Factors influencing pregnant women's use of antenatal and emergency care services covered by social security: findings from the maternal eCohort in Mexico

Svetlana V. Doubova, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtemoc 330, Ciudad de México, 06720, México. svetlana.doubova@gmail.com.
Martín Paredes Cruz, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtemoc 330, Ciudad de México, 06720, México.
Diana Perez-Moran, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtemoc 330, Ciudad de México, 06720, México.
Luis Rey Cortes, OOAD Estado de México Oriente, Instituto Mexicano del Seguro Social, Estado de México, Av. Recursos Hidráulicos 2 A, Fracc. Industrial La Loma, Tlalnepantla de Baz, Mexico, 54060, México.
Gilberto Espinoza Anrubio, OOAD DF Sur. Instituto Mexicano del Seguro Social, Alcaldía Iztapalapa Ciudad de México, Calzada de la Viga No 1174, Torre B, Piso 2. Colonia El Triunfo, Alcaldía Iztapalapa Ciudad de México, 09430, México.
Claudia Elsa Ruiz, OOAD Veracruz Norte, Instituto Mexicano del Seguro Social, Lomas del Estadio s/n, Col. Centro Xalapa de Enríquez, Veracruz, 91000, Mexico.
Megan Carolina Mancillas, OOAD Coahuila, Instituto Mexicano del Seguro Social. Blvd. Venustiano Carranza, 2809. Colonia La Salle. , Saltillo, Coahuila, 25280, México.
Carlos Alberto Aguilar, OOAD Aguascalientes, Instituto Mexicano del Seguro Social, Av. Alameda 707, Colonia del trabajo, Aguascalientes, 20180, México.
Miguel Ángel Garcia, Jefatura de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Condominio Monterrey 5º. Piso. Morelos 133, Centro, Monterrey, Nuevo León, 64000, Mexico.
Augusto Sarralde Delgado, Jefatura de Servicios de Prestaciones Médicas. Coordinación Auxiliar Médica de Investigación en Salud. OOAD Jalisco, Instituto Mexicano del Seguro Social, Belisario Domínguez No. 1000. Col. Independencia , Guadalajara, Jalisco, 44340, Mexico.
Ricardo Pérez-Cuevas, Division of Social Protection and Health, Interamerican Development Bank, 1300 New York Avenue, N.W. Washington, DC, 20577, USA.
Catherine Arsenault, Department of Global Health. Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Claudio Quinzaños Fresnedo, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Colonia Roma Norte. Alcaldía Cuauhtémoc, Ciudad de México, 06700, México.

Document Type

Journal Article

Publication Date

11-4-2025

Journal

BMC pregnancy and childbirth

Volume

25

Issue

1

DOI

10.1186/s12884-025-08301-9

Keywords

Antenatal care use; Associated factors; Emergency service utilization; Mexico

Abstract

BACKGROUND: Evidence on antenatal care (ANC) and emergency service utilization during pregnancy in Latin America remains limited. Understanding these patterns is critical given the substantial benefits of ANC and emergency services in improving maternal and neonatal outcomes, preventing and managing pregnancy complications, and reducing maternal and infant mortality. This study examined ANC and emergency service utilization among pregnant women affiliated with the Mexican Institute of Social Security (IMSS) and identified factors associated with their use. METHODS: We conducted an observational eCohort study through telephone interviews with 1,390 pregnant women aged 18-49 who initiated ANC at IMSS. Outcomes included the number of ANC visits, emergency room use, perceived quality of ANC, and provider competence assessed through 12 recommended ANC activities: blood pressure and weight measurement, blood and urine tests, ultrasound, and counseling on nutrition, warning signs, birth preparedness, newborn care, psychological health, and folic acid and iron supplementation. Multivariable negative binomial regression models were used to identify factors associated with ANC attendance and emergency service use. RESULTS: Of the full cohort, 3.7% exited due to miscarriage, 12.4% dropped out after baseline, and 11.8% dropped out during follow-up. One-third of women who left rated the quality of their first ANC visit as poor or fair. In addition, 30% of women who remained in the cohort reported poor or fair ANC quality. On average, participants reported six ANC visits, with 64.8% receiving at least 80% of the 12 recommended ANC activities. Nearly 30% sought emergency services during pregnancy. Higher ANC attendance was associated with hypertension, urinary infections, anemia, early ANC initiation, consultations with obstetricians, and hospital-based ANC follow-ups. Use of emergency services was more common among women with chronic diseases, hypertensive disorders of pregnancy, urinary tract infections, risk of miscarriage, or risk of depression. CONCLUSIONS: Substantial improvements in ANC are needed to strengthen women's care experiences and promote consistent utilization of ANC services.

Department

Global Health

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