Evidence map›Paper›PMID 42351120›Full record

ArticleInternational journal for equity in health2026

Heterogeneous income gradients in early motherhood in Mexico: a population-based multi-method study, 2000-2020.

Edson Serván-Mori, Alejandro Zamudio-Sosa, Lucio Esposito, Gabriela Sandoval-Moreno, H Xavier Jara, Daniella Medeiros Cavalcanti, Ana L Moncayo, Davide Rasella, Carlos Chivardi

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Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Edson Serván-Mori *Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.ORCID http://orcid.org/0000-0001-9820-8325
Alejandro Zamudio-Sosa *Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.ORCID http://orcid.org/0000-0002-3902-5585
Lucio EspositoUniversidad Icesi, Cali, Colombia.ORCID http://orcid.org/0000-0003-3497-7517
Gabriela Sandoval-MorenoCentro de Investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.ORCID http://orcid.org/0000-0002-1056-7006
H Xavier JaraLondon School of Economics and Political Science, London, UK.ORCID http://orcid.org/0000-0001-6648-2653
Daniella Medeiros CavalcantiThe Institute of Collective Health, Federal University of Bahia, Bahia, Brazil.ORCID http://orcid.org/0000-0002-0801-9844
Ana L MoncayoCentro de Investigación para la Salud en América Latina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.ORCID http://orcid.org/0000-0003-3592-7503
Davide RasellaThe Institute of Collective Health, Federal University of Bahia, Bahia, Brazil.ORCID http://orcid.org/0000-0002-7260-4386
Carlos ChivardiCentre for Health Economics, University of York, York, YO10 5DD, UK. carlos.chivardi@york.ac.uk.ORCID http://orcid.org/0000-0003-0470-3371

Funding

Medical Research Council (MRC), UK Research and Innovation (UKRI) MR/Y004884/1
6 · The paper itself

Abstract

backgroundEarly motherhood remains a major public health and equity challenge in low- and middle-income countries, especially in Latin America. While poverty, education, gender norms, and barriers to sexual and reproductive health are well-established determinants, how household income translates into (or fails to translate into) delayed childbearing remains insufficiently understood-particularly in highly unequal settings marked by informality and fragmented social protection.

objectiveTo examine the association between household income and early motherhood in Mexico, and to disentangle direct and indirect socioeconomic pathways linking income to early childbearing.

methodsWe conducted a population-based, multi-method analysis using harmonised municipal microdata from the 2000, 2010, and 2020 Mexican Population and Housing Censuses (n = 3.05 million women aged 12-24 years, representing 30.6 million individuals). Total household income was imputed using Quantile Random Forests trained on nationally representative income-expenditure surveys. Our analytical strategy combined: (1) machine learning models to identify key correlates and non-linear individual-level patterns of early motherhood; (2) Bayesian spatial models (INLA) to quantify subnational clustering and contextual heterogeneity; and (3) dynamic structural equation modelling to assess direct and lagged relationships among income, schooling-related indicators, union formation, and early motherhood outcomes.

resultsEarly motherhood prevalence declined modestly from 21.46% (2000) to 19.31% (2020) and remained concentrated in socioeconomically disadvantaged households. In individual-level models, marital status, age, household structure, and dependency ratio were the dominant correlates; income ranked eighth in feature importance. Partial dependence plots indicated a non-linear inverse L-shaped association: predicted risk increased up to approximately Int$ 1,760 (2018 PPP) per adult equivalent, then plateaued and declined slightly. Parity-specific models showed that income's predictive relevance weakened with higher parity, with U-shaped patterns at the lowest income levels for second and ≥third births. Municipal analyses revealed persistent spatial clustering after adjustment for key predictors, and residual "place" effects consistent with unmeasured contextual constraints shaping early motherhood. In dynamic models, the direct income-early motherhood path was not statistically significant. Overall patterns were consistent with predominantly indirect linkages operating through schooling- and union-related indicators and reinforcing disadvantage dynamics at the municipal level.

conclusionsIn Mexico, early motherhood remains strongly shaped by intersecting social and territorial inequalities. Income gradients are modest and appear to operate mainly through schooling lag and union-formation pathways rather than as an isolated driver. Equity-oriented strategies are likely to be most effective when they integrate school retention, prevention of early unions, and youth-friendly sexual and reproductive health services, prioritising municipalities with persistently elevated risk.

Indexed as

IncomeMaternal AgeMothersAdolescentChildFemaleHumansLow Socioeconomic StatusMexicoPregnancySocioeconomic Disparities in HealthSocioeconomic FactorsYoung AdultEarly motherhoodHousehold incomeMexicoReproductive health inequitiesSocial determinantsSocial protection fragmentation

Identifiers

PMID42351120
PMCPMC13587288

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.