COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis.

BACKGROUND: Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico. METHODS: We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits. RESULTS: During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference. CONCLUSIONS: According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.

Reduction in contraceptive use during the COVID-19 pandemic among women in an indigenous Mexican community: a retrospective crossover study.

Background: Being indigenous, being a woman, and living in poverty are social determinants that contribute to reduced access to healthcare, including reproductive health services. The COVID-19 pandemic might have exacerbated this lag. Objective: This study explored how the COVID-19 pandemic affected the contraceptive use of a group of indigenous Mexican women and adolescents in their community. Methods: Between June and December of 2021, 158 indigenous Mexican women who had experienced recurrent pregnancies were interviewed at two health centers in San Cristóbal de las Casas, Chiapas. Participants were either pregnant when they completed the questionnaire or had been pregnant during the COVID-19 pandemic. Women were asked about their contraceptive practices before and during the pandemic. The change in contraceptive practice was estimated using a logistic model. Results: The COVID-19 pandemic reduced contraceptive use by 50%. Among women who wanted contraception, 58% did not receive it. During the pandemic, 77% of previous contraceptive users reported difficulty obtaining contraception, and only 23% sought family planning assistance. Conclusion: During the COVID-19 pandemic, indigenous women in the studied community used fewer contraceptive methods and did not use intrauterine devices. Additionally, there was a decline in the percentage of women using contraceptives. These results highlight the impact on indigenous populations and the difficulties they could face in accessing reproductive health services during health emergencies.

Sociodemographic and Clinical Factors Associated with Severe Obesity in Adults.

BACKGROUND: In the last decades, obesity in general, including severe obesity (BMI ≥40 kg/m2), has increased disproportionately around the world, especially in low-income and lower-middle income regions. AIMS: To analyze sociodemographic and clinical characteristics of people with severe obesity in Mexico, as well as their associated factors. METHODS: A secondary analysis was carried out from the 2018-19 National Health and Nutrition Survey. Descriptive statistics and bivariate analyses by sex were used. Logistic models were estimated to identify the main factors associated with severe obesity. RESULTS: Of the total number of people with obesity in the country (2.2 million people), 3.6% had severe obesity, with an average age of 48.2. There were statistically significant differences by sex in the variables of age group, education, socioeconomic status, health insurance, hypertension, myocardial infarction, and heart failure. Being a woman, having hypertension, and hypertension/diabetes increased the odds of severe obesity. These associations were maintained when comparing people with a BMI <40 kg/m2, with those with a BMI ≥30 kg/m2 and a BMI <40 kg/m2. CONCLUSIONS: Severe obesity must appear on the Mexican political agenda. Data must be produced that can direct decision-making around the promotion of healthy lifestyles, and obesity prevention, treatment, and follow-up, based in people-centered care and through intersectoral strategies, multidisciplinary management, and holistic approaches.