A la protección de la salud: Indigenous status, insurance affiliation, and prenatal care quality in Oaxaca, Mexico
- Type of resource
- Date created
- June 01, 2018
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Collected here are the theses written by the Fisher Family CDDRL Undergraduate Honors Program students during their junior and senior years at Stanford., Collected here are the theses written by the Fisher Family CDDRL Undergraduate Honors Program students during their junior and senior years at Stanford.
- Digital collection
- 12 digital items
- Welgan, Katie
- Wise, Paul
- Degree granting institution
- Stanford University, Fisher Family Honors Program in Democracy, Development and the Rule of Law
Despite the introduction of Seguro Popular, a universal form of health insurance, in the early 2000s, indigenous women in Mexico continue to exhibit disparately poor maternal health outcomes relative to non-indigenous women. This difference has typically been attributed to factors including poverty, rurality, and lack of care adherence, but little work has addressed the role of prenatal care quality in explaining this trend. Similarly, though Seguro Popular has assisted in equalizing the proportion of indigenous and non-indigenous women who receive prenatal care, few studies have compared the substantive quality of care provided to these two groups. Using data from ENADID 2014, this study characterizes the relationship between indigenous status, insurance affiliation, and prenatal care quality, focusing specifically on the state of Oaxaca. After developing an index of prenatal care quality consistent with both international norms and local patient care preferences, I demonstrate significantly worse prenatal care quality among indigenous women across every measure of quality. Even after controls for socioeconomic marginalization, linear and logistic regression models of prenatal care demonstrate that indigenous women received 0.642 fewer prenatal visits (p < 0.05), exhibited reduced odds of receiving prenatal care in the first trimester (OR 0.5929, p < 0.05), received 0.3515 fewer interventions over the course of pregnancy (out of a checklist of 11 essential procedures, p < 0.05), had reduced odds of receiving prenatal care from a doctor (OR 0.3969, p < 0.01), received poorer information quality of care (0.2284 points fewer on a 3-point scale, p < 0.05), and received poorer interpersonal quality of care (0.3791 points fewer on a 3-point scale, p < 0.01). Regression models stratified by indigenous status suggest that these indigenous status- based inequalities are concentrated among Seguro Popular affiliates. The signifiant correlation between indigenous status and poor care quality, independent of socioeconomic marginalization, suggests insufficient cross-cultural communication and implicit discrimination as potential sources of this quality difference. In addition to demonstrating continued indigenous care access inequality in Oaxaca even after the implementation of Seguro Popular, these results suggest discrepancies in access to quality prenatal care as a possible explanation of Mexico’s indigenous maternal health disparities.
- Preferred Citation
- Welgan, Katie. (2018). A la protección de la salud: Indigenous status, insurance affiliation, and prenatal care quality in Oaxaca, Mexico. Stanford Digital Repository. Available at: https://purl.stanford.edu/kq543rv3425
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