Abstract
OBJECTIVE: To explore barriers and opportunities in implementing adolescent sexual and reproductive health interventions in four rural Indigenous communities in Alta Verapaz, Guatemala. METHODS: An exploratory descriptive qualitative study was conducted using stakeholder mapping and a reflexive thematic approach. Data were collected through 20 semistructured interviews with key stakeholders involved in adolescent sexual and reproductive health programming. RESULTS: Persistent barriers included limited institutional capacity, inadequate access to and coverage of comprehensive sexuality education and health care services (including youth-friendly spaces), and resistance rooted in family, religious, and community values. Structural issues, such as underfunding, political turnover, and limited multisectoral coordination, further hinder program sustainability. Opportunities for enhancing interventions were identified through community participation, youth leadership, demographic changes, technological advancements, and the integration of mental health. CONCLUSIONS: Strengthening governance, promoting inclusive multisectoral coordination, and leveraging adolescent and community engagement are crucial for implementing sustainable, culturally grounded sexual and reproductive health interventions in Indigenous communities in Guatemala and similar contexts.