Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico

Figures & data

Table 1. Collected data

Type interviewed	Chiapas	Oaxaca	Total
Health care personnel	Questionnaires: 30	Questionnaires: 31	61
	Qualitative interviews: 25	Qualitative interviews: 24	49
Indigenous women	Questionnaires: 145	Questionnaires: 149	294
	Qualitative interviews: 28	Qualitative interviews: 27	55
		Total questionnaires both states	355
		Total qualitative interviews both states	104

Source: Personal research based on the results.

Table 2. Sociodemographic characteristics of the women interviewed

	Chiapas (n = 145)		Oaxaca (n = 149)		Total (n = 294)
	n	%	n	%	n	%
Age group
15–19	21	14.5	16	10.7	37	12.6
20–29	83	57.2	80	53.7	163	55.4
30–39	35	24.1	48	32.2	83	28.2
40-45	6	4.1	5	3.4	11	3.7
Marital status
Single	4	2.8	18	12.1	22	7.5
Married/cohabiting	136	93.8	125	83.8	261	88.8
Separated/divorced	4	2.8	5	3.4	9	3.1
Widowed	1	0.7	1	0.7	2	0.7
Literacy
Yes	134	92.4	148	99.3	282	95.9
No	11	7.6	1	0.7	12	4.1
Occupation
Home/housewife	141	97.9	124	83.2	265	90.4
Household employee	0	0	5	3.4	5	1.7
Merchant/salesperson	0	0	13	8.7	13	4.4
Employee public/private sector	2	1.4	4	2.7	6	2
Works in the fields	1	0.7	1	0.7	2	0.7
Student	0	0	1	0.7	1	0.3
Other	0	0	1	0.7	1	0.3
Identifies herself as an indigenous person
Yes	2	1.4	112	75.2	114	38.8
No	143	98.6	37	24.8	180	61.2
Speaks an indigenous language
Yes	1	0.7	62	41.6	63	21.4
No	144	99.3	87	58.4	231	78.6
Any of her parents or grandparents speak an indigenous language
Yes	13	9	105	70.5	118	40.1
No	132	91	44	29.5	176	59.9
Indigenous Origin*
Yes	13	9	142	95.3	155	52.7
No	132	91	7	4.7	139	47.3

* Including self-identification as an indigenous person or the interviewee or her parents or grandparents speak an indigenous language.

Source: Personal research based on the results.

Table 3. Sociodemographic and occupational characteristics of the health care personnel in both models

	Chiapas (n = 30)		Oaxaca (n = 31)		Total (n=61)
	n	%	n	%	n	%
Sex
Female	17	60.7	14	51.9	31	56.4
Male	11	39.3	13	48.1	24	43.6
Age
Average	27	28.8 years	24	34.0 years	51 years	31.2 years
Minimum		21 years		18 years		18 years
Maximum		46 years		58 years		58 years
Position
Ward or on call obstetrician	0	0	2	7.1	2	3.7
Obstetrics and gynecology resident	0	0	1	3.6	1	1.9
Obstetrics and gynecology nurse	8	30.8	2	7.1	10	18.5
Medical assistant	3	11.5	2	7.1	5	9.3
Medical intern	6	23.1	2	7.1	8	14.8
Chief of Emergency	0	0	3	10.7	3	5.6
General practitioner	7	26.9	1	3.6	8	14.8
Other	2	7.7	15	53.6	17	31.4
Director of the medical unit
Yes	5	17.9	6	19.4	11	18.6
No	23	82.1	25	80.6	48	81.4
Institution of Affiliation
Institution providing medical services for the federal social support program	1	3.3	9	30.00	10	16.7
State public health services	29	96.7	21	70.00	50	83.3
Level of care
Primary level	19	67.9	24	77.4	43	72.9
Secondary level	9	32.1	7	22.6	16	27.1

Source: Personal research based on the results.

Table 4. Characteristics of prenatal and postnatal care (last obstetric event)

	Chiapas (n = 145)		Oaxaca (n = 149)		Total (n = 294)
	n	%	n	%	n	%
Prenatal care
Had prenatal control medical consultations	142	97.9	130	95.6	272	96.8
Pregnancy trimester when she initiated prenatal visits
1st trimester	122	87.1	109	84.5	231	85.9
2nd trimester	16	11.4	19	14.7	35	13
3rd trimester	2	1.4	1	0.8	3	1.1
Complications in last pregnancy	53	36.6	37	27.6	90	32.3
First pregnancy at the time of survey (primipara)	0	0	13	8.7	13	4.4
Childbirth care^a
Point of care *
Home (own or midwife’s)	29	20.0	3	2.2	32	11.3
State public health services	105	72.4	80	58.0	185	65.4
Institution providing medical services for the federal social support program	7	4.8	51	37.0	58	20.5
Social Security Institution	0	0.0	1	0.7	1	0.4
Private	3	2.1	3	2.2	6	2.1
Other	1	0.7	0	0.0	1	0.4
Birth resolution*
Normal/vaginal	130	89.7	75	54.3	205	72.4
Scheduled caesarean	8	5.5	13	9.4	21	7.4
Emergency caesarean	7	4.8	47	34.1	54	19.1
Accompaniment in the birth process^b,*	38	33.0	22	16.5	60	24.2
She was given information concerning the birth process^b	53	45.7	60	45.5	113	45.6
Skin to skin contact at birth	85	58.6	72	52.9	157	55.9
Post-obstetric event counselling
Postnatal depression*	34	24.0	17	13.0	51	18.0
Signs and symptoms of bleeding *	58	40.0	97	71.0	155	55.0
Preeclampsia-eclampsia*	82	71.0	114	86.0	196	70.0
Signs and symptoms of potential infections*	42	29.0	86	63.0	128	46.0
Thrombosis*	66	46.0	96	71.0	162	58.0
Nutrition*	80	56.0	93	68.0	173	62.0
Hand-washing*	89	62.0	107	79.0	196	70.0

^aExcluding 13 cases of women whose first pregnancy was at the time of the survey

^bDoes not include home birth information

*P < 0.5 value, chi 2 independence test

Note: The difference in the percentage of C-sections in Chiapas versus Oaxaca may be attributable to the model of care followed by the NGO that favours the resolution of “natural birth” in the region studied in Chiapas in contrast to the standard care model subsidised by the government (Oaxaca), where the indication of caesarean section for the resolution of childbirth is usually more common. Likewise, this percentage of caesarean section for the Frailesca region of Chiapas does not necessarily reflect the general situation of the State, although it can be said that the State of Chiapas has presented a comparatively lower percentage of caesarean sections than Oaxaca in recent years (Chiapas 34% versus Oaxaca 45% in 2016).

Source: Personal research based on the results

Table 5. Availability of infrastructure and personnel, and management and organisational aspects required in the care of high-risk pregnancies and obstetric emergencies, according to the opinion of health personnel in both Chiapas and Oaxaca models

	Chiapas (n = 30)		Oaxaca (n = 31)
	n	%	n	%	P value
The medical unit or hospital is sufficiently equipped to attend high-risk pregnancies
Agree	4	13.8	12	44.4	0.011*
Disagree	25	86.2	15	55.6
The medical unit or hospital has the necessary medical personnel to attend high-risk pregnancies
Agree	7	24.1	11	42.3	0.152
Disagree	22	75.9	15	57.7
If required, vehicles (ambulances) are normally available or accessible in the medical unit or hospital for the transfer of patients-women with obstetric emergencies
Agree	17	58.6	22	81.5	0.063
Disagree	12	41.4	5	18.5
If required, the medical unit or hospital normally has or has access to communication services (radio, telephone, internet) that are necessary in the provision of medical care to patients with high-risk pregnancy or obstetric emergency
Agree	14	48.3	20	74.1	0.048*
Disagree	15	51.7	7	25.9
The medical unit or hospital provides me with sufficient training to care for high-risk patients
Agree	12	42.9	14	53.9	0.419
Disagree	16	57.2	12	46.1
The medical unit or hospital provides me with sufficient training to care for patients with obstetric emergencies
Agree	8	28.6	13	56.5	0.044*
Disagree	20	71.4	10	43.5
The medical unit or hospital provides me with sufficient training to care for patients from native communities
Agree	6	21.4	11	44.0	0.079
Disagree	22	78.6	14	56.0
There is an active policy of interaction in the treatment of the health of indigenous women between the health system and the beliefs of the native peoples
Agree	7	28.0	11	47.8	0.156
Disagree	18	72.0	12	52.2
The link between health services and the indigenous community is adequate
Agree	14	53.9	11	45.8	0.571
Disagree	12	46.1	13	54.2
The relationship between the clinic/hospital and the community facilitates the treatment of high-risk pregnancies of indigenous mothers
Agree	24	85.7	16	69.6	0.163
Disagree	4	14.3	7	30.4
In case of being required to attend an emergency or high-risk pregnancy of an indigenous woman, this clinic/hospital has the support of a translator
Agree	2	7.4	9	39.1	0.007*
Disagree	25	92.6	14	60.9

*P value of chi2 independence test statistic.

Table 6. Characteristics of the quality of care by model of care^a

	Chiapas		Oaxaca		Total
	n	%	n	%	n	%
Felt mistreated by health personnel *	17	14.8	37	27.8	54	21.8
Was informed about her condition and the procedure to follow *	105	91.3	104	78.2	209	84.3
Understood everything the medical staff said to her *	105	91.3	102	76.7	207	83.5
Needed a translator to understand the explanations of the care process^b	0	0	7	11.3	7	11.1
Has lost her file or documents at some point	3	2.6	5	3.8	8	3.2
Was asked for her consent before the birth procedure *	82	71.3	114	85.7	196	79
Was given a medical report about her health status *	88	76.5	121	91.0	209	84.3
Received the birth certificate of her child	109	94.8	131	98.5	240	96.8
Knows that she can complain if she does not like the way she is treated	86	74.8	90	67.7	176	71

^aThis table does not include information on deliveries performed at the woman’s or the midwife’s home.

^bIt only includes women who speak an indigenous language.

*P value of chi2 independence test statistic.