Public health insurance and ethnic disparities in maternal health care: the case of vulnerable Mexican women over the last 25 years
Por:
Servan-Mori, Edson, Orozco-Nunez, Emanuel, Heredia-Pi, Ileana, Armenta-Paulino, Nancy, Wirtz, Veronika J., Meneses-Navarro, Sergio, Nigenda, Gustavo
Publicada:
1 dic 2021
Categoría:
Health policy
Resumen:
This article examines the coverage in the continuum of
antenatal-postnatal care for vulnerable women in Mexico according to
indigenous status and assesses the influence of public health insurance
strategies on the evolution of coverage over the last 25 years. We
studied a total of 19 613 567 Mexican women, aged 12-54 years at last
birth, based on a pooled cross-sectional analysis of data from the 1997,
2009, 2014 and 2018 waves of the National Survey of Demographic
Dynamics. After describing sociodemographic characteristics and
maternal-health coverage by indigenous status, we constructed a pooled
fixed-effects and interaction multivariable regression model to assess
the influence of the Seguro Popular programme on continuum of care. We
estimated adjusted continuum of care coverage between 1994 and 2018
according to Seguro Popular affiliation and indigenous status. Prior to
the Seguro Popular programme, crude coverage in the continuum of care
for non-indigenous women stood at 14.5% [95% confidence interval
(CI): 13.2-15.8%] or 11 percentage points higher than for indigenous
women. During the last period of the programme, it rose to 46.5%
[95% CI: 45.6-475%] and 34.1% [95% CI: 30.7-374%],
respectively. Our regression analysis corroborated findings that, on
average, indigenous women faced lower odds of benefiting from continuum
of care [adjusted odds ratio (aOR)= 0.48, 95% CI: 0.40-0.57] than did
their non-indigenous counterparts. It also revealed that coverage for
indigenous women without Seguro Popular affiliation was 26.7% [95%
CI: 23.3-30.1%] or 12 percentage points lower than for those with
Seguro Popular affiliation (38.6%, 95% CI: 35.7-41.4%). Our
regression results confirmed that the latter benefited from higher odds
of continuum of care (aOR = 1.67, 95% CI: 1.36-2.26). Gaps between
those of indigenous and non-indigenous status have persisted, but the
Seguro Popular clearly contributed to reducing the coverage gaps between
these two groups of women. Strategies yielding better outcomes are
required to improve the structural conditions of indigenous populations.
Filiaciones:
Natl Inst Publ Hlth, Ctr Hlth Syst Res, Ave Univ 655, Cuernavaca 62100, Morelos, Mexico
Univ Fed Pelotas, Int Ctr Equ Hlth, BR-96020220 Pelotas, RS, Brazil
Boston Univ, Dept Global Hlth, Sch Publ Hlth, Boston, MA 02118 USA
Univ Nacl Autonoma Mexico, Natl Sch Nursing & Obstet, Mexico City 14370, DF, Mexico
|