From marginalisation to invisibility: Adolescent pregnancy within the Mexican Ministry of Health as a structurally produced, gender-mediated, and institutionally shaped phenomenon

This thesis examines adolescent pregnancy (AP) within Mexico’s Ministry of Health (MMH) as a structurally produced, gender-regulated, and institutionally mediated phenomenon. Moving beyond individualistic explanations, it adopts a sequential explanatory mixed-methods design grounded in feminist and transformative paradigms to illuminate how AP is generated, experienced, governed, and potentially re-signified with inequitable social and health-system environments.

Chapter 1 establishes AP as embedded in intersecting inequalities—gender, age, ethnicity, and class—and shaped by fragmented sexual and reproductive health systems and weak comprehensive sexuality education. Chapter 2 synthesises global evidence from low- and middle-income countries (LMIC), revealing 82 heterogeneous measures that are related mainly to individual-level educational impact. Major domains central to feminist scholarship—violence, labour precarity, care burdens, and health-system costs—remain critically undermeasured.

Chapter 3 analyses MMH administrative datasets from 2016 to 2020, demonstrating pronounced territorial inequities: adolescent maternal deaths and obstetric events cluster in historically marginalised southern states in Mexico characterised by systemic underinvestment and fragmented care pathways. Structural data gaps—including absence of variables on violence, education, gender identity, and Indigenous status—highlight the limitations of the existing MMH information systems. Chapter 4 provides an in-depth qualitative exploration of 23 women who experienced AP, revealing pervasive violence, coercion, silence around sexuality, moralisation within clinical encounters, and reliance on gendered kinship economies. Yet participants also articulated forms of agency, resilience, and meaning-making that reflect Judith Butler’s concept of subversive re-signification.

Taken together, the integrated findings show that AP is not an isolated reproductive event but a manifestation of structural inequality. This thesis advances gender inequity scholarship, feminist public health, and mixed-methods integration by demonstrating how structural determinants, the impact of AP, and lived experiences intersect. It concludes with gender-transformative implications for policy, practice, and research aimed at re-signifying adolescents’ reproductive lives as sites of rights, dignity, and equity.