In Paraguay, nurse Mariel Díaz delivers culturally-sensitive healthcare to indigenous communities

LAGUNA NEGRA, Paraguay – Nurse Mariel Díaz Flores, 37, regularly travelled more than 70 kilometres by motorcycle to complete her studies – all while working full time and taking care of her three sons.

But her dedication paid off: Now equipped with a nursing degree, Ms. Flores works at the Canaán Family Health Unit at the Guaraní Ñandeva Indigenous community in Laguna Negra, in the sparsely populated region of Chaco. The community is located in the department of Boquerón, more than 500 kilometres from the country's capital Asunción and close to the Bolivian border.

Ms. Flores belongs to the Western Guaraní community, one of 19 indigenous peoples living in Paraguay. Her own experience has taught her the importance of having access to sexual and reproductive healthcare. 

“Thanks to family planning, my husband and I were able to space the births of our children. That allowed me to complete my second degree,” she told UNFPA, the United Nations sexual and reproductive health agency. 

While she feels lucky to have had access to quality healthcare, she knows that the reality is different for many other women in indigenous communities, who often face barriers due to the racism, discrimination and intolerance they encounter when seeking healthcare.

Communication as a tool

Although Paraguay’s indigenous population represents just over 2 per cent of the total population, the maternal mortality ratio is more than four times higher than among non-indigenous women. The unmet need for family planning of indigenous women sits at 20 per cent – twice the national average.

And while progress has been made in reducing adolescent birth rates, which decreased by 26 per cent among adolescents aged 15-19 years between 2016 and 2020, disaggregated data show that rates for indigenous adolescents are in fact increasing: The adolescent birth rate among indigenous adolescent girls is now double the national average.

Many of these challenges have their roots in the cultural barriers indigenous communities face when accessing quality information and healthcare.

For Ms. Flores, being able to communicate with women and girls in her community is half the battle. As a bilingual Guaraní-Spanish speaker, she can talk to women about topics like family planning in their own language, and deliver information in a familiar and culturally-sensitive way.

“I have a conversation with each woman to inform her about the available contraceptive methods, seeking to create an environment of trust,” she told UNFPA. “It's not an easy topic to address due to the fear generated by misinformation."

To address the need for localized information on healthcare, UNFPA has partnered with Paraguay’s Ministry of Public Health to train personnel and strengthen communication tools in the region. In 2024, UNFPA supported the training of over 1,000 physicians and obstetricians in sexual and reproductive healthcare and family planning.

“Sharing my own experience with my patients helps debunk many myths surrounding birth control,” she explained.

Finding a way

Another obstacle faced by indigenous communities in Paraguay is geography: The department of Boquerón is located in the Paraguayan Chaco – a remote semi-arid region that often faces droughts, severe floods and high temperatures. The majority of Paraguay’s indigenous peoples live in the region, yet the lack of roads and basic infrastructure can make it difficult for these communities to access healthcare services.

“Not all pregnant women get checked because they face difficulties such as distance, lack of transportation and lack of information,” Ms. Flores told UNFPA.

But health workers are making a critical difference. Between the first quarters of 2023 and 2024, the number of women using contraceptives in the department of Boquerón increased by 60 per cent, an uptake that can partly be explained by the new methods being offered: UNFPA has supported the introduction of contraceptive implants and other long-acting, reversible contraceptive methods into health services in the Paraguayan Chaco for the first time.

“A pregnant woman requires a lot of care, and when the baby is born, you have to care for it, breastfeed it and feed it,” said Ms. Flores. “That's why I used temporary birth control until I had my desired number of children.”

With UNFPA's support, she and other indigenous health workers are building a bridge to communities who need the most support. She’s proud of her work, and plans to continue supporting the women who come to her so that they can exercise their rights as she was able to do.