Abstract
BACKGROUND: The number of undocumented in-transit migrant women (UITMW) traveling through Mexico to the U.S. is increasing, with longer stays in Mexico. We explore how UITMW's sexual and reproductive health (SRH) needs and service utilization for these needs vary by time spent in Mexico and availability of instrumental social support. We also identify barriers to care and propose actionable steps to improve service delivery. METHODS: We conducted a sequential quantitative-qualitative mixed-methods study in Ciudad Juárez, Mexico. It includes a secondary analysis of a 2021 survey of 252 UITMW and a primary analysis of 31 stakeholder interviews in 2023, that elaborated on the survey findings. Guided by Andersen's Behavioral Model of Health Care Utilization, we performed bivariate analyses to assess SRH needs and service utilization by time spent in Mexico and instrumental social support. Multivariate logistic regression models estimated unadjusted (ORs), adjusted odds ratios (aORs), and 95% confidence intervals (95% CIs) to assess these associations and the modifying effect of instrumental social support. For the qualitative component, we applied a framework analysis structured around four key themes from the quantitative findings to contextualize results and identify barriers and actionable solutions. RESULTS: Nine in ten UITMW experienced at least one SRH need, yet only 33.6% accessed SRH services. Interviewees cited fear of organized crime, government authorities, and constant mobility as key barriers. While longer stays in Mexico were initially associated with higher SRH utilization, this was no longer significant when adjusting for covariates (aOR 1.87; 95% CI 0.83-4.19). However, among women without instrumental social support, longer stays significantly increased the odds of SRH service utilization (aOR 6.99; 95% CI 1.42-34.45). This pattern may reflect greater challenges accessing care earlier in their stay. Qualitative findings suggest that instrumental social support may facilitate service utilization by enabling childcare, sharing information, and fostering connections. CONCLUSIONS: UITMW face SRH needs and multiple barriers to care while in Mexico. Utilization is particularly challenging for UITMW who experience sexual violence and lack instrumental social support. Understanding the factors influencing the health needs and SRH utilization of UITMW can help Mexico's health system plan effective interventions.