Ethnic Disparities in Effective Coverage of Maternal Healthcare in Mexico, 2006-2018: a Decomposition Analysis
Por:
Servan-Mori, Edson, Juarez-Ramirez, Clara, Meneses-Navarro, Sergio, Heredia-Pi, Ileana, Armenta-Paulino, Nancy, Orozco-Nunez, Emanuel, Nigenda, Gustavo
Publicada:
1 jun 2023
Ahead of Print:
1 ene 2022
Resumen:
Introduction This paper examines ethnic disparities in the effective
coverage (EC) of maternal healthcare for interventions carried out among
Mexican women in the last decade. It also explores the proportion of
this gap that can be explained by observable characteristics in
indigenous and nonindigenous women, as well as by structural
discrimination against indigenous women. Methods We conducted a
retrospective and repeated cross-sectional study using data from the two
latest Health and Nutrition Surveys carried out in 2011/2012 and
2018/2019. We analyzed a total of 11,304 Mexican women aged 12-49 years
at the time of their last pregnancy, who reported having received
obstetric services from 2006 to 2018, the result of which was a live
birth. We adjusted EC according to indigenous status and the time of the
most recent obstetric episode using a pooled fixed-effects and robust
logistic model. In order to analyze which ethnic disparities in EC might
be attributable to discrimination, we used the nonlinear Blinder-Oaxaca
(BO) decomposition technique. Results Indigenous women were less likely
to enjoy EC for maternal health than their nonindigenous peers (aOR =
0.86, 95% CI: 0.75,0.98). Interventions aimed at providing adequate
antenatal care (ANC) and skilled, institutional delivery care were the
EC components registering the largest gaps by ethnicity. BO
decomposition results demonstrated that structural discrimination
accounted for 33.29% of this gap. Conclusions and Policy Implications
It is possible that the largest proportion of the gap in EC attributable
to differences in unobservable characteristics between women in both
groups could be explained by omitted variables that are often predictors
of EC. However, these differences in EC may also be related to
discriminatory practices experienced by indigenous women. Such practices
could also jeopardize the aspirations of LMICs for achieving universal
health coverage.
Filiaciones:
Natl Inst Publ Hlth, Ctr Hlth Syst Res, Cuernavaca, Morelos, Mexico
Univ Fed Pelotas, Int Ctr Equ Hlth, Pelotas, RS, Brazil
Univ Nacl Autonoma Mexico, Natl Sch Nursing & Obstet, Mexico City, DF, Mexico
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