In recent years, Mexican women have experienced a significant downgrade in the quality and accessibility of public healthcare – and not due to the COVID-19 pandemic – said Irene Tello, Executive Director of Mexican impunity watchdog Impunidad Cero, at a recent event hosted by the Wilson Center’s Mexico Institute. The expert panel agreed that the greatest barriers for Mexican women seeking medical attention lie in the current government’s nearsighted health policies and mismanagement of the public health sector.

In 2018, President López Obrador’s administration inherited a flawed public health system. Their subsequent decisions broke that system entirely, said Tello. Previous administrations oversaw a deeply fragmented, inefficient, and slow healthcare system. But it was universal, providing free or reduced-cost medical services to all Mexicans regardless of their employment status. Instead of strengthening it, President López Obrador’s health policies have aggravated existing deficiencies, placing disproportionate and significant burdens on women, she said.

Issues of access to and quality of healthcare in Mexico affect the entire population; however, Mexico’s machista culture perpetuates gender-based inequalities, which are evident in the public healthcare system. Moreover, since women are the primary beneficiaries of healthcare in Mexico, disruptions in public health disproportionately affect them, said Tello.

Curing Inequity through Empowerment

In 2004, the Mexican government launched Seguro Popular, a universal public healthcare program that did not factor employment status into eligibility, offering coverage for millions of informal sector workers, including two thirds of the country’s women. While Seguro Popular was not perfect – featuring lengthy treatment delays and overcrowded hospitals – it offered healthcare coverage for all Mexicans and extended services to the country’s most remote areas.

For women, Seguro Popular was an essential 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, it also included major educational components that informed women of their common health needs and rights, she said. Expanded access to healthcare replaced male-dominated narratives about women’s wellness with reliable information regarding female-specific diseases and their symptoms, healthy sex and sexuality, intimate partner violence, and family planning options, said Cruz.

These benefits were additionally salient in rural communities, where education is scant and often controlled by patriarchal interests, where a deep prejudice against women prevails, and the nearest clinic is hours away by foot, said Cruz. To reach remote areas, Seguro Popular installed Casas de Salud (Health Houses) and staffed them with local trainees to provide basic health services. In addition to job creation for local communities, the Casas de Salud offered villagers a primary healthcare clinic within walking distance that included practitioners who spoke their language – an essential component of inclusive and quality healthcare, she said.

Beyond providing medical attention to previously disenfranchised women, these programs made women’s issues visible – to themselves and to their communities. Above all, women’s healthcare empowered them to explore their specific health needs and rights, inviting women to question what men can regiment – from childbearing to housework to personal health decisions, said Cruz.

Ailing Health Policies

These strides in health and gender equality were stopped short when President López Obrador repealed Seguro Popular and replaced it with the National Health Institute for Wellbeing (INSABI) in 2020 to centralize the public health system and enhance its efficiency. INSABI does not cover many health conditions (including chronic or severe illnesses) and places 40 to 60 percent of the financial burden on the patient. It has also failed to insure some 16 million women, doubling the number of uninsured women between 2018 and 2020.

As well, the policy that gave way to INSABI restructured how the government sources and dispatches medications, creating major supply and distribution disruptions for medications that were previously widely available, said Tello. The COVID-19 pandemic further exacerbated medication shortages – it did not cause them, she said.

These complications reverberated across Mexico’s hyper-fragmented healthcare system, which includes an unregulated (and expensive) private sector; an employer-funded and government-run quasi-public sector for which eligibility hinges on formal employment; and a public sector, formerly Seguro Popular and now INSABI, explained Arantxa Colchero, a health economist and researcher. Like its predecessor, INSABI should protect Mexico’s most vulnerable – the unemployed and informally employed – including nearly 60 percent of Mexican women who are not participating in the formal workforce. Yet, women – who, particularly during their reproductive years, have more health needs than men – often cannot access necessary services because either they are publicly unavailable or privately cost-prohibitive, said Colchero.

These shortcomings have tangible consequences. Since 2020, Mexico’s maternal mortality rate has increased by 22 percent, which suggests that the health system’s structural faults often lead to medical complications or neglect instead of providing reliable patient care, said Tello. Moreover, practitioners tend to reprimand patients for their ailments, said Colchero. Obstetric violence takes many forms aside from verbal abuse, and often involves practitioners performing unnecessary or unapproved procedures on women during childbirth, including unprompted caesarian sections or forced sterilizations, said Tello. These issues highlight an intersection of impunity and obstetric violence that needs correction – not through stricter laws, but through effective investigations and reparations – to prevent jeopardizing more women’s wellbeing, said Colchero.

Engendering Health

Ultimately, removing Seguro Popular, along with the mid-pandemic cancellation of other social programs – like public daycares and free internet for all – signals to women that they are once again not a priority, said Cruz. Reinstating a truly popular healthcare system is a titanic priority for women, and panelists agreed that the current administration is unlikely to achieve this victory for women.

Nonetheless, preventative and educational measures are reachable and could help women avoid a multitude of diseases, unintended pregnancies, and advanced illnesses, said Colchero. Teaching young children – regardless of gender – about safe and consensual sex could reduce these issues’ preponderance while curbing sexual violence, she stressed.

Women’s health must comprise wellness, general education, and sexual education, said Colchero. Programs that inform women of their rights and healthcare needs, distinguishing what is healthy from what is violence, will undoubtedly support women’s health and their emancipation from patriarchic oppressors, said Cruz.