Claudia Díaz Olavarrieta

Estimates of induced abortion in Mexico: what's changed between 1990 and 2006?

CONTEXT In Mexico, where abortion remains largely illegal and clandestine, reliable data on induced abortion and related morbidity are critical for informing policies and programs. The only available national estimate of abortion is for 1990, and demographic and socioeconomic changes since then have likely affected abortion incidence. METHODS This study used official statistics on women treated for abortion-related complications in public hospitals in 2006 and data from a survey of informed health professionals. Indirect estimation techniques were used to calculate national and regional abortion measures, which were compared with 1990 estimates. RESULTS In 2006, an estimated 150,000 women were treated for induced abortion complications in public-sector hospitals, and one in every 5.8 women having an induced abortion were estimated to have received such treatment. The estimated total number of induced abortions in 2006 was 875,000, and the abortion rate was 33 per 1,000 women aged 15-44. Between 1990 and 2006, the abortion rate increased by 33% (from a rate of 25). The severity of morbidity due to unsafe abortion declined (as seen in shorter hospital stays), but the annual rate of hospitalization did not-it was 5.4 per 1,000 women in 1990 and 5.7 in 2006. The abortion rate was similar to the national average in three regions (34-36), but substantially lower in one (25 in the South/East region). CONCLUSIONS Clandestine abortion continues to negatively affect womens health in Mexico. Recommended responses include broadening the legal criteria for abortion throughout Mexico, improving contraceptive and postabortion services, and expanding training in the provision of safe abortion, including medical abortion.

Qualitative Evidence on Abortion Stigma from Mexico City and Five States in Mexico

Social manifestations of abortion stigma depend upon cultural, legal, and religious context. Abortion stigma in Mexico is under-researched. This study explored the sources, experiences, and consequences of stigma from the perspectives of women who had had an abortion, male partners, and members of the general population in different regional and legal contexts. We explored abortion stigma in Mexico City where abortion is legal in the first trimester and five states—Chihuahua, Chiapas, Jalisco, Oaxaca, and Yucatán—where abortion remains restricted. In each state, we conducted three focus groups—men ages 24–40 years (n = 36), women 25–40 years (n = 37), and young women ages 18–24 years (n = 27)—and four in-depth face-to-face interviews in total; two with women (n = 12) and two with the male partners of women who had had an abortion (n = 12). For 4 of the 12 women, this was their second abortion. This exploratory study suggests that abortion stigma was influenced by norms that placed a high value on motherhood and a conservative Catholic discourse. Some participants in this study described abortion as an “indelible mark” on a woman’s identity and “divine punishment” as a consequence. Perspectives encountered in Mexico City often differed from the conservative postures in the states.

Evaluating a health care provider delivered intervention to reduce intimate partner violence and mitigate associated health risks: study protocol for a randomized controlled trial in Mexico City

BackgroundIntimate partner violence (IPV) victimization is a prevalent issue among women residing in Mexico City. Comprehensive and integrated health care provider (HCP) delivered programs in clinic-settings are needed, yet few have been evaluated in Latin America, including Mexico. In addition, there has been minimal attention to interventions among lower income women presenting at settings outside of antenatal care clinics. The current randomized controlled trial seeks to increase midlevel HCPs’ capacity, specifically nurses, who are often the first point of contact in this setting, to identify women presenting at health clinics with experiences of IPV and to assist these women with health risk mitigation. Specific outcomes include changes in past-year IPV (physical and/or sexual), reproductive coercion, safety planning, use of community resources, and quality of life.Methods/DesignForty-two public health clinics in Mexico City were randomized to treatment or control clinics. Nurses meeting eligibility criteria in treatment groups received an intensive training on screening for IPV, providing supportive referrals, and assessing for health and safety risks. Nurses meeting eligibility criteria at control clinics received the standard of care which included a one-day training focused on sensitizing staff to IPV as a health issue and referral cards to give to women. Women were screened for eligibility (currently experiencing abuse in a heterosexual relationship, 18-44 years of age, non-pregnant or in first trimester) by research assistants in private areas of waiting rooms in health clinics. Consenting women completed a baseline survey and received the study protocol for that clinic. In treatment clinics, women received the nurse delivered session at baseline and received a follow-up counseling session after three months. Surveys are conducted at baseline, three months, and fifteen months from baseline.DiscussionThis study will provide important insight into whether a nurse-delivered program can assist women currently experiencing abuse in a Latin American context. Findings can be used to inform IPV programs and policies in Mexico City’s public health clinics.Trial registrationNCT01661504

Nurse versus physician-provision of early medical abortion in Mexico: a randomized controlled non-inferiority trial

Abstract Objective To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City. Methods We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self–administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7–15 days later. We did an intention-to-treat analysis for risk differences between physicians’ and nurses’ provision for completion and the need for surgical intervention. Findings Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians’ provision and 97.9% (425/434) for nurses’ provision. The risk difference between the group was 0.5% (95% confidence interval, CI: −1.2% to 2.3%). There were no differences between providers for examined gestational duration or women’s contraceptive method uptake. Both types of providers were rated by the women as highly acceptable. Conclusion Nurses’ provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.

Decriminalization of Abortion in Mexico City: The Effects on Women’s Reproductive Rights

In April 2007, the Mexico City, Mexico, legislature passed landmark legislation decriminalizing elective abortion in the first 12 weeks of pregnancy. In Mexico City, safe abortion services are now available to women through the Mexico City Ministry of Healths free public sector legal abortion program and in the private sector, and more than 89 000 legal abortions have been performed. By contrast, abortion has continued to be restricted across the Mexican states (each state makes its own abortion laws), and there has been an antichoice backlash against the legislation in 16 states. Mexico Citys abortion legislation is an important first step in improving reproductive rights, but unsafe abortions will only be eliminated if similar abortion legislation is adopted across the entire country.

Women's experiences of and perspectives on abortion at public facilities in Mexico City three years following decriminalization

To understand the experiences of women undergoing legal first‐trimester abortion through Mexico Citys Ministry of Health (MOH) services. Aims included comparing satisfaction with medical and surgical abortion services; drawing evidence‐based recommendations for program improvement; and measuring contraceptive uptake following abortion.

Use of magnesium sulfate for treatment of pre-eclampsia and eclampsia in Mexico

To establish a baseline of magnesium sulfate utilization prior to publication of the updated 2006 technical guidelines on pre‐eclampsia and eclampsia in Mexico, and to examine barriers to treating pregnant women with magnesium sulfate as perceived by maternal health experts.

Experiencias de mujeres mexicanas migrantes indocumentadas en California, Estados Unidos, en su acceso a los servicios de salud sexual y reproductiva: estudio de caso

El objetivo de este estudio fue conocer la experiencia de mujeres mexicanas migrantes en California, Estados Unidos, en torno a la utilizacion de los servicios formales de salud para resolver problemas relacionados con su salud sexual y reproductiva. El diseno fue cualitativo, con enfoque teorico metodologico de antropologia interpretativa. Las tecnicas utilizadas fueron historias de vida con mujeres usuarias de los servicios de salud en California y entrevistas breves con informantes clave. Se encontraron tres tipos de barreras principales para el acceso al sistema de salud: condicion migratoria, idioma y genero. Los tiempos de espera, actitudes discriminatorias y costo del servicio se expresaron como caracteristicas que mas incomodaron a las migrantes. La percepcion de calidad de atencion estuvo relacionada con la condicion de ilegalidad migratoria. La red de apoyo tanto en Mexico, como en California, colabora en la resolucion de enfermedades. Se debe incorporar la perspectiva intercultural en los servicios.

Intimate partner violence against low-income women in Mexico City and associations with work-related disruptions: a latent class analysis using cross-sectional data

Background Disrupting women’s employment is a strategy that abusive partners could use to prevent women from maintaining economic independence and stability. Yet, few studies have investigated disruptions in employment among victims of intimate partner violence (IPV) in low-income and middle-income countries. Moreover, even fewer have sought to identify which female victims of IPV are most vulnerable to such disruptions. Methods Using baseline data from 947 women in Mexico City enrolled in a randomised controlled trial, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Furthermore, multilevel logistic regression analyses were performed on a subsample of women reporting current work (n=572) to investigate associations between LCA membership and IPV-related employment disruptions. Results Overall, 40.6% of women who were working at the time of the survey reported some form of work-related disruption due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); High Sexual and Low Physical Violence class (9.6%); High Physical and Low Sexual Violence and Injuries (36.5%); High Physical and Sexual Violence and Injuries (14.8%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of work disruption (adjusted relative risk (ARR) 2.44, 95% CI 1.80 to 3.29; ARR 2.05, 95% CI 1.56 to 2.70, respectively). No other statistically significant associations emerged. Conclusion IPV, and specific patterns of IPV experiences, must be considered both in work settings and, more broadly, by economic development programmes. Trial registration number NCT01661504.

Experiences of undocumented Mexican migrant women when accessing sexual and reproductive health services in California, USA: a case study

To evaluate the frequency of maternal smoking in successive pregnancies and its association with repetition of low birthweight, a study was conducted of a subsample of mothers from the 2004 Pelotas Birth Cohort in Brazil. Only women with previous histories of low birthweight newborns were included. Women with ≥ 2 previous births were eligible only if at least one of the two births immediately preceding the 2004 birth had low birthweight. From 4,458 births, 565 were included in this study. Frequency of smoking was 32.4%. Considering past pregnancies, 67.1% of mothers never smoked, 21.4% smoked during all pregnancies, 6.5% were ex-smokers, and 5% smoked only during the current pregnancy. In the adjusted analyses, when compared to mothers who never smoked, those who smoked during all pregnancies had 2.5 times greater probability of low birthweight recurrence in 2004 (PR = 2.5; 95%CI: 1.32-4.80). Smoking persistence is an important factor for the recurrence of low birthweight in successive pregnancies.This study focuses on the experience of Mexican women migrants in California, USA, with the use of formal health services for sexual and reproductive health issues. The authors used a qualitative interpretative approach with life histories, interviewing eight female users of healthcare services in California and seven key informants in Mexico and California. There were three main types of barriers to healthcare: immigration status, language, and gender. Participants reported long waiting times, discriminatory attitudes, and high cost of services. A combination of formal and informal healthcare services was common. The assessment of quality of care was closely related to undocumented immigration status. Social support networks are crucial to help solve healthcare issues. Quality of care should take intercultural health issues into account.