Ethnic Disparities in Effective Coverage of Maternal Healthcare in Mexico, 2006–2018: a Decomposition Analysis

Introduction This paper examines ethnic disparities in the effective coverage (EC) of maternal healthcare for interventions carried out among Mexican women in the last decade. It also explores the proportion of this gap that can be explained by observable characteristics in indigenous and nonindigenous women, as well as by structural discrimination against indigenous women. Methods We conducted a retrospective and repeated cross-sectional study using data from the two latest Health and Nutrition Surveys carried out in 2011/2012 and 2018/2019. We analyzed a total of 11,304 Mexican women aged 12–49 years at the time of their last pregnancy, who reported having received obstetric services from 2006 to 2018, the result of which was a live birth. We adjusted EC according to indigenous status and the time of the most recent obstetric episode using a pooled fixed-effects and robust logistic model. In order to analyze which ethnic disparities in EC might be attributable to discrimination, we used the nonlinear Blinder–Oaxaca (BO) decomposition technique. Results Indigenous women were less likely to enjoy EC for maternal health than their nonindigenous peers (aOR = 0.86, 95% CI: 0.75,0.98). Interventions aimed at providing adequate antenatal care (ANC) and skilled, institutional delivery care were the EC components registering the largest gaps by ethnicity. BO decomposition results demonstrated that structural discrimination accounted for 33.29% of this gap. Conclusions and Policy Implications It is possible that the largest proportion of the gap in EC attributable to differences in unobservable characteristics between women in both groups could be explained by omitted variables that are often predictors of EC. However, these differences in EC may also be related to discriminatory practices experienced by indigenous women. Such practices could also jeopardize the aspirations of LMICs for achieving universal health coverage.