Gender and Family Planning Among Indigenous Women in Mexico and Central America: A Call to Action

  • Jessica K. LevyEmail author
  • Audrey Goold
  • April Houston
  • Diego Rios-Zertuche
  • Wolfgang Munar
Part of the Global Maternal and Child Health book series (GMCH)


The freedom to make informed decisions about one’s fertility is essential to securing the autonomy and well-being of women and girls while promoting the health and development of families and communities. Modern contraceptive use is significantly correlated with decreases in unintended pregnancy, maternal and newborn mortality, and unsafe abortion. It is also positively correlated with gains in individual- and population-level education and economic prosperity. Over the last few decades, policies and programs committed to increasing voluntary contraceptive use have made great strides across most of Latin America; however, to date, no country has been able to bridge the contraceptive use gap between the region’s indigenous and nonindigenous populations. As program planners and policy-makers look for ways to reduce these disparities, we assert that: (1) the most effective and efficient interventions will be those that address gender norms and inequalities that are significantly correlated with poor family planning outcomes; and (2) addressing these norms and inequalities among indigenous populations will require integrated, crosscutting approaches at all levels of program and policy planning, implementation, and evaluation. To make our argument, we highlight the pathways through which social constructs of gender roles and expectations serve as strong predictors for family planning outcomes. Then, through an analysis of gender norms among various indigenous populations across the region, we identify areas that can be best leveraged to see positive family planning results. We conclude by making recommendations on how to integrate gender into current and future initiatives and highlight the role that inter-sectorial action and systems-informed evaluation may play in such processes.


Indigenous women Gender Contraception Mexico Central America Reproductive health Family planning Unintended pregnancy Unmet need Fertility Pregnancy Fertility Unmet need Contraceptive prevalence rate 


  1. Ahmed, S., Creanga, A. A., Gillespie, D. G., & Tsui, A. O. (2010). Economic status, education and empowerment: Implications for maternal health service utilization in developing countries. PLoS One, 5(6), e11190. CrossRefPubMedPubMedCentralGoogle Scholar
  2. Ahmed, S., Li, Q., Liu, L., & Tsui, A. O. (2012). Maternal deaths averted by contraceptive use: An analysis of 172 countries. The Lancet, 380(9837), 111–125.CrossRefGoogle Scholar
  3. Andrews, R., & Entwistle, T. (2010). Does cross-sectoral partnership deliver? An empirical exploration of public service effectiveness, efficiency, and equity. Journal of Public Administration Research and Theory, 20(3), 679–701. CrossRefGoogle Scholar
  4. AusAid. (2011). Promoting opportunities for all: Gender equality and women’s empowerment. Resource Document. Australian Government. Retrieved from
  5. Babb, F. (2013). Gender in postcolonial Latin America. Oxford Bibliographies in Latin American Studies.
  6. Barroso-Calderon, C. G. (2004). La fecundidad indígena en México bis a bis la visión de los programas oficiales ¿caminos divergentes? Estudios sobre las Culturas Contemporáneas X, 20, 79–105.Google Scholar
  7. Becerril-Montekio, V., & López-Dávila, L. (2011). Sistema de salud de Guatemala. Salud Pública de México, 53(2), 197–208.Google Scholar
  8. Bermúdez-Madriz, J. L., Sáenz, M. d. R., Muiser, J., & Acosta, M. (2011). Sistema de salud de Honduras. Salud Pública de México, 53(2), 209–219.Google Scholar
  9. Bertrand, J.T., Ward, V.M., Santiso-Gálvez, R. (2015). Family planning in Latin America and the Caribbean: the achievements of 50 years. Carolina Population Center, MEASURE Evaluation. Retrieved from
  10. Black, L. J., & Andersen, D. F. (2012). Using visual representations as boundary objects to resolve conflict in collaborative model-building approaches. Systems Research and Behavioral Science, 29(2), 194–208. CrossRefGoogle Scholar
  11. Blanc, A. K. (2001). The effect of power in sexual relationships on sexual and reproductive health: An examination of the evidence. Studies in Family Planning, 32(3), 189–213.CrossRefPubMedGoogle Scholar
  12. Bott, S., Guedes, A., Goodwin, M., & Adams-Mendoza, J. (2012). Violence against women in Latin America and the Caribbean: A comparative analysis of population-based data from 12 countries. Washington, DC: PAHO & CDC. Retrieved from Google Scholar
  13. Byam, M. (2008). The modernization of resistance: Latin American women since 1500. Undergraduate Review, 4(1), 145–150. Retrieved from Scholar
  14. CARE. (n.d.). Enegaging men and boys for gender equality. Retrieved from
  15. Comisión Económica para América Latina y el Caribe (CEPAL). (2013). Proyecciones de población. InAmérica Latina y El Caribe: Observatorio Demográfico. Santiago de Chile: Naciones Unidas. Retrieved from Google Scholar
  16. CEPAL. (2003). Educacion reproductiva y paternidad responsable en el istmo Centroamericao. Retrieved from
  17. Chioda, L.(2016). Work & family: Latin American and Caribbean women in search of a new balance. World Bank Group, Latin American Development Forum.
  18. Cleland, J., Bernstein, S., Ezeh, A., Faundes, A., Glasier, A., & Innis, J. (2006). Family planning: The unfinished agenda. The Lancet, 368(9549), 1810–1827.CrossRefGoogle Scholar
  19. Corroon, M., Speizer, I. S., Fotso, J. C., Akiode, A., Saad, A., Calhoun, L., et al. (2014). The role of gender empowerment on reproductive health outcomes in urban Nigeria. Maternal and Child Health Journal, 18(1), 307–315. CrossRefPubMedPubMedCentralGoogle Scholar
  20. Corpuz, V.T. (2015). Report of the special rapporteur on the rights of indigenous peoples. (Annual Report HC) UN General Assembly, Human Rights Council, 13th Session, Agenda item 3. Retrieved from
  21. Cunill-Grau, N., & Ospina, S. M. (2012). Performance measurement and evaluation systems: Institutionalizing accountability for governmental results in Latin America. New Directions for Evaluation, 134, 77–91. CrossRefGoogle Scholar
  22. DevTech Systems, Inc. (2012). USAID/Mexico gender assessment. Short-term technical assistance & training task order, under Contract No. GEW-I-01-02-00019-00. Retrieved from
  23. DfID (Department for International Development) and UKaid. (2011). A new strategic vision for girls and women: Stopping poverty before it starts. Retrieved from
  24. Diaz, C. J., & Fiel, J. E. (2016). The effect(s) of teen pregnancy: Reconciling theory, methods, and findings. Demography, 53(1), 85–116. CrossRefPubMedGoogle Scholar
  25. Do, M., & Kurimoto, N. (2012). Women’s empowerment and choice of contraceptive methods in selected African countries. International Perspectives on Sexual and Reproductive Health, 38(1), 23–33. CrossRefPubMedGoogle Scholar
  26. Duban, E. (2012). Toward gender equality in Europe and Eurasia: A toolkit for analysis. Washington, DC: USAID.Google Scholar
  27. Faulkner, S. L. (2003). Good girl or flirt girl: Latinas’ definitions of sex and sexual relationships. Hispanic Journal of Behavioral Sciences, 25(2), 197.CrossRefGoogle Scholar
  28. Gibbons, J. L., & Luna, S. E. (2015). For men life is hard, for women life is harder: Gender roles in central America. In S. Safdar & N. Kasakowska-Berezecka (Eds.), Psychology of gender through the lens of culture (pp. 307–325). New York: Springer.Google Scholar
  29. Girls not brides. (2017). Child marriage around the world: Guatemala. Retrieved from
  30. Greene, M. E. (2013). A practical guide for managing and conducting gender assessments in the health sector. Washington, DC: Population Reference Bureau. Retrieved from Scholar
  31. Guinan, J. (2015). Guatemala: Gender-based violence at epidemic levels. Atlanta: CNN. Retrieved from Google Scholar
  32. Hardin, M. (2002). Altering masculinities: The Spanish conquest and the evolution of the Latin American machismo. International Journal of Sexuality and Gender Studies, 7(1), 1–22. CrossRefGoogle Scholar
  33. Hindin, M. J., Kishor, S., & Ansara, D. L. (2008). Intimate partner violence among couples in 10 DHS countries: Predictors and health outcomes, DHS analytical studies no. 18. Washington, DC: USAID. Retrieved from Google Scholar
  34. Hovmand, P. S. (2014). Community based system dynamics. New York: Springer.CrossRefGoogle Scholar
  35. Hughes, J. (2004). Gender, equity, and indigenous women’s health in the Americas. Washington, DC: Pan-American Health Organization. Retrieved from Google Scholar
  36. IGWG. (n.d.). Gender integration continuum. Adapted from IGWG training materials. Retrieved from
  37. Inegi, C. (2015). Encuesta nacional de la dinámica demográfica ENADID 2014: Principales resultados. Mexico: Instituto Nacional de Estadística y Geografía y Consejo Nacional de Población.Google Scholar
  38. International Fund for Agricultural Development. (2011). Enhancing the role of indigenous women in sustainable development. Retrieved from
  39. Jaspers-Faijer, D., & Montano, S. (2013). Mujeres indigenas en America Latina: Dinámicas demográficas y sociales en el marco de los derechos humanos. Santiago: CEPAL. Retrieved from Google Scholar
  40. Jhpiego (2016). Gender analysis toolkit efor health systems. USAID’s maternal child survival program. Retrieved from
  41. Kabeer, N., & Natali, L. (2013). Gender equality and economic growth: Is there a win-win? IDS Working Papers, 2013(417), 1–58. CrossRefGoogle Scholar
  42. Kågesten, A., Gibbs, S., Blum, R. W., Moreau, C., Chandra-Mouli, V., Herbert, A., et al. (2016). Understanding factors that shape gender attitudes in early adolescence globally: A mixed-methods systematic review. PLoS One, 11(6), e0157805. CrossRefPubMedPubMedCentralGoogle Scholar
  43. Karver, T. S., Sorhaindo, A., Wilson, K. S., & Contreras, X. (2016). Exploring intergenerational changes in perceptions of gender roles and sexuality among indigenous women in Oaxaca. Culture, Health & Sexuality, 18(8), 845–859. CrossRefGoogle Scholar
  44. Kellogg, S. (2005). Weaving the past: A history of Latin America’s indigenous women from the Prehispanic period to the present. New York: Oxford University Press.Google Scholar
  45. Kolodin, S., Rodriguez, G., & Alegria-Flores, K. (2015). Asuntos de familia: Estudio cualitativo sobre las redes sociales durante el embarazo y parto en Mesomearica Chiapas-Mexico. Guatemala, Panama: Honduras y Nicaragua. Retrieved from Scholar
  46. Lambert, V., Roos, E., & Pinilla, S. (2010). Gender assessment: USAID/Panama. Washington, DC: USAID. Retrieved from Google Scholar
  47. LINKAGES. (2017). Gender analysis toolkit for key population HIV prevention, care, and treatment FHI 360. Retrieved from
  48. MADRE and FIMI. (n.d.). Inputs for the secretary-General’s study on violence against women. New York: UN Women. Retrieved from
  49. Meentzen, A. (2001). Estrategias de desarrollo culturalmente adecuadas para mujeres indígenas. Washington, DC: Banco Interamericano de Desarrollo, Unidad de Pueblos Indígenas y Desarrollo Comunitario. Retrieved from Google Scholar
  50. Mercer. (2016). When women thrive, businesses thrive: The world’s most comprehensive research on women in the workplace. Retrieved from
  51. Muiser, J., SáenzMdel, R., & Bermúdez, J. L. (2011). Sistema de salud de Nicaragua. Salud Pública de México, 53(2), 233–242.Google Scholar
  52. Munar, W., Hovmand, P., & Darmstadt, G. L. (2015). Scaling-up impact in perinatology through systems science – Bridging the collaboration and translational divides in cross-disciplinary research and public policy. Seminars in Perinatology, 39, 416–423. CrossRefPubMedGoogle Scholar
  53. Ospina, S., Cunill Grau, N. (2011). Institutionalizing accountability for governmental results: Public performance measurement and evaluation systems in Latin America. Paper presented at the Public Management Research Association Conference.Google Scholar
  54. PAHO. (2005). Pan American Health Organization gender equality policy. Retrieved from
  55. Rios-Zertuche, D., Blanco, L. C., Zuniga-Brenes, P., Palmisano, E. B., Colombara, D. V., Mokdad, A. H., et al. (2017). Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries. Contraception, 95(6), 549–557. CrossRefPubMedPubMedCentralGoogle Scholar
  56. Romo, L. F., Lefkowitz, E. S., Sigman, M., & Au, T. K. (2002). A longitudinal study of maternal messages about dating and sexuality and their influence on Latino adolescents. Journal of Adolescent Health, 31, 59–69.CrossRefPubMedGoogle Scholar
  57. Santiso, R, Bertrand, J.T. (2000). The stymied contraceptive revolution in Guatemala. Working paper WP-00-22. Chapel Hill, NC: Measure Evaluation.Google Scholar
  58. Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Geneva: WHO. Retrieved from Google Scholar
  59. Solar, O., Valentine, N., Rice, M., Albrecht, D. (2009). Moving forward to equity in health: What kind of intersectoral action is needed? An approach to an intersectoral typology. Paper presented at the 7th Global Conference For Health Promotion, Nairobi, Kenya.Google Scholar
  60. Sterman, J. D. (2006). Learning from evidence in a complex world. American Journal of Public Health, 96(3), 505–514. CrossRefPubMedPubMedCentralGoogle Scholar
  61. Swiss, L., Fallon, K. M., & Burgos, G. (2012). Does critical mass matter? Women’s political representation and child health in developing countries. Social Forces: a Scientific Medium of Social Study and Interpretation, 91(2), 531–558.CrossRefGoogle Scholar
  62. Taukobong, H., Kincaid, M., Levy, J., Bloom, S., Platt, J., Henry, S. K., et al. (2016). Does addressing gender inequalities and empowering women and girls improve health and development programme outcomes? Health Policy and Planning, 31(10), 1492–1514. CrossRefPubMedGoogle Scholar
  63. UNICEF. (2016). Las edades mínimas legales y la realización de los derechos de los y las adolescentes. Panama City, Panama: UNICEF Oficina Regional para América Latina y el Caribe. Retrieved from Google Scholar
  64. UNICEF, UN Women, UNFPA, ILO, OSRSG/VAC. (2013). Breaking the silence on violence against indigenous girls, adolescents and young women: A call to action based on an overview of existing evidence from Africa, Asia Pacific and Latin America. Retrieved from
  65. United Nations. (2015). Department of economic and social affairs, population division: Trends in contraceptive use worldwide 2015. Retrieved from
  66. UNDP. (2015). Sustainable development goals: 17 goals to transform our world. Retrieved from
  67. UNFPA. (2012). Marrying too young: End child marriage. New York: United Nations Population Fund. Retrieved from Google Scholar
  68. UN Women. (2014). UN Women Americas and the Caribbean - Results achieved in 2014. Retrieved from
  69. USAID. (2012a). United States Agency for International Development/Latin American & Caribbean (LAC) Regional Sustainable Development Office: Gender assessment. Washington, DC: USAID. Retrieved from Google Scholar
  70. USAID. (2012b). Gender equality and female empowerment policy. Washington, D.C.: USAID. Retrieved from Google Scholar
  71. USAID. (2013). ADS chapter 205: Integrating gender equality and female empowerment in USAID’s program cycle. Washington, DC: USAID. Retrieved from Google Scholar
  72. Valaskakis, G. G. (2009). Restoring the balance: First nations women, community, and culture. Winnipeg: University of Manitoba Press.Google Scholar
  73. Valente, T. W. (2012). Network interventions. Science, 337(6090), 49–53.CrossRefPubMedGoogle Scholar
  74. Vinding, D. (1998). Indigenous women: The right to a voice. Copenhagen: International Work Group for Indigenous Affairs. Retrieved from Google Scholar
  75. Wehr, H., Chary, A., Farley Webb, M., Rohloff, P. (2014). Implications of gender and household roles in indigenous Maya communities in Guatemala for child nutrition interventions. International Journal of Indigenous Health, 10(1). Scholar
  76. Williams, B. (2015). Prosaic or profound? The adoption of systems ideas by impact evaluation. IDS Bulletin, 46(1), 7–16.CrossRefGoogle Scholar
  77. Williams, B., & Imam, I. (2006). Systems concepts in evaluation: An expert anthology. Point Reyes, CA: EdgePress of Inverness.Google Scholar
  78. World Bank. (2012). World development report 2012: Gender equality and development. Washington, D.C.: World Bank.CrossRefGoogle Scholar
  79. WHO. (2010). Defining sexual health: Working definitions. Geneva: World Health Organization. Retrieved from Google Scholar
  80. World Economic Forum. (2016). The global gender gap report 2016. Retrieved from

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jessica K. Levy
    • 1
    Email author
  • Audrey Goold
    • 1
  • April Houston
    • 2
  • Diego Rios-Zertuche
    • 3
  • Wolfgang Munar
    • 4
  1. 1.George Warren Brown School of Social Work, Washington University in St. LouisSt. LouisUSA
  2. 2.Sexual and Reproductive Health and Rights Team, CAREAtlantaUSA
  3. 3.Salud Mesoamerica InitiativeInter-American Development BankWashington, DCUSA
  4. 4.Department of Global HealthGeorge Washington UniversityWashington, DCUSA

Personalised recommendations