This article provides case studies in Guatemala and Bolivia that are useful strategies for family planning and health outreach to indigenous populations. A general discussion of barriers to contraceptive use identifies multiple barriers including poverty and illiteracy rural residence mistrust of outsiders and political unrest belief systems in conflict with modern health systems Catholicism social disapproval and womens status and male attitudes. Institutional barriers are identified as reliance on Spanish language materials that are difficult to understand by indigenous groups discrimination lack of indigenous personnel in decision making positions and unrealistic donor expectations. Qualitative and quantitative data from eight small towns in El Quiche Guatemala reveal that 71% had never been to school. 75% of the women and 48% of the men were unable to read. 12% had electricity. Access to mass communication was limited. The mean number of children still living was 6.6. Live births averaged 8.3. 43% were satisfied with birth spacing. 31% viewed birth spacing as undesirable. 26% had no opinion about birth spacing. 32% referred to Gods will in response to queries about the ideal family size. The most common ideal was 5.0 children among those responding. Only 15% reported satisfaction with their last birth. 19% of the 123 pregnant women were not happy about being pregnant. 23% of nonpregnant women did not want any more children. Focus group respondents differed from interview respondents who reported greater use of modern methods. 90% reported interest in a home visit about healthy children. 57% reported ever use of health centers or posts. Based on both case studies and other experiences it is argued that programs can be improved through use of community workers offering a mix of services and providing local bilingual personnel. Program involvement of local indigenous people was strongly suggested. It is urged that indigenous men be targeted for family planning and community outreach. Political and religious barriers need to be overcome.