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.

Social manifestations of abortion stigma depend upon cultural, legal, and religious context. Abortion stigma in Mexico is under-researched. This study explored the sources, experiences, and consequences of stigma from the perspectives of women who had had an abortion, male partners, and members of the general population in different regional and legal contexts. We explored abortion stigma in Mexico City where abortion is legal in the first trimester and five states-Chihuahua, Chiapas, Jalisco, Oaxaca, and Yucatán-where abortion remains restricted. In each state, we conducted three focus groups-men ages 24-40 years (n = 36), women 25-40 years (n = 37), and young women ages 18-24 years (n = 27)-and four in-depth face-to-face interviews in total; two with women (n = 12) and two with the male partners of women who had had an abortion (n = 12). For 4 of the 12 women, this was their second abortion. This exploratory study suggests that abortion stigma was influenced by norms that placed a high value on motherhood and a conservative Catholic discourse. Some participants in this study described abortion as an "indelible mark" on a woman's identity and "divine punishment" as a consequence. Perspectives encountered in Mexico City often differed from the conservative postures in the states.

study in Mexico that it is often sold on a pill by pill basis, which may explain the drop in sales. 22 The present study provides new national and regional estimates for 2006. It uses the same methodology as the 1990 study, but adapts those methods when necessarymost importantly by incorporating the use of misoprostol to induce abortion, a practice that was rare in the earlier survey period. This approach provides for comparability, and enables us to assess trends in induced abortion in Mexico over the past decade and a half. In addition to looking at changes in abortion incidence between 1990 and 2006, we examine patterns in hospitalization due to abortion-related complications, a key indicator of morbidity resulting from unsafe abortion. Finally, we explore the relationship between contraceptive use and differences in abortion incidence among the four regions and at the national level, and discuss the broader relevance and implications of our findings. DATA AND METHODS Data SourcesWe used two data sources for estimating abortion incidence: hospital discharge data on the number of women treated for abortion complications in 2006, and a survey of key informants who were knowledgeable about abortion provision in Mexico to obtain an estimate of the proportion of women who get abortions who are hospitalized.•Hospital discharge data. Data from Mexico's National System of Health Information (Sistema Nacional de Información en Salud) on the number of women treated in publicsector hospitals for abortion complications in 2006 were aggregated for seven hospital systems (see Web site Appendix at http://www.guttmacher.org/pubs/ifpp/appendix/ 3404.pdf). 27 We examined the data for quality and completeness and to ensure comparability with data for 1990. To obtain a count of patients treated for postabortion complications in 2006 that was comparable to the count used in 1990, we selected the appropriate diagnostic codes from the new ICD-10 classification system that matched those from the earlier ICD-9 system. The previous study had made other adjustments to the hospital discharge data to account for misclassification of codes; 16 because the 2006 data are of higher quality, these adjustments were not necessary.The sources of health systems data on hospital care changed between 1990 and 2006: In 2006, the number of women hospitalized for abortion complications was obtained from three sources (outpatient, inpatient and emergency cases), whereas a single source was used in 1990 (only inpatient cases were available at that time). The total number of women treated for abortion complications (resulting from spontaneous or induced abortion) in all components of the public-sector hospital system in 2006 was 194,774 (112,978 reported inpatients, 26,823 reported outpatients and 54,973 estimated emergency cases; see Appendix Table 1).•Health Professionals Survey. The Health Professionals Survey (HPS) was designed to assess the conditions of induced abortions; given the rise in use of contraceptives since the 1980s and the increase ...

BackgroundRigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life.MethodsWe randomized 42 public health clinics in Mexico City to treatment or control arms. In treatment clinics, women received the nurse-delivered session (IPV screening, supportive referrals, health/safety risk assessments) at baseline (T1), and a booster counselling session after 3 months (T2). In control clinics, women received screening and a referral card from nurses. Surveys were conducted at T1, T2, and T3 (15 months from baseline). Our main outcome was past-year physical and sexual IPV. Intent-to-treat analyses were conducted via three-level random intercepts models to evaluate the interaction term for treatment status by time.ResultsBetween April and October 2013, 950 women (480 in control clinics, 470 in treatment clinics) with recent IPV experiences enrolled in the study. While reductions in IPV were observed for both women enrolled in treatment (OR, 0.40; 95% CI, 0.28–0.55; P < 0.01) and control (OR, 0.51; 95% CI, 0.36–0.72; P < 0.01) clinics at T3 (July to December 2014), no significant treatment effects were observed (OR, 0.78; 95% CI, 0.49–1.24; P = 0.30). At T2 (July to December 2013), women in treatment clinics reported significant improvements, compared to women in control clinics, in mental quality of life (β, 1.45; 95% CI, 0.14–2.75; P = 0.03) and safety planning behaviors (β, 0.41; 95% CI, 0.02–0.79; P = 0.04).ConclusionWhile reductions in IPV levels were seen among women in both treatment and control clinics, the enhanced nurse intervention was no more effective in reducing IPV. The enhanced nursing intervention may offer short-term improvements in addressing safety planning and mental quality of life. Nurses can play a supportive role in assisting women with IPV experiences.Trial RegistrationClinicaltrials.gov (NCT01661504). Registration Date: August 2, 2012Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0880-y) contains supplementary material, which is available to authorized users.

Legal abortion services have been available in public and private health facilities in Mexico City since April 2007 for pregnancies of up to 12 weeks gestation. As of January 2011, more than 50,000 procedures have been performed by Ministry of Health hospitals and clinics. We researched trends in service users' characteristics, types of procedures performed, post-procedure complications, repeat abortions, and postabortion uptake of contraception in 15 designated hospitals from April 2007 to March 2010. The trend in procedures has been toward more medication and manual vacuum aspiration abortions and fewer done through dilation and curettage. Percentages of post-procedure complications and repeat abortions remain low (2.3 and 0.9 percent, respectively). Uptake of postabortion contraception has increased over time; 85 percent of women selected a method in 2009-10, compared with 73 percent in 2007-08. Our findings indicate that the Ministry of Health's program provides safe services that contribute to the prevention of repeat unintended pregnancies.