by Laura E Jacobson, Biani Saavedra-Avendano, Evelyn Funestes-Rivera, Raffaela Schiavon, Blair G Darney
BMJ SRH Journal, 28 July 2021 (Early version, Open access)
Abstract
Objective: To describe the community context of women who travel to access Mexico City’s public sector abortion programme and identify factors associated with travelling from highly marginalised settings.
Methods: We used data from the Interrupción Legal de Embarazo (ILE) programme (2016–2019) and identified all abortion clients who travelled from outside Mexico City. We merged in contextual information at the municipality level and used descriptive statistics to describe ILE clients’ individual characteristics and municipalities on several measures of vulnerability. We also compared municipalities that ILE clients travelled from with those where no one travelled from. We used logistic regression to identify factors associated with travelling to access ILE services from highly marginalised versus less marginalised municipalities.
Results: Our sample included 21 629 ILE clients who travelled to Mexico City from 491 municipalities within all 31 states outside Mexico City. The majority of clients travelled from the least marginalised (81.9%) and most populated (over 100 000 inhabitants; 91.3%) municipalities. Most (91.2%) ILE clients came from municipalities with adolescent fertility rates in the bottom three quintiles. Clients with a primary or secondary education (vs high school or more) and those from a municipality with a high adolescent fertility rate (top two quintiles) had higher odds of travelling from a highly marginalised (vs less) municipality (adjusted odds ratio (aOR) 1.46, 95% CI 1.35 to 1.58 and aOR 1.89, 95% CI 1.68 to 2.12, respectively).
Conclusion: ILE clients travel from geographically and socioeconomically diverse communities. There is an unmet need for legal abortion across Mexico.
Key messages
- Clients travel for abortions from all Mexican states to Mexico City, indicating unmet need for abortion services.
- Women from more vulnerable communities are not travelling to Mexico City to obtain public sector abortion services.
- Abortion law allows access to safe abortion in Mexico City, but creates disparities in access to safe abortion services for women in vulnerable communities.
From the Introduction
In Mexico, abortion law is determined at the state level and access to legal abortion is available only under narrow indications in 30 of Mexico’s 32 states. In 2007, first-trimester abortion was decriminalised in Mexico City, followed by Oaxaca in 2019.* The Mexico City Ministry of Health (Secretaria de Salud) operates a public sector first-trimester abortion programme, known as the Interrupción Legal de Embarazo (ILE) programme. Abortion services are available to anyone who presents for care at no cost or on a sliding scale for residents outside of Mexico City. Since 2007, the ILE programme has provided over 225 000 first-trimester abortions and approximately 30% of clients have travelled from outside Mexico City, with little change in this proportion over time. Previous work showed that ILE clients who were unmarried, with less than a high school education, and who resided outside of Mexico City experienced difficulties travelling to ILE facilities. Evidence also shows that access to abortion under legal indications, or ‘causales’, remains very limited in public facilities outside of Mexico City, making travel for services an important research focus.
VISUAL: Noticias Milenio, Celebran despenalizacion del aborto en Hidalgo, 1 July 2021
* [Note: The states of Veracruz in 2021 and Oaxaca in 2019 also legalised first-trimester abortion.]