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Published on: January 12, 2018
Assessing the quality of childbirth care in Mexico: findings from the maternal eCohort
Svetlana V Doubova1, Martín Paredes-Cruz2, Mtra Diana Perez-Moran2
1Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. svetlana.doubova@gmail.com.
Background:
In 2022, the Mexican Institute of Social Security (IMSS) launched the "Comprehensive Women-Centered Maternal Health Care Model" (AMIIMSS program) to improve maternal healthcare. This research evaluated the childbirth care quality, comparing outcomes between IMSS and private hospitals and between IMSS hospitals with high and low adherence to the AMIIMSS program, and assessed whether the type of healthcare provider and delivery, the content of care, and the occurrence of obstetric violence were associated with the perceived quality of childbirth care, after controlling for other relevant demographic and clinical covariates.
Methods:
Data were collected from an observational IMSS-affiliated eCohort of pregnant women aged 18 to 49, focusing on their experiences, perceptions of healthcare quality, obstetric violence, and health outcomes. The analysis included Chi-square tests and multivariable linear regression.
Results:
The study included 988 women; 14.9% went to private facilities for childbirth primarily because they perceived poor quality and past mistreatment at IMSS. C-sections rates were higher in private hospitals (92.5%) than at IMSS (51.3%). IMSS hospitals with high adherence to AMIIMSS program had a 10% lower C-section rate, and their care content was similar to that in private hospitals (85% of expected clinical actions). Complications affected 20.8% of women and 28% of newborns. The overall quality of care perceptions score was higher in private hospitals (mean 34.2, standard deviation 6.7) than at IMSS (mean 27.0, SD 6.7) on an 8-40-point scale. Delivering in private hospitals or at tertiary care facilities and receiving a higher care content was associated with better quality perceived by women. Whereas obstetric violence was associated with lower perceived quality.
Conclusion:
AMIIMSS improves women's childbirth experiences but reveals weaknesses due to poor hospital adherence to the program and poor perceived quality. This underscores the need to strengthen the program's pillars-training, infrastructure, regulatory adaptation, and women's empowerment.
