Health system financing fragmentation and maternal mortality transition in Mexico, 2000-2022

Area of Science:

• Public Health
• Health Economics
• Sociology

Background:

• Health system financing fragmentation is a growing concern globally.
• Understanding its impact on maternal health outcomes is crucial for policy development.
• Mexico's diverse population and healthcare system present a unique case study.

Purpose of the Study:

• To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in Mexico over the past two decades.
• To identify demographic profiles and geographic disparities associated with maternal deaths.
• To evaluate the role of social security in maternal mortality trends.

Main Methods:

• An ecological-longitudinal study design was employed, analyzing data from 2000-2022 across all 32 Mexican states.
• Maternal Mortality Ratios (MMR) were estimated nationally and by state, stratified by health insurance status.
• Demographic attributes and residential data of deceased women were compared between those with and without social security.

Main Results:

• Mexico's MMR decreased until 2018 but significantly increased from 2019 to 2022 (from 48.7 to 72.4 per 100,000 live births).
• While most deaths were among the uninsured (2000-2018), the uninsured proportion decreased post-2019.
• From 2019 onwards, the MMR was higher in the population with social security, with uninsured deaths concentrated among younger, less educated, rural, and marginalized women.

Conclusions:

• Maternal mortality is closely linked to social inequalities in Mexico.
• Social security affiliation is no longer a significant differentiator in maternal mortality risk.
• Quantifying these inequalities is essential for designing effective policies to improve maternal healthcare access and reduce preventable deaths.