The Pretense of Inclusion: Contextualizing Sexual and Reproductive Health Policies in Lived Realities of Indigenous Youth
Enabling Culturally Relevant Sexual and Reproductive Health Care for Indigenous Youth in Mexico
Adolescents and youth compose over a quarter of Mexico’s total population; and while the overall fertility rate among 15- to 19-year-olds has declined, there remains great variation across the country in fertility trends, contraceptive needs and health care access. Fundamental to the explanations for such disparities are the sociocultural contexts of Mexico’s indigenous populations. Access to quality reproductive health care among indigenous youth is influenced and affected by community and cultural contexts as well as cultural incompetence, as exemplified by health care providers and policymakers.
These issues are of pressing concern given the lack of clarity on how the current administration of President López Obrador will respond to the unique needs of indigenous youth across Mexico, particularly in the ongoing implementation of the Estrategia Nacional para la Prevención del Embarazo en Adolescentes (National Strategy for Prevention of Adolescent Pregnancy, ENAPEA). Introduced in January 2015, the ENAPEA, which seeks to halve fertility among 15- to 19-year-old adolescents and to eliminate pregnancy among girls ages 10 to 14 by 2030, is a focused blueprint aligned with the broader Programa Sectorial de Salud (Health Sector Program, PROSESA) 2013-2018. Like PROSESA, the ENAPEA in part aims to reduce health inequities among various populations and improve the social conditions of the most vulnerable. Of relevance, it categorically prioritizes municipalities with indigenous populations of 20% or larger and of more than 1,000 persons aged three years or older who speak an indigenous language.
While the needs for improved sexual and reproductive health (SRH) services among indigenous populations are widely known, there is scarce information about the relationship among institutional barriers, societal norms and limited health care access for indigenous youth and adolescents. Moreover, the country’s indigenous populations continue to be overlooked or altogether forgotten in the development and execution of national plans. As such, while civil society representatives participated in the development of the interdisciplinary and multisectoral ENAPEA, and all 32 Mexican states are represented in local implementations of the plan through Grupo Estatal para la Prevención del Embarazo en Adolescentes (State Groups for the Prevention of Adolescent Pregnancy, GEPEA), it remains unclear whether and, if so, how the ENAPEA will respond to the different needs of indigenous youth across the country.
