieve than a brief workshop series, but it is an essential element to achieve an empowered adolescence for Maya teens.

Silvia suggests beginning the process of sexual and reproductive health education in same-sex groups before integrating boys and girls. This is an argument for parallel programmes for adolescent boys and girls that would ultimately bring them together at the age when adolescents begin to interact in their communities. More research needs to be done to provide evidence for the timing of these interventions and recommendations for working with adolescent boys and young men.

The final element that must be addressed to improve the overall sexual and reproductive health intervention as a package is the element of community. The decisions that an indigenous adolescent girl makes do not happen in a vacuum – they involve her partner, family, community and health providers too. These various parties all present barriers for adolescent girls to make their own decisions. Even when contraceptives may be accessible, contraceptive services may not be provided in the local Mayan language.⁶ Similar calls to action have already been made for the reproductive health of mothers in Guatemala, but the importance of adolescent sexual and reproductive health cannot be forgotten.⁷

Partnerships between adolescent programmers and health care organizations providing services in Mayan languages, such as Wuqu' Kawoq, will not only ensure appropriate sexual and reproductive health services are available, but simultaneously build development institutions and supportive environments for Mayan languages and culture. These development institutions would include both governmental and non-governmental initiatives to increase access to health care and education. Services must be offered in Mayan languages not just as an afterthought, but actively used during planning stages and throughout implementation with the community. Wuqu' Kawoq serves as a model because it was founded with this goal in mind – to carry out development projects that do not disrupt Mayan languages and cultures, but strengthen them. Their projects to date include primary health care, SRH education for women and clean water technologies, as well as Mayan language training for development practitioners. Taking this culturally and linguistically sensitive approach from organizations like Wuqu' Kawoq and applying it to work with adolescents, especially SRH programmes, will provide new opportunities to talk about issues such as contraception.

Several implications for policy change can be drawn from this discussion. Most importantly, there is a lot of misinformation, rumours and suspicion around contraception, condom use and STIs in rural communities. This misinformation can sometimes be clarified through educational programmes, but a higher level policy change – making sexual and reproductive health services more ready available to not only Maya populations, but all Guatemalan adolescents, would be a strong signal that contraceptive use is something acceptable and desirable. This type of policy change would increase contraceptive support at the community and national level.

Conclusions

Programmes like Abriendo Oportunidades and NGOs such as Wuqu' Kawoq are attempting to fill the gap in sex education for both adolescent and adult Maya women in Guatemala. In 2008, the Guatemalan government signed a declaration with 30 other Latin American and Caribbean countries to include a sexual education component in the curriculum of all schools in the country by 2015.⁸ It remains to be seen whether the government will follow through with this promise. So far many children receive a lesson on male and female body parts in school, but this lesson is often pushed onto student teachers during their practicum and not developed any further. Much work must be done at the community level so that young people who do want to use condoms for protection or contraceptive methods not only have access to the methods, but the support of their families and communities to use them. Programmes that are not culturally and linguistically sensitive to the people living in rural, indigenous communities will not only be unsuccessful, but could even be damaging by excluding Maya and other indigenous language speakers from receiving services they can understand and service providers they can communicate with. A community-based participatory approach is key to addressing sexual and reproductive health issues in these communities. Important work remains for adolescent programmers, policy makers and researchers in order to provide evidence and make changes across the country. Beginning sex education with young men and women separately and then integrating them later on in the process may be an important starting point for reducing the gender inequality that exists in Guatemala today. Once young women are empowered to act and young men are empowered to negotiate with and listen to their partners, a healthy conversation about sex, contraception and preventing sexually transmitted infections can take place among them and with the involvement of adults, also with the community.

Note

Translation of the interview from Spanish to English was by Heather Wehr.