Guatemala ranks 113th out of 153 countries in the Global Gender Gap Index, ranking last out of all Latin American and Caribbean countries 1. In the region, Guatemala has the highest infant and under-five mortality rates with 22 deaths per 1,000 live births and 26.2 deaths per 1,000 lives births, respectively 23; it is the most malnourished country 3; and spends the least amount on healthcare and public health efforts than most of its surrounding countries 4. The lack of resources designated to healthcare disproportionally impacts Guatemalan women and girls, specifically as it relates to maternal mortality, fertility rates and child marriage. According to a 2018 study, seven percent of girls are married by the age of 15, and this increases to 30% by the age of 18 5. In addition, gender-based violence remains prevalent as presented by the USAID Guatemala Gender Analysis report, reporting that 19.2% of women of child-bearing age report ‘ever having experienced physical violence,’ and 8.4% report sexual violence, metrics widely regarded as an underestimate of violence against women in Guatemala 5.

There are large educational disparities in Guatemala. More recently, primary education enrollment dropped from 84% in 2014 to 77% in 2017. Secondary education enrollment has remained the same at about 45% of adolescents attending school, however, there are significant gender differences with girls less likely than boys to continue on to secondary school 6. Further, these educational disparities have transpired into the workforce. For women who are able to receive an education, obtaining a career remains difficult. This is especially seen in rural parts of Guatemala where only 28.1% of women are employed, compared to 89.1% of men 5. This may be associated with growing poverty in the country; as of 2017, 59% of the general population was impoverished, along with 79% of the indigenous population 7.

The educational disparities seen amongst adolescent boys and girls is even more prevalent between indigenous and nonindigenous populations in Guatemala. Only 39% of Mayan adolescent girls and women are literate, and Mayan girls are less likely to be enrolled in school at every education level due to barriers related to poverty, culture, and domestic work 8. In many indigenous Guatemalan communities, cultural norms dictate that girls are not as intelligent as boys and are supposed to remain in the home to do housework 9. In Sololá, a community primarily made up of indigenous populations, girls attend school for an average 2.6 years and the literacy rate is lower than the national average, at 65.2% among boys and girls 15 years or older. In girls, this rate is even lower at 56.8%. Additionally, 50% of the girls who attended 6^th grade did not enroll in their 7^th grade class 10.

Adolescence (ages 10-19 years) is a time of rapid physical, social, and cognitive growth. It is also a time where young boys and girls begin to develop and form ideas on gender norms and attitudes, most often yielding to greater disparities for girls and women throughout their lifespan 11. The gender inequalities seen in the Guatemalan education system has been shown to have a negative impact on the health, well-being and long-term success of girls and young women. Therefore, gender sensitization and empowerment programs aimed at adolescents, precisely at the time when they are forming their gender attitudes, have the potential to diminish gender inequity in the short and long-term 11. Interventions aimed at addressing girls’ education in Guatemala have also been shown to increase gender equitable attitudes. A study by Schuler et al. found that by participating in interactive workshops focused on gender norms and family planning in rural communities, both men’s and women’s gender attitude scores increased 12.

Quantitative analysis was conducted using IBM SPSS Statistics Version 25. Descriptive tests were performed to define the study sample, along with chi square and t-tests to determine if the differences between the pre- and post-test data were statistically significant. Additional t-tests were run to compare the mean and standard deviation of the scale and score variables between baseline and follow-up. For the bivariate analysis, demographic variables were run against dependent variables using Pearson correlations, T-tests, and ANOVA tests. Lastly, for the multivariate models, three linear regression models were run to adjust for significant variables and changes between baseline and follow-up.

The total study sample (Table 1) consisted of 265 female participants at baseline, and 229 female participants at follow-up. The majority of participants were attending school at the time of the program, 92.5% at baseline and 91.3% at follow-up. The community distribution changed significantly between pre- and post-test due to loss to follow-up of participants from specific locations (<0.01). The mean age was 11.62 years at baseline and 11.71 years at follow-up; the mean number of brothers per participant was 2.19 at baseline and 2.38 at follow-up; and the mean number of sisters per participant was 1.85 at baseline and 1.88 at follow-up, although none of these were statistically significant.

 The means of all three primary outcome variables changed significantly between baseline and follow-up (See Table 2). The communication scale increased from 1.95 at baseline to 2.39 at follow-up (<0.01). The gender equitable attitude score increased from 13.27 at baseline to 15.00 at follow-up (<0.01). The aspirations variable increased from 4.15 at baseline to 4.48 at follow-up (<0.01).

There was a significant positive correlation between age and all three outcome variables (p<0.01). Number of brothers was positively correlated with aspirations (p<0.05) and gender equitable attitudes (p<0.01). Those who attended school at the time of the pilot program were significantly different than those who did not only on the communication scale, and there was a significant difference between the communities for all three outcome variables (p<0.01). There was no correlation between number of sisters and any of the dependent variables (Table 3).

Pearson correlations were conducted to explore the associations between the outcome variables (See Table 2). The aspirations variable was positively correlated with communication and gender equity (p<0.01); communication was positively correlated with gender equity and aspirations (p<0.01); and gender equity was positively correlated with aspirations and communication (p<0.01).

Multivariable models were run to control for variables that were significantly different between baseline and follow-up (time period), and to further assess the changes in outcome variables.

The Girl Rising Pilot Program (GR) was developed to address the myriad of challenges young girls and adolescents face in Guatemala, particularly in rural indigenous communities. GR has developed and tested similar interventions in schools and community-organizations in India and found that a school-based intervention played an important role in changing gender attitudes during adolescence 11. The GR India program found that key outcomes changed positively post-intervention: gender equality scores increased; gender roles/privileges/restrictions scores increased; and gender attribute scores increased. The GR Guatemala program yielded positive outcomes for the girls who participated after just one iteration of the intervention. After the intervention, girls were more likely to report positive gender equitable attitudes which supports a previous 2015 study in Guatemala which found that that by participating in interactive workshops focused on gender norms and family planning in rural communities, both men’s and women’s gender attitude scores increased 12. This study provides further evidence that these changes can occur during adolescence as well.

Participants were also more likely to communicate with their parents or another adult about their education, future goals, and the obstacles that girls and women face in their community. After the intervention, girls spoke to adults more often about these important issues than they had prior to the GR program. While aspirations did not increase significantly between baseline and follow-up, they did increase as gender equitable attitudes increased and as communication increased. Girls were more likely to believe that they could be anything they wanted to be if they thought that boys and girls were more equal, or if they communicated more with adults about their education and goals. One possible reason for why aspirations did not increase significantly is that the mean score was already high at the onset e.g., participants ‘agreed’ with the statement “I think I can be anything I want or dream to be” prior to the intervention (mean = 4.15) and moved slightly closer to ‘strongly agree’ after the intervention (mean = 4.48).

In many parts of the world, including Guatemala, gender disparities exist from the moment a girl is born, and as she becomes an adolescent, it also the time when more pronounced gender discrimination begins to take hold. Unfortunately, this discrimination continues through the life course and into the next generation, and therefore, to break this inter-generational cycle of gender inequity, community organizations and schools have recognized the importance of reducing gender inequality by focusing more attention on adolescents, as this is the developmental time when are forming their own gender attitudes. However, few programs focusing on gender sensitization, equity, and empowerment have been adequately implemented, and even fewer have assessed quantifiable outcomes. Improving gender attitudes, aspirations and communication with adults is critical in increasing voice, agency, empowerment and gender equity in both the short and long term.

Although the results of the pilot program are encouraging, there are several limitations which must be considered. Given this was a pilot program and evaluation, the sample size for this analysis was small and likely not generalizable to the entire Maya Guatemalan population. In the next iteration of the GR Guatemala program, it is suggested that a greater number of young people and adolescents participate and are included in the baseline and follow-up analysis to have more representative data. The questionnaire used to gather participant data was not comprehensive. The survey for this analysis only consisted of 25 questions and the scores and scales were not tested for validity and reliability. Finally, the drop-out rate and subsequent loss to follow-up during the intervention was high; many participants started the program but dropped out before it was completed. This means that many did not complete the entire intervention, and didn’t receive a full dose of the program. Therefore, the results from this analysis may be an underestimation of the change that the GR pilot program produced in its participants. Future programs should focus on participant retention and tracking the reasons for drop-out. Overall, the results of this analysis show the need to expand the Girl Rising program and altering several of the methods for the monitoring and evaluation of the intervention.

The GR Guatemala program was uniquely developed with features aimed at influencing attitudes and behaviors in a developmentally salient and culturally appropriate manner. The program included high quality media tools produced with celebrity influencers; engaging storytelling that transports viewers and listeners; showing role models; and utilizing interactive curriculum components that 5provide an opportunity for adolescents to reflect, discuss, and take action. Much of the curriculum is interactive and provides an opportunity for self-reflection which has the potential to make a positive difference in attitudes.

Evidence-based solutions for adolescents are critical in addressing the multiple challenges girls and women face across their life course. The findings from this pilot evaluation has the potential to add to the knowledge gap on interventions that can shape gender attitudes in Guatemala. Through a new generation of self-aware, gender-conscious youth, we can imagine a world where girls and women are no longer discriminated against.