Public and private prenatal care providers in urban Mexico: how does their quality compare?

Objective. To evaluate variations in prenatal care quality by public and private clinical settings and by household wealth. Design. The study uses 2003 data detailing retrospective reports of 12 prenatal care procedures received that correspond to clinical guidelines. The 12 procedures are summed up, and prenatal care quality is described as the average procedures received by clinical setting, provider qualifications, and household wealth. Setting. Low-income communities in 17 states in urban Mexico. Participants. A total of 1253 women of reproductive age who received prenatal care within 1 year of the survey. Main outcome measure. The mean of the 12 prenatal care procedures received, reported as unadjusted and adjusted for individual, household, and community characteristics. Results. Women received significantly more procedures in public clinical settings [80.7, 95% confidence interval (CI) = 79.3-82.1; P <= 0.05] compared with private (60.2, 95% CI = 57.8-62.7; P <= 0.05). Within private clinical settings, an increase in household wealth is associated with an increase in procedures received. Care from medical doctors is associated with significantly more procedures (78.8, 95% CI = 77.5-80.1; P <= 0.05) compared with non-medical doctors (50.3, 95% CI = 46.7-53.9; P <= 0.05). These differences are independent of individual, household, and community characteristics that affect health-seeking behavior. Conclusions. Significant differences in prenatal care quality exist across clinical settings, provider qualifications, and household wealth in urban Mexico. Strategies to improve quality include quality reporting, training, accreditation, regulation, and franchising.