Improving Access to Reproductive Health and Gender-based Violence Services during COVID-19 in Guatemala

Lessons from a Social Behavioral Change Communications Campaign

At the height of the COVID-19 crisis and lockdowns in 2020 and 2021, Guatemala’s Women’s Observatory of the Public Prosecutor’s Office saw a decrease in reported cases of gender-based violence (GBV). The Sexual and Reproductive Health Observatory (OSAR)—a prominent national civil society organization—determined that this decrease was likely due to women’s and adolescent’s lack of access to essential GBV services, especially in urban areas of Guatemala City and the Western Highlands. 

The pandemic put enormous pressure on an already strained public health system that struggled to respond to the crisis without neglecting other pressing health needs of the population, especially for adolescents and women. In Guatemala, a country with some of the highest levels of maternal mortality in Latin America, around half of women ages 15 to 19 have an unmet need for contraception, and access to sexual and reproductive health information and services is even more limited for women living in poverty and in rural or indigenous areas of the country. An analysis led by OSAR shows that between 2019 and 2020, the country saw decreases of 30% in prenatal care attendance, 70% in access to family planning, and 35% in institutional delivery rates, with sharper decreases in indigenous (vs nonindigenous) and poor communities. 

“Life has Changed” Campaign 

In 2021, the Pan American Social Marketing Organization (PASMO) launched a 10-month social behavioral change communications project with support from MSH through its Small Grants Mechanism. The project included a four-month campaign called La vida cambió (Life has Changed) to increase mestizo and indigenous women’s and adolescent’s access to health and GBV services among the urban and predominantly indigenous areas of Quetzaltenango, San Marcos, and Huehuetenango in Guatemala.  

PASMO developed a multimedia and multimessage campaign under the creative concept La vida cambió. Toca cuidarnos (Life has changed. We need to take care of ourselves), which aimed to motivate women and adolescents to seek out reproductive health services and support for GBV in the context of the COVID-19 pandemic. Between February and May 2021, outdoor advertising, billboards, and radio spots shared key messages in Spanish and in the local Mayan languages, Mam and K’iché. The campaign was also disseminated through eight sets of digital materials adapted to different social media channels. The campaign reached more than 260,000 women ages 15 to 25 in Quetzaltenango, San Marcos, and Huehuetenango through mass media channels and 787,713 women and adolescents in that age group through online and social media channels, with online engagement with campaign materials of 39,074 interactions (likes, comments, and shares). 

Keys to the campaign’s success included national and local alignment and coordination coupled with active engagement of young women and adolescents in the targeted communities. 

Local and National Alignment  

To support a comprehensive and integrated response to GBV, campaign materials included the Public Prosecution Office’s short emergency phone number for responding to cases of violence against women and girls, through which GBV survivors could be confidentially referred to appropriate health, legal, and other support services. Campaign materials on reproductive and other health services included the logo and endorsement of the Ministry of Health, which helped target audiences know that they could seek out public health services for support and care. The Vice-President’s Office on Sexual Violence, Exploitation, and Trafficking in Persons (SVET) also provided its logo and institutional backing to all campaign materials regarding GBV.  

This institutional support for the campaign was not limited to national-level partners. To ensure local buy-in and leverage resources and political will, PASMO first worked to map, contact, and engage both national- and local-level partners and stakeholders that provide health and GBV services, including the Ministry of Health and its local health areas, the Public Prosecution Office and its gender offices and teams, SVET, local NGOs and associations that promote women’s and adolescent’s health, and shelters for survivors of GBV. 

Once these local partners were contacted and confirmed, PASMO led data analysis and co-creation exercises with these stakeholders in San Marcos, Huehuetenango, and Quetzaltenango to ensure the participation of young mestizo and Mayan women and adolescents in the workshops and motivate them to share their perspectives, experiences, and insights for the communications development process. Their feedback was used to adapt messages and images to ensure they were clear and user friendly.  

After the campaign materials and messages were developed and designed, PASMO reviewed and validated them with the same women to ensure they were comprehensible to this audience. Throughout the campaign development process, PASMO actively coordinated with key contacts within the Ministry of Health, Public Prosecution Office, and SVET to ensure that audiences would know where to reach out for support with any potential demand generated by the campaign.  

Lessons Learned  

In the months following the campaign, PASMO reached out to partner institutions to compile any data that could indicate if there had been an increase in women and adolescents seeking health and GBV services in the targeted geographic areas. Despite the short length of the project and its limited time on air, PASMO received positive feedback from partners and key audiences on the importance of sustaining this type of communication, considering COVID-19’s significant impact of on the health and wellbeing of women and adolescents in Guatemala. The campaign also provided an important opportunity to integrate health and GBV communications, as the topics are generally addressed separately. 

Looking forward, PASMO will explore opportunities to continue disseminating campaign materials and messages in coordination with the Ministry of Health to sustain this campaign beyond the life of the project. Future projects should include pre- and post-assessments and impact indicators to capture their potential effect on demand generation or other key behaviors included in the social behavioral change campaigns, including with rural and indigenous audiences.  

Dr. Susana Lungo is Regional Executive Director of the Pan American Social Marketing Organization (PASMO). 

Dr. Cristina Maldonado is MSH’s Monitoring and Learning Advisor, supporting the Utz’ Na’n project in Guatemala.