ObjectiveTo examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City.MethodsWe conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 μg of misoprostol self–administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7–15 days later. We did an intention-to-treat analysis for risk differences between physicians’ and nurses’ provision for completion and the need for surgical intervention.FindingsOf 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician-provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians’ provision and 97.9% (425/434) for nurses’ provision. The risk difference between the group was 0.5% (95% confidence interval, CI: −1.2% to 2.3%). There were no differences between providers for examined gestational duration or women’s contraceptive method uptake. Both types of providers were rated by the women as highly acceptable.ConclusionNurses’ provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services.

Objetivo. Analizar la cobertura de la educación sexual integral (ESI) en México y describir su integralidad, homogeneidad y continuidad en cuanto a contenidos sobre salud sexual yreproductiva, autoeficacia, derechos y relaciones. Material y métodos. En una encuesta probabilística transversal con muestreo estratificado y por conglomerados, se aplicó uncuestionario sobre ESI a una muestra representativa a nivel nacional de 3 824 adolescentes de 45 escuelas de educación media superior públicas y privadas, en localidades urbanasy rurales. Resultados. El porcentaje de adolescentes que reportan recibir educación sexual integral varía dependiendo de los temas y nivel escolar. Los temas más frecuentes estánrelacionados con salud sexual y reproductiva; los menos tratados con derechos y relaciones. Los contenidos de educación sexual se trasmiten mayoritariamente durante la escuela secundaria. Conclusiones. Se requiere garantizar la integralidad, homogeneidad y continuidad de los contenidos de la ESI, asegurando que se imparta la totalidad de los temas planteados en recomendaciones nacionales e internacionales.

Adolescent pregnancy is associated with poor health and socioeconomic factors. The adolescent pregnancy rate in Mexico is the highest among the Organization for Economic Co-operation and Development (OECD) countries. We aimed to explore the factors associated with pregnancies and births in adolescent and young adult women. Using the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM), we examined two dichotomous outcomes: “ever pregnant” and “being a mother” in women from 15 to 19 years and from 20 to 24 years without pregnancies during adolescence. We conducted bivariate analysis for each age group and used general linear models (GLM) to assess the association between the outcome variables and selected socioeconomic variables. Among adolescents, school attendance and tertiary education significantly decreased the likelihood of ever having been pregnant or being mothers, while being married/cohabiting increased the likelihood. Older age at first intercourse was negatively associated with ever having been pregnant. For adult women, in addition to school attendance, tertiary education, and being married/cohabiting, the region of residence also showed a significant association with ever having been pregnant. Similar socioeconomic factors were associated with pregnancy and motherhood between adolescents and young adults. However, it was found that delaying sexual debut could reduce the adolescent pregnancy rate. Our results highlight the importance of attending school and attaining tertiary education in reducing adolescent fertility rates.

Objetivo. Evaluar el desarrollo infantil temprano (DIT) y sus determinantes en niños/as de 12 a 59 meses residentes en localidades de menos de 100 000 habitantes. Material y métodos. La Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes (Ensanut 100k) evaluó el nivel de lenguaje, acceso a servicios de atención al DIT e indicadores de calidad del contexto de desarrollo. Se estiman prevalencias de indicadores y puntajes estandarizados de lenguaje según variables de interés. Resultados. 20.7% de los niños/as asistió a ocho consultas del niño sano en su primer año, 13.0% recibió evaluación de DIT, 75.0% recibe apoyo al aprendizaje, 23.4% cuenta con libros y 57.7% sufre disciplina violenta. Mejores niveles de lenguaje se asocian con las capacidades económicas, escolaridad materna, asistencia a preescolar, apoyo al aprendizaje y acceso a libros. Los niños/ as expuestos a más factores protectores presentan nivel de lenguaje 1.5 DE mayor que en niños/as con más factores de riesgo. Conclusión. Se requiere aumentar la cobertura de atención al DIT y mejorar las oportunidades de desarrollo en hogares.

No abstract