Social manifestations of abortion stigma depend upon cultural, legal, and religious context. Abortion stigma in Mexico is under-researched. This study explored the sources, experiences, and consequences of stigma from the perspectives of women who had had an abortion, male partners, and members of the general population in different regional and legal contexts. We explored abortion stigma in Mexico City where abortion is legal in the first trimester and five states-Chihuahua, Chiapas, Jalisco, Oaxaca, and Yucatán-where abortion remains restricted. In each state, we conducted three focus groups-men ages 24-40 years (n = 36), women 25-40 years (n = 37), and young women ages 18-24 years (n = 27)-and four in-depth face-to-face interviews in total; two with women (n = 12) and two with the male partners of women who had had an abortion (n = 12). For 4 of the 12 women, this was their second abortion. This exploratory study suggests that abortion stigma was influenced by norms that placed a high value on motherhood and a conservative Catholic discourse. Some participants in this study described abortion as an "indelible mark" on a woman's identity and "divine punishment" as a consequence. Perspectives encountered in Mexico City often differed from the conservative postures in the states.

BackgroundIn 2003, Mexico’s Seguro Popular de Salud (SPS), was launched as an innovative financial mechanism implemented to channel new funds to provide health insurance to 50 million Mexicans and to reduce systemic financial inequities. The objective of this article is to understand the complexity and dynamics that contributed to the adaptation of the policy in the implementation stage, how these changes occurred, and why, from a complex and adaptive systems perspective.MethodsA complex adaptive systems (CAS) framework was used to carry out a secondary analysis of data obtained from four SPS’s implementation evaluations. We first identified key actors, their roles, incentives and power, and their responses to the policy and guidelines. We then developed a causal loop diagram to disentangle the feedback dynamics associated with the modifications of the policy implementation which we then analyzed using a CAS perspective.ResultsImplementation variations were identified in seven core design features during the first 10 years of implementation period, and in each case, the SPS’s central coordination introduced modifications in response to the reactions of the different actors. We identified several CAS phenomena associated with these changes including phase transitions, network emergence, resistance to change, history dependence, and feedback loops.ConclusionsOur findings generate valuable lessons to policy implementation processes, especially those involving a monetary component, where the emergence of coping mechanisms and other CAS phenomena inevitably lead to modifications of policies and their interpretation by those who implement them. These include the difficulty of implementing strategies that aim to pool funds through solidarity among beneficiaries where the rich support the poor when there are no incentives for the rich to do so. Also, how resistance to change and history dependence can pose significant challenges to implementing changes, where the local actors use their significant power to oppose or modify these changes.

The implications of results in the care of ill and disabled populations are highly relevant for the future of the Mexican health care system. Population aging and the increase of chronic diseases call for a reinforced relationship between institutional and household care so as to complement capacities, a situation already taking place in other countries.

Objetivo. Identificar la percepción de los usuarios de los servicios de salud ambulatorios en México sobre la calidad de atención y los factores asociados con dicha percepción. Material y métodos. De los datos obtenidos por las Encuestas Nacionales de Salud y Nutrición 2006 y 2012 se analizó la percepción de la atención recibida y de mejoría en salud después de la atención; se elaboró un modelo multivariado para identificar los factores de los servicios asociados con la percepción de mejoría. Resultados. La buena percepción de atención se elevó de 82 a 85%, y la de mejoría del estado de salud, de 79 a 81%, entre los años 2006 y 2012. La explicación sobre la enfermedad y tratamiento, la consulta sin cita previa, la oportunidad de elegir el servicio de salud y menor tiempo de espera se asociaron con la percepción de mejoría. Conclusiones. Existen avances en la calidad de atención percibida en la atención ambulatoria en México. Es necesario fortalecer estrategias organizacionales para brindar atención con mayor oportunidad y responder a las expectativas de los usuarios.

opportunities for the regulation of food and beverage advertising to children in Mexico. Salud Publica Mex 2014;56 suppl 2:S123-S129. AbstractObjective. To identify barriers and opportunities for the regulation of food and beverage advertising to children. Materials and methods. A qualitative study. Fourteen key informants from the congress, private sector, officials from the ministry of health and academics involved in the issue of regulation of advertising were interviewed. Results. Barriers identified: conception of obesity as an individual problem, minimization of the negative effects on health, definition of the vulnerability of children bounded to their cognitive development. Facilitators support from various sectors of society regulation, extensive scientific discussion on the subject, successful experience and its lessons on tabacco industry. Conclusion. Mexico has key elements for achieving effective regulation on advertising.

ObjectiveThis study aimed to describe the ways social support works in the daily life of patients with type 2 diabetes living in conditions of social and economic marginality, in order to understand how that support relates to treatment compliance.MethodsSequential mixed methods research was used. The sample of patients was obtained from primary health care units and selected considering regional representativeness, and levels of morbidity and mortality for type 2 diabetes.ResultsResults point to the nuclear family as the main source of support. Regardless of the area of residence, four main dimensions of support were identified: economic support, help with treatment compliance, emotional support, and material aid.ConclusionsWe conclude that the support network assists the patient in different ways and helps cope with the disease, but in conditions of social and economic marginality, does not guarantee the quality of attention nor enable the self-management of treatment.

Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

OBJECTIVE:This article describes the experience of the aval ciudadano "Citizens' Representative" (CR) in improving the Mexican health care system. METHODS:This is a qualitative study which took place in eight Mexican states in 2008. It evaluates different aspects of a nationwide program to increase the quality of health care services (National Crusade for Quality in Health Services). The Mexican strategy is compared with experiences in other Latin American countries. RESULTS:In this paper, there is the description of achievements and problems encountered by the CR in promoting social participation in the health of the population. CONCLUSIONS:The CR has great infl uence when representing health service users and passing on their demands for improvements to health care quality. Social participation in health services Nigenda-López GH et al DESCRIPTORS: