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Background: Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems., Methods: We conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009-2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12-54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment., Findings: Indigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013-2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%)., Conclusions: Despite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic and coinciding with the government's cancellation of targeted social programs and public health insurance focused on the poorest populations, including Indigenous peoples. Thus, prioritizing maternal and child health underscores the need for comprehensive policies, including specific anti-racist interventions. Addressing these inequities requires the recognition of both observable and unobservable factors driven by discriminatory ideologies and the implementation of targeted measures to confront the complex interactions driving discrimination in maternal health care services for Indigenous women., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. This study involved no human participants. Memorial dedication: We dedicate this manuscript to our colleague and friend Sandra Sosa-Rubí, Ph.D., who inspired us to analyse equity during her fruitful lifetime and passed away in March 2021. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico., Methods: A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group., Results: Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes., Conclusions: The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives., (© 2024. The Author(s).)

Background: There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020., Methods: We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors., Results: We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs)., Conclusion: In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health., (© 2023. W. Montague Cobb-NMA Health Institute.)

Health systems are complex entities. The Mexican health system includes the private and public sectors, and subsystems that target different populations based on corporatist criteria. Lack of unity and its consequences can be better understood using two concepts, segmentation and fragmentation. These reveal mechanisms and strategies that impede progress toward universality and equity in Mexico and other low- and middle-income countries. Segmentation refers to separation of the population by position in the labour market. Fragmentation refers to institutions, and to financial aspects, health care levels, states' systems of care, and organizational models. These elements explain inequitable allocation of resources and packages of health services offered by each institution to its population. Overcoming segmentation will require a shift from employment to citizenship as the basis for eligibility for public health care. Shortcomings of fragmentation can be avoided by establishing a common package of guaranteed benefits. Mexico illustrates how these two concepts characterize a common reality in low- and middle-income countries., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Literature on barriers and facilitators for early detection of Breast Cancer (BC) among indigenous women is very scarce. This study aimed to identify barriers and facilitators for BC early diagnosis as perceived by women of the otomí ethnic group in Mexico., Methods: We performed an exploratory qualitative study. Data was collected in 2021 through three focus group interviews with 19 otomí women. The interview transcripts were analyzed using the constant comparison method and guided by a conceptual framework that integrates the Social Ecological Model (SEM), the Health Belief Model and the Institute of Medicine's Healthcare Quality Framework., Results: Barriers and facilitators were identified at several levels of the SEM. Among the main barriers reported by the study participants were: beliefs about illness, cancer stigma, cultural gender norms, access barriers to medical care, and mistreatment and discrimination by health care personnel. Our participants perceived as facilitators: information provided by doctors, social support, perceived severity of the disease and perceived benefits of seeking care for breast symptoms., Conclusions: Healthcare policies need to be responsive to the particular barriers faced by indigenous women in order to improve their participation in early detection and early help-seeking of care for breast symptoms. Measures to prevent and eradicate all forms of discrimination in healthcare are required to improve the quality of healthcare provided and the trust of the indigenous population in healthcare practitioners., (© 2024. The Author(s).)

The aim of this study was to estimate the prevalence of health needs and use of outpatient services for indigenous (IP) and non-indigenous (NIP) populations aged ≥15 years, and to explore the associated factors and types of need. A cross-sectional study was conducted based on the 2018-19 National Health and Nutrition Survey. The population aged ≥15 years who had health needs and used outpatient services was identified. Logistic models were developed to explore the factors underlying the use of outpatient services. For both populations, being a woman increased the likelihood of using health services, and having health insurance was the most important variable in explaining the use of public health services. Compared to the NIP, a lower proportion of IP reported health needs during the month prior to the survey (12.8% vs. 14.7%); a higher proportion refrained from using outpatient services (19.6% vs. 12.6%); and a slightly higher proportion used public health services (56% vs. 55.4%). For the NIP, older age and belonging to a household that had received cash transfers from a social program, had few members, a high socioeconomic level, and a head with no educational lag, all increased the likelihood of using public health services. It is crucial to implement strategies that both increase the use of public health services by the IP and incorporate health-insurance coverage as a universal right.

Health is a human right that everyone should be able to exercise. Yet health systems segmentation and fragmentation are a major challenge to advancing universal health coverage (UHC) and achieving health equity. Between 2019 and 2020, Mexico launched a profound restructuration of its health system claiming its aim was to attain UHC, free healthcare services and drugs and to combat corruption. We analyse the implications of the modifications of the Mexican Constitution and the dismantling of the Seguro Popular de Salud (Popular Health Insurance) in relation to segmentation. We argue that, instead of advancing towards UHC and equality, these changes reinforce inequalities and that transforming health systems must respect human rights., (© 2022 John Wiley & Sons Ltd.)

This article examines the coverage in the continuum of antenatal-postnatal care for vulnerable women in Mexico according to indigenous status and assesses the influence of public health insurance strategies on the evolution of coverage over the last 25 years. We studied a total of 19 613 567 Mexican women, aged 12-54 years at last birth, based on a pooled cross-sectional analysis of data from the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics. After describing sociodemographic characteristics and maternal-health coverage by indigenous status, we constructed a pooled fixed-effects and interaction multivariable regression model to assess the influence of the Seguro Popular programme on continuum of care. We estimated adjusted continuum of care coverage between 1994 and 2018 according to Seguro Popular affiliation and indigenous status. Prior to the Seguro Popular programme, crude coverage in the continuum of care for non-indigenous women stood at 14.5% [95% confidence interval (CI): 13.2-15.8%] or 11 percentage points higher than for indigenous women. During the last period of the programme, it rose to 46.5% [95% CI: 45.6-47.5%] and 34.1% [95% CI: 30.7-37.4%], respectively. Our regression analysis corroborated findings that, on average, indigenous women faced lower odds of benefiting from continuum of care [adjusted odds ratio (aOR) = 0.48, 95% CI: 0.40-0.57] than did their non-indigenous counterparts. It also revealed that coverage for indigenous women without Seguro Popular affiliation was 26.7% [95% CI: 23.3-30.1%] or 12 percentage points lower than for those with Seguro Popular affiliation (38.6%, 95% CI: 35.7-41.4%). Our regression results confirmed that the latter benefited from higher odds of continuum of care (aOR = 1.67, 95% CI: 1.36-2.26). Gaps between those of indigenous and non-indigenous status have persisted, but the Seguro Popular clearly contributed to reducing the coverage gaps between these two groups of women. Strategies yielding better outcomes are required to improve the structural conditions of indigenous populations., (© The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Competing Interests: None

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Objetivo. Presentar los resultados de una intervención pedagógica para mejorar la calidad en el trato que brindan los prestadores de servicios de salud en regiones indígenas. Material y métodos. Se diseñó una metodología didáctica con enfoque crítico-constructivista dirigida a personal de salud que atiende a población indígena en cinco entidades de México. Resultados. Entre 09/2016 a 01/2020 se capacitó a 1 825 trabajadores de la salud que deconstruyeron las creencias que determinan prácticas de discriminación y maltrato durante la atención a la salud de los usuarios indígenas. La intervención logró un aprendizaje significativo transformador de las valoraciones y prácticas sociales, con propuestas para evitar cualquier forma de maltrato y garantizar el trato digno. Conclusiones. Para la construcción de un sistema de salud universal y equitativo, es necesario incluir intervenciones que actúen sobre las creencias determinantes de las prácticas de discriminación y maltrato en los servicios de salud hacia grupos sociales vulnerables.

Objective: To identify differences in socioeconomic indi-cators, health conditions and use of services between the indigenous (IP) and non-indigenous population (NIP) of the country., Materials and Methods: Descriptive cross-sectional study carried out with information obtained by the 2018-19 National Health and Nutrition Survey., Results: Most IP are in the lowest socioeconomic quintile and they use less health services. Indigenous women reported a higher number of children, as well as childbirth care with midwives. IP go for medical care to institutions for the population without social security as the first option but expressed less desire to return to the same place., Conclusions: IPs use less health services. An epidemiological panorama of double burden and inequity in access indicators that affect IP is configured. Reproductive health is the area where the greatest inequali-ties are observed., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities.

The Health of Indigenous Peoples Program is a transversal axis of institutional policy. Its objective is to contribute to the well-being of indigenous peoples by doing research about their health needs, training human resources for their care, and innovating in policy development. This document presents the program's theoretical framework, which focuses on the structural determination of inequalities. It also describes its main lines of action, which contribute to the development of policies and programs aimed at the well-being of this population., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

From an ethno-gerontological perspective, new models are needed to fulfill the health needs of the indigenous older adult population in Mexico. In this paper we developed a comprehensive healthcare model, interculturally appropriate, designed to meet the needs of Mexican indigenous older adults. The model was constructed using a qualitative design with semi-structured interviews of older adults, health providers, and available health resources in three Mexican indigenous regions. An ethnographical review was carried out to contextually characterize these communities. At the same time, a comprehensive bibliographic revision was made to identify socio-demographic markers. Results pointed out that Mexican indigenous older adults are not covered by any type of social health insurance program. Their health problems tend in large part to be chronic in nature due to the lack of early diagnosis and treatment. There is a need for trained human resources in the field of gerontology encompassing the sociocultural context of the indigenous groups. The geographical location of these communities limits the permanent presence of healthcare givers and thus limits access to continuous care. Traditional healthcare givers, able to speak the native language, are a great asset allowing the invaluable possibility of direct verbal communication. Based upon the data gathered from indigenous older adults and service providers, in tandem with evidence from the literature, we identified key elements for successful intervention and designed an intervention model. We concluded that indigenous older adults are a more vulnerable group, given that aside from being elderly in a country where the health needs of these populations exceed the capacity of existing healthcare services, their ethnicity serves as an added barrier preventing their access to the limited available healthcare resources. To achieve uniformity in providing health care, today's health systems need to address intercultural and participative aspects of healthcare models.

Background: Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations., Methods: This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012., Results: The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.)., Conclusions: Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.

Objective: To assess the use and understanding of the Nutritional information Panel (NIP) of pre-packaged foods by Mexican consumers., Materials and Methods: A questionnaire and an understanding test for NIP were applied to adult consumers in supermarkets of six cities in the Northern, Central, and Southern regions of Mexico. Data were analyzed by frequencies and Poisson regression models., Results: Interviewed 731 consumers; 71.5% were women, mean age 33 ± 9.7 (range: 18-60), 70% completed high-school or a higher degree. In total, 17% of consumers use the NIP for making purchase decisions; 49% did not understand the NIP. Only 1.2% of consumers answered correctly the five questions of the NIP understanding test., Conclusions: The use and understanding of the NIP are low despite a high proportion self-reported reading and understanding. The lack of previous knowledge of the technical language prevents use and interpretation of NIP nutritional information for purchasing decisions.