Ethnic inequalities and contraception in Latin America and the Caribbean: a scoping review

Abstract

Background

One of the Sustainable Development Goals (SDGs) is SDG 3.7. Ensuring universal access to sexual and reproductive health. The COVID-19 pandemic exacerbated pre-existing inequalities, disproportionately impacting ethnic groups in Latin America and the Caribbean (LAC). This review examines 23 years of evidence on contraceptive inequalities among these populations.

Methods

A comprehensive literature review was conducted covering the period from 2000 to 2023 across seven databases. A combination of natural language and MESH/DECS terms was used, focusing on ethnicity and contraception in LAC countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews (PRISMA-ScR), 856 studies were identified. After title and abstract screening, 92 full texts were reviewed, and 33 studies were included that analyzed or compared contraceptive coverage based on ethnicity.

Results

The countries with the highest output on this topic are Guatemala, Mexico, and Ecuador. More than half (22) relied on national representative surveys, with most focusing on women of reproductive age, while only five included adolescents. Eight studies analyzed Afro-descendant populations, and 27 studies included indigenous populations. Although some studies reported increases in contraceptive coverage over time, 85% identified lower usage rates or probabilities among ethnic minorities, with persistent gaps.

Conclusion

This review highlights contraceptive coverage gaps related to ethnicity in LAC, revealing enduring inequalities. As post-pandemic efforts aim to reduce disparities, countries with significant indigenous populations must prioritize evidence generation. Further research is needed in countries showing progress and among subgroups, such as adolescents or intra-country ethnic groups, to understand underlying causes and enhance contraceptive Access.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-025-02501-7.

Background

The use of modern contraceptive methods is essential for maternal and neonatal health, enabling women to avoid unintended and high-risk pregnancies, and significantly reducing associated mortality and morbidity [1, 2]. Since 1980, investments in family planning programs have proven effective, preventing millions of maternal deaths [1]. Beyond health benefits, fertility control has transformative effects on women’s lives, allowing them to invest in education and improve their economic status, contributing to sustainable societal development [3].

It is estimated that around 45 million people in Latin America self-identify as Indigenous, representing approximately 8.3% of the region’s population [4]. However, about 30% of the population in Latin America and the Caribbean identifies with an ethnic origin, with considerable variation between countries [5]. Poverty remains high: 43.6% of Indigenous people and 30% of Afro-descendants live in poverty; 17% of those in extreme poverty are Indigenous, and Afro-descendants have a 13% unemployment rate and 2.5 times higher risk of extreme poverty [6, 7]

Maternal and neonatal mortality rates among Indigenous and Afro-descendant populations in the Americas remain alarmingly high. Indigenous women face maternal mortality rates that could be significantly reduced with effective interventions, such as universal access to contraceptives, as 90% of these deaths are preventable [8]. The maternal mortality gap for Afro-descendant mothers is nearly three times the national maternal mortality ratio in Ecuador and 1.3 times in Colombia, while in Brazil, the excess is 36% [9]. Neonatal mortality rates are also higher among Indigenous and Afro-descendant populations, driven by factors such as higher poverty levels, limited access to prenatal care, and geographical remoteness, underscoring the deep inequalities and the need for inclusive health policies [2].

Structural and historical conditions that perpetuate inequalities and limit access to resources among Indigenous and Afro-descendant populations in Latin America and the Caribbean (LAC) cannot be overlooked. These communities bear a legacy of exploitation and racism that undermines their socioeconomic and political opportunities, perpetuating inequalities that hinder a dignified life. Inadequate access to public services and forced displacement from their lands reinforce historical colonial barriers, hampering efforts to improve health and address disparities. Additionally, accumulated disadvantages, such as geographical isolation, limited access to basic education, and higher poverty rates, restrict access to contraceptive methods and quality care [2].

Within the framework of the Sustainable Development Goals (SDGs), with the SDG3. 7, universal access to contraception has been prioritized to enable women and their partners to exercise their right to decide freely and responsibly the number of children they wish to have and the intervals between births. With the adoption of the 2030 Agenda [10], governments committed to ensuring that “no one is left behind” and to intensify efforts to reduce maternal mortality and inequalities in maternal health. This commitment emphasizes the importance of an anti-racist research agenda that collects disaggregated data by ethnicity, ensuring quality, accessible, and timely information [11]. This approach has increased the political relevance of monitoring health inequalities to reduce disparities [12].

The COVID-19 pandemic severely disrupted sexual and reproductive health services in Latin America, leaving 9 to 20 million women without contraceptive access and causing up to 1.7 million unintended pregnancies[13, 14]. This situation increased unmet family planning needs, particularly among vulnerable populations already facing access barriers before the pandemic [15, 16]. Expanding LARCs is recommended to recover lost coverage. Identifying coverage gaps by ethnicity will enable more effective, targeted interventions [17].

In this context, the present study aims to investigate: What evidence has been generated over the past 23 years, pre- and post-pandemic, regarding contraceptive use or family planning by ethnicity in Latin American and Caribbean countries (LAC)?

Methods

This review was conducted following the Joanna Briggs Institute’s scoping review methodology [18] and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [19] (Appendix 1). Details on the published protocol can be accessed on the Open Science Framework platform (https://doi.org/10.17605/OSF.IO/Q5XH6).

Search strategy

A reproducible search strategy was implemented using a combination of Medical Subject Heading (MESH) terms and natural language in titles and abstracts, focusing on contraception, ethnicity, and location; the terms were combined to align with the study objectives (Table 1). References were extracted, and duplicates were manually removed. The studies of interest focused on the LAC region, considering the historical and cultural similarities among Indigenous and Afro-descendant populations in these areas [20].

Table 1.

Search terms, inclusion, and exclusion criteria

ETHNIC	CONTRACEPTION	PLACE
((ethnicity[MeSH Terms]) OR (ethnic group[MeSH Terms]) OR (racism[MeSH Terms])	AND ((contraception[MeSH Terms]) OR (agents, contraceptive[MeSH Terms]) OR (barrier methods, contraceptive[MeSH Terms]) OR (family planning [MeSH Terms])	AND ((latin America[MeSH Terms] OR south American[MeSH Terms] OR caribbean[MeSH Terms]OR central america[MeSH Terms]
OR (ethnicity[Title/Abstract]) OR (ethnic group* [Title/Abstract]) OR (indigenous[Title/Abstract]) OR (indian[Title/Abstract]) OR (indigen*[Title/Abstract]) OR (racial[Title/Abstract]) OR (race[Title/Abstract]) OR (etnia[Title/Abstract]) OR (grupo étnico[Title/Abstract]))	OR (contracept*[Title/Abstract]) OR (contraceptive methods[Title/Abstract]) OR (anticonceptivos[Title/Abstract]) OR (métodos anticonceptivos[Title/Abstract]))	OR latin America*[Title/Abstract] OR Argentina[Title/Abstract] OR Bolivia[Title/Abstract] OR Brazil[Title/Abstract] OR Chile[Title/Abstract] OR Colombia[Title/Abstract] OR Costa Rica[Title/Abstract] OR Cuba[Title/Abstract] OR Ecuador[Title/Abstract] OR El Salvador[Title/Abstract]OR Guatemala[Title/Abstract] OR Haiti[Title/Abstract] OR Honduras[Title/Abstract] OR México[Title/Abstract] OR Nicaragua[Title/Abstract] OR Panamá[Title/Abstract] OR Paraguay[Title/Abstract] OR Peru[Title/Abstract] OR Dominican Republic[Title/Abstract] OR Uruguay[Title/Abstract] OR Venezuela[Title/Abstract]))

Information sources

Articles published between 2000 and 2023 were retrieved from seven databases: Medline/PubMed, Virtual Health Library (VHL), Web of Science, Cochrane, Medes, EBSCO, and Dimensions, with specific search equations developed for each (Appendix 2). This period was chosen to capture changes in sexual and reproductive health policies and pre- and post-pandemic shifts in the region. No language restrictions were applied.

Study selection

Peer reviewers screened titles and abstracts in the first review stage (R-QP, E-MJ, R-AS, and YA). Discrepancies were resolved by the most experienced reviewer in qualitative studies focused on ethnicity (A-PN). For full-text review, reviewers maintained their initial screening decisions and resolved any further discrepancies through discussion and consensus (Fig. 1). The online Rayyan Web software was used for the screening process [21].

Fig. 1.

PRISMA flowchart

Inclusion criteria focused on studies addressing women self-identifying as belonging to Indigenous or Afro-descendant ethnic groups or equivalent terms reflecting Indigenous or African ancestry based on the country context in LAC. Studies must have addressed interventions related to modern or traditional contraceptive methods or family planning. Observational studies were included, while reviews, commentaries, editorials, case reports, governmental programs, animal studies, and articles without full-text access were excluded. Studies lacking an ethnic or racial focus, as well as those addressing abortion, theoretical contraceptive knowledge, or male contraception, were also excluded.

Data extraction and management

Two reviewers (R-QP and E-MJ) developed a data extraction form refined by the author team. Data were independently extracted by reviewers (R-QP, E-MJ, R-AS, and YA), and discrepancies were resolved by a fifth reviewer (A-PN). Extracted data included author(s), publication year, study objective, country, ethnic groups, contraceptive methods, study design, participant age, study measures, analytical approach, and main findings.

Data analysis and synthesis

The included studies were analyzed for their focus, design, and methodologies. Indicators for contraceptive inequality, such as usage and preference, prevalence coverage, and odds ratios, were evaluated. Usage disparities among ethnic groups were identified. Results will be presented in tables detailing ethnic groups, contraceptive methods, and main outcomes.

Quality assessment

The quality of the included studies was assessed using the interpretative synthesis criteria for vulnerable populations proposed by Dixon-Woods et al. [22] (Appendix 3). Studies failing to meet at least one of the five criteria were excluded. Articles were reviewed by R-QP and cross-checked by R-AS, with discrepancies resolved through discussion among three reviewers and a fourth (A-PN) as needed.

Results

The initial search identified a total of 856 publications. After removing duplicates, 516 studies were eligible for title and abstract screening. Subsequently, 97 full-text studies were reviewed, and 33 studies met the inclusion criteria. The selection process adhered to the previously established eligibility criteria. A summary of the bibliographic search and study selection is provided in Fig. 1.

Study characteristics

Table 2 summarizes the characteristics of the analyzed studies, categorized by population or analytical group, ethnic groups, contraceptive indicators, study design, and information sources. The majority of studies employed quantitative methodologies (88%), with only four using mixed methods. Most studies focused on women of reproductive age (WRA), particularly those who were married or in union, with a few including adolescents or combined groups. Ethnic categorization was typically broad, including Indigenous, Afro-descendant, and White/Mestizo groups, with some examining intra-group differences among Indigenous communities. Contraceptive use was mainly studied in terms of modern methods, either alone or combined with traditional methods. Cross-sectional designs predominated, utilizing national representative surveys (NRS). Descriptive stratified analyses were the most common, while logistic regression models were used in 30% of studies to estimate factors associated with contraceptive use or satisfied family planning demand. This focus on married or unionized WRA largely reflects the predefined target populations in national surveys, often overlooking other groups such as adolescents and unmarried women.

Table 2.

Characteristics of the analyzed studies: ethnic groups, contraception, study design, and information sources

	Quantitative		Mixed methods
Analytical Group	N	%	N	%
Women of Reproductive Age (WRA), Married or in Union	25	75,76	3	9,09
Adolescents	2	6,06
WRAa and Adolescents	2	6,06	1	3,03
	29	87,88	4	12,12
Ethnic-Racial Groups
Indigenous	18	54,55	4	12,12
Color/Race	5	15,15
Indigenous, Afro-descendants, and Other Groups	5	15,15
Belonging or Not to an Ethnic Group	1	3,03
	29	87,88	4	12,12
Ethnic Groups and Subgroups (Peoples or Nationalities)
Ethnic-Racial Groups	23	69,7	2	6,06
Indigenous Peoples or Nationalities	6	18,18	2	6,06
	29	87,88	4	12,12
Contraceptive Indicator
Use of Modern Contraceptives	15	45,45
Use of Modern and Traditional Contraceptives	7	21,22	4	12,12
Satisfied Family Planning Demand and Use of Modern Contraceptive Methods	3	9,09
Unmet Family Planning Need and Use of Modern Methods	2	6,06
Unspecified Method	2	6,06
	29	87,88	4	12,12
Study Design and Method
Cross-Sectional	21	63,64	1	3,03
Repeated cross-sectional study	6	18,18
In-depth interviews, Documentaries, Policy Analysis			3	9,09
Longitudinal	2	6,06
	29	87,88	4	12,12
Source of Information
National Representative Surveys (NRSb)	22	66,67
Local Survey and Semi-Structured Interviews	4	12,12	3	9,09
Local Survey	3	9,09	1	3,03
	29	87,88	4	12,12

^aWomen of Reproductive Age (WRA) 12 to 49

^bNRS National Representative Surveys

Table 2 summarizes the characteristics of the analyzed studies, categorized by population or analytical group, ethnic groups, contraceptive indicators, study design, and information sources. The studies employed two main methodological approaches: quantitative (29 studies) and mixed methods (4 studies). Analytical groups focused on women of reproductive age (WRA) who were married or in union, adolescents, and combined groups of WRA and adolescents. Most studies broadly categorized participants into Indigenous, Afro-descendant, and White/Mestizo groups for comparative purposes, though some examined intra-group differences among Indigenous communities or nationalities.

Regarding contraceptive use, studies primarily focused on modern contraceptives or a combination of modern and traditional methods. Most were cross-sectional studies using national representative surveys (NRS).

Most reviewed studies employed quantitative methodologies (88%), with only four utilizing mixed methods. Descriptive stratified analyses were the most common approach (70%), while logistic regression models were used in 30% to estimate factors associated with modern contraceptive use or satisfied family planning demand. Most studies focused on WRA who were married or in union, likely due to the predefined target populations of national surveys used to generate health indicators. This approach, however, overlooked other groups, such as adolescents and unmarried women.

Critical appraisal results

Of the 97 full-text studies reviewed, 33 met the five quality criteria established by Dixon-Woods et al. and were included in the review. Among the 64 excluded studies, 15 failed to meet at least one of the five criteria. Key reasons for exclusion included the absence of a clearly differentiated focus on the relationship between ethnicity and contraceptive use (criterion 1) and insufficient data to support interpretations and conclusions (criterion 4). Special attention was given to excluding studies that did not precisely measure contraceptive coverage and differences in use among populations or subpopulations classified by ethnicity (Appendix 4).

Synthesis of findings

The scientific output included 33 studies, with the highest representation in Guatemala (13 studies, 39.39%), followed by Mexico (9 studies, 27.27%) and Ecuador (8 studies, 24.24%). Five studies (15.15%) were classified as “multi-country,” as they included evaluations across more than two countries. Countries with lower study representation included Panama (5 studies, 15.15%), Nicaragua, Honduras, Colombia, and Bolivia (4 studies, 12.12% each), and Costa Rica, Guyana, Peru, and Suriname (3 studies, 9.09% each). Belize and Paraguay contributed 2 studies each (6.06%), while Argentina, Barbados, Cuba, the Dominican Republic, El Salvador, Haiti, Saint Lucia, and Trinidad and Tobago contributed one study each (3.03%). These results are illustrated in Fig. 2.

Fig. 2.

Distribution of scientific production on ethnicity and factors related to contraceptive

Choice in Latin America and the Caribbean

The countries with the highest published scientific output on this topic are Guatemala, Mexico, and Ecuador.

The studies examined various aspects of contraceptive use among Indigenous and Afro-descendant populations, revealing common patterns of inequality in contraceptive coverage. Overall, Indigenous and Afro-descendant women were less likely to use contraceptives compared to other groups. Countries such as Guatemala, Bolivia, Ecuador, and Panama reported lower coverage rates among Indigenous women, while Afro-descendant populations showed lower rates in Suriname, Guyana, Belize, and Brazil.

Indigenous women exhibited lower probabilities of using modern contraceptives, including long-acting reversible contraceptives (LARC), and often initiated sexual activity at younger ages with limited knowledge about contraceptive methods, perpetuating unmet family planning needs. Rural areas and regions with high Indigenous populations faced significant barriers to family planning services, exacerbated by socioeconomic and cultural factors. Detailed findings are summarized in Table 3.

Table 3.

Summary table of the included articles

Author, year	Country, countries; year, and type of survey	Ethnic stratification, ethnic groups, and subgroups	Type of method (modern or traditional)	Study design and participants	Analytical approach (AP)- Outcome (O)
Woolley N, et al. 2019 [18]	Brazil 2015; NRS	Color/Race: White, Black, Mixed Race, Others	Modern	Cross-Sectional Study	AP: Logistic Regression Models Stratified by Sex (Factors Associated with Condom Use, Contraceptive Use, and Multiple Partnerships)
				School-aged male and female adolescents in Brazil	O: Race/ethnicity was associated with condom use and multiple sexual partners among men. Black men were 22% less likely to use condoms (OR = 0.78; 95% CI: 0.65–0.94) compared to White men.
					A LOWER PROBABILITY OF USE
Mesenburg M, et al. 2018 [19]	Belize 2011, Bolivia 2008, Brazil 2006, Colombia 2010, Ecuador 2004, Costa Rica 2011, Guatemala 2014, Guyana 2014, Honduras 2011, Mexico 2015, Nicaragua 2006, Panama 2013, Paraguay 2008, Peru 2012, Suriname 2010; NRS	Indigenous, Afro-descendants, and Reference Group (European Descendants, Mestizos, etc.)	Modern	Cross-Sectional Study	AP: Stratified Descriptive Analysis & Poisson Regression Models (Relative Measure of Inequality)
				Women aged 15 to 49 years in LAC countries who are currently married or in a union.	O1: In analyses by color/race, Suriname and Guyana showed lower coverage of modern contraceptive methods.
					O2: In almost all countries, modern contraceptive coverage was lower among Indigenous women compared to other groups. Countries with the lowest adjusted coverage ratios (IQR ≤ 0.7) included Ecuador, Panama, Bolivia, and Belize. IQR ≤ 0.9 included Guatemala, Peru, Nicaragua, and Colombia.
					A LOWER PERCENTAGE OF USE
Armenta-Paulino N, et al. 2020 [20]	Bolivia 2008, Guatemala 2014–2015, Mexico 2015, and Peru 2016; NRS	PERU: Non-Indigenous (Black, Mulatto, Afro, Peruvian, White Mestizo) vs Indigenous (Quechua, Aymara, Native Amazonians). BOLIVIA: Indigenous (Quechua, Aymara, Guarani) vs Non-Indigenous. GUATEMALA: Maya, Xinca, Other Ethnicities vs Ladinos, Mestizos, Garifuna	Modern	Cross-Sectional Study	AP: Stratified Descriptive Analysis & Poisson Regression Models (Relative Measure of Inequality)
				Women aged 15 to 49 years in 4 countries who are currently married or in a union.	O: Across all countries, regardless of the criteria for ethnic identification, Indigenous women had lower contraceptive coverage than non-Indigenous women.
		MEXICO: Indigenous vs Non-Indigenous			The greatest inequalities were observed in Bolivia and Guatemala, regardless of other socioeconomic factors.
					A LOWER PERCENTAGE OF USE
Rios-Quituizaca P, et al. 2022 [21]	Ecuador, 2004 and 2012; NRS	Indigenous, Afro-descendants, and Reference Group	Modern	Repeated Cross-Sectional Study (2004–2012)	AP: Stratified Descriptive Analysis & Poisson Regression Models (Relative Measure of Inequality)
				Women aged 15 to 49 years in Ecuador who are currently married or in a union	O: Indigenous women had lower coverage rates compared to the other two groups. In 2012, they had a 24% lower prevalence of modern contraceptive use (RP = 0.76; 95% CI: 0.70–0.83). While Indigenous coverage remained lower in both years, the gaps with the reference group narrowed over time. Afro-Ecuadorian women showed no significant differences.
					A LOWER PROBABILITY OF USE
Quizphe E, et al. 2020 [22]	Ecuador 2006 and 2014; NRS	Indigenous, Afro-descendants, and Reference Group	Modern	Repeated Cross-Sectional Study (2006–2014)	AP: Descriptive Analysis (Absolute Measure Inequalities) & Binomial Regression Analysis (Slope Index of Inequality - Absolute Measure Inequalities)
				Women aged 15 to 49 years in Ecuador who are currently married or in a union	O: Lower coverage rates were observed for Indigenous women in both years (2006: 36% vs. 41%; 2014: 42% vs. 48%) compared to the reference population.
					A slight reduction in inequality gaps and an increase in contraceptive coverage over time were noted.
					A LOWER PERCENTAGE OF USE
Davis J, et al. 2015 [23]	Ecuador 2001 and 2012; local survey	Shuar, Kichwa, Waorani, Cofán, and Secoya	Modern	Cross-Sectional Study	AP: Stratified Descriptive Analysis (by Ethnic Group) & Logistic Regression Model (Factors Associated with Modern Contraceptive Use)
				Women aged 15 to 49 years in Amazonian Indigenous communities in Ecuador, of reproductive age.	O: Among Kichwas, Wuaoranis and Secoyas reported lower use of contraceptives. The fertility transition among Indigenous populations has slowed over time.
					Cofán women increased their modern contraceptive use from 0% to 12%.
					Significant heterogeneity exists among Indigenous communities regarding contraceptive use.
					A LOWER PERCENTAGE OF USE
Figueroa W, et al. 2006 [24]	Guatemala 1995 and 2002; NRS	Indigenous, Non-Indigenous	Modern	Cross-Sectional Study	AP: Stratified Descriptive Analysis
				Women aged 15 to 19 and 20 to 24 years in Guatemala who are currently married or in a union, or sexually active	O: A lower percentage of Indigenous women reported knowledge of any contraceptive method compared to non-Indigenous women, with these disparities persisting over time.
					Sexually active Indigenous women were less likely to use modern contraceptives than non-Indigenous women, with these gaps persisting over time.
					Among sexually active women with unmet contraceptive needs, the percentage was higher among Indigenous women compared to non-Indigenous women.
					A LOWER PERCENTAGE OF USE
Ishida K, et al. 2012 [25]	Guatemala 2008-2009; NRS	Indigenous vs Ladina	Modern	Cross-Sectional Study. MER aged 15 to 49 years in Guatemala	AP: Stratified Descriptive Analysis & Logistic Regression Models (Factors Related to the Probability of Meeting Demand for Modern Contraceptives)
					O: Significant ethnic disparities were observed in meeting a demand for modern contraceptives (49% vs. 72%).
					Indigenous status reduced the likelihood of meeting contraceptive demand even after adjusting for sociodemographic factors.
					A LOWER PROBABILITY OF USE
Lindstrom D, et al. 2006 [26]	Guatemala 1999; NRS	Mayas and Ladinos	Modern	Cross-Sectional Study. Married or unioned men and women aged 15 to 49 years in Guatemala	AP: Negative Binomial Regression Models (Determinants of Knowledge of Modern Contraceptives) & Logistic Regression Models (Factors Associated with Current Modern Contraceptive Use)
					O: Maya men and women migrating to Guatemala City gained knowledge about modern contraceptive methods at a slower pace than Ladino migrants.
					The probability of contraceptive use was negatively associated with Maya ethnicity.
					A LOWER PROBABILITY OF USE

Traditional vs. modern contraceptive methods

Regarding the contraceptive methods analyzed, 45.5% of the studies included an analysis of modern contraceptives [23–36], of which only one examined long-acting reversible contraceptives (LARC) [37], one studied emergency contraception [38] and one focused on female sterilization [39]. Additionally, 33.3% of the studies analyzed both modern and traditional methods [40–50]. Three studies examined satisfied demand for family planning and the use of modern contraceptives [30, 37, 51], while unmet family planning needs and modern contraceptive use were analyzed in two studies [52, 53]. Two studies did not specify the contraceptive methods used [54, 55].

Contraceptive use in Afro-descendant populations

A total of eight studies analyzed Afro-descendant populations [23, 24, 26, 37, 39–41, 51], three of which were multi-country studies. While most studies were conducted in Brazil, other countries included were Belize, Colombia, Ecuador, Guyana, Suriname, Honduras, Costa Rica, Panama, Bolivia, Mexico, Nicaragua, Paraguay, and Peru.

Countries with notably low contraceptive coverage and lower probabilities of modern contraceptive use among Afro-descendant populations included Suriname [24, 51], Guyana [24, 51], Belize [51], Brazil [23, 41], and Costa Rica [51]. Results from Brazil were contradictory, as some studies did not report statistically significant differences in contraceptive coverage [39, 40]. Two studies analyzed adolescents in Brazil [23, 40]; one found lower contraceptive use among Black women with educational delays. Only one study included Black men [23], identifying a lower likelihood of condom use compared to White men. Regarding methods, one study found that Afro-descendant populations generally used LARC more than Indigenous populations or reference groups [37]. While access to permanent methods, such as sterilization, did not differ significantly between Afro-descendant populations and reference groups [39], the highest sterilization rates were among Indigenous women.

Contraceptive use in indigenous populations

A total of 27 studies included Indigenous populations in their analyses, five of which were multi-country studies. Countries represented included Guatemala (13 studies), Mexico (9 studies), Ecuador (8 studies), Bolivia, Nicaragua, and Panama (4 studies each); Colombia, Peru, and Honduras (3 studies each); Costa Rica and Guyana (2 studies each); and Belize and Paraguay (1 study each).

Countries with lower percentages or probabilities of contraceptive use or satisfied family planning demand among Indigenous populations included Guatemala [24, 25, 29, 30, 42, 46, 47], Bolivia [24, 25, 53], Ecuador [24, 26, 27, 43, 44], Panama [24, 42]. Peru also showed low coverage, particularly among populations identified as “speaking the language” [24, 25]. Mexico exhibited coverage gaps (inequalities) by ethnicity at both individual and municipal levels [32], with lower modern contraceptive use [35], particularly in the Chiapas region Conversely, Honduras, Costa Rica, Guyana, and Suriname showed no significant differences when analyzing self-identified Indigenous populations. Multi-country studies confirmed lower coverage and probabilities of contraceptive use among Indigenous populations in Bolivia, Guatemala [24, 25], Ecuador, Panama, Peru, Belize, and Colombia [24] as well as in Mesoamerican regions like Panama, Nicaragua, and Chiapas, Mexico [42].

Few studies analyzed intra-community or intra-nationality differences, recognizing the historical and territorial diversity among Indigenous groups. In Ecuador [28, 44], the Kichwa nationality showed higher coverage compared to others. In Guatemala [31, 46, 48, 49, 52], Ladino women had higher contraceptive use rates than Maya women. In Mexico, Indigenous women in Chiapas used modern contraceptives less frequently than the national average. In Colombia [50], the Embera Eyabida ethnicity in Antioquia used less than half the contraceptives used by the other study groups (Embera Chamibida and Zenu), where use was socially discouraged. In Panama [55] unmet family planning needs were significantly higher among the Ngäbe-Buglé group than among the Emberá-Wounaan.

Temporal trends in contraceptive use disparities

Several studies using a repeat cross-sectional design analyzed changes in contraceptive coverage and disparities over time, highlighting significant differences between countries and periods. In Mexico [35], Guatemala [29, 46], and Ecuador [26, 27, 44], contraceptive coverage among Indigenous populations remained consistently lower compared to non-Indigenous populations over time. Specifically, Guatemala [29, 46, 47] saw no increase in coverage from 1978 to 1998 and only minimal progress by 2002, with coverage stagnating or declining thereafter. In contrast, Mexico [35] experienced a smaller increase in coverage for Indigenous women compared to non-Indigenous women.

Ecuador [26, 27] has shown notable progress in contraceptive use among Indigenous groups between 2004 and 2012, particularly among Kichwa women, who increased their adoption of non-traditional methods from 10% in 2001 to 30% in 2012 [28, 44]. Despite these advancements, overall levels of contraceptive use among Indigenous populations still lag behind non-Indigenous groups, and certain nationalities, such as the Waorani and Secoya, continue to demonstrate lower usage rates. This increase in contraceptive uptake included some Amazonian nationalities [44], highlighting pockets of improvement within the broader Indigenous community, yet the disparities in coverage remain significant.

Social determinants related to contraceptive use and ethnicity in Latin America

Women with lower educational levels, Afro-descendants, or Indigenous populations reported less access to modern methods such as condoms and emergency contraception, with usage probabilities reduced by 22% and 34%, respectively [23, 36, 38]. Knowledge gaps regarding contraceptive methods are also significant, with coverage rates of 74.9% among Indigenous women compared to 97.8% among Mestizo populations [43].

In rural areas with high Indigenous concentrations, such as municipalities in Guatemala, modern contraceptive coverage is insufficient, with high unmet demand persisting [32, 34, 48]. Other studies identified a lower likelihood of postpartum contraceptive use among Indigenous women [33] and disparities in satisfied family planning demand [30, 35]. Collectively, these findings reflect deep and persistent inequalities in contraceptive access and use, attributable to structural, socioeconomic, and ethnic factors disproportionately affecting vulnerable populations [29, 31, 41, 45, 46, 49, 52].

Discussion

Although literature related to contraceptive use among Indigenous and Afro-descendant populations does exist, it remains limited, and much of it lacks methodological rigor. Nevertheless, this effort compiles the available evidence, identifying 33 studies that analyze contraceptive use in Indigenous and Afro-descendant populations. Contraceptive use among Indigenous and Afro-descendant populations revealed significant disparities in modern contraceptive coverage, with consistently lower prevalence compared to other ethnic groups. Despite the multiple advantages of LARCs over other types of modern contraceptives, the use of intrauterine devices among women in Latin America and the Caribbean remains relatively low [56], and few studies differentiate LARC coverage by ethnicity. The study by Ponce et al. found particularly low LARC use among young women aged 15 to 17 years, Indigenous women, those living in the poorest quintiles, rural areas, or with no formal education. Female sterilization was the most common method in some areas, particularly among Indigenous women [39, 48], possibly as an alternative to the multiple barriers to accessing modern contraceptive methods.

The evidence indicates persistent inequalities in access to modern contraceptives among Afro-descendant populations in Latin America and the Caribbean, especially in Suriname, Guyana, Belize, Brazil, and Costa Rica. Afro-descendant women face greater unmet needs, with substantial coverage gaps compared to non-Afro-descendant women in countries like Suriname and Belize [24, 25, 51]. Costa et al. [51], also reported disadvantages in broader health, nutrition, and sanitation outcomes. These disparities likely reflect intersecting structural and socioeconomic barriers. Moreover, limited studies address these inequities in detail [51, 57], and only one included Afro-descendant men—revealing lower condom use than among White men—highlighting gaps in research and persistent gender-race inequalities in sexual health.

Significant barriers to access and coverage of contraceptive methods persist in regions with high Indigenous populations in Latin America. Unmet family planning needs are significantly higher among Indigenous populations, with lower adjusted coverage probabilities in countries such as Guatemala and Panama [50, 53, 55]. The observed intra-ethnic and intra-community differences—such as among Indigenous nationalities in Ecuador or specific ethnic groups in Colombia and Panama—suggest that aggregated categories obscure local diversity and realities. The limited integration of intercultural perspectives in family planning programs may contribute to institutional mistrust, affecting their acceptability and effectiveness. These findings underscore the need for differentiated, culturally appropriate, and territorially sensitive policies to ensure equitable and sustained coverage.

The study by Hellwig et al. [58] identified Ecuador as one of five countries showing historical improvements in contraceptive coverage, linked to political commitment, expanded access to modern methods, and targeted outreach to marginalized groups, including adolescents. These advancements likely reflect comprehensive public policies that prioritized sexual and reproductive health and strengthened primary care services. However, such progress may not have been equitably distributed across ethnic or territorial groups, raising concerns about the sustainability and inclusiveness of these achievements.

During the COVID-19 pandemic, inequalities in sexual and reproductive health deepened, disproportionately affecting Indigenous and rural populations in Latin America and the Caribbean. The study by Valley et al. [49], in Guatemala showed a lower probability of modern and traditional contraceptive use among Indigenous Maya women. Similarly, Castro-Porras et al. [16] reported that the pandemic reduced contraceptive use by 50% among Indigenous women in Chiapas, Mexico, due to access difficulties and the diversion of health resources toward the emergency. In Loreto, Peru, the closure of health centers and a shortage of healthcare personnel led communities to use medicinal plants as alternatives for family planning within Indigenous communities [53]. These restrictions not only limited physical access to contraceptive methods but also negatively impacted sexual health information, exacerbating knowledge gaps, particularly among young and Indigenous women.

In the post-pandemic period, studies indicate progress in awareness of contraceptives. According to Punina et al. [54], 89.6% of respondents in Yatzaputzan, Ecuador, reported knowledge of family planning, demonstrating greater overall awareness than in previous periods. However, significant barriers persist, such as limited specific understanding of contraceptive methods, with 80.2% of participants reporting limited knowledge. Additionally, sociocultural factors, such as partner opposition (17.8%) and religious restrictions (13.4%), continue to influence reproductive decisions, aligning with challenges identified during the pandemic.

Despite these advances in Indigenous communities, information about Afro-descendant populations remains limited. Restrepo et al. [55] noted that Afro-descendant women experienced higher maternal mortality rates and reduced access to health services during the pandemic, reflecting profound inequality in this population. However, a few studies have specifically explored the needs and barriers to contraception access for this group in the post-pandemic context. This lack of data limits the ability to implement effective policies to address reproductive inequalities inclusively.

Recommendations

Despite the persistent statistical invisibility surrounding Indigenous and Afro-descendant populations [56], our review highlights that inequalities in contraceptive use in the region are consistently reflected in quantitative studies. However, it also underscores the limited presence of qualitative or mixed-method research, which is essential to understanding the reasons behind low coverage levels and persistent gaps.

In this regard, future research must explore the determining factors that shape access, use, or decisions related to contraception in these populations. Available evidence aligns with other studies that have identified the lack of detailed analyses within Indigenous and Afro-descendant communities as a limitation, particularly in observing differences among ethnic subgroups, which is reflected in the absence of such studies [35, 57]. This gap impedes the identification of communities with significantly lower or higher coverage than the average.

The limited number of studies focused on ethnic subgroups and adolescents addressing the social and community context is compounded by the lack of research on contraceptive use among male populations. A comprehensive understanding of contraception dynamics and structural racism would better address positive health outcomes, reducing the likelihood of engaging in risky health behaviors and their consequences [58]. This emphasizes the need for more inclusive and specific approaches in future research.

Strengths and limitations

This scoping review offers a comprehensive and systematic overview of ethnicity and contraceptive use in Latin America, applying rigorous quality assessment tools. A major strength lies in identifying research gaps that can inform future interventions. However, several limitations must be noted. Although specific search terms were used, not all descriptors for certain Indigenous and Afro-descendant subpopulations were included, possibly omitting localized studies. The exclusion of gray literature and non-indexed sources may have further restricted the scope. Additionally, the review emphasized general terms related to Latin America, South America, the Caribbean, and Central America; however, the specific inclusion of several Caribbean countries'names was omitted. Although this omission may have left some Caribbean countries underrepresented or excluded certain findings related to Afro-descendant populations from these nations, multi-country studies analyzing health inequalities across Latin America and the Caribbean provided consistent evidence supporting the results presented in this review. Finally, the heterogeneity in study designs and methodological quality complicates direct comparisons and synthesis of results.

Conclusions

This review evidences the persistence of ethnic inequalities in contraceptive use across LAC. Despite advancements in modern contraceptive coverage in some countries in Latin America and the Caribbean, current evidence shows that usage remains lower among Indigenous and Afro-descendant women. These inequalities persist even within contexts of overall growth, with particularly pronounced gaps in Guatemala, Bolivia, Suriname, and Belize.

Although some progress in coverage has been documented, the COVID-19 pandemic widened gaps in access to contraceptive methods by disrupting essential health services and exacerbating economic and social barriers, particularly among vulnerable populations. This study reveals that most research conducted in recent years focuses on married or cohabiting women, overlooking the needs of adolescents, single women, and specific ethnic subgroups. Indigenous women from certain communities and nationalities, and Afro-descendant adolescents face greater access barriers compared to other subpopulations within their communities. These differences highlight the need to better understand disparities and design more targeted and differentiated strategies.

The progress observed in countries such as Ecuador and Mexico underscores that implementing comprehensive policies aimed at addressing social determinants such as education, poverty, and territorial access to healthcare services is fundamental to reducing contraceptive disparities. These experiences demonstrate the importance of sustained political will, the prioritization of reproductive health, and the development of inclusive and culturally relevant strategies. Nonetheless, the need remains to generate disaggregated data by ethnicity, conduct more in-depth analyses of specific subgroups, and collect qualitative information to design more effective interventions in historically marginalized communities. Only through deep and contextualized analyses can effective policies be developed to ensure universal access to family planning and reduce structural inequalities.

Abbreviations

CI

Confidence Interval

IQR

Interquartile Range

LAC

Latin America and the Caribbean

LARC

Long-Acting Reversible Contraceptives

MAC

Modern Contraceptive Methods

NGO

Non-Governmental Organization

NRS

National Representative Surveys

OR

Odds Ratio

PPC

Postpartum Contraception

PreC

Preconceptional Contraceptive Methods

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews

RP

Relative Prevalence

SARC

Short-Acting Reversible Contraceptives

SDGs

Sustainable Development Goals

WRA

Women of Reproductive Age

Authors’ contributions

The conception of the research idea was executed by PR-Q, JE-M, and NA-P. PR-Q performed the statistical analysis and drafted the entire manuscript. JE-M contributed to the search for scientific evidence, the preparation of the datasets, and the analysis of the dates, NA-P contributed to the preparation of the datasets, statistical analysis, and critical revision of the manuscript and the tables, SR-A contributed to the search for scientific evidence, improvement of tables and figures. YA contributed to the search for scientific evidence and the preparation of the datasets. The final manuscript was read and approved by PR-Q, JE-M, NA-P, SR-A and AY. All of them had full access to all the study data. The corresponding author had final responsibility for the decision to submit for publication.

Funding

No institutional funds were used for the development of this research.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.