This report was written by Marie S. Cole, research and policy analyst, PAI. The study was conducted by Marie S. Cole with support from Shilpa Kothari, program manager for Latin America and the Caribbean, PAI, and María Hernandez, international advocacy associate, PAI. This report was designed by Rebeca Anaya. Primary photography for PAI by Allison Shelley; additional photos courtesy of Gabriela Torres Freyermuth and Juan Carlos Martínez. The study team would like to extend its gratitude to the young participants for their time and efforts. A special thank you to the youth health promoters at the Observatorio de Mortalidad Materna en México (Observatory for Maternal Mortality in Mexico, OMM) for their contributions. We would like to acknowledge Mauricio Cruz Avendaño and Oscar Jiménez for their assistance with coordinating participants. The team also thanks the staff at OMM for their support in coordination, transcriptions and review of the final report. We are especially grateful for Dr. Hilda Argüello Avendaño, Francisco Gómez Guillén and Aracelly Pereira Patrón for their collaboration and dedicated efforts, which were vital to the project’s success.
The relationships among government policies, bureaucracy and institutional barriers and sociocultural norms have produced an environment that fails to adequately address the needs and concerns of Indigenous young people. Authorities have neglected to appreciate their lived experiences or use culturally relevant and acceptable approaches that may improve their SRH and the delivery of care. Findings demonstrate that while the ENAPEA is a critical factor in meeting the SRH needs of Indigenous populations and reducing adolescent fertility, its design and local implementation must address the realities of sexual and reproductive life and confounding variables, in addition to ensuring access to quality health care. Discussions across the focus groups suggested that the ENAPEA implementation has been narrow, inadequately addressing the intricacies of SRH and well-being in predominantly Indigenous municipalities. Quantitative data on adolescent pregnancy largely steered the development of the ENAPEA, and although sparse, qualitative data is necessary to inform proactive and responsive policymaking that addresses the root causes of this issue. The collection and dissemination of mixed-methods evidence would broaden the scope of attention and support for — as well as emphasize the distinct needs of — Indigenous youth. To that end, it is imperative for federal and state strategies and programs to integrate a multicultural lens into health care in order to meet the needs of Indigenous youth and other marginalized groups throughout the country. Building robust intercultural frameworks requires the meaningful inclusion and continuous engagement of Indigenous youth in the ongoing implementation, monitoring and evaluation of the ENAPEA, in monitoring and evaluation of the strategy and its related programs across states and in the future development of government programs and policies. .