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To identify factors associated with having an abortion (spontaneous or induced) at the time of first pregnancy, and to test the association between abortion in the first pregnancy and the number of live births among young women 20-24 years of age. Cross-sectional study. We used a nationally representative survey of Mexican women 20-24 years of age with data at time of survey and retrospective measures of exposures in adolescence. We include 1913 women who reported ever having a pregnancy. Our outcomes were history of abortion (spontaneous or induced) and number of live births by 20-24 years of age. We used multivariable logistic regression models to estimate the association between sociodemographic factors at the time of pregnancy and abortion history, and between abortion history and number of live births. Among women 20-24 years of age who ever had a pregnancy, 15.5% reported an abortion in the first pregnancy, and 84.4% never had an abortion. Among women who had an abortion in the first pregnancy, 62.3% did not report any live birth by age 20-24 years. Young women living with their parents (adjusted odds ratio [AOR] = 1.87; confidence interval [CI] = 1.16-3.02) or with a partner with a higher educational level (AOR = 4.64; CI = 1.05-20.44) had greater odds of having an abortion in the first pregnancy. Compared with women who never had an abortion, women who reported an abortion in the first pregnancy had lower odds (AOR = 0.02; CI = 0.01-0.03) of having 1 or more children by the age of 20-24 years. Young women who reported abortion in the first pregnancy had fewer live births at ages 20-24 years compared to women with no history of abortion. [ABSTRACT FROM AUTHOR]

Objective: To describe utilization of prenatal care and outcomes of low birth weight and preterm birth among adolescent births in Mexico. Methods: We used birth certificate data and included live births to individuals 10–24 years, 2008–2019. Our outcomes were binary measures of adequate prenatal care, low birth weight, and preterm birth. We compared adolescents (10–14 years, 15–16, and 17–19) to those 20–24 years. We included individual‐, clinical‐, and municipality‐level variables, used multivariable logistic regression, and calculated adjusted predicted probabilities. We also tested whether receipt of prenatal care moderated the relationship of age with preterm birth and low birth weight. Results: We included a total of 12 106 710 births to women 10–24 years. The adjusted predicted probability of adequate prenatal care increased with age: 56.07% (95% CI 55.82–56.31%) adjusted probability among adolescents 10–14 years compared with 65.51% (95% CI 65.48%–65.55%) among individuals 20–24 years. Receipt of adequate prenatal care in part mitigated disparities in preterm birth and low birthweight across all age groups: 7.30% (95% CI 7.17%–7.43%) adjusted probability of delivering a preterm infant among those 10–14 years who received adequate prenatal care compared with 9.37% (95% CI 9.20%–9.53%) among those 10–14 years without adequate prenatal care. Conclusion: In Mexico, adolescent pregnancies are associated with inadequate prenatal care as well as higher odds of preterm delivery and low birth weight. Youngest adolescents (10–14 years) have the highest probability of adverse outcomes. Adequate prenatal care may help partially mitigate disparities in poor perinatal outcomes. Synopsis: In Mexico, adolescent pregnancies have higher odds of prematurity and low birthweight. Adequate prenatal care may partially mitigate these disparities. [ABSTRACT FROM AUTHOR]

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]

Background: Gestational age estimation is key to the provision of abortion, to ensure safety and successful termination of pregnancy. We compared gestational age based on reported last menstrual period and ultrasonography among a large sample of women in Mexico City's public first trimester abortion program, Interrupcion Legal de Embarazo (ILE). Methods: We conducted a retrospective study of 43,219 clinical records of women seeking abortion services in the public abortion program from 2007 to 2015. We extracted gestational age estimates in days based on last menstrual period and ultrasonography. We calculated the proportion of under- and over-estimation of gestational age based on last menstrual period versus ultrasonography. We compared overall differences in estimates and focused on discrepancies at two relevant cut-offs points (70 days for medication abortion eligibility and 90 days for ILE program eligibility). Results: On average, ultrasonography estimation was nearly 1 (− 0.97) days less than the last menstrual period estimation (SD = 13.9), indicating women tended to overestimate the duration of their pregnancy based on recall of date of last menstrual period. Overall, 51.4% of women overestimated and 38.5% underestimated their gestations based on last menstrual period. Using a 70-day limit, 93.8% of women who were eligible for medication abortion based on ultrasonography would have been correctly classified using last menstrual period estimation alone. Using the 90-day limit for ILE program eligibility, 96.0% would have been eligible for first trimester abortion based on last menstrual period estimation alone. Conclusions: The majority of women can estimate gestational age using last menstrual period date. Where available, ultrasonography can be used, but it should not be a barrier to providing care. [ABSTRACT FROM AUTHOR]

Objective: To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City’s public sector first trimester abortion program. Methods: We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007–2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women’s characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics. Results: Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12–17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p< 0.05). In multivariable analyses, all age groups of adult women had significantly lower odds than adolescents of presenting past the limit (aOR = 0.77, aOR = 0.63, aOR = 0.58 and aOR = 0.37 for 19–24, 25–29, 30–39, and > = 40 years’ old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02–4.26% across adult age groups). Conclusions: Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services. [ABSTRACT FROM AUTHOR]

Objective: To evaluate prenatal care utilization, low birth weight, and preterm birth among women aged 35 years and older in Mexico from 2008 to 2019. Methods: We conducted a historical cohort study of all singleton live births in Mexico from 2008 to 2019. Outcomes were inadequate prenatal care, preterm birth, and low birth weight. We compared outcomes among women aged 35–39, 40–44, and 45–49 years with births to women aged 20–34 years. We used logistic regression to account for individual, health system, and contextual confounders. Results: We included a total of 19 526 922 births; 2 325 725 (11.9%) were to women aged 35 years and older. Women aged 45‐49 years had the lowest levels of education, were more likely to be uninsured, and came from highly marginalized municipalities while those aged 35‐39 years had the highest levels of education and insurance and came from the least marginalized municipalities. The odds of inadequate prenatal care (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI] 1.09–1.15), preterm birth (aOR 2.05; 95% CI 1.97–2.13), and low birth weight (aOR 2.03; 95% CI 1.95–2.12) were highest for women aged 45–49 years, compared with women aged 20–34 years. The odds of adverse perinatal outcomes increased progressively with age, but the odds of inadequate prenatal care (aOR 0.77; 95% CI 0.76–0.77) were lowest for women aged 35–39 years, when compared with women aged 20–34 years. Conclusion: Women who deliver at 35 years and over are a heterogeneous group in Mexico. Being 35 years old and older is associated with increases in preterm birth and low birth weight neonates. Women who give birth between 45 and 49 years may be especially vulnerable. Synopsis: Women delivering after 35 years are heterogeneous; the oldest have the lowest prenatal care utilization and worst birth outcomes. Advantaged populations may be delaying births in Mexico. [ABSTRACT FROM AUTHOR]

Objective. To evaluate health coverage for birth care in Mexico within the frame of maternal mortality reduction. Materials and methods. Two information sources were used: 1) The comparison between the results yield by the Mexican National Health and Nutrition Surveys 2006 and 2012 (ENSANUT 2006 and 2012), and 2) the databases monitoring maternal deaths during 2012 (up to December 26), and live births (LB) in Mexico as estimated by the Mexican National Population Council (Conapo). Results. The national coverage for birth care by medical units is nearly 94.4% at the national level, but in some federal entities such as Chiapas (60.5%), Nayarit (87.8%), Guerrero (91.2%), Durango (92.5%), Oaxaca (92.6%), and Puebla (93.4%), coverage remains below the national average. In women belonging to any social security system (eg. IMSS, IMSS Oportunidades, ISSSTE), coverage is almost 99%, whereas in those affiliated to the Mexican Popular Health Insurance (which depends directly from the Federal Ministry of Health), coverage reached 92.9%. In terms of Maternal Mortality Ratio (MMR), there are still large disparities among federal states in Mexico, with a national average of 47.0 per 100 000 LB (preliminary data for 2012, up to December 26). The MMR estimation has been updated using the most recent population projections. Conclusion. There is no correlation between the level of institutional birth care and the MMR in Mexico. It is thus necessary not only to guarantee universal birth care by health professionals, but also to provide obstetric care by qualified personnel in functional health services networks, to strengthen the quality of obstetric care, family planning programs, and to promote the implementation of new and innovative health policies that include intersectoral actions and human rights-based approaches targeted to reduce the enormous social inequity still prevailing in Mexico. [ABSTRACT FROM AUTHOR]

To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100 000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100 000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico. [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]

Comprehensive sexuality education (CSE) aims to prepare adolescents for safe, healthy, and fulfilling lives. The aim of this study was to assess the perspective of key informants regarding CSE content to prevent teenage pregnancy, as well as to identify implementation barriers in predominantly indigenous communities in Chiapas, Mexico. We conducted a descriptive qualitative study using semi-structured interviews to explore three different groups’ perceptions, opinions and experiences. Adhering to grounded theory principles, we performed an inductive analysis and identified categories of interest. A total of 45 key informants (16 school staff members, 15 health personnel and 14 community leaders) were interviewed. School staff members are primarily responsible for CSE. Among all the participants, we identified a lack of training and the presence of prejudices. The information provided to adolescents by the informants was diverse and at times, incomplete. There was limited parental involvement and even opposition to sharing CSE content. Deeply rooted customs and traditions within a patriarchal context posed a significant obstacle to the implementation of CSE in the studied communities. Gaining a deeper understanding of rural and Indigenous contexts can facilitate the identification of barriers and promote the design of targeted strategies to reduce obstacles to pregnancy prevention in vulnerable populations. [ABSTRACT FROM AUTHOR]

Objectives: In the Mexico City Metropolitan Area, only women in the city center have local access to legal first-trimester abortion. We quantify how this legislative discrepancy affects access to legal, public-sector abortion across the metropolitan area.Study Design: In this observational study, we used a dataset representing 67.2% of all abortions occurring between 2010 and 2012 in Mexico City's public abortion program and census population data. We calculate utilization rates for 75 municipalities in the metropolitan area for 2010-2012. We compare utilization between municipalities with and without local legal access, adjusting for differences in sociodemographic drivers of abortion demand. We explore the effects of local abortion legality, travel time and socioeconomic status (SES).Results: Women who had to travel into the city center for legal abortions used services at only 18.6% (95% CI 13.3%-33.0%) of the expected rate if they had local access, adjusting for sociodemographic factors. After controlling for travel time and SES, women who lived where abortion is illegal had a 58.6% (95% CI 21.5%-78.1%) reduction in access, and each additional 15 min of travel further reduced access by 33.7% (95% CI 18.2%-46.3%). Women who travel to seek legal abortions are more likely to have completed secondary education compared to other reproductive age women in their municipality (p = <.00001).Conclusions: We find that, in the Mexico City Metropolitan Area, both living where abortion is illegal and having to travel further to access services substantially reduce access to legal, public-sector abortion. These burdens disproportionately affect women of lower SES.Implications: Both local legality and proximate access are key to ensuring equity in access to public-sector abortion. Legalization of abortion services across the greater Mexico City Metropolitan Area has the potential to increase equity in utilization and meet unmet demand for legal abortion. [ABSTRACT FROM AUTHOR]

To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100,000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100,000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico. [ABSTRACT FROM AUTHOR]

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]

There is still controversy regarding the mechanism of action of levonorgestrel (LNG) for emergency contraception (EC). For those who state that pregnancy starts prior to implantation, any compound able to interfere with post-fertilization and pre-implantation stages, should be considered as abortifacient. Previous research suggests that EC in humans acts predominantly after fertilization. Current evidence with LNG-only EC supports a pre-fertilization mechanisms to explain its action. There are many potential mechanisms of action, which could vary pending on the day during the fertilization window of the ovarian cycle at which the contraceptive is given. This paper reviews the evidence for each potential mechanism of action. According to the most recently statements, it is concluded that the primary and possible the only mechanism of action of LNG-only EC is preventing or delaying ovulation. [ABSTRACT FROM AUTHOR]

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico City, we conducted a pre-intervention/post-intervention research study of one way to introduce EC. Following a baseline survey of family planning providers and clients in 1997, we organized and implemented a three-year program of training for health care providers and a multi-faceted information campaign for the general public, including a national toll-free hotline and website. In 2000, we again surveyed family planning clinic providers and clients, using instruments similar to those employed in the baseline study. EC awareness increased significantly from 13% of clients to 32%, and support jumped from 73% to 83%. Providers at study clinics improved method recognition from 88% to 100%. [Copyright &y& Elsevier]

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]

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]

Introduction. Although the international literature suggests that women who interrupt a pregnancy in safe conditions do not develop mental health problems, it continues to be a highly stigmatized issue by broad social sectors. It is therefore not surprising that abortion stigma is one of the main factors associated with the presence of mental health problems in women who abort voluntarily. This study explores the association between perceived abortion stigma and depressive symptomatology. Method. In a non-probabilistic convenience sample, 114 users of a Legal Interruption of Pregnancy Clinic in Mexico City were interviewed with a structured instrument. Results. Respondents obtained low scores of internalized stigma and reported feeling confident that they had made the right decision to terminate their pregnancies, and at peace with themselves. The highest scores for abortion stigma were reported in the group with high depressive symptomatology, with no statistically significant differences being observed due to the sociodemographic characteristics explored. The participants in this study were more concerned about what others might think about their decision to terminate a pregnancy and about how their abortion might affect their relationship with them. Discussion and conclusion. These concerns highlight the need to reduce the negative social stigma surrounding abortion and to provide interventions in the same direction among women who interrupt a pregnancy legally in order to reduce the risk of mental health problems such as depression. [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]

Emergency contraception (EC) has the potential to reduce unwanted pregnancy significantly, in Mexico as elsewhere. Recent years have seen tremendous growth in programs and research devoted to expanding access to emergency methods worldwide. In Mexico we developed a comprehensive model introduction effort that included four components: provider training, public information (through a dedicated hotline and website, free media, paid radio and TV spots, participation in talk shows, and alternative media channels), collaboration with the public sector to include EC in the official family planning norms, and assistance to partner with commercial firms to register a dedicated EC product. Ongoing efforts to combat misperceptions and overcome opposition are crucial to informing the public and ensuring greater access to the method. [Copyright &y& Elsevier]

An introduction to the journal is presented in which the editors discuss the main challenges that demographic, social and epidemiological changes will pose to women's health in the Americas.