HUAJUAPAN DE LEON, Mexico — The pangs were quickening when Nancy Salazar Lopez arrived at a hospital in the remote city of Huajuapan de Leon in Oaxaca one recent Sunday. She felt her baby was coming.

But doctors did a cursory check and said she wasn’t ready. They asked her to return in a few hours. She did, again and again. They kept turning her away, the last time after her water had already broken and blood dribbled down her legs.

“They said there weren’t enough doctors,” said Salazar’s mother, Jesus Ofelia Lopez Cisneros, a 47-year-old ethnic Mazatec, one of 15 major indigenous groups that live in the southern Mexican state.

Her daughter gave birth that evening on the hospital’s concrete steps, unable to gain entry. As the birth took place, a crowd gathered. The father swaddled the newborn in a cloth. A physician emerged after more than five minutes.

“They were shouting at him. They said he was an idiot, that he should help her,” Lopez said. The physician asked for forceps to clip the umbilical cord. A second doctor emerged and helped lift the mother onto a gurney.

The birth of Salazar’s child Jan. 26 on the periphery of the main state hospital here is far from unusual. Seven times since mid-2013, women have given birth on the lawns or steps of hospitals or health clinics in the states of Oaxaca and Puebla. The cases are known largely because bystanders snapped photos or took videos, and later posted images on the Internet.

The cases almost always involve darker-skinned women _ mostly indigenous, as Mexico’s native groups are known _ and they’ve laid bare the discrimination that some patients say underlies Mexico’s health-care system. A cardboard sign taped to the wall outside the General Hospital here says, “Enough of racism!” But the cases also expose shortcomings in policies that have swamped hospitals with routine pregnancies.

• MCT Campus