When culture and health care collide: Rethinking sexual and reproductive health for Mayan youth

Many Mayan Indigenous and Afro-descendant adolescents in Mexico consider that existing sexual and reproductive health services are not designed with their realities in mind. Cultural barriers, gender stereotypes and discrimination often result in young people refraining from seeking health services, particularly when mental health needs intersect with sexual and reproductive health.

The COVID-19 pandemic deepened these gaps, exposing just how fragile health systems can be for youth living in vulnerable conditions in low- and middle-income countries. Access to contraceptive services declined, risks of sexual and gender-based violence increased, and funding for sexual, reproductive and maternal health services and comprehensive sexuality education was deprioritized.   

Mental health and sexual and reproductive health are often treated in silos in policy and practice, despite being closely linked in the lives of adolescents and youth. For Indigenous and Afro-descendent youth, this disconnect can make services harder to access and less effective. 

In 2023, IDRC issued a call for implementation research, under its Improving Sexual, Reproductive, Maternal and Mental Health in the Global South initiative in Latin America and the Caribbean and the Middle East and North Africa, to generate evidence on this intersection among populations facing multiple forms of vulnerability.

One of the funded projects in Latin America is Deconstructing Mayan Indigenous-Afro-descendant adolescents’ sexual and reproductive health: intersectional gender and decolonizing mental health, led by Clara Juárez-Ramírez at the National Institute of Public of Health of Mexico. The research aimed to document and learn from the lived experiences of Mayan and Afro-descendant adolescents and youth, including how ethnicity, sexuality and gender identity shape:  

• their information and care needs  
• the social repercussions on their physical and mental wellbeing 

The project’s goal aimed to increase awareness of gender equality among adolescents and youth, and support a more gender-responsive approach to providing sexual and reproductive health services to them in Mexico. The research team worked with key actors and strategic partners in the Quintana Roo and Yucatán states to:  

• promote evidence-informed public health policies based on the project’s findings 
• transform the power dynamics when adolescents and young people request health services  

The project was designed in three phases.

Phase 1: Adolescent and youth support networks and needs are mapped out

In the project’s first phase, from November 2023 to October 2024, the research team identified and mapped the linkages across government institutions, civil society organizations and Indigenous women leaders. The team documented the ecosystem of actors that adolescents and youth interact with, including non-governmental organizations, schools, health services and health providers, to help guide project implementation. 

Next, the research team used qualitative-participatory techniques to conduct 45 interviews with young people, 19 interviews and three focus groups with health-care professionals and 23 workshops with 250 secondary school students. Focused on sexual and reproductive health, students attending the workshops reported the following top-of-mind health issues: 

• early pregnancy  
• public alcohol consumption  
• pollution, unmanaged waste and concerns for the environment 
• high rates of motorcycle and car accidents 

These findings helped the research team identify where existing health services were failing to reflect the youth’s lived realities and priorities. 

Phase 2: Surveys and workshops help shape health messages for Mayan and Afro-descendant youth

During phase 2, from November 2024 to October 2025, the research team developed a questionnaire with a gender-equality perspective using insights from the workshops. They administered the survey to 760 Indigenous Mayan and Afro-descendant adolescents and youth. The team also administered a needs assessment questionnaire to health-care professionals.

The research team led six school-based workshops where students like Jessica and Roxanna used creative techniques such as fanzine storytelling to deliver preventive health messages grounded in their own experiences and concerns. Based on the students’ work, professional designers collaborated with the research team to develop images and health messages. These were developed for sharing through animated videos, fanzines, infographics and posters — and as part of a prevention campaign called “Mayan youth exist.”

By co-creating messages with students, the project enabled young people to shape prevention and awareness materials based on their own experiences and priorities.  

Phase 3: Courses and workshops to engage teachers, health-care professionals and youth 

For the final phase, the team designed interventions to support the sexual and reproductive health and mental health needs of Mayan Indigenous and Afro-descendant adolescents in schools and health centres in four locations across the two states comprising: 

Course for secondary school teachers: A practical course to deliver techniques to help teachers improve communication with students and foster a culture of peace.  

Workshops for health-care providers: Focused on providers connecting with young people, learning to detect risks and how to respond to their mental health and early pregnancy needs, these sessions are envisioned to help providers reflect on the unequal gender and power relations in medical hierarchies along four central themes:  

• early pregnancy 
• violence: social, domestic, bullying, harassment 
• discrimination, including Indigenous and LGBTQ+ identity 
• alcohol and drug abuse 

Experiential workshops for young people: These sessions use graphic materials to support discussions of the four themes. 

Materials for health-care providers: Infographics for use by health-care providers feature practical information on how to detect and respond to the risks youth face. 

Advancing culturally sensitive services for Mayan and Afro-descendant youth

By focusing on decolonizing mental health and sexual and reproductive health services, the project addresses long-standing gaps in how services respond to Mayan and Afro-descendant youth. The research team has engaged Mayan-identifying researchers to carry out the research. They have strengthened ties with community and Indigenous women leaders, who help plan the intervention strategy with health-care providers.  

The team is also connecting with municipal and state political representatives to identify champions who will use the project’s insights to shape policies and programs. Survey results and project findings will be shared with the institutions that develop state and national surveys, with the aim of integrating these important social and demographic characteristics in population surveys. This approach could help make health services more responsive, inclusive and grounded in the lived realities of Mayan Indigenous and Afro-descendant adolescents.