Empowering Women in Priority Attention Zones of Tijuana: A Transdisciplinary Participatory Intervention to Address Socioeconomic and Cultural Vulnerabilities and Promote Gender Equity

1. Introduction

In the ongoing global pursuit of gender equity, substantial barriers remain that restrict the empowerment and holistic development of women. This research is positioned within a critical context where gender equality transcends being an aspirational goal and emerges as an urgent requirement for sustainable development and the protection of fundamental human rights. The study zeros in on the Priority Attention Zones (ZAP) of Tijuana, regions defined by distinct socioeconomic and cultural challenges, where women are particularly vulnerable and face unique inequalities.

This research specifically targets the gender inequities that manifest as social and labor disparities within Tijuana’s Priority Attention Zones (ZAP). By employing a transdisciplinary and participatory socio-educational intervention, the study aims to strengthen the social fabric, with a focused effort on enhancing the capacities, competencies, and knowledge of women. The initiative seeks to improve women’s health and well-being within a framework of gender equality, directly addressing the specific needs and expectations of women residing in these zones.

The importance of this project is underscored by its potential to narrow gender gaps at the local level, with broader implications for advancing global gender equity. The study operates on the hypothesis that a participatory social intervention, centered on women and informed by the identification of their specific needs, can serve as an effective mechanism to improve their quality of life and foster their development. To achieve this, the research aims to conduct a comprehensive diagnosis of the needs and expectations of women in the ZAP, with the ultimate goal of designing and implementing a participatory social intervention that empowers women across various dimensions of social and economic life.

The methodology proposed for this study is both comprehensive and innovative, integrating situational analysis with the identification and delimitation of the ZAP, followed by the execution of pre-intervention diagnostics. This is further supported by the implementation and impact assessment of an intervention-action plan. This methodological framework emphasizes the necessity for public policies that prioritize improving the quality of life for women, facilitating access to education, employment, health, and security in an environment that supports their well-being and upholds their rights.

Grounded in the belief that full access to human rights is essential for achieving equality and living a dignified life, this project advocates for a holistic approach that positions public policies and these rights at its core. The project’s structure meticulously outlines each phase, from situational analysis to the evaluation of the intervention’s impact, with the dual aim of enhancing the lives of women in Tijuana’s ZAP and contributing to global knowledge and practices in the fields of social intervention and gender equity. Consequently, this study represents a significant contribution to social and political research, with the potential to influence public policies and practices both locally and nationally.

2. Addressing gender inequality through participatory social interventions in Tijuana’s Priority Attention Zones

Since 2015, the team from the Faculty of Economics and International Relations at the Autonomous University of Baja California has played a crucial role in supporting social-based microenterprises in the state of Baja California. This effort has led to the formalization of 12,000 businesses, of which 70% are led by women. The experience accumulated over these years has enabled the team to develop a robust methodology for assistance and training, which has not only been successfully implemented in these microenterprises but has also been shared in various academic forums and scientific publications [1].

The present project, titled “Social Intervention for the Pursuit of Well-being with Equity in Women Living in Priority Attention Zones,” arises from the need to address the deep gender inequalities that persist in the Priority Attention Zones (ZAP) of Tijuana. These areas, characterized by high levels of poverty and social exclusion, present unique challenges that disproportionately affect women, limiting their access to opportunities for economic, educational, and social development.

The research methodology adopted in this project is transdisciplinary and participatory, focused on identifying the specific needs and expectations of women in these zones. The objective is to design and implement public policies that not only mitigate existing inequalities but also strengthen the capacities and competencies of these women, thereby promoting their overall well-being. This approach is based on the premise that a social intervention actively involving the beneficiaries in diagnosing and solving their problems has a greater potential to generate sustainable and significant changes.

The project is structured into several stages, each with clear objectives and expected outcomes. In the first stage, the ZAPs are selected according to the criteria established by CONEVAL¹, and a detailed diagnosis is conducted on the needs and expectations of the women in these areas. This information will be used to design a social intervention that addresses economic, political, educational, cultural, social security, infrastructure, and environmental dimensions. In subsequent stages, the designed interventions will be implemented, their impact evaluated, and necessary adjustments made to improve outcomes.

Additionally, the project includes a component for the social appropriation of knowledge, aimed at ensuring that the findings and lessons learned are shared with the community, social organizations, and relevant public institutions. This will be achieved through workshops, discussion forums, and the dissemination of digital content that will enable women in the ZAPs and other social actors to understand and act on issues related to gender inequality.

In summary, this project not only seeks to improve the quality of life of women in the ZAPs of Tijuana but also to contribute to the development of more effective and equitable public policies. The successful implementation of this project has the potential to serve as a model for similar interventions in other regions, helping to close gender gaps and promoting a more just and sustainable social development.

3. Empowerment through participatory health models: A transdisciplinary perspective for women’s well-being

The literature on participatory interventions in women’s health and well-being has utilized a variety of theoretical frameworks and conceptual models to explore and understand the effectiveness and impacts of these interventions [2, 3, 4]. A critical analysis of the current literature reveals a wide range of approaches and outcomes in the field of participatory interventions in women’s health and well-being [5, 6, 7].

The diversity of approaches within the literature on participatory interventions in women’s health and well-being reflects the broad perspective and interest in the efficacy of these strategies. A notable example is the Theory of Participation and Autonomy in Health, presented by Chor et al. [8], which highlights the critical importance of women’s active participation in health programs. This theory emphasizes not only the improvement in autonomy and access to key services achieved through women’s participation but also the importance of adequate training for health personnel. Particularly in the context of post-abortion care, this approach has proven fundamental in increasing women’s satisfaction and safety in essential aspects of their reproductive health and contraceptive care, underscoring the need for policies and programs that recognize and strengthen effective and informed participation of women in their own healthcare.

Similarly, the Food Security and Nutritional Education Model presented by Ebadi-Vanestanagh et al. [9] addresses another crucial aspect of women’s health: nutrition. This model proposes that nutritional education programs, especially when tailored to the cultural realities of women, can have a significant impact on their health and food security. Both approaches underscore the critical need for public policies and programs that not only address the physical aspects of women’s health but also consider cultural and educational contexts for effective and empowering implementation.

The Food Security and Nutritional Education Model, proposed by Ebadi-Vanestanagh et al. [9], also focuses on nutrition, complements and enriches the landscape of interventions in women’s health and well-being. This model emphasizes that nutritional education programs, when adapted to the specific cultural realities of women, can play a transformative role in improving their health and food security. Like the Theory of Participation and Autonomy in Health, these strategies highlight the urgency of policies and programs that encompass not only physical aspects of health but also educational and cultural contexts for the effective empowerment of women. Similarly, Maury et al.’s [10] focus on empowerment through education emphasizes the importance of education as a means to empower women, particularly those in vulnerable situations. This model demonstrates how well-designed and focused educational interventions can induce substantial changes in dietary habits and knowledge in critical areas such as diabetes management, reaffirming the positive influence of education in strengthening women’s autonomy and well-being.

Additionally, the Social Support and Mental Health Model [11], which studies how the lack of social support can exacerbate mental health problems in older women, highlights the need to incorporate community support into the design of women-centered interventions. Like the previously mentioned models, this approach underscores the importance of considering mental and emotional well-being in the design of women-centered interventions. This approach complements previous perspectives by highlighting the need for a comprehensive approach that includes not only physical well-being but also the mental and emotional health of women. Integrating this model with nutritional education and empowerment through education approaches offers a holistic framework for the design of policies and programs. This demonstrates that to achieve true advancement in women’s well-being, it is essential to consider all facets of their lives, from nutrition and education to social support and mental health, thus recognizing the diversity and complexity of their needs.

The perspective of Ebadi-Vanestanagh et al. [9] on food security and nutritional education integrates seamlessly with Maury et al.’s [10] approach to female empowerment through education. Both models recognize the need for interventions that go beyond addressing physical health issues and also tackling educational and cultural aspects to achieve a lasting and significant impact on women’s lives. While Ebadi-Vanestanagh et al. [9] focus on how nutritional education can transform women’s health and food security, Maury et al. [10] highlight the influence of education in empowering women in vulnerable situations, such as those facing chronic illnesses. These approaches emphasize the importance of a holistic strategy in women’s health, where education acts as a fundamental pillar for empowerment and the improvement of quality of life.

The combination of these models provides a comprehensive framework for the development of women’s health and well-being policies and programs that integrate nutritional, educational, and social support aspects, highlighting the importance of addressing women’s needs in a way that recognizes and respects their complexity and diversity.

Chor et al.’s [8] proposal for training female health workers in community contexts emphasizes the importance of training health workers in communities, where they can act as agents of change, suggesting that women’s empowerment through education and training can have a multiplier effect on improving community health. This approach suggests that by training women as health workers in their communities, not only is access to health services improved, but their role as agents of change is also promoted. This training model has the potential to create a multiplier effect, where empowered women can lead and promote improvements in the health and well-being of their communities. The combination of these models and approaches provides a robust and multifaceted landscape for developing interventions and policies that comprehensively address women’s well-being, thus promoting significant change at both the individual and community levels.

This approach stands out as a progressive strategy that empowers women within their own communities. It underscores the importance of health training, not only to improve access to health services but also to promote female leadership in the health sector. By training women as health workers, they are given a vital role as agents of change, enhancing their capacity to influence and improve the health and well-being of their communities. This approach highlights the potential for significant and sustainable change in community health, driven by empowered and educated women. Integrating this model with nutritional education and social support approaches offers a comprehensive framework for addressing women’s health and well-being challenges in a community context.

In the context of Tijuana’s Priority Attention Zones (ZAP), the implementation of these models and theoretical approaches takes on special relevance. Adapting participatory interventions, nutritional education, and social support in these areas can effectively address the needs and expectations of women. By applying these theoretical frameworks, it is possible to develop and implement social interventions that not only build and strengthen women’s capacities and competencies in aspects of social and economic life but also promote their health and well-being. The practical application of these models in Tijuana has the potential to significantly improve the quality of life for women in these areas, thereby contributing to the reduction of gender inequalities in a context historically marked by vulnerability.

The synergy of these models and approaches in Tijuana’s ZAPs may be key to achieving sustainable social and health transformation. By focusing on training female health workers in the community and combining it with nutritional education and social support, a conducive environment is created for the empowerment and well-being of women. These interventions, rooted in a deep understanding of local realities and women’s needs, can establish a new standard in the development of health policies and programs. With such a comprehensive approach, it is possible not only to address immediate needs but also to build the foundations for lasting and equitable change, thus fostering a more just and healthy future for the women of Tijuana.

The application of these models and theories to Tijuana’s Priority Attention Zones is particularly relevant. By considering participatory interventions, nutritional education, and social support in these areas, the needs and expectations of women in these environments can be effectively addressed. These theoretical frameworks provide a solid foundation for developing and implementing social interventions that build and strengthen capacities and competencies in various aspects of the social and economic lives of women in Tijuana. The application of these models in policy research and development can lead to a significant improvement in these women’s quality of life and promote gender equity in a context historically marked by inequalities and vulnerabilities.

After examining the theoretical models and approaches in the literature on participatory interventions in women’s health and well-being, the importance of applying this knowledge in a practical and targeted manner becomes evident. The transition toward the proposed methodology is based on the pressing need to implement effective strategies that respond to the specific conditions and needs of women in Tijuana’s ZAPs. A deep understanding of these theories has not only illuminated the path toward more sensitive and adaptive interventions but also underscored the importance of an evidence-based approach to designing interventions that sustainably promote well-being and gender equity.

With this theoretical foundation, the next section addresses the practical application of these principles through a diagnostic tool designed to capture the complexities of the lived realities of women in the ZAPs. This methodological approach reflects a commitment to precision and relevance in research while emphasizing the active participation of affected communities in the process of identifying problems and solutions. The integration of research and practice, in this sense, becomes a critical step toward realizing interventions that are not only effective in the short term but also have the potential to generate positive and lasting change in the health and well-being of the women participating in the study.

4. Methodological proposal

This research is part of Project CF-2023-G-1287, approved by CONAHCYT under the Frontier Science 2023 Call. The initiative, titled “Social Intervention for the Pursuit of Well-being with Equity in Women Living in Priority Attention Zones,” focuses on neighborhoods identified as Priority Attention Zones (ZAP) in Tijuana, Baja California. The study was conducted using a holistic and empirical approach, aimed at designing interventions based on the specific needs and realities of women in the ZAPs, following methodological proposals that emphasize mixed methods to develop empirical research on women’s relationships with resources in vulnerable contexts [12].

Over an intensive three-month period, field teams engaged with the communities in the Priority Attention Zones on weekends, conducting a total of 250 surveys. To facilitate the participation of women in our research, weekend workshops were organized, focusing on women’s economic and social empowerment [13]. These workshops not only encouraged participation in the survey process but also served as a platform for skill development in critical areas for their empowerment and autonomy [12, 14]. Interactions during these survey sessions and workshops highlighted the need for interventions aimed at achieving tangible progress in local infrastructure and removing barriers to accessing essential services.

The methodological component of this work involved several phases. In September 2023, an intensive training workshop was held, focusing on social security, violence against women, infrastructure, and the environment. The workshop at the Faculty of Economics and International Relations of the Autonomous University of Baja California, aimed to raise awareness and prepare students for fieldwork, acknowledging the substantial barriers to accessing education and other basic services faced by many women in these communities [15]. In October 2023, field visits to the Nido de las Águilas Priority Attention Zone provided students with firsthand observation of the living conditions of women, characterized by inadequate infrastructure, such as unpaved streets and insufficient drainage systems. This reinforced the importance of prioritizing effective access to resources and comprehensive training for the target population in intervention proposals [16].

During the fieldwork sessions, students expanded their practical experience by gaining a deeper understanding of the terrain [17]. This stage focused on addressing sensitive topics, emphasizing the importance of empathetic and reflective communication for effective interaction with women in the ZAP. These interactions were crucial for the students’ learning and practical skill acquisition, highlighting the need to continuously adapt the data collection methodology [18]. To support this process, a field diary technique was implemented. The field diaries maintained by the students became a tool for reflection and analysis on field dynamics, significantly contributing to the design of more informed interventions aligned with the lived experiences of the women surveyed [19].

The responses obtained from the surveys provided vital information on the most urgent needs and expectations in terms of social promotion and development for women in the Nido de las Águilas and División del Norte neighborhoods. The objective was to structure support and technical assistance programs that effectively respond to these needs, with the aim of improving quality of life and promoting social development with gender equity [13].

The results of this applied methodology constitute a solid foundation for the formulation of public policies and programs [12, 14]. The project reflects a commitment to inclusion and equity, fostering a participatory approach that integrates the voices of affected women, their families, governmental institutions, and civil organizations in the process of improving living conditions and well-being in the ZAPs of Tijuana [13].

The database corresponding to the results of the project’s first stage represents a fundamental compendium for analyzing the socioeconomic and health conditions of women in the Priority Attention Zones. This database includes demographic information, indicators of access to health services, education, social security, and employment, as well as data on perceptions of well-being and specific obstacles faced by women in Tijuana [15].

The data collection was carried out using a mixed-methods approach involving both quantitative and qualitative techniques [18]. The central instrument was a structured survey administered to a representative sample of women in the ZAPs, selected through a stratified random sampling process. The questionnaire included closed-ended questions for quantitative data collection and open-ended sections to allow for detailed expression of personal experiences, thus providing valuable qualitative insights [17].

During the field phase, data from 250 complete surveys were collected, ensuring adequate representation of the various subpopulations within the ZAPs. Additionally, focus groups and semi-structured interviews were conducted with selected participants to delve deeper into issues that emerged as relevant in the surveys. This ethnographic approach allowed for a richer understanding of the social and cultural contexts affecting the daily lives of women [20].

The data analysis phase involved a process of cleaning and coding, followed by descriptive and inferential statistical techniques. Qualitative analysis tools such as Maxqda (Analytics Pro Student, version 24.2.0) were used to identify patterns and themes within the narrative responses [21]. This facilitated a contextualized interpretation of the quantitative data, providing a holistic view of the needs and challenges faced by women in the ZAPs.

The analysis of data collected during the project’s first phase has provided a detailed understanding of the multiple dimensions of women’s lives in the Priority Attention Zones. Through descriptive statistics, this study has explored crucial relationships between various variables that directly influence women’s well-being and autonomy. These include the type of social security and its relationship to healthcare service accessibility, the frequency of service use in the face of insurance coverage gaps, and how these conditions impact critical health-related decisions, such as attending medical appointments and purchasing medications.

The findings were reviewed in collaborative work sessions with experts in public health, social work, economics, and urban development, enriching data interpretation and informing recommendations for the second intervention stage. Critical intervention areas were identified, and pilot programs were designed, focusing on health promotion, human rights education, and economic capacity building.

The methodology applied for cross-referencing these variables was designed to identify not only existing correlations but also to delve into the underlying causes of observed inequalities. This approach enables researchers and policymakers to better understand the specific barriers women face in these areas and to design more effective interventions. By addressing issues such as depression and anxiety in relation to received treatment, and expectations regarding health policies versus social security types, this analysis highlights specific needs and areas of dissatisfaction that must be prioritized.

In the next section of the article, a detailed analysis of these variable cross-references will be presented. This discussion will focus on interpreting how existing support structures, or their absence, influence the daily lives and health decisions of women in the ZAPs. The analysis will seek to provide concrete recommendations for public policies that can effectively address the identified challenges, aiming to improve both gender equity and the quality of life for women in Tijuana. This transition from data analysis to practical recommendations underscores the project’s commitment to sustainable, evidence-based change.

Entering the discussion phase, the research findings highlight the urgency of addressing deficiencies in access to and the quality of mental health services, as well as the critical need to expand social insurance coverage. These problematic areas, identified through comprehensive analysis, underscore the interconnectedness of mental health, physical well-being, and social security in promoting a dignified and fulfilling life for women in the ZAPs. Discussing these results not only allows for a better understanding of the complexities of health inequalities in Tijuana but also serves as a call to action for policymakers, health professionals, and the community at large. Considering these findings, the importance of designing and implementing public policies and programs that effectively respond to the identified needs is emphasized, promoting a more inclusive and equitable approach to the health and well-being of women in Tijuana.

5. Health access disparities and utilization patterns: Analyzing the impact of social security coverage on women’s healthcare engagement

Delving into a detailed analysis of the data collected through this study reveals realities that demand immediate attention and well-directed strategies to address inequalities in access to and the quality of health services in the considered Priority Attention Zones (ZAP). The evidence gathered highlights critical patterns and significant challenges in the realms of mental health, social security coverage, and healthcare accessibility, which become the central focus of this discussion. This section aims to deepen the understanding of these issues and explore the implications of these findings for the development of policies and intervention programs that are not only effective but also inclusive and equitable for the women in these communities.

The variation in perceptions of healthcare accessibility, depending on the type of social security coverage, underscores the complexity of the healthcare system and the need to adopt differentiated approaches that consider the specific needs of each group of women. Similarly, the impact of a lack of insurance coverage on health-related decisions highlights a critical gap in social protection and access to essential care.

The data indicate that a large proportion of individuals with anxiety or depression have not received treatment, suggesting significant barriers to accessing mental health services. Moreover, the expectations for health services in relation to accessibility suggest that the more accessible the services, the greater the expectations in areas such as preventive care and mental health. This pattern underscores the need for policies that improve access to and the quality of mental health services, particularly in vulnerable communities.

The analysis of the impact of the lack of social security coverage reveals that the absence of this benefit leads to adverse health-related decisions, such as missing medical appointments and not purchasing medications. This underscores the critical importance of social security in facilitating access to healthcare and highlights the need to expand coverage to include the most vulnerable populations.

The analysis of Figure 1 “Comparison of Social Security Type and Perceived Accessibility of Health Services in the Study Population” offers a compelling examination of the disparities in healthcare access among women based on their type of social security coverage. This data underscores the critical role that social security plays in determining the quality and accessibility of health services, revealing both strengths and significant gaps that need to be addressed to promote healthcare equity.

Figure 1 reveals that women covered by the Mexican Social Security Institute (IMSS) generally report better access to health services, with a considerable proportion finding these services either “Accessible” or “Very Accessible.” This pattern suggests that IMSS provides a relatively robust healthcare infrastructure and perhaps clearer communication regarding the services available to its affiliates. However, the presence of a significant number of IMSS beneficiaries who find health services “Not Accessible” or “Little Accessible” highlights persistent systemic issues within the IMSS framework. These challenges might include bureaucratic inefficiencies, uneven service distribution, or regional disparities in healthcare infrastructure that continue to hinder equitable access to care for all IMSS beneficiaries.

In contrast, the perception of healthcare accessibility among women covered by IMSS-Bienestar (formerly Seguro Popular) is notably less favorable. A larger proportion of respondents in this group report difficulties in accessing health services, which points to potential deficiencies in the reach and quality of the services provided under this program. The lower accessibility could be attributed to a range of factors, including inadequate healthcare infrastructure, insufficient service coverage, and administrative barriers that disproportionately affect the most vulnerable populations who rely on public health programs. This finding is particularly concerning, as it underscores the need for targeted improvements within IMSS-Bienestar to ensure that its services meet the needs of all beneficiaries effectively.

The data also starkly contrasts the experiences of women with and without social security coverage. Those without any form of social security overwhelmingly report that health services are either “Not Accessible” or “Little Accessible.” This disparity highlights a significant equity gap in healthcare access, where the absence of social security exacerbates existing barriers to essential health services. The findings reinforce the critical role that social security plays in mitigating these barriers and ensuring that healthcare is a universal right, rather than a privilege tied to employment or socioeconomic status.

Given these insights, policy interventions must be tailored to address the specific challenges faced by different groups. For IMSS, while the data suggests that it provides relatively better access to healthcare, there is still a need to streamline services and address the specific pain points that lead to reports of inaccessibility. This might involve improving communication strategies, simplifying bureaucratic processes, and expanding service availability in underserved regions to ensure that all beneficiaries can fully exercise their healthcare rights.

For IMSS-Bienestar, the data indicates a more urgent need for systemic reforms. With a significant proportion of its beneficiaries perceiving services as inaccessible, policy efforts should focus on strengthening the program’s infrastructure, enhancing the quality and availability of services, and ensuring that beneficiaries are well-informed about how to access these services. Addressing these issues will be crucial for improving the effectiveness of IMSS-Bienestar and ensuring that it meets the healthcare needs of its diverse beneficiary base.

The analysis also underscores the necessity of expanding social security coverage to include the uninsured. The stark differences in accessibility perceptions between those with and without social security highlight the urgent need for innovative solutions that can bridge the access gap. Community-based health programs, mobile clinics, and partnerships with non-governmental organizations could play a vital role in providing essential services to uninsured populations. These efforts should be accompanied by advocacy for broader systemic reforms aimed at achieving universal health coverage, thereby ensuring that no one is left without access to the healthcare they need.

Figure 2 titled “Impact of Insurance Coverage on Frequency of Health Service Use Among Respondents” provides a compelling visual representation of the profound impact that social security coverage has on healthcare utilization among women. The data clearly illustrates that women who possess social security are more likely to access health services regularly, engage in preventive care, and maintain ongoing management of health conditions. This proactive approach to healthcare is essential for early detection and treatment, leading to better health outcomes and a reduction in the long-term costs associated with untreated conditions.

In contrast, Figure 2 reveals a starkly different pattern among women without social security coverage. This group predominantly utilizes health services only when necessary, indicating a reactive rather than preventive approach to healthcare. Such behavior is often driven by financial constraints and the high out-of-pocket costs associated with uninsured healthcare visits. The reactive use of health services suggests that these women are more likely to delay care until their health issues become severe, increasing the risk of complications and more intensive, costly treatments. This pattern not only underscores the vulnerability of uninsured populations but also highlights the critical role that social security plays in enabling regular access to necessary healthcare services.

The disparities in healthcare access between insured and uninsured women are particularly concerning. The data clearly indicates that women with social security are better equipped to manage their health proactively, while those without coverage face significant barriers that limit their ability to access even basic healthcare. These disparities exacerbate existing health inequities and contribute to the overall burden on the healthcare system, particularly when preventable conditions go untreated due to lack of access.

Given these findings, there are significant policy implications. Expanding social security coverage to include all women, particularly those in marginalized communities, is essential for promoting equitable access to healthcare. Such expansion would likely result in more regular and preventive use of health services, improving health outcomes and reducing long-term healthcare costs. Moreover, public health initiatives should aim to educate uninsured populations about the importance of regular healthcare visits and the benefits of preventive care, even in the absence of insurance.

Furthermore, addressing the financial, geographic, and organizational barriers that prevent uninsured women from accessing healthcare is crucial. Innovative solutions such as mobile health clinics, community health workers, and subsidized healthcare services could help bridge these gaps, ensuring that all women could engage in proactive health management.

Figure 3 titled “Effect of Lack of Social Security Coverage on Health-Related Decisions” provides a stark illustration of the significant impact that the absence of social security coverage has on women’s healthcare decisions. The data presented in the chart reveals troubling trends that highlight the barriers faced by uninsured women, which ultimately affect their ability to maintain their health and well-being.

A critical observation from Figure 3 is that a substantial number of respondents did not attend medical appointments due to the lack of social security coverage. This decision, driven likely by financial constraints and the perceived or real cost of healthcare without insurance, is particularly concerning because it directly impedes early detection and timely treatment of health conditions. Skipping medical appointments can lead to the progression of untreated diseases, which not only compromises the health of these women but also increases the likelihood of more severe health complications in the future.

The chart further indicates that the absence of social security coverage has led many women to postpone medical appointments and delay necessary treatments. These delays can exacerbate treatable conditions, leading to poorer health outcomes and potentially requiring more intensive and expensive medical interventions later. Additionally, the decision to forgo purchasing necessary medications, as indicated by the chart, is another critical issue. Medication non-adherence can result in the deterioration of chronic conditions, reduce the effectiveness of treatment plans, and increase the risk of hospitalizations and emergency care visits.

The data presented underscores the multifaceted impact of lacking social security coverage on health-related decision-making. The choices to cancel or delay care, avoid purchasing medications, and skip medical appointments reflect broader systemic issues, including the inaccessibility of affordable healthcare services for uninsured populations. These trends are indicative of the broader public health implications, where the absence of social security coverage not only affects individual health outcomes but also places a greater strain on the healthcare system as untreated conditions escalate into emergencies.

Given these findings, the necessity for policy interventions becomes apparent. Expanding social security coverage to ensure that all women have access to affordable healthcare services is crucial. Such expansion would help mitigate the financial barriers that currently lead to the avoidance of necessary care. Moreover, public health campaigns should focus on educating women about the importance of regular medical care and adherence to prescribed treatments, even in the absence of social security. Providing information on available financial assistance programs and community health resources could help alleviate some of the burdens faced by uninsured women.

Figure 4 titled “Treatment Types Received by Individuals with Anxiety/Depression” provides a clear visual representation of a significant gap in the accessibility and utilization of mental health services. The data starkly illustrates that most individuals who report symptoms of anxiety or depression have not received any form of treatment. This is a deeply concerning finding, as untreated mental health conditions can lead to severe and long-lasting consequences, not only for the individuals affected but also for their families and communities.

The overwhelming proportion of respondents who indicate that they have not received treatment suggests several underlying issues. First, there may be substantial barriers to accessing mental health services, such as financial constraints, a lack of available services, or long waiting times. Additionally, this finding could reflect a lack of awareness or understanding of mental health issues and the importance of seeking treatment. Cultural factors and stigma associated with mental health may also play a significant role, deterring individuals from pursuing the help they need.

Figure 4 also shows that among those who have received treatment, therapy is slightly more common than medication. This could indicate a preference for therapeutic interventions or greater availability of counseling services compared to pharmacological options. It might also reflect a broader trend toward holistic approaches in managing mental health, where talking therapies are valued for their focus on addressing underlying psychological issues rather than just alleviating symptoms.

However, the relatively low numbers of individuals receiving either therapy or medication highlight a critical underutilization of established treatment methods. This underutilization points to a disconnect between the availability of these services and their uptake, potentially due to issues such as inadequate mental health literacy, concerns about the side effects of medication, or the perceived ineffectiveness of therapy.

The presence of a significant “No Response” category further complicates the analysis, as it may suggest a lack of awareness about the available treatment options or reluctance to disclose personal information related to mental health. The stigma surrounding mental health conditions may lead to underreporting, which in turn makes it challenging to fully understand the extent of unmet treatment needs within the population.

This chart underscores the urgent need for comprehensive strategies to address the mental health treatment gap. Policymakers and healthcare providers must focus on improving access to mental health services by reducing financial barriers, expanding the availability of mental health professionals, and integrating mental health services into primary care settings. Additionally, public health campaigns should aim to raise awareness about the importance of mental health care and reduce the stigma associated with seeking treatment.

Figure 5 titled “Health Topics Expectations According to Social Security Type” provides a nuanced view of how women’s health expectations vary depending on their type of social security coverage. This visualization reveals critical insights that can inform the design and implementation of targeted health interventions in the community.

The data indicates that regardless of the specific social security coverage, women universally express strong expectations for comprehensive reproductive health programs, preventive care, and access to medications and treatments. This broad demand suggests that existing health services might not be fully addressing the needs of women in these areas. For women with social security, such as those covered by IMSS and Seguro Popular, these expectations highlight the potential gaps in service delivery, particularly in reproductive health and preventive care. It is crucial for healthcare providers and policymakers to recognize these gaps and work toward enhancing the availability and quality of these services to meet the needs of their beneficiaries effectively.

A particularly noteworthy observation is that women without social security demonstrate a heightened concern for mental health services. This concern likely reflects significant barriers to accessing mental health care, including financial limitations, lack of service availability, and perhaps a greater burden of mental health issues within this group due to socioeconomic stressors. The strong emphasis on mental health among uninsured women underscores the urgent need for mental health services to be integrated into community health programs, especially in underserved areas. The inclusion of mental health care and counseling services in these programs could play a pivotal role in improving the overall well-being of women who lack social security.

Moreover, Figure 5 shows that women across different types of social security coverage, including those under ISSSTE and IMSS, also express concerns about chronic conditions and disabilities. This indicates a broader need for health systems to prioritize long-term care management and support for chronic illnesses. The presence of these concerns across various social security types suggests that current healthcare provisions may not be sufficiently addressing the complexities of managing chronic conditions, which require continuous and specialized care.

The “No Response” category also merits attention, as it may reflect a lack of awareness or reluctance to engage with certain aspects of healthcare. This could indicate the need for improved health literacy and more effective communication strategies to ensure that women fully understand the health services available to them and feel empowered to utilize these services.

Overall, the chart highlights the critical importance of designing a multifaceted intervention strategy that addresses the specific needs and expectations of women based on their social security status. For women without social security, expanding access to mental health services and ensuring coverage for chronic conditions should be a priority. For those with social security, efforts should focus on closing the gaps in reproductive health and preventive care, as well as enhancing the quality of services related to chronic disease management.

Figure 6 titled “Health Care Expectations in Relation to Frequency of Health Service Use” provides an intricate view of how different health care expectations align with the frequency of service utilization among women. This visualization is crucial in understanding not only the demands placed on the healthcare system but also the behaviors and challenges women face in accessing necessary services.

A notable observation from Figure 6 is that across various healthcare expectation types—whether it be mental health, reproductive health programs, medication and treatment, preventive care, or care for chronic conditions—there is a consistent pattern of service underutilization. Many women appear to access services infrequently, with significant portions of respondents using services only when necessary or not at all. This pattern suggests that barriers such as financial constraints, lack of availability, or possibly even a lack of perceived need could be influencing the irregular use of health services.

Moreover, the “No Response” category present across all health expectation types indicates a potential gap in awareness or a reluctance to disclose information about health service use. This could stem from stigma, especially in areas such as mental health, or from a lack of engagement with the healthcare system altogether. The presence of this category across various expectations suggests that public health initiatives might need to focus more on outreach and education to ensure that women are both aware of and able to access the services they need.

Figure 6 also highlights the concerning trend of minimal service use for critical areas such as mental health and chronic conditions. These areas, which typically require ongoing and consistent care, are underrepresented in terms of frequent service utilization. This underuse is troubling, as it may lead to worsening conditions and higher long-term healthcare costs due to the need for more intensive interventions later.

Interestingly, the overall distribution of service use shows that while there is a segment of women who use services more than once every three months, this group is relatively small compared to those who use services infrequently or not at all. This disparity reinforces the idea that there are significant barriers to consistent healthcare access and that these barriers must be addressed to improve health outcomes.

The alignment between healthcare expectations and actual service use reveals a critical disconnect. Women have clear expectations for comprehensive care across various domains, yet the frequency with which they utilize these services does not meet these expectations. This disconnect points to the need for targeted interventions that not only expand access to healthcare but also encourage regular and proactive engagement with health services.

The data collected within this project reveals significant patterns in healthcare access and utilization among women, particularly concerning the disparities associated with social security coverage. The findings indicate that women with social security are more likely to engage in regular and preventive healthcare practices, whereas those without coverage tend to seek medical attention only when necessary. This difference suggests that social security plays a crucial role in enabling consistent access to healthcare services, which is essential for early detection and management of health conditions. The data highlights the importance of understanding how social security influences health behaviors and access to services, which is critical for informing public health policies.

Additionally, the data uncovers the varied health expectations among women based on their social security status. Regardless of the type of coverage, there is a notable demand for comprehensive reproductive health programs, preventive care, and access to medications and treatments. However, women without social security coverage express a heightened concern for mental health services, indicating a potential gap in the availability or accessibility of these services for uninsured populations. This finding points to the need for targeted interventions that address both the coverage and quality of health services, particularly in underserved communities where mental health care appears to be a significant unmet need.

The project also reveals a broader trend of underutilization of health services, even among women with social security coverage, which may reflect barriers beyond financial constraints, such as geographical access, awareness, and cultural factors. The presence of a substantial “No Response” category in the data suggests gaps in health literacy or a reluctance to engage with the healthcare system, which could be driven by stigma or mistrust. These results underscore the complexity of healthcare access and the need for multifaceted public policy approaches that not only expand coverage but also address the underlying factors that influence healthcare utilization.

6. Conclusions

The study’s conclusions underscore the significant implications that the critical findings of this research have for the design of future policies and practices. A notable proportion of individuals with anxiety or depression have not received treatment, indicating substantial barriers to accessing mental health care. This highlights an urgent need to develop policies that not only improve the availability but also the quality of mental health services, particularly for vulnerable populations.

The relationship between social security coverage and health-related decisions emphasizes the pivotal role of social security as a key facilitator of access to medical care. The absence of coverage is associated with the avoidance of medical appointments and the purchase of medications, underscoring the need for an expansion of coverage that is inclusive of the most vulnerable segments of the population.

Social security coverage emerges as a fundamental factor affecting both the frequency of healthcare utilization and health-related decisions. Insufficient coverage leads to adverse consequences such as missed medical appointments and the inability to purchase necessary medications. The importance of expanding insurance coverage to include the most vulnerable is evident, and future policies should advocate for universal health coverage that enables access to essential services without the barrier of cost.

The perception of healthcare accessibility varies significantly between women affiliated with IMSS and those covered by Seguro Popular (now IMSS-Bienestar), with the latter group reporting more difficulties. This underscores the need for differentiated policies that consider the type of social security coverage and seek to strengthen women’s capacity to navigate the social security system, as well as improve the infrastructure and processes of healthcare services.

The implications for future research include the need for more in-depth studies on the barriers to accessing and utilizing mental health services, as well as the effects of different types of insurance coverage on healthcare accessibility. Future practices should focus on developing interventions that enhance the accessibility, quality, and communication of healthcare services, and on promoting mental health education and preventive care.

In terms of limitations, the study faced challenges in collecting detailed responses regarding the use of mental health services due to the stigma associated with these issues, suggesting the need for awareness-raising and destigmatization strategies in future research and practice. Additionally, the self-selection of respondents and differences in the interpretation of accessibility may have influenced the results, indicating the need for more robust methodological approaches to fully understand the complexity of these issues.

Finally, the research underscores the importance of community intervention and the active participation of women in the design of health policies and programs that respond to their needs and expectations. The implementation of well-informed interventions and policies based on these findings can lead to significant improvements in the quality of life for women and advance toward greater health equity.