Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico

Abstract

Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, including access to health care, compared with a standard model of care in government-subsidised health care units (setting of health services networks). Universal health coverage advocates access for the most disadvantaged and vulnerable populations as a priority. However, the issue of access includes problems related to the effect of certain structural social determinants that limit different aspects of the obstetric care process. The findings of this study show the need to modify the structure of organisational values in order to place users at the centre of medical care and ensure respect for their rights. The participation of agents outside the public system, such as NGOs, can be of great value for moving in this direction. Women's participation is also necessary for learning how they are being cared for and the extent to which they are satisfied with obstetric services. This research experience can be used for other countries with similar conditions.

“Imagining the world anew”: a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond

“…privacy, freedom of choice, respectful care, availability of translators) from the users’ perspective continues to be a challenge for indigenous women in Mexico. 13 Appleford et al propose a “5-P” approach (people, package, provider, payment, polity) to ensuring quality of SRH care within the UHC agenda, arguing for both “systems” and “design” lenses as important steps to quality. 12 This approach needs to be tested across different settings, particularly in contexts of marked social and income inequalities.…”

“… 18 As noted earlier, in Mexico, where indigenous women account for a disproportionate number of annual maternal deaths, Juárez-Ramírez et al highlight both how the standard model of obstetric care continues to fail indigenous women, and the significant gulf between how healthcare personnel and indigenous women themselves explain the barriers to respectful, quality maternal health care. 13 Both pieces serve as reminders that if the voices and perspectives of populations that continue to face disproportionate marginalisation are excluded, SRH services – even when integrated in UHC systems – are unlikely to have the transformative health impacts to which we aspire.…”