Visualizing pathways out of poverty: Reframing reproductive health programs and the role of economic opportunity and collective efficacy using Photovoice methodology among women in the highlands of Guatemala

Background The linkage between economic well-being and reproductive health among disenfranchised populations in Latin American is well-documented. The way in which indigenous women visualize and explain their views related to poverty is less understood. The current study uses Photovoice methodology to uncover the unique perspectives of Mayan women in Guatemala.

Methods In-depth interviews regarding poverty and reproductive health were conducted with 15 Mayan women, all members of a women's reproductive health network. Afterwards, respondents engaged in Photovoice, a participatory qualitative methodology, whereby they received basic photography skills, photographed self-selected images within their communities, and then described the meaning behind the images.

The photographs and accompanying narratives, combined with in-depth interviews were coded using ATLAS.ti 6 software. Drawing on the Critical Analysis Framework content was analyzed through subjective, cultural and structural frames. Analysis from these frames informed inductive and deductive codes which were combined into comprehensive themes and mapped onto the study's main objective.

Results As women described their photographs, themes related to collective efficacy and economic well-being emerged. Images depicting strength in unity were described as pathways to overcome adversity. Although the in-depth interviews addressed reproductive health and poverty, when women were given the chance to illustrate what was most salient for them they chose to photograph economic circumstances.

Conclusions The study suggests that Guatemalan Mayan women may prioritize economic well-being over reproductive health. The use of participatory methods, such as Photovoice, as programmatic formative research will help foster more culturally relevant and sustainable reproductive health and income generation interventions.