Unveiling the Unseen: Exploring the Complexities of Social Factors and Their Impact on Mexican Women’s Access to Healthcare and Adherence

Challenging opportunities to shape more equitable healthcare services and better patient experiences.

Illustration by Daniel Hosoya

In Pursuit of Unraveling Abstract Complexities

I wrote this article based on some of the learnings and reflections I gained from my participation as a Service Designer in various engagements related to chronic diseases. During these engagements, I had close interactions with Mexican female patients who were dealing with health conditions such as breast cancer and infertility, among others.

In the pursuit of understanding their patient experience and the main challenges they face in accessing healthcare and adhering to treatment, I delved into a complex web of factors that extend beyond biological and infrastructural limitations: social determinants of health (SDH).

SDH are defined by the World Health Organization as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”. You can refer to other definitions and diagrams with different interpretations, but in summary, these determinants encompass the social, economic, cultural, and gender-related factors that shape individuals’ health outcomes. Factors such as income, education, housing, religion, and social support influence a patient’s daily life conditions.

Model by the author. Illustration by Daniel Hosoya.

Recognizing the influence of SDH becomes increasingly important as healthcare providers strive to become more patient-centered, personalized, and value-based. By shedding light on these unseen factors, I aim to highlight the pressing need for a more comprehensive understanding of the social determinants that shape health outcomes to inform strategies that fully account for the unique social circumstances of women in Mexico (and probably other countries with a similar cultural context).

Navigating the Silent Forces Hindering Mexican Women’s Access and Adherence to Healthcare

In Mexico, women face a range of social obstacles when seeking healthcare. The context and cultural mental models established within society tend to assign women specific roles and restrictions within the family and social structures. These roles typically focus on household responsibilities, reproduction, and caregiving for children and other family members, rather than allowing women to prioritize other aspects of their lives. These constructs often influence decision-making and perpetuate gender stereotypes that marginalize women’s health.

Mexican reactive health culture also plays an important role. Limited health education and awareness about preventative measures and reproductive health, observed across different socioeconomic levels, contribute to delayed or inadequate healthcare-seeking behavior. Additionally, socioeconomic factors such as men’s migration to the US, financial constraints, and the lack of health insurance coverage further limit women’s access and adherence to healthcare services. Furthermore, geographical barriers, particularly in rural and marginalized urban areas, compound the challenge with limited healthcare infrastructure, long distances, and economic resources required for travel to obtain necessary care.

Some of the most challenging cultural barriers to reflect on, which may be intertwined among each other, are the following:

• Sociocultural norms: Cultural taboos surrounding topics such as menstruation, contraception, infertility, or mental health discourage women from openly discussing these issues and seeking necessary information, preventive measures, and adequate healthcare services in a timely manner.

“Not being able to get pregnant ‘naturally’ led my husband to ask for a divorce and made me feel that I’m not woman enough.”

• Lack of health culture: In Mexico, there is a heavy focus on curative care (reactive) rather than preventive measures such as a healthy lifestyle, routine check-ups, self-exams, and recognizing the value of health insurance (for those who can afford it). This leads to a lack of awareness of risk factors, delayed disease detection, and missed opportunities for early intervention.
• Gender disparities: Gender and modesty norms restrict women’s autonomy in decision-making regarding their healthcare or reproductive choices. Expectations of stereotypical gender roles and gender-based violence often place men as women’s ‘owners’ and primary decision-makers, resulting in women having less control over their own health choices. Such experiences limit women’s ability to seek and access healthcare services, undergo screenings, or even perform self-examinations, as they may fear stigma, judgment, or retaliation.

“No one other than my husband can see or touch my body. Not even a doctor.”

• Religious beliefs: Certain beliefs and rituals stigmatize, discourage, or delay the use of evidence-based medical care, such as contraception or reproductive health services. Additionally, religion may lead women to believe that health conditions are divine punishments for past conducts and sins or just the faith God has prepared for them, which may emphasize faith healing or spiritual practices as the primary means of addressing health concerns.

“This is what God wanted for me. Must be (breast cancer) because of my sins.”

• Financial burden and increased household responsibilities: Some women are pillars of the family structure and are required to take on additional responsibilities and become the primary breadwinners because they are single women, lack a support network, or because collective income is not sufficient. This places them under increased financial strain, stress, and increased workload, as they take on the responsibilities of earning income, managing household tasks, childcare, and elderly care. Combined with the cost of healthcare services, transportation to get services, medications, health insurance, and other complementary well-being activities, women often prioritize household responsibilities over their health.

“I’m a single mom. I can’t go to the hospital every 3 weeks for chemo because my employers won’t let me leave for extended periods. I can’t afford to lose either of my two jobs.”

• Geographical accessibility: Women living in rural or marginalized urban areas often face challenges related to long travel distances, lack of reliable transportation options, economic expenses, and time required to access appropriate healthcare services, including hospitals, clinics, medical equipment, and specialized care.
• Limited healthcare knowledge and access to technology: Limited access to accurate health information and practices, low health literacy and limited access to technology hinder women’s ability to obtain reliable and up-to-date information, understand and detect health issues and their impact timely, and optimize their healthcare management.

“I didn’t know what breast cancer was so I never imagined the lump I felt on my chest was a tumor. I thought it was a result of a punch I had received and thought it would disappear with time.”

The Quest to Tear Down the Invisible Barriers

To achieve more equitable healthcare requires increased recognition and prioritization of the SDH. However, the effects of addressing these factors may not be immediately evident, and outcomes may take time to materialize. The abstract, intangible, interconnected, interdependent, and ever-changing nature of social conditions makes them wicked problems to solve. They are accumulated constructs over the years, rooted in historical traditions, geographical location, and socioeconomic context. Therefore, it not only takes time to understand them but also requires a systemic effort to intervene.

Some initial reflections and questions we can be asking ourselves to navigate these complex challenges and analyze how we can better assist in tackling them are around the following interconnected areas:

Social sensitivity: Understanding the cultural norms, beliefs, and taboos surrounding women’s health issues from a multi-disciplinary perspective.

• How might we design healthcare services and information materials that address and challenge cultural taboos surrounding women’s health topics such as menstruation, contraception, infertility, and mental health?
• How can design and technology support women in navigating the intersection of religious beliefs and evidence-based healthcare?
• How might we create healthcare experiences that take into account religious beliefs while providing comprehensive, scientifically informed care?
• How can healthcare providers develop cultural competence and deliver care that is sensitive to the diverse cultural beliefs, values, and preferences of different communities?

Empowerment: Promoting autonomy and providing adequate support in decision-making regarding women’s health.

• What interventions can help women to overcome gender disparities in decision-making regarding their health?
• How might we create spaces and tools that promote women’s autonomy in healthcare decision-making?
• What approaches can be taken to ensure patient-centered care, involving female patients in decision-making and tailoring care plans to their specific needs and preferences?
• How can we help women stay adhered to and in control of their treatment and well-being?
• How can we influence other roles in society to enable women to take charge of their health?

Financing models: Establishing innovative models and mechanisms to address financial challenges.

• How might we alleviate the financial burden that hinders women from prioritizing their health care?
• Can we develop systems that support economic constraints and mindful distribution of responsibilities within households?
• How can public-private partnerships leverage resources from both sectors to contribute to addressing financial barriers for women?
• What initiatives can help pool resources and spread the financial burden among community/family members?
• What’s the point in developing advanced medical devices, services, and medications if women can’t adhere to their treatment because they lack economic resources, support at their jobs or families to engage with their healthcare, can’t access technology, etc.?

Health literacy and education: Providing accessible, engaging, and culturally relevant health education plans and materials to effectively convey health information, equip women with the knowledge they need, and cultivate a better health culture from a young age to help them make informed decisions and take preventive measures throughout their life cycle.

• How might design and technology interventions enhance healthcare knowledge and awareness among Mexican women?
• What initiatives can be implemented to improve health education and promotion efforts to reach diverse populations and ensure information is accessible and culturally appropriate?

Preventive health behaviors: Raising awareness about risk factors, promoting healthy lifestyles, encouraging routine check-ups and screenings, and highlighting the importance of early intervention.

• How can design and technology shift the healthcare culture in Mexico from a focus on curative care to preventive measures from younger ages?
• How might we promote preventive healthcare practices, raise awareness about the value of routine check-ups and self-exams, and integrate prevention into healthcare systems and messaging?

Accessibility facilitation: Leveraging technologies to bridge the geographical accessibility gap, considering technology literacy, to ensure access to healthcare services, education, and support, particularly for women in rural or marginalized areas.

• How might design contribute to improving geographical accessibility to healthcare services? How might we bring healthcare services and technology closer to women in rural and marginalized areas?
• What’s the point in designing advanced technology for more accurate diagnosis if women can’t even get access to primary healthcare?

Collective participation: Bringing together diverse perspectives from different disciplines and sectors to understand and address these complex challenges (designers, strategists, marketing specialists, healthcare providers, policymakers, community leaders, religious leaders, women’s advocacy groups, etc.). Collective efforts can lead to more comprehensive, effective, and sustainable solutions.

• How might our different design domains play a vital role in contributing to overcoming non-obvious, complex, and systemic problems such as cultural codes like religion, gender gap, etc.?
• What policy reforms are needed to address barriers, inequalities, and systemic issues that limit equitable access to healthcare?

A Call for Multidisciplinary Dialogue and Action

My intention in sharing these thoughts, based on my experience and personal analysis, is to invite the design community and other disciplines to use them as conversation starters for further discussion. I aim to ignite more questions and reflect on the importance of gaining a deeper understanding of a woman’s context.

Journey maps and ecosystem maps are great tools to better understand a woman’s overall experience and context in more detail. These mapping activities should not be perceived as an easy task or just a design exercise, but rather as a strategic and multidisciplinary responsibility. These types of tools help synthesize and illustrate how various factors with different levels of complexities, including the more abstract ones such as social determinants, connect and impact multiple dimensions of a woman’s patient journey, determining how and when she accesses healthcare services and conditioning her treatment adherence.

Through human-centered, multi-disciplinary, and systems thinking approaches we can leverage technology to generate strategies and solutions that are culturally sensitive, inclusive, and targeted to other actors involved in the women’s direct and indirect entourage. This would greatly contribute to overcoming these cultural barriers and help define specific actions and strategies for more equitable access to healthcare.