Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage

Serván-Mori, Edson; Meneses-Navarro, Sergio; García-Díaz, Rocío; Cerecero-García, Diego; Contreras-Loya, David; Gómez-Dantés, Octavio; Castro, Arachu

doi:10.1186/s12939-024-02374-2

International Journal for Equity in Health

Table 1 Main characteristics of Mexican women studied by indigenous status, 2009–2023

From: Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage

	Estimated percentage of weighted population (95% CI)
	Overall		2009–2012		2013–2018		Pre-Covid-19^a		Covid-19^b		Post-Covid-19^c
	Non-Indigenous	Indigenous	Non-Indigenous	Indigenous	Non-Indigenous	Indigenous	Non-Indigenous	Indigenous	Non-Indigenous	Indigenous	Non-Indigenous	Indigenous
N	21,513,681	1,731,787	5,045,725	365,820	11,063,753	875,119	1,286,649	98,781	2,352,354	225,568	1,764,220	167,478
%	92.6	7.5	93.2	6.8	92.7	7.3	92.9	7.1	91.3	8.8	91.3	8.7
Age at time of last delivery birth, years
12―19	15.7 [15.3, 16.1]	13.9 [12.8, 15.1]	14.8 [14.1, 15.6]	11.6 [9.6, 13.6]	17.0 [16.4, 17.5]	15.3 [13.7, 16.9]	13.7 [12.1, 15.2]	12.8 [8.3, 17.3]	13.8 [12.7, 15.0]	11.7 [8.8, 14.5]	14.4 [13.1, 15.6]	15.7 [11.9, 19.5]
20―29	53.6 [53.0, 54.1]	51.0 [49.4, 52.7]	53.1 [52.1, 54.2]	53.6 [49.9, 57.3]	53.6 [52.9, 54.3]	51.6 [49.4, 53.8]	52.5 [50.3, 54.6]	46.8 [39.7, 53.8]	53.8 [52.1, 55.4]	48.1 [43.3, 52.9]	54.8 [52.9, 56.6]	49.0 [44.0, 54.0]
30―39	28.0 [27.5, 28.4]	30.9 [29.2, 32.6]	29.4 [28.4, 30.4]	30.8 [27.3, 34.4]	26.7 [26.1, 27.4]	29.4 [27.1, 31.8]	30.8 [28.8, 32.8]	33.3 [26.5, 40.2]	28.9 [27.4, 30.4]	35.8 [30.7, 40.9]	28.4 [26.7, 30.1]	31.1 [26.7, 35.6]
40―54	2.8 [2.6, 2.9]	4.1 [3.4, 4.8]	2.7 [2.3, 3.0]	4.0 [2.5, 5.4]	2.7 [2.5, 2.9]	3.7 [2.8, 4.6]	3.0 [2.3, 3.7]	7.1 [3.7, 10.5]	3.5 [2.9, 4.1]	4.4 [2.3, 6.6]	2.5 [1.9, 3.2]	4.2 [2.1, 6.3]
Head of household	10.1 [9.7, 10.4]	9.9 [8.8, 10.9]	9.6 [9.0, 10.1]	11.9 [9.6, 14.3]	9.4 [9.0, 9.8]	8.1 [6.9, 9.2]	13.9 [12.5, 15.4]	17.1 [11.4, 22.8]	13.1 [12.0, 14.2]	12.7 [9.1, 16.2]	8.7 [7.7, 9.7]	6.6 [4.0, 9.1]
Marital status
Single	8.3 [8.0, 8.6]	4.1 [3.4, 4.7]	8.4 [7.8, 9.0]	4.5 [3.1, 5.9]	8.3 [7.9, 8.8]	3.9 [3.1, 4.7]	8.8 [7.5, 10.1]	4.0 [1.6, 6.5]	8.1 [7.2, 9.1]	4.4 [2.2, 6.6]	7.3 [6.3, 8.4]	3.4 [1.2, 5.7]
Married/free union	81.0 [80.6, 81.5]	89.6 [88.7, 90.6]	80.9 [80.0, 81.7]	88.7 [86.6, 90.8]	81.4 [80.8, 82.0]	90.9 [89.6, 92.1]	75.5 [73.6, 77.4]	86.7 [82.2, 91.1]	80.0 [78.6, 81.3]	86.6 [83.2, 90.1]	84.8 [83.4, 86.1]	90.9 [87.9, 94.0]
Divorced/separated/widowed	10.7 [10.4, 11.0]	6.3 [5.6, 7.1]	10.8 [10.1, 11.4]	6.8 [5.2, 8.5]	10.2 [9.8, 10.7]	5.2 [4.3, 6.2]	15.7 [14.1, 17.3]	9.3 [5.5, 13.0]	11.9 [10.9, 13.0]	9.0 [6.2, 11.7]	7.9 [7.0, 8.8]	5.6 [3.3, 7.9]
Schooling, years
0―6 (none/elementary school)	15.4 [15.0, 15.9]	44.9 [42.6, 47.2]	21.2 [20.3, 22.1]	56.4 [51.7, 61.1]	15.0 [14.4, 15.6]	46.4 [43.3, 49.5]	11.9 [10.4, 13.3]	35.8 [28.9, 42.7]	10.8 [9.7, 11.8]	32.9 [28.4, 37.5]	10.3 [9.0, 11.5]	33.2 [27.7, 38.7]
7―9 (middle school)	37.7 [37.1, 38.2]	36.3 [34.4, 38.2]	38.2 [37.1, 39.2]	29.9 [25.7, 34.2]	38.3 [37.6, 39.0]	35.2 [32.7, 37.8]	36.3 [34.2, 38.4]	40.8 [34.4, 47.3]	36.5 [34.9, 38.1]	44.1 [40.0, 48.1]	35.1 [33.2, 36.9]	42.6 [36.9, 48.3]
10―12 (high school)	28.1 [27.6, 28.6]	14.3 [12.9, 15.6]	23.9 [23.0, 24.9]	9.6 [7.3, 11.9]	28.2 [27.5, 28.8]	14.2 [12.3, 16.1]	30.0 [27.9, 32.2]	16.4 [11.2, 21.6]	31.7 [30.2, 33.3]	18.1 [14.6, 21.7]	33.1 [31.2, 34.9]	18.4 [14.3, 22.5]
13―24 (bachelor’s or higher)	18.8 [18.4, 19.3]	4.5 [3.8, 5.3]	16.7 [15.9, 17.5]	4.0 [2.6, 5.5]	18.6 [18.0, 19.2]	4.2 [3.1, 5.2]	21.8 [20.0, 23.7]	7.0 [3.9, 10.2]	21.0 [19.6, 22.3]	4.8 [3.1, 6.6]	21.6 [19.9, 23.2]	5.8 [3.0, 8.5]
Employed in the last week	40.4 [39.8, 40.9]	27.9 [26.1, 29.6]	40.4 [39.3, 41.5]	29.4 [26.1, 32.7]	38.6 [37.9, 39.4]	23.9 [21.6, 26.2]	53.3 [51.0, 55.5]	37.1 [30.5, 43.8]	46.3 [44.7, 48.0]	38.7 [34.0, 43.4]	34.1 [32.3, 35.9]	25.3 [20.1, 30.4]
Health insurance
None	22.5 [21.9, 23.0]	23.0 [21.0, 25.0]	16.0 [15.2, 16.9]	11.7 [9.2, 14.2]	16.2 [15.6, 16.8]	14.3 [12.4, 16.3]	40.3 [38.0, 42.6]	44.7 [37.2, 52.3]	41.8 [40.0, 43.5]	47.6 [42.3, 52.8]	41.2 [39.2, 43.2]	47.1 [41.3, 53.0]
Seguro Popular/INSABI^d	42.8 [42.1, 43.4]	68.4 [66.2, 70.6]	49.7 [48.5, 50.9]	80.8 [77.8, 83.8]	49.5 [48.6, 50.3]	77.4 [75.0, 79.8]	20.8 [19.0, 22.5]	41.3 [33.8, 48.8]	21.9 [20.5, 23.2]	43.7 [38.6, 48.9]	24.8 [23.1, 26.4]	43.3 [37.4, 49.3]
Social Security	34.8 [34.2, 35.4]	8.6 [7.6, 9.6]	34.3 [33.2, 35.4]	7.5 [5.7, 9.3]	34.3 [33.5, 35.1]	8.3 [6.9, 9.6]	38.9 [36.7, 41.1]	14.0 [9.4, 18.6]	36.4 [34.7, 38.0]	8.7 [5.7, 11.7]	34.0 [32.2, 35.9]	9.6 [6.0, 13.1]
Parity at time of last delivery birth
Primiparous	35.8 [35.3, 36.4]	28.4 [26.7, 30.0]	32.4 [31.5, 33.4]	25.1 [21.9, 28.3]	37.0 [36.3, 37.7]	28.8 [26.5, 31.2]	35.7 [33.5, 37.8]	29.7 [23.6, 35.7]	35.3 [33.8, 36.9]	28.6 [24.2, 33.0]	39.0 [37.2, 40.8]	32.0 [26.9, 37.1]
One	32.7 [32.2, 33.2]	27.2 [25.7, 28.7]	32.4 [31.4, 33.4]	26.4 [23.3, 29.5]	32.5 [31.8, 33.1]	26.4 [24.5, 28.4]	34.2 [32.1, 36.3]	27.1 [20.6, 33.6]	33.4 [31.8, 34.9]	29.8 [25.4, 34.2]	33.4 [31.6, 35.2]	29.8 [24.7, 34.9]
Two	20.3 [19.9, 20.7]	18.5 [17.2, 19.8]	21.3 [20.5, 22.2]	17.5 [15.0, 20.1]	19.8 [19.3, 20.4]	18.2 [16.4, 20.1]	20.5 [18.7, 22.2]	20.4 [15.1, 25.7]	21.5 [20.1, 22.9]	19.9 [15.9, 23.9]	18.3 [16.9, 19.7]	19.0 [14.6, 23.3]
Three or over	11.1 [10.8, 11.5]	25.9 [24.3, 27.6]	13.8 [13.1, 14.6]	31.0 [27.7, 34.3]	10.7 [10.2, 11.1]	26.5 [24.2, 28.9]	9.7 [8.5, 10.9]	22.8 [16.6, 29.1]	9.8 [8.8, 10.7]	21.7 [17.3, 26.2]	9.3 [8.3, 10.3]	19.2 [14.7, 23.8]
Perinatal losses^e	15.5 [15.1, 15.9]	11.4 [10.3, 12.4]	14.9 [14.2, 15.7]	12.5 [10.2, 14.8]	15.1 [14.6, 15.6]	10.7 [9.4, 12.0]	16.1 [14.5, 17.7]	10.9 [6.9, 14.8]	16.5 [15.3, 17.6]	10.3 [7.7, 13.0]	17.8 [16.4, 19.2]	14.1 [10.3, 18.0]
Health problem diagnosed during pregnancy
None	33.7 [33.2, 34.2]	49.4 [47.4, 51.4]	36.5 [35.4, 37.6]	52.4 [48.5, 56.2]	32.9 [32.2, 33.6]	51.3 [48.7, 53.9]	34.0 [32.0, 36.1]	42.1 [35.1, 49.2]	34.0 [32.4, 35.6]	44.2 [39.0, 49.4]	30.0 [28.2, 31.9]	44.1 [37.9, 50.3]
One	26.4 [25.9, 26.9]	23.0 [21.6, 24.4]	26.2 [25.2, 27.1]	21.1 [18.4, 23.8]	26.8 [26.1, 27.4]	23.3 [21.4, 25.3]	25.6 [23.7, 27.5]	27.5 [21.3, 33.8]	26.5 [25.0, 27.9]	22.7 [18.9, 26.6]	25.0 [23.4, 26.6]	23.0 [18.0, 28.0]
Two	18.3 [17.9, 18.7]	12.8 [11.7, 14.0]	17.6 [16.7, 18.4]	13.0 [10.6, 15.4]	18.7 [18.1, 19.2]	11.7 [10.3, 13.2]	18.3 [16.8, 19.9]	12.4 [7.8, 17.0]	17.4 [16.2, 18.6]	16.8 [13.3, 20.4]	19.5 [17.9, 21.0]	13.2 [9.4, 17.0]
Three or over	21.6 [21.1, 22.0]	14.8 [13.6, 16.1]	19.8 [18.9, 20.6]	13.5 [11.2, 15.9]	21.6 [21.0, 22.2]	13.7 [12.0, 15.3]	22.0 [20.1, 23.9]	17.9 [12.8, 23.0]	22.1 [20.8, 23.4]	16.2 [12.5, 19.9]	25.5 [23.9, 27.2]	19.8 [15.1, 24.4]
Health problem diagnosed during childbirth
None	61.2 [60.7, 61.7]	62.9 [61.1, 64.8]	63.3 [62.2, 64.4]	67.7 [64.3, 71.1]	60.7 [60.0, 61.4]	64.7 [62.2, 67.1]	61.1 [59.0, 63.2]	54.7 [47.5, 61.9]	61.0 [59.4, 62.6]	57.6 [52.6, 62.5]	58.7 [56.9, 60.6]	55.6 [49.9, 61.2]
One	24.9 [24.5, 25.4]	23.0 [21.5, 24.4]	23.6 [22.7, 24.4]	20.4 [17.7, 23.2]	25.0 [24.4, 25.7]	22.6 [20.5, 24.7]	25.1 [23.2, 27.0]	26.3 [20.3, 32.3]	25.2 [23.8, 26.6]	24.8 [21.0, 28.6]	27.5 [25.9, 29.2]	25.7 [21.0, 30.5]
Two	9.1 [8.8, 9.4]	9.0 [8.0, 10.1]	8.4 [7.9, 9.0]	7.8 [5.9, 9.7]	9.3 [8.9, 9.7]	8.2 [6.9, 9.5]	10.1 [8.8, 11.3]	12.9 [8.3, 17.4]	9.1 [8.1, 10.1]	11.3 [8.1, 14.6]	9.2 [8.1, 10.4]	10.8 [6.6, 15.0]
Three or over	4.8 [4.5, 5.0]	5.1 [4.3, 5.8]	4.7 [4.2, 5.3]	4.1 [2.8, 5.3]	5.0 [4.7, 5.3]	4.5 [3.6, 5.4]	3.8 [3.1, 4.5]	6.1 [2.4, 9.9]	4.6 [4.0, 5.3]	6.3 [3.5, 9.1]	4.5 [3.7, 5.3]	7.9 [5.0, 10.7]
Socioeconomic level
Lowest	5.9 [5.5, 6.2]	40.4 [38.0, 42.8]	6.9 [6.3, 7.6]	47.6 [42.9, 52.3]	6.3 [5.8, 6.7]	42.1 [38.9, 45.2]	3.4 [2.3, 4.4]	26.9 [20.9, 32.9]	4.3 [3.6, 5.1]	33.1 [27.9, 38.2]	4.5 [3.6, 5.3]	33.5 [27.9, 39.2]
Low	16.2 [15.8, 16.7]	32.0 [30.3, 33.7]	19.3 [18.3, 20.3]	29.2 [25.6, 32.7]	16.5 [15.8, 17.1]	31.0 [28.7, 33.4]	12.4 [10.9, 13.8]	37.9 [31.3, 44.6]	13.5 [12.2, 14.7]	32.9 [28.5, 37.4]	12.4 [11.1, 13.7]	37.9 [32.6, 43.3]
Middle	19.6 [19.1, 20.0]	14.8 [13.5, 16.1]	21.8 [20.9, 22.7]	14.7 [11.8, 17.6]	19.6 [19.0, 20.2]	13.9 [12.2, 15.6]	17.1 [15.4, 18.7]	16.7 [11.9, 21.6]	17.6 [16.3, 18.8]	17.8 [14.1, 21.6]	17.4 [16.0, 18.9]	14.1 [10.5, 17.8]
High	26.2 [25.7, 26.8]	8.5 [7.5, 9.6]	26.8 [25.8, 27.8]	5.6 [4.2, 7.0]	26.2 [25.5, 26.9]	8.6 [7.2, 10.0]	26.2 [24.3, 28.2]	9.6 [5.5, 13.8]	25.5 [24.1, 26.9]	12.0 [8.5, 15.5]	26.1 [24.5, 27.8]	9.5 [6.4, 12.5]
Highest	32.1 [31.5, 32.6]	4.3 [3.6, 5.0]	25.2 [24.2, 26.2]	2.9 [1.8, 4.0]	31.5 [30.7, 32.3]	4.4 [3.4, 5.4]	41.0 [38.7, 43.2]	8.8 [5.2, 12.5]	39.1 [37.4, 40.8]	4.1 [2.2, 6.0]	39.6 [37.6, 41.6]	5.0 [2.4, 7.5]
Area of residence
Rural	26.8 [25.9, 27.6]	61.2 [58.0, 64.3]	24.4 [23.4, 25.4]	58.2 [53.0, 63.4]	26.3 [25.2, 27.5]	61.7 [57.5, 65.8]	28.9 [26.3, 31.5]	58.3 [50.3, 66.4]	29.9 [27.8, 32.0]	64.3 [57.7, 70.9]	30.6 [28.3, 33.0]	62.5 [55.1, 69.9]
Urban	31.7 [30.9, 32.5]	26.3 [23.4, 29.2]	31.8 [30.8, 32.8]	29.7 [24.8, 34.5]	31.4 [30.2, 32.5]	25.2 [21.3, 29.2]	32.5 [30.0, 35.0]	27.2 [20.2, 34.2]	32.5 [30.3, 34.6]	25.0 [19.0, 31.0]	31.9 [29.5, 34.2]	25.9 [19.4, 32.4]
Metropolitan	41.5 [40.8, 42.3]	12.5 [11.0, 14.0]	43.8 [42.8, 44.8]	12.2 [9.6, 14.7]	42.3 [41.2, 43.4]	13.1 [11.0, 15.1]	38.6 [36.1, 41.0]	14.4 [9.1, 19.8]	37.7 [35.7, 39.6]	10.7 [7.1, 14.3]	37.5 [35.3, 39.7]	11.6 [7.3, 16.0]
Economic Region
Lowest	10.1 [9.6, 10.7]	43.8 [40.3, 47.3]	9.2 [8.6, 9.8]	39.2 [33.9, 44.6]	10.1 [9.4, 10.8]	44.5 [40.0, 49.0]	10.7 [9.3, 12.1]	41.4 [32.9, 49.9]	11.1 [9.8, 12.4]	45.4 [38.0, 52.8]	11.4 [9.9, 12.9]	49.0 [40.8, 57.2]
2nd	19.5 [18.9, 20.2]	26.3 [23.3, 29.3]	19.6 [18.8, 20.4]	31.3 [25.9, 36.8]	19.8 [18.9, 20.8]	25.7 [22.0, 29.4]	19.4 [17.4, 21.3]	26.5 [18.8, 34.1]	19.2 [17.6, 20.9]	23.3 [17.6, 29.0]	18.4 [16.5, 20.3]	22.4 [16.2, 28.7]
3rd	15.1 [14.5, 15.7]	3.8 [2.2, 5.4]	14.6 [14.0, 15.2]	3.6 [1.5, 5.6]	15.0 [14.2, 15.8]	2.7 [1.4, 3.9]	16.0 [14.2, 17.7]	5.6 [1.5, 9.7]	15.4 [13.9, 16.8]	6.2 [1.8, 10.6]	16.1 [14.5, 17.7]	5.9 [1.0, 10.7]
4th	23.8 [22.9, 24.6]	18.2 [15.8, 20.6]	24.7 [23.7, 25.8]	19.0 [15.2, 22.7]	23.7 [22.5, 24.9]	19.1 [15.5, 22.6]	23.6 [20.9, 26.4]	14.3 [9.5, 19.2]	23.1 [20.9, 25.4]	16.9 [11.8, 22.0]	22.5 [20.2, 24.9]	16.1 [11.1, 21.2]
5th	11.5 [11.2, 11.9]	3.9 [3.1, 4.7]	11.8 [11.3, 12.3]	4.3 [2.9, 5.7]	11.5 [11.0, 12.1]	3.7 [2.6, 4.7]	11.4 [10.1, 12.7]	4.6 [2.0, 7.3]	11.6 [10.6, 12.7]	4.1 [2.1, 6.1]	11.1 [9.9, 12.3]	3.2 [1.3, 5.1]
Highest	19.9 [19.3, 20.5]	4.1 [3.2, 4.9]	20.2 [19.4, 20.9]	2.6 [1.4, 3.9]	19.9 [19.0, 20.7]	4.4 [3.3, 5.5]	18.9 [16.9, 20.9]	7.6 [3.2, 11.9]	19.6 [17.9, 21.2]	4.1 [1.9, 6.4]	20.4 [18.5, 22.4]	3.3 [0.9, 5.7]

^aPre-Covid-19 period: Jan 2019 to Mar 2020; ^bCovid-19 period: Apr 2020 to Mar 2022; ^cpost-Covid-19 period: Apr 2022 to Oct 2023. ^dThe Seguro Popular de Salud operated from 2004 until 2019. This programme was cancelled by the current government in 2019 and replaced by the Instituto de Salud para el Bienestar (or INSABI). ^eStillbirth or death within the first year of life or at least one miscarriage or abortion

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