Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022
Abstract Objective To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in the last two decades in Mexico. Methods We conducted an ecological-longitudinal study of the maternal mortality ratio (MMR) in the 32 states of Mexico durin...
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| Format: | Article |
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BMC
2025-01-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-024-02357-3 |
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| author | Edson Serván-Mori Carlos Pineda-Antúnez Diego Cerecero-García Laura Flamand Alejandro Mohar-Betancourt Christopher Millett Thomas Hone Rodrigo Moreno-Serra Octavio Gómez-Dantés |
| author_facet | Edson Serván-Mori Carlos Pineda-Antúnez Diego Cerecero-García Laura Flamand Alejandro Mohar-Betancourt Christopher Millett Thomas Hone Rodrigo Moreno-Serra Octavio Gómez-Dantés |
| author_sort | Edson Serván-Mori |
| collection | DOAJ |
| description | Abstract Objective To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in the last two decades in Mexico. Methods We conducted an ecological-longitudinal study of the maternal mortality ratio (MMR) in the 32 states of Mexico during the period 2000–2022. Annual MMRs were estimated at the national and state levels according to health insurance. We compared the distribution of individual attributes and place of residence between deceased women with and without social security to identify overrepresented demographic profiles. Finally, we mapped state disparities in MMR by health insurance for the last four political administrations. Findings MMR in Mexico decreased from 59.3 maternal deaths per hundred thousand live births in 2000 to 47.3 in 2018. However, from 2019 onwards, MMR increased from 48.7 in 2019 to 72.4 in 2022. Seven out of ten maternal deaths occurred in the population without social security from 2000 to 2018, then decreasing to six out of ten from 2020. Maternal deaths in the population without social security were more frequent among younger women, with less schooling, unmarried, and residing in rural areas, with higher Indigenous presence and greater social marginalization. From 2019 onwards, the MMR was higher in the population with social security. Conclusion The results of this study confirm the close relationship between maternal mortality and social inequalities, and suggest that affiliation with social security has ceased to be a differentiating factor in recent years. Understanding the evolution of maternal mortality between the population with and without social security in Mexico allows us to quantify the gap in maternal deaths attributed to inequalities in access to maternal health services, which can contribute to the design of policies that mitigate these gaps. |
| format | Article |
| id | doaj-art-072005fb5b994a5f998008b6afea5e6a |
| institution | Kabale University |
| issn | 1475-9276 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-072005fb5b994a5f998008b6afea5e6a2025-02-02T12:13:26ZengBMCInternational Journal for Equity in Health1475-92762025-01-0124111210.1186/s12939-024-02357-3Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022Edson Serván-Mori0Carlos Pineda-Antúnez1Diego Cerecero-García2Laura Flamand3Alejandro Mohar-Betancourt4Christopher Millett5Thomas Hone6Rodrigo Moreno-Serra7Octavio Gómez-Dantés8Center for Health Systems Research, National Institute of Public HealthThe CHOICE Institute, University of WashingtonCenter for Health Systems Research, National Institute of Public HealthCenter for International Studies, El Colegio de MexicoEpidemiology and Biomedical Cancer Research Unit, National Cancer Institute, and Biomedical Research Institute, National Autonomous University of MexicoDepartment of Primary Care and Public Health, Public Health Policy Evaluation Unit, School of Public Health, Imperial College LondonDepartment of Primary Care and Public Health, Public Health Policy Evaluation Unit, School of Public Health, Imperial College LondonCentre for Health Economics, University of YorkCenter for Health Systems Research, National Institute of Public HealthAbstract Objective To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in the last two decades in Mexico. Methods We conducted an ecological-longitudinal study of the maternal mortality ratio (MMR) in the 32 states of Mexico during the period 2000–2022. Annual MMRs were estimated at the national and state levels according to health insurance. We compared the distribution of individual attributes and place of residence between deceased women with and without social security to identify overrepresented demographic profiles. Finally, we mapped state disparities in MMR by health insurance for the last four political administrations. Findings MMR in Mexico decreased from 59.3 maternal deaths per hundred thousand live births in 2000 to 47.3 in 2018. However, from 2019 onwards, MMR increased from 48.7 in 2019 to 72.4 in 2022. Seven out of ten maternal deaths occurred in the population without social security from 2000 to 2018, then decreasing to six out of ten from 2020. Maternal deaths in the population without social security were more frequent among younger women, with less schooling, unmarried, and residing in rural areas, with higher Indigenous presence and greater social marginalization. From 2019 onwards, the MMR was higher in the population with social security. Conclusion The results of this study confirm the close relationship between maternal mortality and social inequalities, and suggest that affiliation with social security has ceased to be a differentiating factor in recent years. Understanding the evolution of maternal mortality between the population with and without social security in Mexico allows us to quantify the gap in maternal deaths attributed to inequalities in access to maternal health services, which can contribute to the design of policies that mitigate these gaps.https://doi.org/10.1186/s12939-024-02357-3Maternal mortalityFinancing fragmentationUniversal health coverageMexico |
| spellingShingle | Edson Serván-Mori Carlos Pineda-Antúnez Diego Cerecero-García Laura Flamand Alejandro Mohar-Betancourt Christopher Millett Thomas Hone Rodrigo Moreno-Serra Octavio Gómez-Dantés Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 International Journal for Equity in Health Maternal mortality Financing fragmentation Universal health coverage Mexico |
| title | Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 |
| title_full | Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 |
| title_fullStr | Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 |
| title_full_unstemmed | Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 |
| title_short | Health system financing fragmentation and maternal mortality transition in Mexico, 2000–2022 |
| title_sort | health system financing fragmentation and maternal mortality transition in mexico 2000 2022 |
| topic | Maternal mortality Financing fragmentation Universal health coverage Mexico |
| url | https://doi.org/10.1186/s12939-024-02357-3 |
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