MEXICO – Abortion care seeking should not be conflated with complications: evidence from Mexico’s public hospitals, 2018-2022

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Contraception 2024; 134(June)

by L Jacobson, B Saavedra Avendaño, R Schiavon, BG Darney

Introduction: Complications from abortive events are difficult to measure and compare across settings due to lack of standardized definitions, limited available data, and stigma. Globally, indirect methods are used to estimate the incidence of abortion complications by using provider reports as a proxy; however, few studies rely on clinical data for abortive event complications. Several studies show that many abortion clients seek PAC for reasons other than a complication such as confirmation of a complete abortion. We describe care-seeking for abortive events and complication rates over time (2018–2022) and by state from the Mexican public hospital discharge register.

Method: We used hospital discharge data from Mexico (called SAEH). We included hospital facilities operated by national and state ministries of health; since our focus is on complications (rather than incidence), we included only hospitals where complications are treated. We included ICD-10 codes O02-O08 and Z303. Our primary outcome was the existence of a complication and details about type of complication. Complications reported included codes for excessive bleeding, infection, embolism, and unspecified. We also identified procedure type (aspiration, curettage, misoprostol). We included additional socio-demographic and clinical information available in the discharge record. We described patient characteristics, complications, and procedure type by year (2018-2022). We calculated state-level abortion complication rates (complications per 1,000 events) and created a heat map of the rate of abortion complications by state.

Results: We included 399,405 patients who received hospital-based care for an abortive event between 2018-2022. Patient demographic characteristics were stable over time (2018-2022). Overall, the largest age category was 20-24 years old (27%) and 2.5% of patients spoke an indigenous language. Abortive events primarily occurred at or less than 13 weeks of gestation (74% overall) and this proportion increased slightly over time from 73% in 2018 to 77% in 2022. Of all the patients who received care for abortive events, the overwhelming majority (93%) had no complication recorded, which was stable over time. Of the 6-8% of patients who did experience a complication, the most common designation was “unspecified” with 6% of abortive events in 2018-2020; 5.6 % in 2021 and 3.9% in 2022. Reports of excessive bleeding, embolism, and infections were between <0.1-1% for all years. The states with higher complication rates are located primarily in the central and southern regions. The proportion of cases that were treated using curettage decreased from 55% in 2018 to 46% in 2022; the use of aspiration increased over time from 22% in 2018 to 29% in 2022, and use of misoprostol was less than 2% of cases overall.

Conclusions: In Mexico, most patients who seek care for abortive events (induced, spontaneous, or post-abortion) in Ministry of Health hospitals have no complications. Curettage remains common and misoprostol is under-utilized in the hospital setting in Mexico. Conflating care-seeking and complications overestimates the risks of abortion.

PHOTO: Amnesty International, 2023