Inequalities in access to and quality of abortion services in Mexico: Can task-sharing be an opportunity to increase legal and safe abortion care?

Schiavon, Raffaela; Troncoso, Erika

doi:10.1002/ijgo.13002

Cited by 13 publications

(7 citation statements)

References 35 publications

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“…In the case of Chile, participants stated that the framework of illegality was the main motivation for choosing WoW as this platform facilitates access to a private and safe service. These issues are in line with similar studies done in both countries 3 4…”

supporting

confidence: 91%

Reasons for using telemedicine medical abortion in Mexico and Chile

Guevara

Ilozumba

Brandell

et al. 2021

BMJ Sex Reprod Health

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supporting

confidence: 91%

Reasons for using telemedicine medical abortion in Mexico and Chile

Guevara

Ilozumba

Brandell

et al. 2021

BMJ Sex Reprod Health

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“… 33 , 36 Abortion services provided by nurses and midwives have been documented to be just as effective, of higher quality, and with less over-medicalization and unnecessary practices compared to those provided by physicians. 37 According to WHO guidelines, self-management abortion is as effective as assessment by a trained health worker and results in more satisfaction with the process. 38 Therefore, one cost-saving alternative is to make nurses eligible as providers and get rid of the unnecessary and substantial costs of all rest staff involved, and promote the use of alternatives such as self-management abortion since they provide higher quality and satisfaction, with the same effectiveness but with less use of resources.…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Surgical and Medical Uterine Evacuation Methods for First-Trimester Abortion Used in Public Hospitals in Mexico

Sanchez-Morales

Rodriguez-Contreras²,

Ruiz-Lara³

et al. 2022

Health�Serv�Insights

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Background: Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from years before the abortion legislation. This study estimated the costs, from the health system’s perspective, of surgical and medical abortion methods commonly used by women who undergo first-trimester abortion in Mexico. Methods: Data were collected on staff time, salaries, medications, consumables, equipment, imaging, and lab studies, at 5 public general hospitals. A bottom-up micro-costing approach was used. Results: Surgical abortion costs were US$201 for manual vacuum aspiration and US$298 for sharp curettage. The cost of medical abortion with misoprostol was US$85. The use of cervical ripening increases the costs by up to 18%. Staff comprised up to 72% of total costs in surgical abortions. Hospitalization was the area where most of the spending occurred, due to the staff and post-surgical surveillance required. Conclusions: Our estimates reflect the costs of “real-life” implementation and highlight the impact on costs of the overuse of resources not routinely recommended by clinical guidelines, such as cervical ripening for surgical abortion. This information will help decision-makers to generate policies that contribute to more efficient use of resources.

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“… 29 , 30 Similarly, evidence shows that promoting task sharing and involvement of midwives, nurses, and primary care providers would go a long way in making abortion more widely accessible and would promote less medicalized models of care that prioritize MVA and MA. 31 While availability of abortion supplies was the most commonly cited reason for continued use of D&C among these respondents, it is important to look deeply at the power structures that remain in place in hospitals in Mexico and that also contribute to doctor-oriented models of abortion care. Given the benefits of MA and MVA over D&C, empowering the abortion client to choose the procedure method and embracing task shifting for abortion care would likely drastically reduce use of D&C. In fact, considering methods presented to abortion patients should only be recommended methods, transferring decision-making power to the patients would effectively remove D&C entirely from the method roster.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico

Küng¹,

Ochoa²,

Avendano³

et al. 2021

Womens Health (Lond Engl)

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Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.

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Inequalities in access to and quality of abortion services in Mexico: Can task-sharing be an opportunity to increase legal and safe abortion care?

Cited by 13 publications

References 35 publications

Reasons for using telemedicine medical abortion in Mexico and Chile

Reasons for using telemedicine medical abortion in Mexico and Chile

Cost Analysis of Surgical and Medical Uterine Evacuation Methods for First-Trimester Abortion Used in Public Hospitals in Mexico

Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico

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