Advancing Sexual and Reproductive Health and Rights

Unintended Pregnancy and Induced Abortion In Mexico: Causes and Consequences

Fatima Juárez, Susheela Singh, Isaac Maddow-Zimet and Deirdre Wulf

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Executive Summary

Examining the hidden and stigmatized practice of induced abortion is very hard to do. Throughout the Mexican Republic’s 31 states, induced abortion is highly restricted. (The exception is the capital, the Federal District, which decriminalized first-trimester abortions in 2007.) This report presents estimates of induced abortion for 2009, by the country’s 32 entidades federativas (or federative entities) and by the woman’s age. The report also examines what causes women to resort to abortion in the first place— unintended pregnancy.

Progress has been made on many fronts

• As of 2009, a high proportion of Mexican women in union (formal and consensual) practice contraception—67% use a modern method and another 5% rely on a less effective, traditional method.

• Widespread use of contraceptives has been an essential factor underlying the country’s rapid decline in fertility: Average family size, which has been falling steadily over the past two decades, is now nearly at replacement level of two children per woman.

• A breakthrough occurred in 2007 when the Federal District allowed legal interruptions of pregnancy (known by the Spanish acronym, ILE) in the first trimester. Thus, because of strict safety protocols instituted by the Ministry of Health of the Federal District, women who used the Federal District’s abortion services had almost no risk of complications in the year roughly corresponding to our estimates.

Unintended pregnancy remains widespread

• Behind almost every induced abortion is an unintended pregnancy. As of 2009, more than half—55%—of all pregnancies in Mexico are estimated to have been unintended.

• Categorizing the country’s 32 federative entities into six regions by level of development shows that Mexico fits established patterns where levels of unintended pregnancy are highest in the most developed and urbanized areas: An estimated 70% of pregnancies are unintended in the most-developed region (Federal District; Region 1), compared with 45% in the least-developed region (Chiapas, Guerrero and Oaxaca; Region 6).

• Each year, 71 unintended pregnancies occur per 1,000 women of reproductive age, a rate that is virtually the same as that estimated for all of Latin America and the Caribbean (72 per 1,000 women).

Many unintended pregnancies end in induced abortion

• Legally restricting abortion does not prevent it from happening. More than half (54%) of all unintended pregnancies in Mexico are estimated to end in an induced abortion, despite it being legally restricted in 31 of the 32 federative entities.

• This translates to more than one million (1,026,000) induced abortions taking place each year, for a rate of 38 per 1,000 women aged 15–44. The abortion rate increases uniformly as the level of development rises, from 26 procedures per 1,000 women in Region 6 (the least-developed region) to 54 per 1,000 in Region 1 (the most-developed region).

• As of 2009, Mexico’s rate of abortion had increased by more than half since 1990, when it was 25 per 1,000. This increase over time in the rate (which is not affected by population growth) suggests that women are having a harder time now avoiding unintended pregnancy and are also more motivated to avoid having unplanned births.

• Abortion estimates by age (the first time such estimates have been made for Mexico) show an expected pattern whereby the rate peaks among women in their early 20s (at 55 per 1,000 20–24-year-olds), and then gradually declines with age. Unfortunately, adolescents aged 15–19 share the second-highest rate with women aged 25–29 (44 abortions per 1,000 women).

• By federative entity, the Federal District, as the most developed part of the country, unsurprisingly has one of the highest abortion rates (54 per 1,000). The Northern state of Nuevo León, on the other hand, has the lowest (17 per 1,000), possibly reflecting both a very low unmet need for contraception and travel across the U.S. border for safe, legal procedures.

Clandestine abortions endanger women’s health and use up scarce health resources

• An induced abortion performed outside the law is often unsafe. Government hospital data clearly show the toll on women’s health and facilities: In 2009, some 159,000 women nationally were treated for complications of an induced abortion in public-sector hospitals alone.

• More than one-third of all women having an induced abortion (36%) are estimated to develop complications that need medical treatment. The proportion of abortions accompanied by complications is highest—at 45%—among those obtained by poor rural women.

• Unfortunately, one-quarter of all Mexican women experiencing abortion complications do not obtain the treatment they need, making them especially likely to suffer debilitating health consequences.

The risk of complications is tied to how an abortion is performed and by whom

• An estimated one in every three abortions is induced through the drug misoprostol. That some 39% of these procedures are thought to lead to complications requiring treatment likely reflects providers’ and women’s inadequate knowledge and use of misoprostol.

• For abortions not involving misoprostol, the safest ones are the surgical procedures performed by doctors (accounting for 23% of all abortions); the least safe are those that are self-induced with a method other than misoprostol (16% of all abortions, but 24% of those among poor rural women).

Action is needed to improve women’s health and lives

The recent rise in the rate of abortion points to the need for concerted efforts to help Mexican women better prevent the unintended pregnancies that lead to abortions. Below are some suggestions to help alleviate unsafe abortion’s burden on women and the medical system. We also propose some recommendations for improving the provision of legal procedures and for reducing unintended pregnancy.

Strengthen contraceptive services. Women need better information about correct and consistent use of contraception. To prevent unintended pregnancies and abortions, the 12% of women in union with an unmet need for contraception plus the 5% using traditional methods should start using a highly effective method that fits their personal preferences and situation. Tailored interventions are needed to help the group at highest risk for unwanted pregnancy—young women aged 15–24, in union and never married (both those with past sexual experience and currently sexually active). A high proportion of these women are not using a contraceptive method despite not wanting to become pregnant soon, which signals the need for more information about effective contraception and better services. An improved understanding of temporary methods and better access to them would help these young women prevent unintended pregnancy and thus enable them to more precisely plan and time their births.

Improve postabortion services. The coverage of postabortion services needs to be extended and their quality improved. Providers need more accurate information about caring for women who have used misoprostol; they also need training in treating complications with manual vacuum aspiration, a technique far less invasive and less resource-dependent than the widely used dilation and curettage. Contraceptive services, including counseling, need to be made a standard feature to prevent repeat abortion.

Improve provision of legal abortions. Public education campaigns are essential to spread awareness of each federative entity’s conditions for legal abortion. Mechanisms to assure that women can actually get the legal abortions that they qualify for are also vital, along with the political will to put them into place. All 32 entity-level ministries of health, which are directly responsible for providing and funding care, should take the opportunity to use these newly available data to guide improvements in contraceptive and postabortion care in their respective jurisdictions.