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Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007–2015
  1. Lily T Alexander1,
  2. Evelyn Fuentes-Rivera2,
  3. Biani Saavedra-Avendaño3,
  4. Raffaela Schiavon4,
  5. Noe Maldonado Rueda5,
  6. Bernardo Hernández6,
  7. Alison L Drake1,
  8. Blair G Darney7,8
  1. 1 Department of Global Health, University of Washington, Seattle, Washington, USA
  2. 2 National Institute of Public Health (INSP), Center for Health Systems Research (CISS), Cuernavaca, Mexico
  3. 3 Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico
  4. 4 Independent Consultant, Mexico City, Mexico
  5. 5 Department of Environmental Health Exposure, Epidemiology & Risk Program, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts, USA
  6. 6 Institute for Health Metrics and Evaluation (IHME), Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
  7. 7 Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
  8. 8 Center for Population Health Research (CISP), Instituto Nacional de Salud Pública, Cuernavaca, Mexico
  1. Correspondence to Dr Blair G Darney, Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA; darneyb{at}ohsu.edu

Abstract

Background Data on utilisation of in-facility second-trimester abortion services are sparse. We describe temporal and geographical trends in utilisation of in-facility second-trimester abortion services across Mexico.

Methods We used 2007–2015 data from Mexico’s Automated Hospital Discharge System (SAEH) to identify second-trimester abortive events (ICD O02-O08) in public hospitals across Mexico’s 32 states. We described utilisation, calculated rates using population data, and used logistic regression to identify woman- and state-level factors (municipality-level marginalisation, state-level abortion law) associated with utilisation of second-trimester versus first-trimester services.

Results We identified 145 956 second-trimester abortions, or 13.4% of total documented hospitalizations for abortion between 2007 to 2015. The annual utilisation rate of second-trimester abortion remained constant, between 0.5 to 0.6 per 1000 women aged 15–44 years. Women living in highly marginalised municipalities had 1.43 higher odds of utilising abortions services in their second versus their first trimester, when compared with women in municipalities with low marginalisation (95% CI 1.18 to 1.73). Living in a state with a health or fetal anomaly exception to abortion restrictions was not associated with higher utilisation of second-trimester abortion services.

Conclusions Our results suggest there is a need for all types of second-trimester abortion services in Mexico. To improve health outcomes for Mexican women, especially the most vulnerable, access to safe second-trimester abortion services must be ensured through the implementation of current legal exceptions and renewed attention to the training of healthcare providers.

  • abortion
  • statistics
  • epidemiology
  • service delivery
  • reproductive health politics

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Funding BGD was supported by Society of Family Planning awards SFPRF11-02, SFPRF10-II2-2, R01HS025155 (Cottrell, PI), and grant number K12HS022981 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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