Beyond a conventional analysis of supply and demand: the Ecuadorian process of universal healthcare, the development of an ‘intercultural project’, and its gaps in maternal health

The research aimed to identify and seek an explanation for the gaps between the state provisioning of maternal healthcare and the needs of the female population from various ethnic groups, in a context of both health universalism and the development of an intercultural project for 2007-2017. Taking an innovative approach of mixed methods and using primary data from interviews of ethnic minority users, health practitioners, and the CSO, and secondary data from national statistics, budget information, and data set surveys, it shows that despite investment and legal reforms, there remain vital unaddressed aspects that jeopardise access to the public system. The gaps include the lack of coverage of hidden and opportunity costs, legal reforms, and concrete provision issues that make women choose between their ancestral practices and the public free of charge services. It concludes that both universalism and intercultural processes are fragmented and limited, shaped by the interactions of economic, cultural, and structural factors, and follow historical paths resulting in constraining the use of public facilities and thus, it is proposed to re-think the policy and call for future research.