The study aims to explore sexual and reproductive health prevention and promotion of Mapuche youth between 18 and 24 years old. It looks at their relationships with the biomedical health system and the challenges of delivering cross-cultural healthcare services for this age group. Qualitative case study. Thirty-two in-depth interviews were conducted with young Mapuche from rural and urban sectors of the Araucan & iacute;a Region, Chile. The approach to sexual and reproductive health prevention and promotion of Mapuche youth lacks a cross-cultural lens and only limitedly accounts for sexual and reproductive rights. Young women report a lack of access to sex education because of the distance from biomedical primary care services and the challenges of discussing sexuality with adults in their communities. Indigenous young people, especially women, experience persistent sexual and reproductive health inequities. It is necessary to incorporate the cross-cultural approach as well as sexual and reproductive rights in the formulation of public policies for this population. Such interventions must be designed and implemented together with the young Mapuche population and health workers in their communities of origin.