Gender inequality in Mexico’s fractured public health system

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In recent years, Mexican women have experienced a significant decline in the quality and accessibility of public health care – and not because of the COVID-19 pandemic – said Irene Tello, executive director of the Mexican body. monitoring impunity. Impunidad Ceroto recent event organized by the Wilson Center’s Mexico Institute. The panel of experts agreed that the greatest obstacles for Mexican women seeking medical care are the short-sighted health policies of the current government and the mismanagement of the public health sector.

In 2018, President López Obrador’s administration inherited a failing public health system. Their subsequent decisions completely broke that system, Tello said. Previous administrations have overseen a deeply fragmented, inefficient and slow-moving health system. But it was universal, offering free or reduced-cost medical services to all Mexicans, regardless of employment status. Instead of reinforcing it, President López Obrador’s health policies have made existing deficiencies worse, placing a disproportionate and significant burden on women, she said.

The problems of access and quality of health care in Mexico affect the entire population; however, Mexico macho Culture perpetuates gender inequalities, which manifest themselves in the public health system. Additionally, because women are the primary recipients of health care in Mexico, public health disruptions disproportionately affect them, Tello said.

Healing inequalities through empowerment

In 2004, the Mexican government launched Seguro Populara universal public health program that disregarded employment status in eligibility, providing coverage to millions of informal sector workers, including two-thirds women of the country. While Seguro Popular was not perfect – with long treatment times and overcrowded hospitals – it offered medical coverage to all Mexicans and extended services to the most remote areas of the country.

For women, Seguro Popular was a key vehicle for empowerment, said Eufrosina Cruz, a congresswoman from Oaxaca who grew up in a marginalized indigenous mountain community. It not only benefited millions of previously uninsured women, but also included major educational components that informed women of their common health needs and rights, she said. Expanded access to health care has replaced male-dominated narratives about women’s well-being with reliable information about women-specific illnesses and their symptoms, healthy sex and sexuality, domestic violence, and options family planning, Cruz said.

These benefits were further salient in rural communities, where education is scarce and often controlled by patriarchal interests, where a deep bias against women prevails, and where the nearest clinic is hours’ walk away, said Cruz. To reach remote areas, Seguro Popular installed Houses of Salud (Nursing homes) and staffed them with local interns to provide basic health services. In addition to creating jobs for local communities, the Houses of Salud provided villagers with a primary health care clinic within walking distance that included practitioners who spoke their language — an essential part of inclusive, quality health care, she said.

In addition to providing medical care to previously disenfranchised women, these programs have made women’s issues visible – to themselves and to their communities. Above all, women’s health care has allowed them to explore their specific health needs and rights, inviting women to ask themselves what men can regulate – from motherhood to household chores to personal health decisions, Cruz said.

Health policies in trouble

These advances in health and gender equality were halted when President López Obrador repealed Seguro Popular and replaced it with National Institute of Health for Welfare (INSABI) in 2020 to centralize the public health system and strengthen its efficiency. INSABI does not cover many health conditions (including chronic or serious illnesses) and places 40 to 60% of the financial burden on the patient. He also did not assure some 16 million womendoubling the number of uninsured women between 2018 and 2020.

Additionally, the policy that gave way to INSABI restructured the way the government procures and distributes drugs, creating significant disruptions in the supply and distribution of drugs that were previously widely available, Tello said. The COVID-19 pandemic has further exacerbated drug shortages — it didn’t cause them, she said.

these complications reverberated through Mexico’s hyper-fragmented healthcare system, which includes an unregulated (and expensive) private sector; a quasi-public sector financed by employers and managed by the government for which eligibility depends on formal employment; and a public sector, formerly Seguro Popular and now INSABI, explained Arantxa Colchero, health economist and researcher. Like its predecessor, INSABI is expected to protect Mexico’s most vulnerable – the unemployed and informal workers – including nearly 60 percent Mexican women who do not participate in the formal labor force. Yet women – who, particularly in their reproductive years, have more health needs than men – often cannot access needed services because they are either publicly inaccessible or privately prohibitively expensive. , said Colchero.

These shortcomings have tangible consequences. Since 2020, Mexico the maternal mortality rate increased by 22 percent, suggesting that structural flaws in the healthcare system often lead to medical complications or neglect instead of providing reliable patient care, Tello said. Additionally, practitioners tend to chastise patients for their ailments, Colchero said. Obstetrical violence takes many forms outside of verbal abuse and often involves practitioners performing unnecessary or unapproved procedures on women during childbirth, including unsolicited C-sections or forced sterilizations, Tello said. These issues highlight an intersection of impunity and obstetric violence that must be addressed – not through stricter laws, but through effective investigation and reparations – to avoid further compromising the well-being of women, said Colchero.

Engage health

Ultimately, the deletion Seguro Popular, along with the cancellation amid the pandemic of other social programs — like public child care and free internet for all — signals to women that they are no longer a priority, Cruz said. Restoring a truly grassroots health care system is a titanic priority for women, and panelists agreed that the current administration is unlikely to achieve this victory for women.

Nevertheless, preventive and educational measures are accessible and could help women avoid a multitude of diseases, unwanted pregnancies and advanced diseases, Colchero said. Teaching young children – regardless of gender – about safe and consensual sex could reduce the prevalence of these issues while curbing sexual violence, she pointed out.

Women’s health should include wellness, general education and sex education, Colchero said. Programs that educate women about their health care rights and needs, distinguishing what is healthy from what is violent, will undoubtedly support women’s health. and their emancipation from patriarchal oppressors, Cruz said.

Samantha Kane Jiménez is a program assistant at the Mexican Institute at the Wilson Center.

Sources: Catalyst, El Economista, Guardian Insurance, INEGI, International Labor Organization, LJA.mx, Nexos, World Bank.

Photo credit: Covid-19 vaccination day for the elderly at the BUAP, one of the vaccination points. Alejandro Munoz/Shutterstock.com.

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