Programa de Acción Específico: Salud Sexual y Reproductiva 2020-2024

Objectives

The 2020–2024 Specific Action Programme for Sexual and Reproductive Health seeks to improve population wellbeing through universal access to technically competent, evidence-based, equitable, socioculturally relevant and non-discriminatory information and services, grounded in human rights.[1]It treats sexual and reproductive health as continuous, life-course care and aims to leave no one behind.[2][3]

• Advance adolescents’ sexual and reproductive rights through information, prevention and timely care, while supporting progressive autonomy, participation and access to adolescent-friendly services.[1][4]
• Promote chosen, protected and healthy sexuality through contraception, family planning, prevention, detection and timely care for sexual and reproductive health conditions.[1][5][6]
• Improve comprehensive, respectful and safe maternal care from before pregnancy through the puerperium, reducing maternal morbidity and mortality and addressing territorial, socioeconomic, ethnic and age-related inequalities.[1][7][8]
• Support child wellbeing through prevention, detection and care during pregnancy and the newborn period, including early newborn care, breastfeeding and metabolic screening.[1][9][10]
• Guarantee access to safe abortion information and services within the applicable legal framework, including for pregnancies resulting from sexual violence.[1][11][12]
• Prevent gender-based and sexual violence and reduce its health consequences through timely, rights-based and non-discriminatory care.[1][13][14]

The framework prioritises bodily autonomy, informed and voluntary decision-making, privacy, confidentiality, equality, gender equality, interculturality and respect for diversity.[15][16]It calls for differentiated strategies for adolescents; Indigenous, Afro-descendant and other ethnic populations; sexual and gender-diverse people; people with disabilities; migrants; people experiencing homelessness; people deprived of liberty; and communities facing poverty, exclusion or historical discrimination.[15][17][18]

Headline outcome ambitions include reducing the maternal mortality ratio from 34.6 deaths per 100,000 live births in 2018 to 31.0 by 2024, neonatal mortality from 7.73 to 6.9 per 1,000 live births, and increasing newborn metabolic-screening coverage from 83.4% to 95%.[8][19][10][20]The programme also targets increased modern contraceptive use among sexually active women aged 15–19, a lower adolescent fertility rate, greater coverage of safe abortion following sexual violence, and improved specialised violence-care and post-exposure HIV prophylaxis coverage.[21][22][23][24][25]

Implementation

Implementation combines a primary-healthcare-led public-health model with integrated care networks, community action, evidence-based clinical practice, referral pathways and inter-institutional coordination.[2][4]The programme comprises 18 priority strategies and 87 specific actions, operating through community information, education and intervention; strengthened health-sector capacity; and institutional functions requiring intersectoral collaboration.[2][4]

• Deliver education, counselling, prevention, clinical care, referral and follow-up across the life course, using culturally appropriate, person-centred and stigma-free services.[26][27]
• Strengthen adolescent services through comprehensive sexuality education, youth participation and leadership, engagement with teachers, parents, guardians and communities, and targeted action for rural and Indigenous adolescents.[4][5]
• Ensure contraceptive choice, reliable supplies, trained personnel, post-obstetric contraception, long-acting reversible methods and no-scalpel vasectomy, alongside action addressing men’s shared responsibility.[28][29][6]
• Improve maternal and newborn care through pre-pregnancy assessment, quality antenatal care, HIV and syphilis testing, respectful childbirth, obstetric-emergency response, breastfeeding support, neonatal resuscitation, screening and referral.[30][9][11]
• Expand safe abortion capacity through trained multidisciplinary teams, evidence-based pharmacological or procedural methods, quality standards, timely care, reliable registration and state-level protocols.[11][13][31]
• Strengthen prevention and response to gender-based and sexual violence through specialised services, protocols, referral routes, psychosocial and clinical care, emergency contraception, safe abortion where applicable, prophylactic medicines and antiretroviral treatment within 72 hours after sexual assault.[32][33][31]

The Ministry of Health and National Health System provide the central institutional setting, with the National Centre for Gender Equity and Reproductive Health holding key reporting and coordination responsibilities.[34][8][12]Implementation requires cooperation among federal and state health authorities, education and other public sectors, private and social organisations, academia, civil society, communities and service users.[5][14][35]States are expected to lead through medical units and complementary services, while territorialisation enables local adaptation of objectives, targets and interventions.[25][36]

Operational support includes workforce development, professional midwives and obstetric nurses, community promoters, interpreters and intercultural links, digital tools, tele-education, teleconsultation, contact centres and specialised information lines.[37][38][39]Annual work plans, supply assurance, local governance, service supervision and continuous improvement are intended to support adaptation to regional needs, emergencies and humanitarian contexts.[36][40]

Monitoring uses national and federal-entity indicators, surveillance, health-information systems, registration, committee review and periodic evaluation.[11][36]Named measures include contraceptive use, adolescent fertility, maternal and neonatal mortality, first-trimester antenatal care, newborn screening, safe abortion after sexual violence, specialised violence-care coverage and post-exposure HIV prophylaxis.[41][42][43][44][12][45][14]Programme actions, coordination, monitoring and reporting are financed from budgets assigned to participating responsible units, although no total budget, allocation or detailed costing is specified.[46]

Monitoring & Evaluation

The programme establishes a monitoring and evaluation architecture combining strategic wellbeing and management indicators, administrative records, population surveys, epidemiological surveillance, supervision, registration, committee review and territorial analysis. It assigns reporting roles primarily to the National Centre for Gender Equity and Reproductive Health and the National Population Council, while linking information use to continuous improvement, local planning, transparency and accountability.[4][14][36]

• Monitor adolescent sexual and reproductive health through modern contraceptive use among sexually active women aged 15–19, with a baseline of 57.3% in 2018 and programmed values of 59.0% in 2023 and 59.3% in 2024; the National Population Council reports this quinquennial survey-based measure.[41][21]
• Track the adolescent fertility rate annually, declining from 70.5 live births per 1,000 women aged 15–19 in 2018 towards 56.5 in 2024, with reporting responsibility shared by the National Population Council and the National Centre for Gender Equity and Health.[42][22]
• Measure modern contraceptive use among sexually active women aged 15–49, from a 72.0% baseline in 2018 to targets of 72.8% in 2023 and 73.0% in 2024, and measure modern-method demand satisfaction from 83.3% in 2018 towards 84.0% in 2024.[47][48][49][50]
• Track maternal mortality annually through maternal deaths per 100,000 live births, reducing the ratio from 34.6 in 2018 to 31.0 by 2024; use epidemiological surveillance, annual data collection and reporting by the National Centre for Gender Equity and Reproductive Health.[8][19]
• Increase first-trimester initial antenatal consultations from 36.07% in 2018 to 45.0% in 2024, using monthly measurement and national and federal-entity reporting.[51][43]
• Reduce neonatal mortality from approximately 7.7 deaths per 1,000 registered births in 2018 to 6.9 by 2024, and increase neonatal metabolic-screening coverage from 83.4% to 95%; the screening measure is monitored quarterly, disaggregated by federal entity, and reported by the National Centre for Gender Equity and Reproductive Health.[52][53][10][44][20]
• Monitor safe-abortion access following sexual violence through the proportion of women receiving a safe abortion in state health services, increasing from 19.97% in 2018 to 35% in 2024; annual reporting uses the Domestic Violence Directorate’s progress report and health-information-system data.[12][54][55][23]
• Track specialised care for women experiencing recent intimate-partner violence, from 24.12% in 2018 to 25.6% in 2024, and HIV post-exposure prophylaxis for people treated after sexual assault, from 62.57% in 2018 to 79% in 2024.[45][56][24][14][25]
• Strengthen surveillance, investigation and follow-up of severe maternal morbidity and maternal, prenatal and perinatal deaths through relevant committees, improved registration, analysis of causes and follow-up of recommendations.[7][9][11][57][58]
• Use health-information systems, birth registration, mortality databases, dynamic data cubes, survey data and official reporting formats to support analysis, while improving disaggregation for Indigenous, Afro-descendant, ethnic and other population groups.[59][60][16][61][38]
• Apply supervision of compliance with Official Mexican Standard NOM-046-SSA2-2005, monitor safe-abortion standards, and strengthen registration and evaluation of violence prevention and care.[62][63][11][13][33]
• Conduct periodic territorial assessments and annual work planning, recognising that incomplete recording and under-registration can limit identification of priority municipalities and local interventions.[36][40]

Costing & Financing

Financing is principally framed through existing public budgets, financial protection, efficient resource allocation and the need to secure supplies, equipment and qualified personnel. The programme does not provide a total cost, budget envelope, detailed allocations, quantified funding gap, additional financing source or formal economic assumptions in the supplied material.[46][64][4][35]

• Finance programme actions, inter-institutional coordination, monitoring and reporting from budgets assigned to the responsible units participating during 2020–2024.[46]
• Promote financial protection and rational, planned and transparent distribution of resources to support universal, equitable and sustainable coverage and prevent impoverishing health costs.[65][64][16]
• Establish federal institutional, regulatory and budgetary conditions for implementation, while requiring federal entities to manage expenditure appropriately, optimise resources and link annual work plans to budget allocation for priority interventions.[36][40]
• Secure contraceptive supplies, material inputs, equipment and sufficient trained human resources as implementation requirements, without assigning monetary values.[28][4][14][35]
• Recognise contraception counselling, breastfeeding and wider evidence-based sexual and reproductive health interventions as cost-effective, while noting that unsafe abortion and violence against women can generate substantial health-system and social costs.[66][67][68][69][70]
• Use professional midwifery and obstetric nursing to diversify the workforce, an approach identified as capable of reducing care and complication-related costs, although no financial estimate is provided.[39]