Young women walk home from school on a street in San Juan Chamelco in the department of Alta Verapaz, Guatemala. Rates of unintended pregnancy between girls aged 10 to 19 remain stubbornly high in Guatemala, particularly in rural areas. Photo by Kristina Blanchflower
June 11th, 2024
“Something so crucial”
A new TulaSalud initiative aimed at Guatemalan girls and young women tackles the challenging issues of sexual and reproductive health and rights
In 2023, Guatemalan health officials recorded more than 62,000 pregnancies in girls and women aged 10 to 19. These reported numbers—which are likely considerably lower than the actual reality—are a stark reminder of the challenges young women face in many countries where attention to sexual and reproductive health and rights (SRHR) is underfunded or underemphasized.
“Most countries have made progress in the past 30 years in terms of maternal mortality rates for women 20 and above,” says TulaSalud president Christy Gombay. “But in most of the world, the level of adolescent pregnancies, and deaths related to these pregnancies, has remained relatively unchanged.”
From left, TulaSalud’s program coordinator Stuart Davidson, TulaSalud health and gender equity specialist Sareen Ali, and TulaSalud manager of digital health Estela Cojoc Suram meet with frontline health workers in the village of Aldea San Luis Tontem in the department of Alta Verapaz. Photo courtesy TulaSalud
In coordination with Guatemala’s Ministry of Health, TulaSalud is launching a new program to address these issues. Called Empowering Indigenous Adolescents & Women for Equitable SRHR, the aim is to reduce adolescent pregnancies and maternal mortality among the country’s Indigenous population.
“It’s a very long name,” laughs Sareen Ali, TulaSalud’s health and gender equity specialist. “But in essence what we are trying to do is something so crucial, which is to empower women and girls in marginalized Indigenous communities to make informed decisions about their sexual and reproductive health and rights.”
The five-year program, which focuses on Indigenous populations in Guatemala’s Western Highlands, will be largely funded by Global Affairs Canada. In 2019, the Canadian government made a 10-year commitment to support the health of women, children, and adolescents around the world—with the intention of spending CAN $1.4 billion on average annually by 2023. Of this funding, $700 million per year is dedicated to SRHR.
The people of Guatemala live in a varied landscape encompassing several different biomes, from tropical rainforest to savannah. This valley near San Jerónimo in the department of Baja Verapaz shows a mix of dry scrub and montane forest. Photo by Kristina Blanchflower
Ali was born in India and raised in South Africa. She trained and practiced as a medical doctor in Port Elizabeth, South Africa, before moving to Canada, where she completed her masters degree in global health at McMaster University in Ontario. Along the way, Ali has seen firsthand the need for SRHR education and empowerment.
“When you work as a physician, you develop very close relationships with your patients, and you are aware of the barriers and challenges that they face when accessing healthcare services,” says Ali. “The reason I’m so passionate about this project comes from having had that personal experience with health inequity, along with a deep interest in how gender plays into it.”
The program will work to educate frontline health workers on SRHR approaches to get better outcomes for the well-being of women and girls, and provide access to reproductive health resources, contraceptives, and counseling via the advent of “adolescent friendly” spaces currently being developed by the Gutatemalan government.
Tula Salud’s executive director Isabel Lobos, left, and Christy Gombay, TulaSalud president, listen at a meeting in Cobán, the capital of Alta Verapaz department. Photo by Kristina Blanchflower
Isabel Lobos, executive director of TulaSalud, notes that in general, Guatemala has “a population pyramid with a wide base” of young people: children, adolescents and people under 30 make up more than one-third of the population. In rural and Indigenous regions of the country, however, the proportion of the under-30 cohort is even greater and makes almost 60 percent of the population.
“The needs and problems of young people historically have not been adequately addressed by the state,” says Lobos. “As a result the country currently faces serious consequences, among them a lack of education, development opportunities, violence, migration, irregular pregnancy, early pregnancies, and emerging diseases.”
Tele-education manager Magdalena Juarez working on her laptop at the TulaSalud offices in Cobán, joined by Lobos, centre, and Gabriela Mancilla, a nursing instructor. Photo by Kristina Blanchflower
TulaSalud’s long history of partnerships in the country dates back to 2003, and includes not only Guatemala’s national and regional health authorities, but also UNICEF and the Pan American Health Organization. These roots will strengthen the SRHR work, as will Kawok, a digital health information system developed by TulaSalud. Kawok allows community health workers, nurses, doctors, and others to access patient health information, even in remote rural areas.
“There is a very real need in Guatemala for a project like this,” says Ali. “Our previous experience working in this context, and the very strong collaborations that we have with local partners—I think these are really going to facilitate the vision that we have for this project and make it come to life.”
