[Barriers for indigenous women to access obstetric services within the framework of integrated health services networks]

Abstract

Objective: To analyze the barriers that indigenous women face in access to the network of obstetric services in the context of the implementation of integrated healthcare networks (IHN).

Method: We designed a cross-sectional descriptive study including quantitative and qualitative methods. Sampling was intentional, no probabilistic. Data collection was carried out in Oaxaca, Mexico, during 2017-2018. A total of 149 indigenous women who used obstetrical services were surveyed and sociodemographic characteristics were obtained. Later were selected 30 cases that had complications during pregnancy and childbirth for a semi-structured interview. Non-participant observation was conducted.

Results: The network of obstetric services comprises four institutions with different models of care and therefore different types of facilities and human resources to assist indigenous women. Nearly 20% of women did not start prenatal care in the first trimester of pregnancy and 27.2% had complications during the gestational period. The main barriers were availability (hours of operation, geographical aspects), accessibility (lack of financial resources), acceptability (ancestral practices vs. medical recommendations), and continuity of service (difficulties for admit patients in hospitals referred from first line of care).

Conclusions: The networks model allows access to obstetric services but does not guarantee care. For this it is necessary to improve both: the infrastructure of the obstetric service providers, and the care processes. It is necessary to broaden the vision of the IHN management model considering the perspective of human rights and equity in health.

Keywords: Accesibilidad; Accessibility; Equidad en salud; Equity in health; Healthcare services; Indigenous population; Maternal health; Población indígena; Salud materna; Servicios de salud.