Editor’s Warning: This article contains graphic descriptions of physical and sexual violence against women that may be upsetting to some readers.
Martina hated men. She had her reasons. Reasons that went back years, to her earliest memories on the family coffee plantation, skittering out of the way when her father beat her mother, leaving bruises and bloody lips. To her uncle cornering her at nine years old, planting sloppy kisses and yucky hugs, followed by death threats should she ever tell. To her 13-year-old cousin following suit when she was 11 years old—grabbing, kissing, rubbing her all over.
Three attempted rapes, each Martina fought off with fists and screams, doing her best to ignore the same “never tell” death threats that followed.
Why does this happen to me?
She wondered every time she saw a man: Is he going to do the same thing? She says, “And so my fear of men grew. I didn’t want to leave the house. I wanted to just be there, closed up.”
To pry Martina out of the house, her mother insisted she come to work with her on the finca (plantation). One morning, as Martina made her way across the finca, balancing on her head a heavy woven bag stuffed with coffee service for the workers, she tripped and fell, spilling the bundle of coffee and fixings.
“When I looked up, there was a man.” He was dressed in black, with his face covered, so no one could identify him. He carried a machete. There was no fighting him off. “I screamed and I screamed for someone to help, but no one heard me.”
The man shrugged off her cries during the kicking, punching, and rape that left her crumpled on the ground. When he was done, he said, “I’m going to do you a favor and kill you so you don’t have to remember what happened.” Martina recalls, “He lifted his machete. He was going to kill me.”
Just then, an armed finca guard came by, pistol in hand, and scared off Martina’s attacker. Martina was so badly beaten, she nearly lost an eye. The guard took Martina home to his wife. “She washed me, gave me clean clothes to wear. Then we cried together.”
In the six months following the attack, Martina had only had one plan: suicide. She tried a variety of methods: starving herself, hanging herself with a rope, roaming the kitchen at night looking for knives (her mother stood guard), begging for a ride to the highway, hoping to be hit by a truck.
“I had a lot of hate. A lot of hate for men. Including my brothers. I didn’t want to see them. I didn’t want to leave the house. So I spent most of my time shut up inside.”
Her mother brought her a sewing machine as a gift. “I began to sew. Little by little, my thoughts began to change. I began to focus on what I can do: washing clothing for money, taking classes at the school, working in a bakery.”
Eventually, Martina found a job with Wuqu’ Kawoq, or Maya Health Alliance, working on water filtration projects. The organization was founded 12 years ago by a Tulane University PhD student, Anne Kraemer Diaz, to address unique barriers rural, indigenous women face in securing quality health care. Most (80 percent) of this population doesn’t speak Spanish as their first language—there are 21 Mayan languages spoken in Guatemala—yet, medical care is typically only offered in Spanish. Maya Health Alliance, founded to fill that gap in health access, has since grown into the second largest health provider in Guatemala, seeing 20,000 patients a year. All services are offered in patients’ native languages and include sexual and reproductive health care through women’s health clinics.
Though Martina was originally hired to work on water filtration projects, her role quickly evolved. “Whenever I went to a house to talk about water, women would tell me: My husband hits me. I don’t want to have any more children.”
Her focus shifted, and with specialized training, Martina’s life’s work emerged. “I wanted to work in the clinic as a nurse. I want to help people. Women.”
Martina is not unique in what drives her to help indigenous women. Maya Health Alliance is one of a larger ecosystem of community-based nonprofits in Guatemala, often founded by American expats, but staffed almost exclusively by indigenous Guatemalan women, many of whom are themselves survivors of abuse. Anne Kraemer Diaz says, “With my mostly female staff, I would say at least 50 percent have suffered [incest] in some way, shape, or form, whether a stepfather, an uncle, or a close neighbor.”
Their survivorship, channeled into newfound careers as advocates, is not only transforming their own lives, but also those of rural women—and by extension, their families and communities.
Racism and Persistent Indigenous Poverty
Guatemala is still recovering from a 36-year civil war, which ended in 1996. The war included ethnically-motivated torture, forced disappearances, massacres, and other acts of genocide against indigenous Mayan communities, which make up about 40 percent of Guatemala’s population. While overt acts of genocide may be in the past, the reverberations of racism touch nearly every aspect of indigenous community life.
Today, the poorest Guatemalans are primarily indigenous. Language is just one of the barriers to health care and poverty alleviation that they face. The poorest quarter of Guatemalans are the most chronically malnourished population on the planet, according to Maya Health Alliance researcher Dr. Caitlin Baird, who specializes in child malnutrition and stunting. Severe malnourishment in the first three years of life, she explains, has permanent effects: anemia, diabetes, high rates of maternal mortality and morbidity later in life. “People have the impression that Guatemalans are short because of genetics. We know that’s not the case.” She explains:
When you don’t get the nourishment you need to grow in your first three years of life, you do end up shorter. You end up with malnourished children who grow up to be sick adults who are less capable of bringing income into the home and are sick more often and they are less productive, and their children end up more stunted. You have this argument that people should just pull themselves up by their bootstraps, which is ridiculous because you’re three. You don’t have any bootstraps.
Strong structural barriers keep most indigenous women from accessing contraception and reproductive health care. Geography of the mountainous regions so many call home can prove close to insurmountable: A 17-mile drive can take up to four hours.
Nurse Maria Ruperta Cosogua Perez works for WINGS Guatemala, another nonprofit health provider that delivers 92 percent of its services in rural, indigenous communities through two mobile clinics. Maria sets out for work at 3:30am every Monday, in order to make the four-hour journey to the WINGS head office in the colonial town of Antigua. From there, she joins colleagues for a seven-hour journey in the WINGS mobile clinic to a base of operations. For the remainder of the week, they drive eight to nine hours per day to various remote villages to reach residents with health services.
Mobile clinics that bring health services to rural, indigenous people where they live are an innovative way to reach potential patients who are often reticent to make the long journey to distant clinics, because the promise of care is so precarious. Beyond language barriers, supplies may have run out. Or worse, providers may be abusive.
Stories abound of indigenous women being denied reproductive care at government hospitals due to their traditional dress. Doctors have been heard mumbling, We don’t serve your kind. Dr. Kraemer Diaz recalls an indigenous patient who was turned away from a health center while in labor, despite having a dangerous condition called placenta previa. She bled to death outside the hospital.
Stories of unwanted procedures being performed are also disturbingly common. Dr. Kraemer Diaz says:
There have been cases where women get their tubes tied, and they haven’t authorized it. They are told: You’ve had enough. You don’t need any more children. So their tubes are tied after a C-section. That’s all about “their kind” can’t make those decisions. Because indigenous women are not seen as people. They are just something to be dealt with.
Machismo at the Root of Gender Inequality
Gender discrimination within indigenous communities begins at birth, with society placing a strong preference on sons over daughters. Karyn Choy, an indigenous nurse with Maya Health Alliance, says, “When it’s a girl, it’s less pay to the midwife. So that’s where our big, big problems start.”
The problems only continue. Karyn describes a typical life for a girl child: “You cannot go out. You need to stay home to cook, clean, take care of the children. If you have brothers and sisters, you have to take care of them. You become the second mother.”
Making matters worse, young girls who are abused often have nowhere to turn. Mothers, out of fear of escalating violence, do not generally intervene.
Dr. Kraemer Diaz explains:
In Guatemala, there’s no safety net. There’s no way mothers are going to go against their family and say what’s happening, because they’ll be cast out. There’s no options. They’ll be killed. So incest is a real, major problem. It stems from the fact that women are seen as objects. They are not cared for as special human beings, but as objects to be dealt with. And to be dealt with in whatever way men think that should be.
Extreme poverty adds additional pressures on girls as they transition to adolescence. With only so many salty corn tortillas to go around, girls as young as 12 or 13 are pressured to get married, just so someone else will feed them. Dr. Baird says, “If you can trade on your sexuality, trade on your femininity in order to get someone to marry you so they will take care of you, that is something you are very much expected to do.”
Any chance of gaining agency evaporates in the move to a new family. The young bride is expected to defer to her husband and in-laws in all things: what to feed the kids, when to have sex, and whether (not even when) she can leave the family home. That pattern of control very much extends to contraceptive use as well.
An annual survey conducted by WINGS repeatedly finds the average indigenous adolescent girl aims to have two children, beginning at age 26. But, few rural indigenous women are able to access reliable health care, and when they can, they often believe bad things can happen from using contraceptives, which are mired in myth.
If you take the pills, you’re going to get really fat and your husband will know. If you get the implant, it’s going to travel through your body and end up in your foot. Do you know what they do in a Pap smear? They take out all of your insides—all of your guts—put them on a table to look at them. And then they put them back inside. They might put something extra, they might leave something out.
Dr. Rodrigo Barillas, Executive Director of WINGS, says, “A huge percentage of women want to space their children, or not have any more, and they just can’t. They don’t know how.”
But none of these forces exact such a heavy toll as the omnipresent force of machismo. Martina explains:
Machismo is the biggest issue facing indigenous women’s health. When we say machismo, that means men think they are the only ones who have a word, decide what to do. Women have to obey them. If their husbands know they are actively trying to not have children, they would be hit.
Experts, from doctors to nurses to violence survivors, echo this refrain. Dr. Barillas says, “It’s the biggest barrier for women trying to access reproductive health services: the men, the partners in their lives.”
In practical terms, that means community health workers often have drop-ins at odd hours for patients looking for a quick method of birth control they can hide easily, like a Depo-Provera shot. Enma Rodas Rodriguez is an indigenous community health worker with WINGS. She says, “Sometimes, just when I’ve laid down, there’s a knock on the door. I don’t want to have to go see who it is. And then I think: It’s my responsibility. These are my ladies.”
Many of the women Enma sees are living with domestic violence.
Sometimes women will say, Please, can you give me the injection fast? He mustn’t know I’m here to get my injection. I just made an excuse I’m going to the mill to grind my corn, so I must get back quickly. Fast, please, my husband doesn’t know I’m here secretly. The husbands think if the woman has the injection, it’s because she has other men in the street. Other men she has a relationship with.
Of the 40 women Enma serves, only two come with their husbands. The rest come alone—and secretly.
Karyn explains that part of the job of health worker is helping cover for the women they serve. The health workers provide extra care for children so they don’t report back to their families about the reproductive care their mothers receive. “We say we are going to weigh the baby or to make sure we are getting glasses for one of the children. In that way [women] can come without letting their children know [the true nature of their visits].”
With rampant sexual abuse, and contraception so hard to access, it is no surprise that the teen pregnancy rate is on the rise. Dr. Barillas recalls that in 2017, there were 90,000 pregnancies to girls under age 18. Of those, 5,000 were to girls ages 10–14. He estimates that hundreds of those were to 10-year-olds—the youngest girls in the age range.
Community health workers mostly skirt questions about abortion (the procedure is illegal in Guatemala, except when it’s necessary to save a woman’s life). Organizations that provide reproductive health care regularly deal with “phishing” schemes: folks turning up asking after illegal abortion services, presumably to secure evidence to bring legal action against clinics, and shut them down. If a woman asks a clinician about her options for pregnancy termination, she is treated as if she has a psychological disorder. Protocol requires her to be referred to a psychologist.
According to Dr. Barillas:
There are about 60,000 unsafe abortions in Guatemala every year, and the consequences can be grave. They end up in our national hospitals with huge infections, or complications. A lot of these women and girls die. You have 60,000 unsafe abortions in our country. So you are going to have 60,000 patients who have consequences from that.
Dr. Ana Michelle Dubon Estrada, Medical Director at WINGS, previously worked as an OB/GYN in public hospitals. In that role, she treated a tiny 13-year-old rape survivor who got an infection during childbirth that turned septic. The girl died in her arms after giving birth. She treated a 16-year-old who impaled her uterus with nails and umbrella spokes during a self-administered abortion. But the patient who haunts her most is the 13-year-old girl who begged her for an abortion, which Dr. Dubon Estrada refused to perform due to legal constraints. The girl hung herself the next day.
The “Good Woman”
For women and girls caught in a web of compounding constraints, there is a widely celebrated alternative to agency, one they are expected to embody: the “good woman.” Dr. Kraemer Diaz articulates this cultural ideal:
To be that indigenous woman, she’s head-to-toe in typical dress. She’s usually a weaver. She cooks well. She’s ready to do whatever it is that needs to be done: taking care of her husband, cooking, and cleaning. And she’s smiling.
But, thanks to the dogged advocacy efforts of local women’s rights groups, expectations around what women should quietly tolerate are beginning to change. In 2008, Guatemala passed the landmark Law Against Femicide and Other Forms of Violence Against Women. The law criminalizes psychological, sexual, and economic forms of violence, in addition to physical violence, and includes as one form of sexual violence “denying [a woman] the right to use contraceptive methods, whether natural or hormonal.”
Of course, these laws only work if the women they are intended to protect know about them, and know how to use them. That’s where community advocates come in, often drawing on their own experiences to guide other women.
Armed with the backing of law, advocates are revising what it means to be a “good woman.” Rural advocates aim to break open the barriers of isolation, oppression, and abuse to create healthier women, families, and communities.
Take Karyn. Her dream was to become an attorney. Following her studies at a community college in the United States, she returned to Guatemala to pursue her law degree. She became a community leader on domestic violence. “Traveling, telling people about violence. The way to report when you get hit: go to police, do this, do that. You’re going to be fine. Don’t worry, the laws are on your side.”
Things changed when she got married and had her first baby at 24 years old. Her husband insisted she quit law school to care for the baby, so Karyn dropped out.
It was two years of psychological violence: You are old. You’re getting fat. You’re not beautiful anymore. I have to look for someone else. The first time I got hit, it was my birthday, and my first day at Maya Health Alliance—hit today, and tomorrow I had to go to work at my new job.
But all those internal tapes about being a “good woman” and having the “right family” kept her from leaving. “I didn’t tell anything to anybody. Put on a smiling face.”
Three months later, it happened again. Harder. This time he drew blood. Choked her. Took her keys. Locked her in the house. Then he mocked her, Karyn, teaching women! Ha, look at you! Can’t you see yourself!
“When he said that to me, I woke up.”
She hid her Maya Health Alliance phone so her husband wouldn’t confiscate it, and later called a friend, who advised her, “This is the second time. The third time, he is going to kill you.”
Karyn went to the police and filed a denuncia (official report). The next day, the police came to escort her safely from the home. Her husband begged her to stay, but the old lines about being a “good woman” didn’t stick. “I told him, No. I’m taking my son. I’m taking my things. And I’m leaving. And I took everything. I took our TV.”
Years later, her now-ex husband still blames her: You went to police. You told them what happened. Why did you do that to me? It was nothing, and I had to go to jail! You are a devil!
She recites the standard response she gives him:
Okay, I’m a devil. You know what? It wasn’t right, what you did to me. And I did it because you have to learn you can’t hit anybody. Even if you get married again, you don’t get to hit anybody.
Now, Karyn is back in nursing school, and working full time for Maya Health Alliance. She uses her hard-won wisdom to counsel her patients.
It’s not easy to say, Okay, I have to leave. Especially with five or six or seven kids. I just had one. It was easier I think. Everyone says you are guilty. Why are you leaving your family? Society judges you.
After nursing school, Karyn dreams of returning to law school. “My thought before was to help women. I knew I could do many things, counseling women.”
Martina describes how helping women in her community has changed her life:
I lost all of the bad vibes about if I could or couldn’t do this. I just do it. As I’m helping them, I’m helping myself. Now my brothers and father, they’re nervous around me. I’ve lost my fear. I don’t want to die. I want to live. I love this work. I identify with the women I’m working with.
Women may come for a Pap smear or family planning. Martina says, “They get those things. But afterwards, they ask questions. That’s when I get their stories.”
Many of those stories are truly tragic.
“Laura,” 14 years old, came to the clinic with stomach pain. When Martina asked about a boyfriend, Laura said, “I don’t really know what that is. But, excuse me, I had blood a few days ago.”
The blood came following a late night incident. Her abusive and philandering father, who was drunk, brought home an equally drunk friend and told Laura, “In all things, you have to please my friend.”
Martina says, “She didn’t really know what was happening. Her dad treated it like it was normal, so she thought it was normal.”
When Martina gave her the news that she was pregnant, Laura had to ask Martina through her tears, “Where is the baby going to come from?”
Martina smelled an infection, and insisted that Laura’s reluctant mother take her to the hospital. Ultimately, Laura miscarried. But, per the 2008 Femicide Law, any pregnancy to a girl age 14 or younger is automatically considered to be the result of rape, and it triggers a mandatory investigation.
The father’s friend went to jail.
Laura has come back to the clinic to let Martina know there is no more hitting in the home because of the open legal case. If there is another report, the father will go to jail along with his friend.
“Roxana” began coming to Martina’s clinic for surreptitious Depo-Provera shots, often covered in bruises, sometimes on her face, sometimes on her arms. At first, when Martina asked Roxana about the injuries, she would simply say she fell. Martina said, “It’s only when you gain trust they tell you what’s happening in reality.”
Over the years, Roxana opened up. When Roxana married, her husband told her his ground rules: I have the right to be with anyone I like. You can’t be with anyone but me. You are supposed to be a ‘woman of the house.’ You can’t go out with friends or with family.
Growing up, her mother wasn’t allowed an opinion. Her father looked for a husband for Roxana—someone who would give him the most land in exchange for her. She told Martina, “My father sold me.”
Roxana thought she had to obey. If her husband beat her, she believed, it was because she did something bad. That needed to be corrected. She would say:
Look, Ms. Martina, my husband hits me. But it’s because I do bad things in the house. It’s to instruct me. I hope that in the future I won’t mess up again, and he won’t need to hit me anymore.
Martina explains, “She felt like she had to stay in the house because her husband was the one who paid for things.” Martina counseled her with a steady stream of messages:
Men are not the only ones who can work. We can too. We can be the head of the family. Look: Women work. We iron, we keep the house, we watch the children. So, yes, of course women can work. We already work harder than men anyway!
Roxana realized she has rights. And so she finally thought to herself: If he hits me again, I’m going to get a denuncia. When her husband was about to hit her, she would say to him, I know there’s a law that protects women. So if you hit me, I’m going to denounce you.
It’s been six years. Roxana still comes to the clinic. She works, embroidering and selling handbags. She’s still with her husband, and he doesn’t hit her anymore. She has the contraceptive implant, so there have been no more children. In six years, she hasn’t gotten pregnant.
Martina says, “I always tell them: You’re very, very important. It’s important to value women as well. We are not objects. We are the treasure of the hearth.”
Standing Up to Intimidation
Through quiet conversations during Depo-Provera shots, frontline health care workers are redefining just what makes a “good woman.” They’re helping women scale structural barriers, standing by them as they reclaim life-affirming choices, whether it be Pap smears for themselves or jail terms for their rapists.
But breaking these norms doesn’t come easy, nor does it come without risk. Like so many indigenous women working in community outreach, Claudia is a survivor. She dropped out of school when she was nine, after being molested by her teacher. She then became a recluse for most of her teen years.
But today, things could not be more different. Several years ago, Claudia was recruited to community-based nonprofit Women’s Justice Initiative by fellow indigenous woman Elvia Raquec, who serves as Programs Director.
Founded by American attorney Kate Flatley, Women’s Justice Initiative is staffed almost exclusively by indigenous women, from the attorneys to the psychologists to the community outreach workers like Claudia. Together, they aim to end violence against women and girls in rural Guatemala. Elvia says:
The problem of violence is not cultural. It’s due to lack of education, lack of opportunities. And in many cases, lack of access to justice. In most cases, information is not available in native languages. This is why violence continues.
Frontline advocates like Claudia bridge that gap in knowledge, opportunities, and services, through prevention education workshops on topics like early marriage, domestic violence, legal services, and engagement with men and boys. Claudia has become such a trusted confidante in her village, she had to set up an outdoor waiting area on her family compound, nestled amongst potted plants and frolicking kittens, for the many women who stop by for a chat about troubles at home.
One day, Claudia arrived home to find a neighbor, “Sandra,” sitting in her front yard, waiting for her. Claudia had grown up knowing Sandra’s daughter, “Blanca,” who has an intellectual disability. Ever a sweet natured helper, Blanca was often asked by folks around town to do stacks of their laundry or clean their homes for little thanks and no pay.
Blanca, now 20 years old, was six months pregnant. A local teen had been sneaking into the family home to have sex with Blanca when her parents were at church. Sandra came to Claudia, hoping she could help force the boy to marry Blanca.
Claudia saw things differently. She knew Blanca was not mentally capable of consenting to sex. Under Guatemalan law, having sex with a severely intellectually disabled person is considered rape. Claudia advised Sandra to pursue a criminal case.
Instead, Sandra threatened the assailant’s family with criminal charges unless he agreed to marry Blanca, citing Claudia as the force behind pressing charges. This is when the death threats began.
One day, when leaving her clinic, Claudia spotted the boy’s father across the street, swinging a machete menacingly. Claudia escaped him by dashing out of her clinic and quickly boarding her bus.
Another day, the boy’s father lurked in cornfields on Claudia’s route home, waiting for her. When she passed, he followed close behind, dragging and scraping his machete on rocks. When she made it safely home, he lingered a long time up the hill, watching her.
With some digging, Claudia learned from other health care workers that the family had recently moved from a neighboring village. The father had been raping his own daughter repeatedly since she was 13. His death threats toward Claudia were aimed at preventing a police investigation that could uncover that he had impregnated his daughter.
Claudia never could get Blanca’s family to press charges, but the death threats and intimidation didn’t slow her down. She describes her hopes for the future:
I want to eliminate machismo. I want to help women. I want the following generations to see change. I want to see violence against women end. I want to set the example. I want to show girls there’s more than getting married. They should enjoy their lives.
Change Starts Here
Martina used to ask herself, Why does this happen to me? She used to want to die.
Her story, and those of the other advocates working to end violence against women in Guatemala, is a testament to the power of culturally appropriate community outreach and a trusted ear. Martina, Karyn, Enma, and Claudia are good women—women who have overcome more than anyone should have to endure, and who still have compassion and care to give others in situations similar to the ones they’ve survived.
In fact, they aren’t just good women—they are magnificent women.