This paper analyzes the drafting, public consultation, review, and publication of NOM-020-SSA-2025, the official Mexican standard on health facilities and the recognition of midwifery in maternal and neonatal care. Using a socio-anthropological approach, the paper examines the controversies, arguments, and institutional responses that emerged throughout the regulatory process, paying special attention to the positions of professional, traditional, and autonomous midwives, service users, civil society organizations, and public officials.

Midwifery in Mexico has been marked by tensions between community knowledge and the biomedical model. Since the mid-20th century, medicalized approaches to childbirth have displaced traditional midwives. By the end of the same century, social and human rights movements challenged this model due to obstetric violence and cultural exclusion. Since 2018, professional midwives have pushed for institutional recognition, successfully incorporating their demands into the draft standard. In contrast, traditional midwives blocked a previous draft standard through social mobilization, but their refusal to join the working group limited their influence.

The study uses actor-network theory (Latour) to trace controversies, and Toulmin’s argumentation model to analyze these controversies and examine how different actors interacted in the construction of midwifery as a regulatory object. The qualitative data analyzed in this study includes: versions of the NOM, databases with 593 official responses, comments with 1,554 arguments and 1,489 citizen proposals, a database of 694 social media observations, as well as interviews and observation.
Public participation was widespread but uneven. Only proposals aligned with the government’s legal and technical requirements (legal compatibility, administrative feasibility) were accepted. 100 percent of the comments of service users were rejected because they were considered individual experiences lacking a legal basis. Autonomous midwives secured minor modifications, but their core demands (autonomy, community governance) were rejected. Traditional midwives gained rhetorical recognition, but received no response to their demands for indigenous consultation and independent certification procedures. Civil society organizations made progress on human rights, gender, and intercultural approaches. Civil servants faced significant rejection when they proposed altering the core structure of the regulatory model.

Engaging technical groups from early stages is crucial. Public consultation favors arguments that can be translated into legal language, excluding experiential knowledge. Social mobilization brings problems to light, but does not transform policy content without sustained institutional dialogue.

NOM-020 reflects ambivalent participation: it expands formal spaces and discursively recognizes diversity, but maintains state control over validity criteria. The standard mentions, but does not fully consult; it incorporates some adjustments, but does not transform power relations. Rather than closing the debate, it opens a new phase on reproductive governance, midwifery autonomy, and justice in Mexico.