Leveraging social networks to support reproductive health and economic wellbeing among Guatemalan Maya women

Abstract

Objective:

Maya women in Guatemala are disproportionately affected by poverty and negative reproductive health outcomes. Although social networks are valued in many Indigenous cultures, few studies have explored whether health education programmes can leverage these networks to improve reproductive health and economic wellbeing.

Design:

This qualitative study explored the role that social networks play in both health education and economic empowerment among women involved in a Maya reproductive health women’s group.

Setting:

Western highlands region of Guatemala.

Method:

Semi-structured in-depth interviews, each lasting 2–3 hours, were conducted with 19 women (aged 18–40 years) who had participated in a formal women’s network. Topics addressed included personal experience with the group, aspirations for the future and attitudes towards reproductive health and economic wellbeing.

Results:

Respondents stated that by engaging in formal group activities and interacting with others in the network, they were able to find their voice. They described gaining self-confidence needed to speak about reproductive health with pre-adolescent and adolescent girls as well as other community members. Respondents also discussed learning new ideas/skills and detailed future aspirations of planning their family and reaching educational/career goals.

Conclusion:

The study illustrates the potential of social networks to provide individuals with knowledge and skills, along with new ways of thinking about themselves and their futures. Health education programmes aspiring to improve the reproductive health and economic wellbeing of vulnerable groups, such as Maya women, should seek to leverage the benefits of such social networks.

Keywords

Empowerment Guatemala Indigenous groups reproductive health social networks

Introduction

Adverse reproductive health outcomes and insufficient employment opportunities for young Maya women in Guatemala perpetuate a cycle of poverty within the Indigenous community (International Planned Parenthood Federation [IPPF] and Guttmacher Institute, 2014). The average fertility rate in Guatemala is 3.6 children per woman, higher than neighbouring El Salvador, Honduras and Nicaragua. High fertility can be attributed to a combination of cultural norms, limited access to services and poor access to reproductive health information (Figueroa et al., 2006; Ministerio de Salud Pública y Asistencia Social [MSPAS], 2011). According to data from the Guatemalan Ministry of Public Health (MSPAS), Guatemalan women who live in rural areas have 1.3 more children than those who live in urban areas, and Indigenous women have 1.6 more children than non-Indigenous, or ladina, women. Women with no schooling have 1.4 more children than women with a primary school education and 2.9 more children than women with a secondary school education. What is more, formally educated ladina women of reproductive age (15–49 years) tend to be more proactive about their health and more familiar with pap-smears, breast cancer, HIV and other sexually transmitted infections (MSPAS, 2011).

Approximately 35% of births among Guatemalan young people aged 15–19 years are unplanned, with childbearing at a young age more prevalent among the poor (Anderson et al., 2014). Approximately 54% of Indigenous women between the ages of 20 and 24 years become mothers before the age of 20 years, compared with 39% among ladina women. Although teenage pregnancy presents challenges for many young mothers and is associated with worse perinatal outcomes, early childbearing is often perceived as the norm in Indigenous Guatemalan communities (Figueroa et al., 2006). Moreover, since educational or employment opportunities for young Maya women are limited, it is common for them to view entering marriage early-on and becoming a mother as their best, or only, option (Figueroa et al., 2006; MSPAS, 2011). Limited access to health services along with inaccurate perceptions about family planning and cultural norms that support early childbearing contribute to low levels of modern contraceptive use among Indigenous Maya women (Bertrand et al., 2001; Lindstrom and Muñoz-Franco, 2005; MSPAS, 2011). Although 88.5% of ladina women in a sexual relationship have ever used a modern contraceptive method, only 57.7% of Indigenous women in a sexual relationship have ever used one (MSPAS, 2011).

While over 50% of the total Guatemalan population live below the poverty line, an overwhelming 76% of its Indigenous population live in poverty. Of the impoverished Maya population, 35% is considered to live in extreme poverty (Gragnolati and Marini, 2003; Instituto Nacional de Estadistica [INE], 2011). Education and labour force participation are important determinants of socioeconomic status among Guatemalan women (Pagán, 2002). Roughly 20.2% of Guatemalan women are not formally educated, a rate that has improved in recent years but still remains higher than other Central American countries (MSPAS, 2011). Socioeconomic conditions often require Indigenous youth to enter the workforce at an earlier age than their ladina counterparts, with girls typically leaving school to take on greater domestic responsibilities (Secretaria Ejecutiva de Servicio Civico [SESC], 2011). As such, only 10% of Indigenous Maya women in Guatemala have completed primary school, with fewer women completing school in rural areas than in urban areas (Figueroa et al., 2006). Low educational attainment negatively affects Indigenous women’s ability to obtain higher paying jobs, access health services and engage in reproductive health behaviours, such as the use of contraception (Hughes, 2004). On the other hand, financial stability has been found to increase self-confidence among women and perceived respect from family members. Economic empowerment further allows women to take ownership of their reproductive health and fertility decisions – decisions that will benefit their children and families in the future (Blumberg, 2001; Grépin and Klugman, 2013).

Although social and health indicators may be poor among Indigenous Guatemalans, social networks are strong between members of this ethnically diverse population (Ferlander, 2007; Lindstrom and Muñoz-Franco, 2005; Skoufias et al., 2010). Social networks have been described by O’Malley and Marsden (2008) as the relationship structures that link individuals and from which they receive knowledge and support. A recent ethnographic study of market women in a remote Indigenous community found that friendships and social networks often reinforce the values and traditions that are intrinsic to Maya identity (Kistler, 2010). What is more, positive and dynamic social relationships can provide individuals with opportunities for training, education and employment that are outside of their normal means (Domínguez and Arford, 2010). Guatemalans, especially those in rural areas, often make work and economic decisions based on the actions and preferences of their neighbours, church members and other social groups (Bertrand et al., 2001; Skoufias et al., 2010; Wydick et al., 2011). Interventions designed to improve economic opportunities for Indigenous populations would benefit from a better understanding of the determinants of behaviour within the social networks that comprise these populations (Skoufias et al., 2010).

Interactions that occur within social groups can also influence reproductive health behaviours and decision making. Social networks may promote the diffusion of new information and ideas, including those regarding reproductive health (De Broe and Hinde, 2006; Lindstrom and Muñoz-Franco, 2006; Richmond and Ross, 2008). A recent MSPAS (2011) survey found that young women are more likely to talk about family planning with friends than with sisters, mothers or other family members. Moreover, a recent meta-analysis found that women’s groups engaging in participatory learning led to improved maternal and neonatal health outcomes in resource-poor settings (Prost et al., 2013). The social support and informal learning fostered within social networks have led them to become a popular approach to current poverty reduction and women’s empowerment initiatives in Guatemala (Cattell, 2001; Prost et al., 2013; UNFPA, 2010, 2013, 2014). Although programming geared towards empowering women and girls through wider education and economic opportunities is widely supported as a strategy for improving reproductive health and economic outcomes, little research is available that analyses this approach in great depth (Grépin and Klugman, 2013; Samandari and Speizer, 2010; Victora and Barros, 2013).

This study explored the lives and experiences of participants of a network of community-based Indigenous women’s organisations in the western highlands region of Guatemala in order to identify factors of social network involvement that could be leveraged to support reproductive health and economic wellbeing among young Indigenous women. The women’s network was founded and run by Guatemalan Indigenous women with the aim of improving the health of Indigenous women and children. The group had implemented a programme in which young Maya women were recruited to work in their hometown for 1 year as health educators and mentors to pre-teenagers to help reduce early marriage and adolescent pregnancy. The health educators, all of whom were required to speak Spanish and have received some formal schooling, were regularly brought together for training and to share experiences with one another. Over time, the health education programme evolved into a wider network which aimed to reach other young women in addition to the health educators and engage them in discussions and activities about a variety of topics, such as self-esteem, contraceptive use, women’s rights and traditional artisanry techniques. At the time of the study, the network was exploring the possibility of extending the women’s group to incorporate opportunities for income generation. This study explores the benefits of participating in this particular social network and provides recommendations for future programming about poverty reduction and women’s empowerment.

Methods

Participants

Respondents were identified from a list of women who were either current or former network participants. The coordinator of the network recruited women for the qualitative study. Women had to be at least 18 years old to participate. As an incentive for participation, each woman received a mobile phone calling card valued at 50 Guatemalan Quetzales (approximately US$7) and, if needed, compensation for travel.

Data collection and analysis

Semi-structured, in-depth interviews were conducted in August 2010 in the Guatemalan departments of Chimaltenango, San Marcos, Totonicapán, Sololá and Quetzaltenango – departments in the western highlands region where the majority of women in the network lived. The research team consisted of three researchers from the George Washington University Milken Institute School of Public Health who were fluent in Spanish, the shared language of network participants. Prior to data collection, the interview guide was tested with network leadership and revised accordingly. In order to make participation convenient, individual interviews were conducted either in the woman’s home or in the office of the local community organisation. Participants were asked questions about their personal experience with the network, current or previous experiences with employment and aspirations for the future, as well as personal and perceived community attitudes towards reproductive health and employment. Interviews were conducted in Spanish and lasted between 2 and 3 hours. They were saved using a digital audio recorder and later transcribed verbatim.

Themes from the interview data were generated using a grounded theory approach, whereby main ideas were identified from within the text and then categorised to establish the main constructs of the study (Corbin and Strauss, 2008). Quotations and preliminary findings were shared with the respondents during a meeting at the end of the fieldwork to generate initial study themes. All members of the research team reviewed the transcribed data and worked together to develop a general set of themes. Once finalised, the themes were compiled into a codebook, which described and provided guidance about each theme. ATLAS.ti 6 qualitative data analysis software was used for data management. The coded data were further analysed by the first author, and more specific themes related to the role of social networks in improving reproductive health and economic wellbeing were identified. The first and third authors decided upon the themes that were ultimately used to organise and synthesise the data for this study. For the purpose of this analysis, the authors distinguished between youth (18–24 years) and women, (>24 years), based on the United Nations definition of youth (UNDESA, 2014).

Ethical considerations

Participant privacy and respect were assured throughout the study. First, study intention and purpose were clearly explained during a thorough introduction. Second, each woman was notified during the consent process that her participation was voluntary and that she could withdraw at any point during the interview without any penalty. Third, verbal consent was obtained and an information sheet was offered to each woman prior to commencing the interview. In order to maintain privacy after the interview, any identifying information was omitted from the transcription. Institutional Review Board approval was obtained by The George Washington University Office of Human Research. Researchers claim no partiality or bias towards the women’s group, its member organisations or the women involved.

Results

A total of 19 women, the majority of whom were aged 18–24 years, were interviewed (see Table 1 for respondent demographics). While women had varying levels of schooling, employment and participation with the group, all reported having benefited in some capacity by their association with the women’s network. Three recurring themes about the way in which the social network functioned emerged from the text. First, the social support that was developed within the network established a safe space where women could interact with, learn from and encourage each other to set goals for the future. Second, respondents gained increased self-awareness and self-confidence as a direct result of their involvement in the women’s network. Third, participating in the group provided women with opportunities for personal and professional development that were not often available in their remote communities. The names used in the following sections are pseudonyms to maintain respondent confidentiality.

Table 1.

Demographic characteristics of in-depth interview respondents (N = 19).

Demography
Age, years
18–24	14
⩾25	5
Department of residence
Chimaltenango	8
Totonicapán	4
Quetzaltenango	6
Quiche	1
Educational level
Some primary	6
Some secondary	9
Some university	3
Unknown	1
Employment status
Work outside of home	8
Work from home	6
Unemployed	5

Social networks provide support and motivation for women

Collaborating and sharing life experiences in a group of similar yet diverse women fostered a sense of solidarity and friendship among the participants. Women were provided with increased social contact and support as they interacted with other Maya women from across the region. Elvira (⩽24 years old), who was active in the network, exclaimed, ‘I really like the way we are treated; there is no discrimination. The other girls are from different departments and I really like sharing with them’. A respondent named Judith (⩾25 years old) expressed,

I really like the collaboration. Because I felt really lonely, but meeting other girls from other departments, other communities, I felt really good because we shared our different experiences. People come from Tecpán, Xela, Patzún, from different municipalities or far-off villages and we share about what we are doing. I began to feel very content.

Maria Patricia (⩽24 years old), who was trying to save money to go to university, shared,

I like the support that we have at our meetings; we talk. We have a lot of communication.

The social support generated through group interaction and the resulting reciprocal learning was valued among participants. Elvira (⩽24 years old), who was working on a college degree in social work, commented, ‘I’ve liked not only sharing, but through the group, I know more girls. I’ve had the opportunity to meet more participants and it’s been really nice learning together’. Through this sharing and learning, women not only supported each other but also broadened their understanding of the complexities of daily life as experienced by their peers.

Part of the network’s activities included engaging women in a process of setting personal goals for the future and supporting them in their efforts to obtain them. This exercise motivated respondents to make priorities and conceptualise how they would like their lives to be in the future. Jenifer (⩽24 years old), who was finishing high school at the time of the interview, said,

When I began to participate, I saw that it was really important to have a plan for my life. My plan was to keep studying and get a degree, and with their help, I’m doing what I said I would.

Judith (⩾25 years old), who was a single mother with a full-time job, stated, ‘In ten years I want to have a degree in education, a degree in psychology, I want to have my own clinic. I also want to start various businesses in my community so that it develops, too’. Another participant, Carolina (⩽24 years old), talked about her dream of having a farm. She said, ‘I want to have a large business, a farm. I want to raise cattle and support my family’.

Several women recognised that achieving their goals had the potential to improve not only their own wellbeing but also that of their community. The aforementioned future farmer added that she would love the opportunity to open an international market for traditional artisanry. She spoke of wanting to sell, ‘artisanry, all of the things that girls make in the communities, the traditional blouses, napkins, all of that. This way I could help other young girls have the opportunity to sell their products’. Another participant, Yolanda (⩾25 years old), who had already begun to accomplish her goals, shared,

In the short-term, I wanted to graduate high school. I did that. In the medium term, I opened a pharmacy in my community to help the people. And in the long term, I want to get my degree in social work and I will do it.

Jenifer (⩽24 years old) noted how she envisioned her participation in the group would affect herself and her community. She commented,

Well, more than anything, I’ve liked participating with the group because, say, we get together and talk about what we want to achieve; not only is that a benefit for us but it is also a benefit for generations to come.

Participation in the women’s group was also noted by several respondents as a reason for remaining in their communities instead of looking for work elsewhere when employment opportunities were limited. For example, Laura (⩽24 years old) expressed that she had considered immigrating illegally to the USA when she was unable to find a teaching job. She shared, hesitantly, ‘I have considered it … but the first thing I thought about was that I don’t want to leave the group’. Another woman contemplated moving to Canada to look for employment but reconsidered in order to remain close to her family and continue participating in the women’s network.

Social networks increased women’s self-awareness and self-confidence

Self-esteem was a focus of several structured activities, and many women claimed these sessions to be among their favourites and most useful. Judith, a young, widowed mother (⩾25 years old), stated that becoming involved in the women’s network helped her to cope with the loss of her husband and realise her potential. She remarked, ‘They’ve given us training on self-esteem, leadership, and all of this has helped me greatly. To bring back meaning to my life and also realise that I have abilities that I didn’t know I had’. Ana Maria (⩽24 years old), who left school at a young age to work in her family’s weaving business and who struggled with self-image, noted,

When I look at myself in the mirror, I tell myself that I don’t love myself. I am not pretty, I’m ugly, I say. But by learning about self-esteem you start to love yourself. We have to love ourselves and later we can love our neighbours.

Other women spoke of recognising their worth, setting goals and working towards them, and applying their new knowledge and skills in different settings. When asked about what she had learned within the network, Judith (⩾25 years old) stated, ‘You learn about your rights, to value yourself as a woman, and your self-esteem improves. You don’t always have to depend on a man, but learn that we can do things. We can know things, too’. By becoming more aware of their capabilities, the women, in turn, became more self-confident and felt empowered to become involved in various activities.

The network promoted a sense of empowerment among its participants by helping them build self-confidence and realise their ability to speak in public. Participants shared that the new self-confidence they gained from participating in the network helped them ‘find their voice’ and feel empowered to speak in public about culturally sensitive topics, such as reproductive health and women’s rights. Practising public speaking during formal group meetings and events enabled the women to share their experiences and lessons learned with younger women and girls in their communities. Verónica (⩽24 years old) shared,

I didn’t always participate. I was scared, I was embarrassed to speak in public and I didn’t know how to express my opinion. But after receiving the lessons within the group, little by little I’m overcoming my shyness; that fear. Now I am active within the group.

An older participant named Adela (⩾25 years old) said,

I have learned to be a little more sociable in the network and communicate better with other people, to get over my nerves. I couldn’t talk very well in front of people. But right now I am overcoming little by little with the help of the other participants. They ask us questions in the workshops; we speak to each other and encourage each other.

Yolanda (⩽24 years old) viewed the women’s group as a resource for professional development and further emphasised the benefit of increased self-confidence. She said, ‘They open up this space for us so we can continue developing professionally and get rid of the fear that we have [of speaking in public] … so we can speak up and help the community’. Carolina (⩽24 years old) described how she helps her community by sharing knowledge of sexual and reproductive health:

I see that in my community, right, there are many adolescents that get pregnant at a very young age … so I tell them what I’ve learned and talk to them, teach them what I’ve learned. And really, I’d like it if in the future things like this wouldn’t happen and there weren’t so many pregnant girls.

A respondent named Sara (⩾25 years old), who had been active in the network for over 5 years, described how she liked to share the information she learned with girls in her community as well as with her friends. She said, ‘I always talk. I talked to my group [of friends] a little while ago and I began to take out a sexual and reproductive health book about contraceptive methods. There is a lot they don’t know about that topic’. Carolina (⩽24 years old) was first introduced to the topic of sexual and reproductive health through the women’s group activities and quickly learned the importance of sharing her knowledge. She remarked,

The truth is that I’ve learned many things about sexuality and reproductive health. In my community it is prohibited to talk about that and before it embarrassed me to talk to my parents about it. But from learning about these topics, I understand more. And that I should talk about it with my parents, my brothers and sisters, my cousins, and with everyone around me.

Carolina went on to note that she even talks to her male friends about sexual health. She remarked,

Some like to talk about it, and I’ll explain everything to them [her male friends], about why there are so many pregnant girls, right. If they want to have relations with their partner, I don’t prohibit it, but I tell them what could happen.

Using their voices to speak with other young people and individuals in their communities allowed the women to extend the knowledge and support they gained through involvement with the network.

Social networks enhance opportunities for women

Participation in the young women’s network provided its members with educational and professional development opportunities that were not readily available in their home communities. Many women described the reality that opportunities for women in the rural areas where they lived were scarce. Carolina (⩽24 years old), who was from a remote community with dreams of being a doctor, stated, ‘Well, certainly, we don’t have very many opportunities there in the very distant areas but, thanks to God, the group opened its doors and gave me this opportunity’.

Network activities also provided the women with the opportunity for professional development by teaching them new information and skills in an informal learning environment. Organised programme activities included exposure to new information and ideas that many participants had not had the opportunity to learn in a formal school setting. Jenifer (⩽24 years old) mentioned different topics that she had learned when talking about her involvement in the group:

[I have learned] about self-esteem, making a plan for your life, communication, political involvement, and women’s rights … also about sexual and reproductive health. With that, let’s say, we talk about getting pregnant and all that. These themes have served me greatly in my personal life.

Respondents noted that education was an important factor in achieving success and gaining meaningful employment. As many of the women had received only basic formal schooling, the opportunity to continue learning through the scheduled activities and informal interactions was highly valued. Adela (⩾25 years old), whose family felt that she did not need to be educated because she was a woman, explained,

I’m happy that they [the women’s network] gave me the opportunity to participate in the network and learn about things that I always wanted to understand but my parents couldn’t give me the opportunity because they were poor. I take advantage of every workshop now and I’m learning many things.

She continued by describing her participation in a week-long workshop related to starting a small business and stated that she ‘learned about things that I had lost because I didn’t go to school’. Angelita (⩽24 years old), who was from a remote village, said, ‘The thing is to learn. If someone stays at home they don’t learn much. They learn about things in the kitchen but nothing else’.

Learning traditional artisan techniques, including weaving, was also a component of network activities. Some of the women already sold their products from home while others mentioned their desire to use their new skills and possibly find a means of selling their handicrafts in the future. Another participant, Raquel (⩽24 years old), commented, ‘Maybe one day I’ll get really good at making something, something that I really want to learn how to make, and I’ll be able to sell it’. Overall, participating in the group provided women with the opportunity to learn new information and skills that could prove useful to them in the future.

Discussion

Findings from this study illustrate that social networks have the ability to make positive contributions in the lives of young women, specifically related to reproductive health and economic wellbeing. Apart from the formal education in reproductive health, life skills and artisan training, women also benefited from the social support and informal learning experienced through interacting with their peers. The social support garnered within the network helped participants overcome feelings of embarrassment, fear and rejection. Women gained the confidence needed to express their opinions and speak in public through the structured activities as well as through more informal peer interactions.

Through participation in network activities, women gained a deeper knowledge of reproductive and sexual health. The solidarity and friendship garnered within the group created an environment in which the women felt comfortable expressing themselves and sharing their newly acquired knowledge with others. As a result, they understood the need to share this information with family, friends and communities. This finding complements previous literature which suggests that social networks can serve as an avenue for the diffusion of novel ideas and innovative behaviours (Lindstrom and Muñoz-Franco, 2005; Richmond and Ross, 2008).

The women’s group, moreover, provided participants with a welcoming space to learn new concepts, ideas and skills that many did not have the opportunity to learn in a formal school setting. Consistent with the national average for Indigenous women, many of the respondents had low levels of formal schooling (Figueroa et al., 2006; MSPAS, 2011). A surprising number of respondents, however, had at least some formal secondary education and some were even pursuing university degrees. Despite their level of schooling, all respondents recognised the importance of gaining knowledge and experience and considered their participation with the network as a chance to enhance their education and gain new skills. Associations between education and maternal and child health outcomes further affirm the value of empowering young Indigenous women through increased access to reproductive health knowledge and enabling them to share it with others in their communities (MSPAS, 2011; UNFPA, 2010).

Respondents additionally expressed the importance of setting life goals and expressed motivation in taking the necessary steps to achieve them. Women recognised what they needed to do in order to find a job and accomplish their diverse ambitions and were confident in their ability to do so. This self-efficacy could ultimately increase women’s ability to improve their economic stability as well as enhance their reproductive decision making (Blumberg, 2001; Grépin and Klugman, 2013).

This study highlights two important elements of social network participation that could be leveraged to inform public health programming among Indigenous populations. First, the social support and reciprocal learning found within this women’s group made it a protected yet dynamic forum in which to share important reproductive health knowledge with young women. Initiatives focused on groups of women and girls should capitalise on social support and shared learning to aid in the culturally appropriate dissemination of reproductive health and family planning information. Moreover, women’s networks could be recruited to transmit important health information to local communities. Second, network participants learned about the importance of goal setting and were given the opportunity to learn new concepts and skills that could be used for income generation. Professional development and capacity building activities should be incorporated into future programming to help foster an environment in which women feel confident and enabled to improve their life circumstances.

Study limitations

Four limitations should be considered in relation to this study. First, it was not possible to conduct follow-up interviews due to time constraints and the distance between interview locations. At the same time, the 2-hour duration of each interview allowed for an in-depth exploration of women’s experiences and opinions. In addition, the number of respondents and diversity of geographic locations, Indigenous group identities and ages allowed for triangulation across themes.

Second, study participants had higher levels of formal education than the national average, spoke Spanish and commonly worked outside of the home – characteristics that are not typical of most Guatemalan Maya women. The insight from this unique group of women, however, is helpful to form an understanding of the type of women that might self-select into women’s empowerment programmes. Although the study did not aim to be representative or generalisable, further research among Indigenous women with lower levels of education and less Spanish proficiency would be valuable to explore whether the same issues and themes arise.

Third, it is important to note that the method used to recruit interview participants could have led to selection bias. The programme coordinator’s involvement was essential, however, to establish credibility among the women and to obtain logistical support. Moreover, the coordinator did not attend the interviews and researchers assured respondents confidentiality so that the women could express their opinions freely.

Finally, although participants commented on changes in perceived knowledge and self-confidence, the study did not measure changes in behaviour as a result of network involvement. Future research should assess the impact of social network involvement on reproductive health behaviours and actual changes in economic wellbeing. For example, a longitudinal study following network participants over time would provide more concrete evidence as to whether improvements occurred as a result of involvement in the network.

Conclusion

Despite the limitations mentioned above, this study demonstrates the potential value of leveraging inherent strengths of social networks by incorporating them into health education programmes aimed to improve reproductive health and economic wellbeing for vulnerable populations, such as Indigenous women. The ambition and curiosity expressed by the women appeared to be cultivated and reinforced through participation in the women’s group. Whether these attributes were inherent to the women or a direct result of network participation, they were all genuine in sharing that they had benefited from increased self-esteem and enhanced opportunities for education and learning. Future programming should harness social support and reciprocal learning within such groups to educate participants about modern contraceptive methods and other innovative health topics. Professional development and skill building activities should also be included in programme objectives to build capacity and empower girls and young women to take control of their health and economic wellbeing. Such programmes would benefit from building upon the support and self-confidence fostered within social networks to provide young Indigenous women with the motivation and agency to improve their lives.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

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