The vast majority of women who obtained a public-sector legal abortion in Mexico City received contraceptive counseling after their procedure and decided on a method to use, according to a survey conducted at three public health facilities.1 Women who had been attended by a female physician were far more likely than those attended by a male physician to be offered postabortion contraception and to choose a method (odds ratios, 3.0 and 6.3, respectively). In addition, the odds of having been offered a method were higher among women who had had a surgical abortion than among those who had had a medication abortion (5.4), and lower among women who had visited a general hospital than among those who had terminated their pregnancy at a primary health center (0.1).
Since the legalization of abortion in Mexico City in 2007, local Ministry of Health facilities have provided free or low-cost first-trimester abortion services. To gauge the quality of the family planning counseling that surgical and medication abortion patients receive, and to determine whether service quality is associated with women’s characteristics and the circumstances of their procedure, the investigators surveyed 402 women aged 18–46 at a general hospital, a maternity hospital and a primary health center between September and December 2009. Three-fifths of public-sector abortions in Mexico City that year were performed at these three locations.
Women aged 18 or older who had obtained a first-trimester procedure were asked to participate in the survey on the same day as their surgical abortion or on the day of their follow-up appointment for a medication abortion. In face-to-face interviews conducted at each facility, women provided their social and demographic characteristics, and answered questions about their abortion and the family planning services they had received, including the contraceptive methods offered to them and the information they had received about STIs and emergency contraception. The investigators conducted logistic regression analyses that controlled for women’s age and education, among other characteristics, to identify factors associated with their having been offered contraceptives by their provider and with having chosen a method.
On average, women were 26 years old and had been at eight weeks’ gestation at the time of their abortion. Six in 10 had at least one child and four in 10 were married or in a civil union. Most lived in Mexico City (71%) and had at least a high school education (60%). Roughly equal proportions of the sample came from each of the three facilities; half of respondents had had a medication abortion and a similar proportion had been attended by a female physician. Some 81% of the women had been using a method when they became pregnant, most commonly condoms (33% of the full sample), the pill (16%), the IUD (15%) and the injectable (7%).
The majority of women discussed post- abortion family planning with their abortion provider (88%) and said they had been offered at least one method during their visit (82%). Women were most often offered an IUD (73%), the pill (46%), the injectable (34%) or condoms (22%); other options offered included the implant, the patch and sterilization (2–4%). While 95% of women seen by a female provider were offered a contraceptive method, the same was true for just 69% of those whose provider was male. Ninety percent of women chose a method at this time—most often the IUD (59%)—and the vast majority (88%) did not feel that the provider had tried to influence their choice. Most women who were provided with contraceptive counseling said they understood the counseling (97%) and felt it was adequate (93%), but considerably lower proportions reported receiving information on when to resume having sex (68%) or on STIs (38%) or emergency contraception (26%).
Multivariate logistic regression analyses revealed that women who had had a surgical abortion were more likely than those who had had a medication abortion to be offered a contraceptive method (odds ratio, 5.4). Compared with those who had visited a primary health center for their abortion, women who had gone to a general hospital had lower odds of having been offered contraception (0.1). Women who had been attended by a female physician were substantially more likely than those attended by a male physician to have been offered contraceptives and to have selected a method (3.0 and 6.3, respectively). Other characteristics, including women’s parity and marital status, were not associated with having been offered a form of post-abortion contraception or having selected a method.
The researchers note that their findings are consistent with those of previous studies on public abortion services in this setting, but caution that the results are not generalizable to all facilities in Mexico City because the survey was limited to three of the city’s 13 public facilities that provided abortion care at the time. In addition, the sample had higher proportions of younger and childless women than did the public abortion client population, and women’s responses may have been subject to social desirability bias. Despite these limitations, the investigators conclude that facilities in Mexico City provide a “high level of postabortion family planning care,” although they emphasize the need for increased focus on emergency contraception, STIs and personalized contraceptive counseling during such care.—S. Ramashwar
1. Becker D et al., Women’s reports on postabortion family-planning services provided by the public-sector legal abortion program in Mexico City, International Journal of Gynecology & Obstetrics, 2013, 121(2):149–153.