Reaching Indigenous Youth with
Reproductive Health Information and Services

The terms "indigenous peoples," "indigenous ethnic minorities," "tribal groups," and "scheduled tribes," describe social groups with a social and cultural identity distinct from the dominant society that makes them vulnerable to being disadvantaged in the development process. --World Bank, 19911

Indigenous people are found throughout the world. The United Nations estimates that more than 300 million indigenous people live in more than 70 countries. Most indigenous groups share the demographic profile of developing countries where youth, defined as those aged 10 to 24 years, comprise the largest segment of the population. In addition, these groups tend to be poor, rural, and left out of the process of economic development. Although there are vast differences among indigenous peoples, all have a traditional culture that is distinct from the national culture of their country; some may identify with an ethnic group with ties to an historical homeland.

Indigenous youth face the same barriers to reproductive health services that other youth face; however, they encounter additional obstacles because of their indigenous roots. Many face social and institutional discrimination and may be reluctant to use available reproductive health services. Indigenous people often dwell in less accessible places, such as the mountainous regions of Asia and the rainforests and mountains of South and Central America. If they are poor and live in a rural area, access to services may be limited. If they live in urban areas, they may face problems with acculturation issues and discrimination. Many indigenous youth, especially girls, speak only their native language and find it difficult to operate in the mainstream culture. They may be more comfortable with their own health belief systems, traditional providers, and treatments than with Western medicine. Together, these and other conditions make indigenous youth a group with a large unmet need for reproductive health services.

Compared to nonindigenous young people, youth from indigenous families are likely to have some of the problems listed below.

Marginal political and legal status. This marginalization has contributed to the racism and discrimination experienced by indigenous youth, and it exacerbates their poverty and lack of access to services. Often, indigenous groups deliberately avoid government services because they fear persecution or human rights abuses. Low levels of literacy and schooling compound this problem.

Lower literacy and educational attainment rates. Cultural, economic, and language barriers have all limited indigenous youth’s access to schooling. This limitation is especially true for girls. Even though the educational attainment of indigenous youth is improving in some places, it still tends to lag behind that of nonindigenous youth. For example, in Guatemala, more than 80% of girls and women living in rural areas are illiterate. Girls are at a greater disadvantage than boys because investment in girls’ education is viewed as wasteful, as girls may marry young and live with their husbands’ family.2

Less access to economic opportunities and employment. Because indigenous youth receive less schooling, they begin economic activities at an earlier age. However, most are employed in subsistence agriculture and low-paying informal sector activities. Sometimes these circumstances lead to an increased vulnerability to prostitution, alcoholism and other forms of substance abuse. In peri-urban areas of Guatemala and some areas of Thailand, young indigenous girls are involved in prostitution that leads to higher rates of sexually transmitted infections (STIs) and HIV/AIDS. Alcohol abuse is a serious health problem among indigenous groups in the Americas, and, in Thailand, hill tribe groups have high rates of opium and heroin abuse.

Less access to health and other services. Geographic and cultural isolation limit the indigenous youth’s access to health education and prevention services, including reproductive health services. This group is less likely to receive curative care for STIs, including HIV and conditions that can affect the outcomes of pregnancy and delivery. Because of persecution, many indigenous people fear and mistrust outsiders and are suspicious of services.

Less knowledge about reproductive health, physiology, and sexuality. Cultural and geographic isolation make indigenous youth even less knowledgeable about reproduction, pregnancy, and disease prevention than other youth. Additionally, some traditional practices are harmful or result in erroneous beliefs about health. These beliefs contribute to higher infant and child mortality rates, higher total fertility rates, lower birth weights, and lower contraceptive prevalence found in indigenous groups. Because of poverty and discrimination, age, and lack of knowledge, indigenous youth are more vulnerable to infectious diseases such as STIs and HIV.

Earlier marriage and childbearing. Their traditional culture and low educational attainment make indigenous youth more likely to marry at an early age. Fertility is usually highly regarded in traditional cultures, and girls often feel great pressure to become pregnant early to prove their fecundity.

Examples of efforts to reach indigenous groups, especially young people, are limited. This is due to a number of obstacles, including language barriers, geographic accessibility, and social and cultural differences between indigenous groups and the mainstream population. Little systematic evaluation has been conducted of the programs that do exist.

Education and Teacher Training

Bilingual Teacher Training. With support from the Population Council, the Guatemalan Association for Sex Education (AGES) trained bilingual primary school teachers to conduct reproductive health classes in Mayan languages in rural indigenous communities. Teachers were trained to conduct three 10-hour courses on topics such as birth spacing, reproductive physiology and contraception, pregnancy, birth, gender, and violence. Fifty-six certified teachers (predominantly indigenous) taught a total of 496 courses to 11,171 indigenous persons. Although this intervention was not specifically targeted at indigenous youth, many young people participated. Following the training, contraceptive use in the participating communities increased by 3%, representing an 18% increase in the use of all methods.3 Since 1993, AGES has also operated the Better Life Options program for girls and young women in Guatemala and has provided scholarships to Mayan girls as part of its efforts to improve the lives of young women.

Residential Center for Prevention of Exploitation and Abuse of Women and Children. The New Life Center in Chiang Mai provides AIDS prevention and sex education to adolescents from hill tribes in Thailand. It offers an education and literacy program designed to prevent the exploitation of women and children by traffickers in prostitution. The staff includes more than 21 young tribal women (15 of whom graduated from the residential program), and the center is the largest tribal and women-run organization in Thailand. In May 1999, a follow-up evaluation of 400 graduates of the program is planned to examine the effect the center has had on their lives.4

High School AIDS Education. Because indigenous people are thought to be highly vulnerable to the spread of HIV, the Ministry of Health of Brazil launched an anti-AIDS campaign for indigenous youth in Brazilian schools. Studies of indigenous culture and anti-AIDS education are taught in 1,310 schools and involve 2,504 teachers and approximately 62,000 indigenous students.5

Work and Employment

Female Factory Workers. The Center for Development and Population Activities (CEDPA) works with indigenous organizations to carry out the Better Life Options program. Conrado de la Cruz, a nongovernmental organization in Guatemala City, provides reproductive health education to young Mayan women who have moved to peri-urban areas to work in foreign-owned assembly plants. The Mayan women are particularly vulnerable to STIs, unwanted pregnancies, and sexual exploitation. Before starting work in the factories, most of the women had never left their home villages and half of them speak only their native Mayan languages.1

Special Clinics

Reproductive Health Clinic. In Ecuador, Centro Médico de Orientación y Planificación Familiar (CEMOPLAF) has run an indigenous reproductive health clinic in Cajabamba for many years. Early efforts to reach indigenous adolescents included adding separate hours (from 5 to 7 p.m.) for youth and training all staff members in adolescent counseling. However, the special clinic schedule for youth was dropped when staff members found that indigenous adolescents were more likely to use the clinic throughout the day. CEMOPLAF helped their young clients in working with local officials to get the resources to construct a recreation center next to the clinic. In contrast to the experience of clinical programs for adolescents instituted in three other areas not serving indigenous populations, CEMOPLAF was surprised to find no opposition from religious leaders or from parents. This program was more successful than CEMOPLAF’s other adolescent programs as measured by increases in the numbers of clients served. Staff members were also surprised to learn that indigenous youth did not want educational print materials made available in their native tongue, Quichua. Although the youth were fluent speakers, they could not read written Quichua and also felt embarrassed to be seen reading in Quichua.6

Community Outreach

Community-based Distribution. CEMOPLAF also used indigenous leaders and mestizo (mixed-race) student promoters to provide education and contraceptive methods to indigenous adolescents in Cajabamba, Ecuador. Many condoms have been sold to adolescents through this program. The use of oral contraceptives is increasing, and the promoters will soon be trained to provide injectables. In a street survey with indigenous youth on their sex lives and abortion, CEMOPLAF found that indigenous youth were often more open to discussing such personal topics than were nonindigenous youth.6

The In FOCUS series summarizes some of the program experience and limited research available on young adult reproductive health concerns for professionals working in developing countries. This issue was developed by Marguerite M. Farrell, James E. Rosen, and Anne Terborgh. The In FOCUS series and other publications can be downloaded from the FOCUS website <www.pathfind.org/focus.htm>.

Endnotes

1World Bank. 1991. "The World Bank Operational Manual Operational Directive (OD) 4.20: Indigenous Peoples." Cited in Davis, S.H. and Ebbe, K. Eds. "Traditional Knowledge and Sustainable Development: Proceedings of a Conference." September 1993, Appendix 4: 52.

2 Vasquez, C. The Centre for Development and Population Activities. Personal communication. December 30, 1998.

3 Cospin, G., and R. Vernon. 1997, April. "Reproductive Health Education in Indigenous Areas Through Bilingual Teachers in Guatemala." (AGES and The Population Council Guatemala City, Guatemala.) The increase in contraceptive use may not have been statistically significant; however, it is noteworthy.

4 Bethell, L. New Life Center. Personal communication, August 18, 1998.

5 Education and prevention: Brazil launches anti-AIDS campaign for Indians. 1996. AIDS Weekly Plus (9 December): 9.

6 De Vargas, T. CEMOPLAF. Personal communication. June 30, 1998.

References

Bethell, L. 1998. New Life Center. Personal communication. August 18, 1998.

Brazil’s Indians under threat from AIDS. 1996. AIDS Weekly Plus (18 November): 19–20.

Cabral, J., et al. 1998, March. "Reproductive Health Needs Assessment in Six Ethnic Groups in Mexico." (Unpublished report, IMSS-Solidaridad and Population Council, Mexico.)

Cospin, G., and R. Vernon. 1997, April. "Reproductive Health Education in Indigenous Areas Through Bilingual Teachers in Guatemala." (Unpublished Report, AGES and The Population Council Guatemala City, Guatemala.)