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First-trimester abortion became legal in Mexico City in April 2007. Since then, 216 755 abortions have been provided, initially in hospitals, by specialized physicians using surgical techniques. With time and experience, services were provided increasingly in health centers, by general physicians using medical therapies. Meanwhile, abortion remains legally restricted in the remaining 31/32 Mexican states. Demand and need for abortion care have increased throughout the country, while overall abortion-specific mortality rates have declined. In an effort to ensure universal access to and improved quality of reproductive and maternal health services, including abortion, Mexico recently expanded its cadres of health professionals. While initial advances are evident in pregnancy and delivery care, many obstacles and barriers impair the task-sharing/shifting process in abortion care. Efforts to expand the provider base for legal abortion and postabortion care to include midlevel professionals should be pursued by authorities in the new Mexican administration to further reduce abortion mortality and complications. [ABSTRACT FROM AUTHOR]

In 2007, first trimester abortion was legalized in Mexico City, and the public sector rapidly expanded its abortion services. In 2008, to obtain information on the effect of the law on private sector abortion services, we interviewed 135 physicians working in private clinics, located through an exhaustive search. A large majority of the clinics offered a range of reproductive health services, including abortions. Over 70% still used dilatation and curettage (D&C); less than a third offered vacuum aspiration or medical abortion. The average number of abortions per facility was only three per month; few reported more than 10 abortions monthly. More than 90% said they had been offering abortion services for less than 20 months. Many women are still accessing abortion services privately, despite the availability of free or low-cost services at public facilities. However, the continuing use of D&C, high fees (mean of $157–505), poor pain management practices, unnecessary use of ultrasound, general anaesthesia and overnight stays, indicate that private sector abortion services are expensive and far from optimal. Now that abortions are legal, these results highlight the need for private abortion providers to be trained in recommended abortion methods and quality of private abortion care improved. En 2007, Mexico a légalisé l'avortement du premier trimestre et le secteur public a rapidement élargi ses services d'avortement. En 2008, pour connaître les conséquences de la loi sur les services d'avortement du secteur privé, nous avons interrogé 135 médecins travaillant dans des centres privés, choisis au moyen d'une recherche exhaustive. Dans leur grande majorité, les centres proposaient un éventail de services de santé génésique, dont l'avortement. Plus de 70% utilisaient encore la dilatation et le curetage ; moins d'un tiers proposaient l'aspiration par le vide ou l'avortement médicamenteux. Le nombre moyen d'avortements par centre n'était que de trois par mois ; rares étaient ceux qui pratiquaient plus de dix avortements mensuels. Plus de 90% ont affirmé qu'ils assuraient des services d'avortement depuis moins de 20 mois. Beaucoup de femmes choisissent encore d'avorter dans le privé, en dépit de la disponibilité de services gratuits ou peu coûteux dans les établissements publics. Néanmoins, la poursuite de l'utilisation de la méthode par dilatation et curetage, les honoraires élevés (moyenne de $157–505), la prise en charge médiocre de la douleur, l'utilisation superflue des ultrasons, de l'anesthésie générale et de l'hospitalisation indiquent que les services d'avortement du secteur privé sont coûteux et loin d'être de qualité optimale. Maintenant que l'avortement est légal, ces résultats montrent qu'il faut former des prestataires privés aux méthodes recommandées d'avortement et améliorer les soins dans le secteur privé. En el año 2007, se legalizó el aborto en el primer trimestre en el Distrito Federal de México y el sector público rápidamente amplió sus servicios de aborto. En 2008, para obtener información sobre el efecto de la ley en los servicios de aborto del sector privado, entrevistamos a 135 médicos que trabajaban en clínicas privadas, localizadas mediante una búsqueda exhaustiva. En la gran mayoría de las clínicas se ofrecía una variedad de servicios de salud reproductiva, incluso abortos. En más del 70% aún se practicaba el procedimiento de dilatación y curetaje (D&C); en menos del 33% se ofrecía aspiración por vacío o aborto con medicamentos. El número promedio de abortos por cada establecimiento de salud era sólo tres al mes; pocos documentaban más de 10 abortos mensuales. Más del 90% relataron que llevaban menos de 20 meses ofreciendo servicios de aborto. Muchas mujeres aún acuden a servicios de aborto privados, a pesar de la disponibilidad de servicios gratuitos o de bajo costo en establecimientos públicos. Sin embargo, el uso continuado de D&C, los altos precios (una media de $157–505), las deficientes prácticas de manejo del dolor, el uso innecesario de ecografía, anestesia general y estancias de un día para otro, indican que los servicios de aborto del sector privado son caros y distan mucho de ser óptimos. Ahora que la interrupción del embarazo es legal, estos resultados destacan la necesidad de capacitar a los prestadores de servicios de aborto privados en los métodos de aborto recomendados y de mejorar la calidad de dichos servicios. [ABSTRACT FROM AUTHOR]

Objective: To describe utilization of health services for, and case fatality from, abortion in Mexico.Method: A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends.Results: The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015.Conclusion: Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward. [ABSTRACT FROM AUTHOR]