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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]

The article discusses the use of contraception by abortion patients and postpartum urban women in Mexico City, Mexico. In a retrospective cohort study, a larger number of women who underwent abortion practiced contraception methods more than postpartum women. Based on the results, it is recommended that women should be offered various contraceptive methods to avoid unintended pregnancy and short interpregnancy intervals.

Objective. To identify sociodemographic and health services factors associated with receipt of immediate postpartum (IPP) contraception and the type of contraceptive method received. Materials and methods. We used the National Health and Nutrition Survey (Ensanut), 2018-19, which contains information on 4 548 women aged 12-49 years who gave birth. We described receipt of IPP contraception and method type and used multivariable logistic (n=4 544) and multinomial regression (n=2 903) to examine receipt of any modern method and type of method. Results. 65% of women received IPP contraception. 56.8% of adolescents received long-acting reversible contraception (43.7% IUD & 13.1% implant). Being indigenous, having only one child, or receiving care in State Health Services/IMSS-Prospera or private sector facilities were associated with lower odds of receiving IPP contraception. Conclusions. We identify progress in the IPP contraception coverage among adolescents. Disparities persist in receipt of IPP contraception by type of health insurance. [ABSTRACT FROM AUTHOR]

Previous research has established that emergency contraceptive pills are safe and have the potential to reduce unintended pregnancy; however, policy makers, providers and even women themselves have expressed concern about repeat use of the method. Evidence regarding the safety, efficacy and frequency of repeat use show that the method is safe and effective, even when used multiple times. Reported rates of repeat use are actually lower than would be expected, and needed, based on the frequency of unprotected intercourse and contraceptive failure reported in most countries. Healthcare providers should encourage use of emergency contraceptive pills as a backup after recognizable failure of barrier methods or other hormonal contraceptive methods, and should expect that women may need emergency contraceptive pills multiple times during their reproductive years. [Copyright &y& Elsevier]