Academic journal article International Perspectives on Sexual and Reproductive Health

Incidence of Induced Abortion by Age and State, Mexico, 2009: New Estimates Using a Modified Methodology

Academic journal article International Perspectives on Sexual and Reproductive Health

Incidence of Induced Abortion by Age and State, Mexico, 2009: New Estimates Using a Modified Methodology

Article excerpt

CONTEXT: Because abortion laws in Mexico, which are generally highly restrictive, are determined by individual states, state-level data are essential for policymakers to make informed decisions. In addition, age-specific abortion estimates are needed, given societal concern about young women's risk for unwanted pregnancy and abortion.

METHODS: The Abortion Incidence Complications Method, an established approach designed to obtain national and broad regional estimates, was extended to produce for the first time estimates for age-groups arid states. Data included government statistics on postabortion patients and health professionals' estimates concerning abortion complications. States were classified into six regions according to level of development.

RESULTS: In 2009, the abortion rate in Mexico was 38 per 1,000 women aged 15-44. The rate was 54 per 1,000 in Region 1 (Mexico City), the most developed region; 35-41 per 1,000 in Regions 2,3 and 4, which are moderately developed; and 26-27 in Regions 5 and 6, which are the least developed. States' rates of abortion incidence and treatment for induced abortion complications were generally consistent with development level, although exceptions emerged. Age-specific abortion rates peaked among women aged 20-24 and then steadily declined with age; this pattern was observed nationally, regionally and in most states.

CONCLUSION: Extension of the Abortion Incidence Complications Method to obtain state- and age-specific data is feasible. Unsafe abortion is common in all states of Mexico, especially among women aged 15-24, suggesting a need for improved family planning and postabortion services.

International Perspectives on Sexual and Reproductive Health, 2012, 38(2):58-67, doi:10.1363/3805812

Unsafe abortion--defined by the World Health Organization as a procedure for termination of an unintended pregnancy performed by people lacking the necessary skills, in an environment that does not conform to minimum medical standards, or both (1)--continues to be an important public health problem. It negatively affects women, their families, public health systems and, ultimately, economic productivity. Addressing the issue of unsafe abortion is an ongoing challenge in Mexico, where the lack of recent national estimates, and especially of state- and age-specific estimates, contributes to denial of the gravity of the problem and its consequences.

Among the most important constraints to measuring the incidence of abortion are the stigma attached to the procedure and abortion's illegality, which result in underreporting by both women and providers, even when they are directly questioned. (2) Because of these difficulties, indirect estimation methodologies are necessary; unfortunately, most of these approaches have strong limitations that result in biased estimates. One widely used method that provides solid estimates is the Abortion Incidence Complications Method, which has been applied to about 15 developing countries, including several in Latin America. It is a useful approach in settings where abortion is highly restricted, or where it is permitted under broad criteria but, for various reasons, is performed under unsafe conditions. (3-7)

The Abortion incidence Complications Method has been applied to Mexico in two previous studies, yielding estimates for 1990 at the national level and for 2006 both for the country as a whole and for four large geographic areas (North, Central, South/East and Mexico City). (5), (6) in the current analysis, we adapt this method to generate estimates, by both state and age-group, of the incidence of abortion and of treatment for postabortion complications in Mexico in 2009. This information is needed to inform policies and programs in Mexico, where induced abortion is legally restricted in all areas except Mexico City (Federal District), which in 2007 legalized first-trimester procedures. (8)


Data Sources

We used two data sources to estimate abortion incidence and related morbidity: government hospital data from the Mexican Ministry of Health and a survey of key informants who were knowledgeable about abortion provision in Mexico. …

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