Academic journal article International Perspectives on Sexual and Reproductive Health

Clients' Perceptions of the Quality of Care in Mexico City's Public-Sector Legal Abortion Program

Academic journal article International Perspectives on Sexual and Reproductive Health

Clients' Perceptions of the Quality of Care in Mexico City's Public-Sector Legal Abortion Program

Article excerpt

CONTEXT: In 2007, first-trimester abortion was legalized in Mexico City. Limited research has been conducted to understand clients' perceptions of the abortion services available in public-sector facilities.

METHODS: Perceptions of quality of care were measured among 402 women aged 7 8 or older who had obtained abortions at any of three public-sector sites in Mexico City in 2009. Six domains of quality of care (client-staff interaction, information provision, technical competence, postabortion contraceptive services, accessibility and the facility environment) were assessed, and ordinal logistic regression analysis was conducted to identify the domains that were important in women's overall evaluation of care.

RESULTS: Clients gave overall services a high rating, with a mean of 8.8 out of 7 0. In multivariate analysis, overall ratings were higher among women who said the doctor made them feel comfortable (odds ratio, 3.3), the receptionist was respectful (1.7), the staff was very careful to protect their privacy (2.5), they had received sufficient information on self-care at home following the abortion and on postabortion emotions (1.9 and 2.0, respectively) and they felt confident in the doctor's technical skill (2.5). Rating site hours as very convenient (2A), waiting time as acceptable (2.8) and the facility as very clean (1.9) were all associated with higher overall scores. Compared with women who had given birth, those who had not rated the services lower overall (0.6).

CONCLUSION: Efforts to improve patient experiences with abortion services should focus on client-staff interaction, information provision, service accessibility, technical competence and the facility environment The most highly significant factor appears to be whether a doctor makes a woman feel comfortable during her visit

International Perspectives on Sexual and Reproductive Health, 2011,37(4)191-20l, doi: 10.1363/3719111

Induced abortion is common in Mexico, but it has historically placed women's lives and health at risk because it is often performed clandestinely in unsafe conditions. (1) Between 1990 and 2005, abortion-related complications were the fifth-leading cause of maternal mortality nationally, and the third-leading cause in Mexico City specifically. (2) In 2006, a national study estimated the rate of hospitalization for the treatment of induced abortion complications at 5.7 per 1,000 women aged 15-44, a 6% increase over the rate in 1990. (3)

Mexico's abortion laws vary by state, but in most states abortion is illegal except in a few limited circumstances, such as when a woman's life or health is in danger, or if a fetus has serious genetic malformations. The only circumstance in which abortion is legal across all states of Mexico is when a pregnancy is the result of a rape. (4) Even when abortion is legally permitted, it can be difficult for women to obtain services because of bureaucratic hurdles, a lack of knowledge about the law or provider refusals to perform a legal abortion. (1), (4), (5)

Recognizing the illegality of abortion as a cause of unsafe procedures that resulted in high maternal mortality and morbidity, (6) the Mexico City legislature decriminalized first-trimester abortion in 2007. The legislature also took steps to ensure that abortion services would be accessible to women regardless of their ability to pay; the law stipulated that at public hospitals that are part of the Mexico City Ministry of Health, abortion services would be provided free of charge for Mexico City residents and on a sliding fee scale for residents of other states. (4)

Nevertheless, this progressive legislation may not be enough to assure women of access to high-quality, confidential services. For example, in India, where abortion has been legal since 1971, studies indicate that unlicensed services remain an important source of abortion care for the population, particularly in rural areas, because of limited access to licensed abortion services and the poor quality of those services. …

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