The title used in the 1999 exhortation Ecclesia in America is "Patroness of all America and Star of the first and new evangelization," and in that year John Paul II had her feast, December 12, kept throughout the continent. "Patroness of the unborn" or "Protectress of the Unborn" is a devotional title: it rests on papal words and prayers and on the devotion of the faithful, and we have not found a decree of the Holy See that confers it.

The dark sash at her waist is commonly explained as a sign of pregnancy in the native culture of the time. That is an interpretation of the image, widely repeated and echoed by Pope Francis, but not a defined teaching. Pilgrims praying for a pregnancy, for a child in danger, or after a loss have long gone to her.