Quantifying Disparities in the Continuum of Care for Maternal Health Attributable to Age Discrimination in Mexico, 1994–2018

Introduction It has been widely recognized that adolescents exhibit a low coverage rate for continuous maternal health services as a result of structural social disadvantages, often exacerbated by age-related discrimination. Notwithstanding its importance, this fact has received little attention during quantitative evaluations of health system performance. The present study quantified the magnitude and trend of the adult-adolescent gap in continuum of care (CoC) coverage for maternal health over the last quarter century. A decomposition analysis of the gap was performed to ascertain the portion of disparities attributable to age discrimination. Methods A pooled, cross-sectional, and retrospective study was conducted utilizing data from the 1997, 2009, 2014, and 2018 waves of the population-based National Survey of Demographic Dynamics in Mexico. After describing the sociodemographic characteristics and CoC coverage levels by age group, a fixed-effects multiple-logistic model was run to assess the predictors of the gap. The nonlinear Blinder-Oaxaca (BO) decomposition method was employed to analyze age disparities in CoC coverage attributable to discrimination. Sensitivity analyses were performed by limiting estimates to the subsample of primiparous women. Results Coverage for all maternal CoC indicators increased in both age groups throughout the periods analyzed; however, gaps persisted in favor of adult mothers (primiparous or otherwise). Timely and frequent antenatal care (ANC), as well as having received postnatal care within the first 15 days following the birth of the last live child, were the indicators reflecting the greatest inter-group inequality. BO analyses showed that discriminatory practices accounted for 89.9% of the overall gap, with this figure dropping to 60.5% among primiparous women. Both the overall gap and the portion attributable to age discrimination increased over time. Conclusions Despite advances in CoC delivery in Mexico, age-related disparities remain to the detriment of adolescent women. The largest portion of the gap between adult and adolescent women can be interpreted as a consequence of the underlying discriminatory practices to which adolescent mothers are exposed. Policy Implications There is a dual agenda for the government, the first aimed at preventing adolescent pregnancy and the second focused on reducing the age-related CoC coverage gap. Efforts to address structural discrimination against adolescent mothers should include social-support initiatives with a focus on first pregnancies.