Doubova Svetlana V, Paredes-Cruz Martín, Perez-Moran Mtra Diana, Pérez-Cuevas Ricardo, Arsenault Catherine, Quinzaños-Fresnedo Claudio
Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Division of Social Protection and Health, Interamerican Development Bank, Washington DC, USA.
BMC Pregnancy Childbirth. 2025 Apr 16;25(1):455. doi: 10.1186/s12884-025-07397-3.
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.
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.
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.
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.
2022年，墨西哥社会保障局（IMSS）推出了“以妇女为中心的全面孕产妇保健模式”（AMIIMSS项目），以改善孕产妇保健。本研究评估了分娩护理质量，比较了IMSS医院与私立医院之间以及AMIIMSS项目依从性高和低的IMSS医院之间的结果，并在控制了其他相关人口统计学和临床协变量后，评估了医疗服务提供者类型、分娩方式、护理内容以及产科暴力的发生是否与分娩护理的感知质量相关。
从一个与IMSS相关的18至49岁孕妇观察性电子队列中收集数据，重点关注她们的经历、对医疗质量的看法、产科暴力和健康结果。分析包括卡方检验和多变量线性回归。
该研究纳入了988名妇女；14.9%的妇女主要因为认为IMSS的质量差和过去受到过虐待而选择去私立机构分娩。私立医院的剖宫产率（92.5%）高于IMSS（51.3%）。高度依从AMIIMSS项目的IMSS医院剖宫产率低10%，其护理内容与私立医院相似（预期临床行动的85%）。20.8%的妇女和28%的新生儿出现并发症。在8至40分的评分中，私立医院的护理总体感知质量得分（平均34.2，标准差为6.7）高于IMSS（平均27.0，标准差6.7）。在私立医院或三级护理机构分娩以及接受更高的护理内容与妇女感知的更高质量相关。而产科暴力与较低的感知质量相关。
AMIIMSS改善了妇女的分娩体验，但由于医院对该项目的依从性差和感知质量低而暴露出弱点。这凸显了加强该项目支柱——培训、基础设施、监管调整和妇女赋权的必要性。
