Care Matters: Centering Patient Rights & Autonomy in Guatemala

Asking for contraception can still feel like crossing an invisible line in Guatemala. 

Women weigh the risk of being judged, dismissed, or misunderstood, especially Maya women who don’t speak Spanish, often the only language many healthcare providers use in Guatemala. Now, with contraceptive shortages spreading across the country, even those willing to take that risk are finding fewer and fewer options available. 

In Santo Domingo Xenacoj, that reality plays out quietly, where women often seek care in private after work, after dark, often with hesitation. Because access isn’t just about availability. It’s about trust. And for many, that trust is hard to find. 

Noemi provides care from her own home, at hours that work for the women in her community, including evenings when work has ended and children are asleep, something formal health facilities rarely offer. This setting helps create a sense of comfort, privacy, and safety. As a Maya Kaqchikel woman herself, she has built her work as a reproductive health promoter around trust, particularly for Indigenous women whose primary language is Kaqchikel. Having firsthand experience with the fear of mistreatment and shame that often prevents Guatemalan women from seeking care in formal clinical settings, Noemi strives to remove those barriers by offering care in a safe, familiar and non-judgmental environment.  “My goal has always been to inspire trust with my patients, since most of them are indigenous,” Noemi said. “Given the stigma around reproductive health in Guatemala, the first thing they think is that I’m going to treat them badly. So what matters is the trust you build with them.” 

Noemi is part of a community-based model supported by the Women’s International Network for Guatemala Solutions (WINGS), a Fòs Feminista partner that provides reproductive health education and services to rural and Indigenous populations. Through this work, she shares counseling, information, and contraceptives with women in her community, meeting them where they feel most comfortable. 

“I often have to tell my patients about the diversity of contraception options available to them”, Noemi said. “If side effects are explained properly, and people are able to ask questions about the reality of each option without fear of judgment, they’re empowered to choose the one that’s right for them.” 

Eventually, Noemi took on an additional role as a nurse at the WINGS mobile clinics, traveling to different communities to provide care. After years of working as a nurse, she continues seeing patients in her community as a promoter, often seeing them in her own home at night or on weekends, so they can come after work in the region’s agricultural industry.  

During one of her regular appointments, Noemi met Anita,* an indigenous mother of four who wanted to prevent another pregnancy. By leading with kindness and building a strong rapport with her from day one, Noemi helped create a trusting environment that gave Anita confidence to continue prioritizing her reproductive health and making informed decisions about her future. 

“It’s very culturally frowned upon to use contraceptives, even if it’s just pills or an injection, everything is seen negatively,” Noemi explained. “But if you consider your options and choose a method that’s best for you, you end up being able to dedicate more time to the children you already have, rather than if you had another baby.” 

“Me being able to have access to contraception means I get to be a better mom, to be a better wife, and have time for myself,” Anita agreed. She remembers the relief she felt when accessing safe and affordable care at WINGS. Purchasing contraception at Guatemalan pharmacies can be significantly more expensive, and pharmacists are known to overstep boundaries and try to provide medical advice. Anita felt much more comfortable and supported by Noemi’s rights-based approach to care. 

Access to reproductive healthcare in Guatemala is under growing strain. Poor government management has slowed contraceptive procurement, disrupting supply chains and leaving clinics without essential methods. With shortages already underway, gaps in access are expected to deepen well into 2026.  

To fill this gap WINGS partnered with Suprimentos de saúde INNOVA, a Fòs Feminista–led initiative developed in partnership with organizations in the region to strengthen access to contraceptives, offering tailored solutions to local healthcare providers in Latin America and the Caribbean to help them avoid high prices, long wait times, and contraceptive products that arrive with a short shelf life. By partnering with INNOVA, WINGS has still been able to provide a range of contraceptive options, helping women maintain continuity of care despite national shortages. 

“It’s so important to provide patients with reliable options, especially when many women lack accurate information about the various kinds of contraception that are available to them,” Noemi said. “That’s why my health promoter counseling sessions involve not only administering a birth control method, but also listening, asking about my patients’ lives, and building long-term relationships. I want to continue that care.” 

Years into her work as a health promoter, Noemí continues to receive women in her home, offering something many of them struggle to find elsewhere: the confidence and autonomy to make decisions about their own bodies. 

*Her real name was omitted to protect her privacy.