Antenatal Care Among Poor Women in Mexico in the Context of Universal Health Coverage
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Antenatal Care Among Poor Women in Mexico in the Context of Universal Health Coverage Edson Servan-Mori1 • Veronika Wirtz2 • Leticia Avila-Burgos1 • Ileana Heredia-Pi1
Springer Science+Business Media New York 2015
Abstract Objectives To study the influence of enrollment in the subsidized insurance program, Seguro Popular (SP), on timely (within three gestational months) and complete (at least four visits) antenatal care, in the context of expanding health coverage in Mexico. Methods A cross-sectional study using data from the National Health and Nutrition Survey 2012 was conducted. Using quasi-experimental matching methods, we analyzed the influence of SP on timely antenatal care and a minimum of four visits for 6175 women (aged 14–49), and explored heterogeneous influences by socioeconomic status (SES) and educational level. Results Approximately 80 % of women reported timely antenatal care, with no significant difference between SP and non-SP—except among SP women from low SES households, who had an increased probability of timely antenatal care by 1.88 (p \ 0.05). Enrollment in SP increased the probability of receiving at least four visits (1.65, p \ 0.01) but this was not independently associated with SP enrollment when modeled together with timely antenatal care. Overall, higher SES increased the probability of antenatal care, while higher educational level increased the probability of four visits. Conclusions To increase the impact of SP on antenatal care requires focusing on efforts to promote timely
attendance as an important factor towards achieving the goal of universal health coverage of maternal and child health services in Mexico. Keywords Antenatal care Seguro Popular Universal health Mexico
Significance Our contributions are twofold: First, previous studies analyzed the impact of Seguro Popular on care during birth and postpartum. Contrastingly, our study evaluates the effect on timely access to prenatal care and the frequency of prenatal care received. Second, our study results contribute to the body of knowledge demonstrating that the scaling up of health insurance coverage is a necessary but not sufficient condition to increase access maternal services. In this sense, the policies promoting coverage need to go beyond the affiliation of individuals and being more comprehensive. The results demonstrate the importance of demand side factors such as socioeconomic and education level. Modification the perception of health services (via information) could result in changes of preferences.
Introduction & Edson Servan-Mori [email protected] 1
National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa Marı´a de Ahuacatitla´n, CP 62100 Cuernavaca, Morelos, Mexico
2
Department of Global Health, Boston University School of Public Health, Boston, MA, USA
Barriers to access to maternal health care are associated with high levels of maternal mortality. Globally, up to 358,000 women die annually from complications of delivery and immediately postpartum [1, 2]. Most of these deat
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