Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage
Abstract Background Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions...
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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/s12939-024-02374-2 |
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| author | Edson Serván-Mori Sergio Meneses-Navarro Rocío García-Díaz Diego Cerecero-García David Contreras-Loya Octavio Gómez-Dantés Arachu Castro |
| author_facet | Edson Serván-Mori Sergio Meneses-Navarro Rocío García-Díaz Diego Cerecero-García David Contreras-Loya Octavio Gómez-Dantés Arachu Castro |
| author_sort | Edson Serván-Mori |
| collection | DOAJ |
| description | Abstract Background Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems. Methods We conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009–2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12–54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment. Findings Indigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013–2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%). Conclusions Despite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic and coinciding with the government’s cancellation of targeted social programs and public health insurance focused on the poorest populations, including Indigenous peoples. Thus, prioritizing maternal and child health underscores the need for comprehensive policies, including specific anti-racist interventions. Addressing these inequities requires the recognition of both observable and unobservable factors driven by discriminatory ideologies and the implementation of targeted measures to confront the complex interactions driving discrimination in maternal health care services for Indigenous women. |
| format | Article |
| id | doaj-art-11cde551ab844c998f52fe22cf8b971f |
| 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-11cde551ab844c998f52fe22cf8b971f2025-01-19T12:14:19ZengBMCInternational Journal for Equity in Health1475-92762025-01-0124111710.1186/s12939-024-02374-2Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverageEdson Serván-Mori0Sergio Meneses-Navarro1Rocío García-Díaz2Diego Cerecero-García3David Contreras-Loya4Octavio Gómez-Dantés5Arachu Castro6Center for Health Systems Research, National Institute of Public HealthCenter for Health Systems Research, National Institute of Public HealthDepartment of Economics, Tecnológico de MonterreyCenter for Health Systems Research, National Institute of Public HealthSchool of Government and Public Transformation, Tecnológico de MonterreyCenter for Health Systems Research, National Institute of Public HealthCenter for Health Equity in Latin America, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane UniversityAbstract Background Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems. Methods We conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009–2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12–54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment. Findings Indigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013–2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%). Conclusions Despite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic and coinciding with the government’s cancellation of targeted social programs and public health insurance focused on the poorest populations, including Indigenous peoples. Thus, prioritizing maternal and child health underscores the need for comprehensive policies, including specific anti-racist interventions. Addressing these inequities requires the recognition of both observable and unobservable factors driven by discriminatory ideologies and the implementation of targeted measures to confront the complex interactions driving discrimination in maternal health care services for Indigenous women.https://doi.org/10.1186/s12939-024-02374-2Ethnic discriminationRacismMaternal health careEquityUniversal health coverageMexico |
| spellingShingle | Edson Serván-Mori Sergio Meneses-Navarro Rocío García-Díaz Diego Cerecero-García David Contreras-Loya Octavio Gómez-Dantés Arachu Castro Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage International Journal for Equity in Health Ethnic discrimination Racism Maternal health care Equity Universal health coverage Mexico |
| title | Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage |
| title_full | Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage |
| title_fullStr | Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage |
| title_full_unstemmed | Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage |
| title_short | Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage |
| title_sort | ethnic and racial discrimination in maternal health care in mexico a neglected challenge in the search for universal health coverage |
| topic | Ethnic discrimination Racism Maternal health care Equity Universal health coverage Mexico |
| url | https://doi.org/10.1186/s12939-024-02374-2 |
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