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Atención fragmentada y cobertura materna efectiva en México, 2009-2023
Edson Serván-Mori1, Diego Cerecero-García1,2, Thomas Hone2
1Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
BMC medicine
|January 9, 2026
Resumen
La atención materna fragmentada en México reduce significativamente la cobertura efectiva, particularmente para las mujeres desfavorecidas. Se necesitan reformas para mejorar la coordinación de la atención y lograr la cobertura sanitaria universal.
Área de la Ciencia:
- Salud Pública
- Investigación de Servicios de Salud
- Equidad en Salud
Sus antecedentes:
- La fragmentación de la atención médica interrumpe la continuidad y la cobertura de la atención materna.
- El sistema de salud segmentado de México puede exacerbar las inequidades en el acceso y la calidad.
- Se examinó la atención materna fragmentada (FHC) y la cobertura de atención materna efectiva (EMHC) en México (2009-2023).
Objetivo del estudio:
- Determinar la prevalencia, los determinantes y las consecuencias de la FHC en la EMHC en México.
- Analizar las tendencias de la FHC y la EMHC durante un período de 14 años.
- Identificar las poblaciones afectadas de manera desproporcionada por la FHC.
Principales métodos:
- Análisis retrospectivo y transversal repetido de 71.874 mujeres de las encuestas ENADID de 2014, 2018 y 2023.
- La EMHC se definió como atención prenatal (ANC) adecuada, parto cualificado/institucional, atención posparto oportuna y puerperio sin complicaciones.
- La FHC se definió como la recepción de atención ANC y de parto de diferentes proveedores; se evaluaron las asociaciones mediante regresiones multivariables.
Principales resultados:
- Aproximadamente el 16,7% de las mujeres experimentaron FHC; solo el 33,3% lograron EMHC.
- La FHC fue más común entre las mujeres con seguro subsidiado, mujeres indígenas, residentes rurales y aquellas con alto riesgo obstétrico.
- La FHC redujo la probabilidad de EMHC en 4,7 puntos porcentuales (aOR=0,80), una reducción del 20% en las probabilidades, lo que afectó más a las usuarias del Ministerio de Salud.
Conclusiones:
- La atención materna fragmentada reduce significativamente la cobertura efectiva, afectando de manera desproporcionada a los grupos vulnerables.
- La fragmentación es un desafío estructural que requiere una mejor coordinación de la atención, interoperabilidad de la información sanitaria y financiación basada en la continuidad.
- Abordar la FHC es crucial para prevenir la atención insegura y avanzar en la cobertura sanitaria universal en México y países similares.
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