The World Health Organization emphasizes the importance of at least eight antenatal contacts to improve maternal and fetal outcomes. Yet, women in socially excluded or economically precarious urban zones often receive fragmented or delayed prenatal care, contributing to increased perinatal risk. In Latin America, structural inequality, limited access to healthcare facilities, and social stigmatization exacerbate this situation.

This study investigates the relationship between social determinants of health and prenatal care adherence, with a focus on institutional trust and socioeconomic barriers. The analysis builds upon previous research in reproductive health equity and contributes new insights into how community-level interventions can be designed to overcome systemic obstacles in perinatal medicine.

This observational study applied a quantitative, cross-sectional design. A purposive sample of 420 pregnant women aged 18–40 was recruited between January and May 2025 from public health centers in Iztapalapa and Gustavo A. Madero, two of Mexico City's most densely populated municipalities

Instruments

• A validated 26-item questionnaire on prenatal care adherence (α = 0.84
• A 12-item scale measuring perceived institutional trust (α = 0.81)
• Sociodemographic data form

Statistical analysis was conducted using SPSS 28.0. Descriptive statistics, chi-square tests, and logistic regression models were applied to examine associations and predictive variables.

Table 1: Socioeconomic Profile of Participants (N = 420).

Table 2: Predictors of Non-Adherence to Prenatal Visits.

Interview Excerpt (Translated)

"I didn’t go to my appointment because they always treat you bad at the clinic. They don’t explain anything, and sometimes they just scold you for being late or poor." (Pregnant woman, Iztapalapa).

The results confirm that social determinants significantly influence whether women attend prenatal consultations, regardless of medical need or geographic accessibility. Institutional trust emerged as the most salient factor, followed by education and housing stability. These findings echo international literature that underscores the relational and perceptual dimensions of healthcare utilization in under-resourced settings.

Importantly, the evidence suggests that improving physical access to clinics is not sufficient. Respectful, patient-centered care and culturally sensitive communication can mediate some of the trust deficits observed in public health systems. Community-based doulas, mobile prenatal units, and integrated health-literacy programs are potential strategies to mitigate barriers.

Adherence to prenatal care is not solely a clinical or behavioral issue but is deeply rooted in broader social structures. Effective maternal-fetal health strategies must address institutional trust, social exclusion, and health inequities. Future research should explore interventions that blend medical services with psychosocial and legal support in urban peripheries.

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