This article examines how reproductive rights in Mexico have been affected by the existence of an international reproductive rights regime. The paper argues that, in the case of maternal health, decentralization of the health care system undermined the nation-state's capacity to fulfill reproductive rights. A degree of re-centralization has taken place since 2004; however, the ability to improve the health care system has been limited by the legacy and continued influence of decentralized responsibilities. In the case of Mexico City, the decentralization of political power opened up the opportunity for feminist lobbying on abortion. However, this was only possible because of the presence of a social-democratic government; in other states, abortion rights have since been rolled back.