Journal Article Epublish 4 citations
PubMed: 39881314 DOI: 10.1186/s12939-024-02357-3
Health system financing fragmentation and maternal mortality transition in Mexico, 2000-2022.
Int J Equity Health 24(1):32
Authors: Edson Serván-Mori, Carlos Pineda-Antúnez, Diego Cerecero-García, Laura Flamand, Alejandro Mohar-Betancourt, Christopher Millett, Thomas Hone, Rodrigo Moreno-Serra, Octavio Gómez-Dantés
Affiliations
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
- The CHOICE Institute, University of Washington, Seattle, WA, USA.
- Department of Primary Care and Public Health, Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
- Center for International Studies, El Colegio de Mexico, Mexico City, Mexico.
- Epidemiology and Biomedical Cancer Research Unit, National Cancer Institute, and Biomedical Research Institute, National Autonomous University of Mexico, Mexico City, Mexico.
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
- Centre for Health Economics, University of York, York, UK.
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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.
MeSH
Mortality, Insurance, Insurance, Health, Social Security, Maternal Death, Maternal Mortality