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Objectives We describe current use of long acting reversible contraception LARC (tier 1), hormonal (tier 2), barrier and traditional contraceptive methods (tier 3) by adolescent women in Mexico. We test whether knowledge of contraceptive methods is associated with current use of LARC. Methods We used the 1992, 1997, 2006, 2009 and 2014 waves of a nationally representative survey (ENADID). We used information from n = 10,376 (N = 3,635,558) adolescents (15-19 years) who reported ever using any contraceptive method. We used descriptive statistics and logistic regression models to test the association of knowledge of method tiers with use of tier 1 (LARC) versus tier 2, tier 3, and no contraceptive use. Results Over time, LARC use in the overall sample was flat (21 % in 1992, 23 % in 2014; p = 0.130). Among adolescents who have had a pregnancy, LARC use has increased (24 % in 1992 to 37 % in 2014). Among adolescents who did not report a pregnancy, current LARC use has remained low (1 % in 1992 and 2 % in 2014). We found positive association between LARC use and knowledge of tier 1 methods. In the overall sample LARC use is strongly correlated with exposure to marriage compared to use of tier 2 or tier 3 methods. Discussion Among adolescents in Mexico who are currently using modern methods, LARC use is relatively high, but remains primarily tied to having had a pregnancy. Our study highlights the need to expand access to LARC methods outside the post-partum hospital setting., Author(s): Biani Saavedra-Avendano [sup.1] , Zafiro Andrade-Romo [sup.1] , Maria I. Rodriguez [sup.2] [sup.3] , Blair G. Darney [sup.1] [sup.2] Author Affiliations: (1) Center for Health Systems Research/Centro de Investigacion [...]

Objective To propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care. Methods In a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012.This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending In live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to Identify correlates of adequate antenatal care and predicted coverage. Findings Based on a population-weighted sample of 9052044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance. Conclusion While basic antenatal care coverage is high In Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care. Objectif Proposer une classification des soins prenataux afin de mesurer Ia continuite des soins et leur caractere adequat: date de debut des soins prenataux, nombre de consultations prenatales et principaux processus de soins. Methodes Lors de notre etude retrospective transversale, nous avons utilise les donnees de 1'enquete nationale sur Ia sante et la nutrition (ENSANUT) realisee au Mexique en 2012. Celle-ci contenait des Informations sur lerecoursaux soins prenataux declare par 6494 femmes lors de leur derniere grossesse ayant abouti a une nalssance vivante. Les soins prenataux ont ete consideres adequats lorsqu'une femme avait eu sa premiere consultation au cours du premier trimestre de grossesse, s'etait rendue au minimum a quatre consultations prenatales et avait beneficie d'au moins sept des huit procedures recommandees lors des consultations. Nous avons utilise une regression logistique ordinale multivariee pour identifier les correlations entre soins prenataux adequats et previsions de Ia couverture de soins. Resultats Sur un echantlllon pondere en fonction de la population de 9 052 044 femmes, 98,4% avaient recu des soins prenataux lors de leur derniere grossesse, mais seulement 71,5% (intervalle de confiance de 95%: 69,7 a 73,2) avaient recu des soins juges adequats. D'importantes differences geographiques ont ete observees entre les Etats au niveau de Ia couverture de soins. La probabillte de beneficier de soins prenataux adequats etait plus forte pour les femmes au statut socioeconomique plus eleve, celles ayant eu une scolarite plus longue et celles disposant d'une assurance maladie. Conclusion Au Mexique, si la couverture en matiere de soins prenataux de base est elevee, les soins adequats restent limites. Les systemes de sante, les gouvernements et les chercheurs, dans leurs efforts pour mesurer et ameliorer les soins prenataux, devraient adopter une definition plus rlgoureuse de ce type de soins afin d'y indure d'importants aspects qualitatifs comme la continuite et les processus de soins. Objetivo Proponer una clasificacion de atencion prenatal para medir la continuidad de la atencion sanitaria segun su idoneidad: momento en que se empieza a recibir atencion prenatal, numero de visitas de atencion prenatal y procesos basicos de atencion. Metodos En un estudio transversal y retrospectivo se utilizaron datos de la Encuesta Nacional de Salud y Nutricion (ENSANUT) realizada en Mexico en 2012, que contenia informacion autodeclarada acerca del uso de atencion prenatal de 6 494 mujeres durante su ultimo embarazo con nacidos vivos. Se considero que la atencion prenatal era adecuada si una mujer realizaba su primera visita durante el primer trimestre de embarazo, hacia al menos cuatro visitas de atencion prenatal y recibia al menos siete- de los ocho procedimientos recomendados durante las visitas. Se utilizo una regresion logistica ordinal multivariable para identificar las correlaciones de la atencion prenatal adecuada y la cobertura prevista. Resultados Segun una muestra ponderada de la poblacion de 9 052 044 personas, el 98,4% de las mujeres recibieron atencion prenatal durante su ultimo embarazo, pero unicamente el 71,5% (intervalo de confianza del 95%: 69,7 a 73,2) recibieron atencion sanitaria prenatal clasificada como adecuada. Se identificaron importantes diferencias geograficas en la cobertura de la atencion sanitaria entre los estados. La probabilidad de recibir una atencion prenatal adecuada era mayor entre mujeres con una mejor situacion socioeconomica, mas anos de escolarizacion y seguro medico. Conclusion Aunque la cobertura basica de atencion prenatal es alta en Mexico, su idoneidad sigue siendo escasa. Los esfuerzos realizados por sistemas sanitarios, gobiernos e investigadores para mediry mejorar la atencion prenatal deberian adoptar una definicion mas rigurosa de la misma para incluir elementos importantes de calidad, como la continuidad y los procesos de atencion., Introduction Optimizing maternal and infant health requires, but is not limited to, the provision of available and accessible health care delivered by skilled health personnel throughout the antenatal period. (1) [...]

Objective To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. Methods We conducted a repeated cross-sectional study using the 2006-2013 Busqueda intencionada y reclasificacion de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. Findings A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold Increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change In deaths from indirect obstetric causes. Direct deaths were concentrated In women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. Conclusion The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care. Objectif Decrire les causes de mortalite maternelle au Mexique sur une periode de huit ans, en s'interessant particulierement aux deces dus a des causes obstetricales Indirectes ainsi qu'aux disparites socioeconomiques. Methodes Nous avons realise une etude transversale repetee a l'aide des donnees de l'outil Busqueda intencionada y redasificacion de muertes maternas (BIRMM) 2006-2013. Nous nous sommes bases sur les frequences pour decrire les nouveaux cas, la repartition des causes et la reclassification des cas de mortalite maternelle selon la procedure BIRMM. Nous avons utilise des tests statistiques pour analyser les differences, sur le plan des caracteristiques sociodemographiques, entre les deces pour cause directe et indirecte, ainsi que les differences dans la proportion globale de deces pour cause directe et Indirecte, par annee et par niveau de pauvrete des municipalites. Resultats Un total de 9043 deces maternels a ete examine. Nous avons constate une augmentation de 13% du nombre global de deces maternels Identifies (de 7829 a 9043) et la proportion de deces maternels classes comme deces maternels, tardifs a ete multipliee par trois (passant de 2,1% a 6,9%). Sur la periode etudiee, le nombre de deces dus a des causes obstetricales directes a diminue, mais il n'a ete observe aucun changement dans le nombre de deces dus a des causes obstetricales Indirectes. Les deces pour cause directe etaient concentres chez les femmes vivant dans les municipalites les plus pauvres. En comparaison des femmes decedees de causes directes, les femmes decedees de causes Indirectes avaient eu moins de grossesses et etalent legerement plus jeunes, plus Instruites et plus susceptibles de vivre dans des municipalites plus riches. Conclusion La procedure BIRMM est une approche qui permet de rectifier les statistiques sur les deces maternels dans les zones ayant peu de ressources. Cette approche pourrait permettre de repenser la strategie du systeme de sante en vue de reduire le nombre de deces maternels dus a des causes obstetricales indirectes, avec notamment la prevention des grossesses non desirees et l'amelioration des soins prenataux et post-obstetricaux. Objetivo Describir las causas de la mortalidad materna en Mexico durante ocho anos, con especial atencion a las muertes obstetricas indirectas y a las desigualdades socioeconomicas. Metodos Se realizo un estudio transversal repetido utilizando el conjunto de datos Busqueda intencionada y reclasificacion de muertes maternas (BIRMM) de 2006-2013. Mediante el proceso de la BIRMM, se utilizaron frecuencias para describir nuevos casos, las distribuciones de las causas y la reclasificacion de los casos de mortalidad materna. Se utilizaron pruebas estadisticas para analizar las diferencias en cuanto a las caracteristicas sododemograficas entre las muertes directas e indirectas y las diferencias en el porcentaje del total de muertes directas e Indirectas, por ano y por nivel de pobreza de los municipios. Resultados Un total de 9 043 muertes maternas fueron sujetas al proceso de revision. En general, el numero de muertes maternas Identificadas aumento un 13% (de 7 829 a 9 043) y el porcentaje de muertes maternas clasificadas como muertes maternas tardias se triplico (de un 2,1% a un 6,9%). Durante el periodo de estudio, las muertes obstetricas directas se redujeron, mientras que las muertes derivadas de causas obstetricas Indirectas se mantuvieron sin cambios. Las muertes directas se concentraron en mujeres que vivian en los municipios mas pobres. En comparacion con aquellas que fallecian por causas directas, las mujeres que fallecian por causas indirectas tuvieron menos embarazos y eran ligeramente mas jovenes, tenian una mejor educacion y mas posibilidades de vivir en municipios mas adinerados. Conclusion La BIRMM es un enfoque cuyo objetivo es corregir las estadisticas de mortalidad materna en entornos con pocos recursos. El enfoque podria ayudar al sistema sanitario a reconsiderar su estrategia para reducir las muertes maternas por causas obstetricas indirectas, incluyendo la prevencion de embarazos no deseados y la mejora del cuidado prenatal y postobstetrico., Introduction Maternal mortality--defined as the death of a woman during pregnancy, childbirth or in the 42 days after delivery--is used as an outcome measure for any health system. The indicator [...]

* BACKGROUND Women delay seeking treatment for symptoms of acute myocardial infarction longer than men delay. Women's delay time has not been thoroughly characterized. * OBJECTIVES To qualitatively describe the [...]

Objective: To describe subdermal implant use in Mexico over time, by state and by age. Methods: We conducted a repeated cross‐sectional study using the 2009, 2014, and 2018 waves of the National Survey of Demographic Dynamics (Encuesta Nacional de la Dinámica Demográfica [ENADID]). Our outcome was current use of contraception, by type, with a focus on the implant. We used visualizations, descriptive and bivariate statistics, and multinomial models to assess change over time, geographic patterns, method mix, and factors associated with implant use (vs intrauterine device [IUD] or other hormonal methods). Results: Implant use is increasing over time in Mexico, from 1.1% of women who have ever used a method in 2009 to 4.5% in 2018 (P < 0.001); the change is greatest among adolescents (2.5% in 2009 to 12.2% in 2018; P < 0.001). Change in implant use as a fraction of modern method use was heterogeneous across Mexican states. The adjusted relative likelihood of using an implant compared with IUD was 34% higher for adolescents compared with women aged 20–29 years (relative risk ratio 1.34, 95% confidence interval 1.16–1.55, P < 0.001), controlling for other variables in the model. Conclusion: Use of subdermal implants is increasing over time in Mexico and is concentrated among adolescents. Implants have the potential to expand access to highly effective contraception in Mexico. Use of the subdermal contraceptive implant is increasing over time in Mexico, especially among adolescents. Increases in implant use are heterogeneous across states. [ABSTRACT FROM AUTHOR]