Serván-Mori Edson, Pineda-Antúnez Carlos, Cerecero-García Diego, Flamand Laura, Mohar-Betancourt Alejandro, Millett Christopher, Hone Thomas, Moreno-Serra Rodrigo, Gómez-Dantés Octavio
Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
The CHOICE Institute, University of Washington, Seattle, WA, USA.
Int J Equity Health. 2025 Jan 30;24(1):32. doi: 10.1186/s12939-024-02357-3.
To analyze the temporal and territorial relationship between health system financing fragmentation and maternal mortality in the last two decades in Mexico.
We conducted an ecological-longitudinal study of the maternal mortality ratio (MMR) in the 32 states of Mexico during the period 2000-2022. Annual MMRs were estimated at the national and state levels according to health insurance. We compared the distribution of individual attributes and place of residence between deceased women with and without social security to identify overrepresented demographic profiles. Finally, we mapped state disparities in MMR by health insurance for the last four political administrations.
MMR in Mexico decreased from 59.3 maternal deaths per hundred thousand live births in 2000 to 47.3 in 2018. However, from 2019 onwards, MMR increased from 48.7 in 2019 to 72.4 in 2022. Seven out of ten maternal deaths occurred in the population without social security from 2000 to 2018, then decreasing to six out of ten from 2020. Maternal deaths in the population without social security were more frequent among younger women, with less schooling, unmarried, and residing in rural areas, with higher Indigenous presence and greater social marginalization. From 2019 onwards, the MMR was higher in the population with social security.
The results of this study confirm the close relationship between maternal mortality and social inequalities, and suggest that affiliation with social security has ceased to be a differentiating factor in recent years. Understanding the evolution of maternal mortality between the population with and without social security in Mexico allows us to quantify the gap in maternal deaths attributed to inequalities in access to maternal health services, which can contribute to the design of policies that mitigate these gaps.
分析过去二十年墨西哥卫生系统筹资碎片化与孕产妇死亡率之间的时间和地域关系。
我们对2000 - 2022年期间墨西哥32个州的孕产妇死亡率（MMR）进行了生态纵向研究。根据医疗保险在国家和州层面估算年度MMR。我们比较了有和没有社会保障的死亡妇女之间的个人属性分布和居住地，以确定代表性过高的人口特征。最后，我们绘制了过去四届政治行政期间按医疗保险划分的各州MMR差异图。
墨西哥的MMR从2000年每十万例活产59.3例孕产妇死亡降至2018年的47.3例。然而，从2019年起，MMR从2019年的48.7例增加到2022年的72.4例。2000年至2018年，十分之七的孕产妇死亡发生在没有社会保障的人群中，到2020年降至十分之六。没有社会保障的人群中的孕产妇死亡在年轻女性、受教育程度较低、未婚且居住在农村地区的人群中更为常见，这些地区原住民比例较高且社会边缘化程度更高。从2019年起，有社会保障的人群中的MMR更高。
本研究结果证实了孕产妇死亡率与社会不平等之间的密切关系，并表明近年来社会保障参保情况已不再是一个区分因素。了解墨西哥有和没有社会保障的人群中孕产妇死亡率的演变情况，使我们能够量化因获得孕产妇保健服务不平等导致的孕产妇死亡差距，这有助于制定缩小这些差距的政策。
