Fragmented healthcare and effective maternal coverage in Mexico, 2009-2023

Area of Science:

• Public Health
• Health Services Research
• Health Equity

Background:

• Healthcare fragmentation disrupts maternal care continuity and coverage.
• Mexico's segmented health system may worsen access and quality inequities.
• Examined fragmented maternal healthcare (FHC) and effective maternal healthcare coverage (EMHC) in Mexico (2009-2023).

Purpose of the Study:

• To determine the prevalence, determinants, and consequences of FHC on EMHC in Mexico.
• To analyze trends in FHC and EMHC over a 14-year period.
• To identify populations disproportionately affected by FHC.

Main Methods:

• Retrospective, repeated cross-sectional analysis of 71,874 women from 2014, 2018, 2023 ENADID surveys.
• EMHC defined as adequate antenatal care (ANC), skilled/institutional delivery, timely postpartum care, and complication-free puerperium.
• FHC defined as receiving ANC and delivery care from different providers; multivariable regressions assessed associations.

Main Results:

• Approximately 16.7% of women experienced FHC; only 33.3% achieved EMHC.
• FHC was more common among women with subsidized insurance, Indigenous women, rural residents, and those with high obstetric risk.
• FHC reduced EMHC probability by 4.7 percentage points (aOR=0.80), a 20% reduction in odds, most impacting Ministry of Health users.

Conclusions:

• Fragmented maternal care significantly lowers effective coverage, disproportionately impacting vulnerable groups.
• Fragmentation is a structural challenge requiring improved care coordination, health information interoperability, and continuity-based financing.
• Addressing FHC is crucial for preventing unsafe care and advancing universal health coverage in Mexico and similar countries.