Academic journal article International Family Planning Perspectives

Comparing the Quality of Three Models of Postabortion Care in Public Hospitals in Mexico City

Academic journal article International Family Planning Perspectives

Comparing the Quality of Three Models of Postabortion Care in Public Hospitals in Mexico City

Article excerpt

CONTEXT: Each year, an estimated 120,000 women in Mexico seek treatment in public hospitals for abortion-related complications--the country's fourth leading cause of maternal mortality. Models of postabortion care emphasizing counseling and provision of contraceptives have the potential to improve the quality of care these women receive.

METHODS: Between April 1997 and August 1998, women treated for abortion complications in six Mexican Institute of Social Security (IMSS) hospitals in the Mexico City metropolitan area were surveyed. Data related to patient-provider interaction, information provision and counseling were analyzed for three models of care: sharp curettage standard care, sharp curettage postabortion care and manual vacuum aspiration postabortion care.

RESULTS: Women in the two postabortion care groups rated the quality of services they received more highly than did those receiving sharp curettage standard care. A significantly greater proportion of women treated under the postabortion care models than of those treated under the sharp curettage standard model received information about their health status before treatment, the uterine evacuation procedure, signs of postabortion complications and care at home. In addition, a greater proportion of women treated under the postabortion care models accepted a contraceptive method before leaving the facility (64-78% vs. 4096).

CONCLUSIONS: Implementation of a postabortion care model contributes to the delivery of high-quality services to women experiencing abortion complications. The standard IMSS model of postabortion treatment should be modified to emulate those in hospitals that systematically rink general counseling and family planning services to the clinical services provided to women with abortion complications.

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Women experiencing complications from a spontaneous or unsafely induced abortion have the right to receive high-quality health care services. Mexico affirmed this right with its endorsement of the 1994 International Conference on Population and Development (ICPD) Programme of Action, which recognizes unsafe abortion as a public health problem that all governments have the responsibility to address. Most important, the document states that "In all cases women should have access to quality services for the management of complications arising from abortion. Postabortion counseling, education and family planning services should be offered promptly, which will also help to avoid repeat abortions." (1)

In this article, we present the results of an operations research project carried out between April 1997 and August 1998 in six Mexican Institute of Social Security (IMSS) hospitals located in the Mexico City metropolitan area. The study examined the implementation of postabortion care as defined in the ICPD Programme of Action, using a quality of care framework (2) for the analysis. *

BACKGROUND

Abortion is the fourth leading cause of maternal mortality in Mexico, accounting for 8% of all registered maternal deaths. (3) In part, this situation reflects limited access to safe and legal abortion services. Given restrictive legislation and the small number of public health care providers and institutions that offer such services, ([dagger]) many women turn to unsafe practices and practitioners to end unwanted pregnancies. Complications of spontaneous abortions (miscarriages) that are not treated appropriately also contribute to abortion-related mortality.

Throughout Mexico, approximately 120,000 women receive abortion-related care every year in public-sector facilities. (4) In 1997, slightly more than 56,000 of these women were treated at IMSS facilities--the most women served among any of the three major social security systems in Mexico. (5 ([double dagger]))

In the IMSS system, women with abortion complications resulting from either spontaneous or induced abortion are treated in secondary- or tertiary-level hospitals. …

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