Women who come from outside of Mexico City to obtain legal abortions are better educated, on average, than abortion seekers residing in the city and, to an even greater extent, than the residents of the communities from which they come. According to "Education, Place of Residence and Utilization of Legal Abortion Services in Mexico City, 2013–2015," by Leigh Senderowicz and Ana Langer of Harvard University’s T.H. Chan School of Public Health and Patricio Sanhueza of Mexico City’s Secretariat of Health, these differences likely reflect that women who are more educated are in a better position to make the journey to obtain the abortion services they need.
Although abortion is illegal in most of Mexico, it was decriminalized during the first 12 weeks of pregnancy within Mexico City in 2007, making the capital the only locale in the country where safe, elective abortion is available. In no other setting in the world are moderate abortion laws such as Mexico City’s found in such close proximity to highly restrictive ones—creating a unique case study on abortion policy reform. Mexico’s legal changes "in essence created an island of access to safe abortion within a sea of restrictive abortion policies," according to the authors.
Because access to abortion in Mexico City is not restricted to municipal residents, women from other parts of Mexico can also obtain these services. Prior to this study, the characteristics of women seeking such abortions—notably their socioeconomic status and place of residence—had not been well documented.
The researchers examined medical records from 22,732 women who sought an abortion at primary-level clinics run by the Mexico City Secretariat of Health between 2013 and 2015. The team explored differences between women from Mexico City and those from elsewhere in Mexico, using education as a proxy for socioeconomic status.
The analysis showed that most abortion seekers came from Mexico City (66%) or its surrounding metropolitan area (22%), while the remainder came from bordering states (7%) or the rest of Mexico (5%). Both well-educated and poorly-educated residents of Mexico City were accessing legal abortion services, but the farther women lived from the capital city, the greater the differential became in the educational levels of women seeking the services.
In analyses that adjusted for typical educational attainment in abortion seekers’ home community, each successive step away from Mexico City was associated with an increase in average years of education: Women from Mexico City had the lowest average level of education (11.1 years), followed by women from the metropolitan area (12.1), women from bordering states (13.3) and, finally, women from the rest of Mexico (16.0). Even after adjusting for differences in age, marital status and other factors, the gradient ranged from 10.1 years among women in Mexico City to 13.4 years among women from the rest of Mexico.
According to the authors, the differences are likely explained by the fact that women who are not well educated and have few resources are less likely to make the journey to Mexico City because of the costs and logistical complexity. Given that desired fertility is so low throughout Mexico, these women are likely obtaining clandestine abortions closer to home. Women with more education and resources, on the other hand, can more easily overcome financial and other obstacles to procure safe services.
The authors conclude that although the policy change has helped all women within Mexico City gain greater access to safe abortion services, it has not helped to a similar extent women outside Mexico City, who lack the means and ability to travel for legal abortion services. Policymakers at the state and federal levels in Mexico should do more to ensure that all Mexican women have access to safe, high-quality and affordable comprehensive abortion care, regardless of place of residence.
Education, Place of Residence and Utilization of Legal Abortion Services in Mexico City, 2013–2015, by Leigh Senderowicz, Patricio Sanhueza and Ana Langer, appears in International Perspectives on Sexual and Reproductive Health and is currently available online.
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IN THIS ISSUE (a summary of articles in this issue of International Perspectives)
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