COVID-19 pandemic exacerbation of disparities in access to public abortion services in Mexico.

IF 3.4 3区 医学 Q1 FAMILY STUDIES BMJ Sexual & Reproductive Health Pub Date : 2024-08-29 DOI:10.1136/bmjsrh-2024-202294
Elizabeth Kravitz, Biani Saavedra-Avendaño, Blair G Darney
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Abstract

Background: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.

Methods: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.

Results: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.

Conclusions: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.

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COVID-19 大流行加剧了墨西哥在获得公共堕胎服务方面的差距。
背景:我们描述了墨西哥城公共人工流产项目 Interrupción Legal de Embarazo (ILE) 在 COVID-19 大流行期间的客户情况,并检验了大流行是否加剧了获得服务方面的不平等:我们对 2019 年 1 月 1 日至 2022 年 6 月 30 日期间 ILE 计划中的所有人工流产进行了一项队列研究。我们按大流行阶段(COVID 前期、急性期、中期和后期)对墨西哥城大都会区(ZMVM)内外的患者进行了比较,并使用按州聚类的线性概率模型评估了按居住地(ZMVM 与 ZMVM 以外)划分的客户特征(青少年年龄、教育程度、妊娠周数)的变化:我们纳入了 45 031 例人工流产。来自 ZMVM 以外地区的妇女堕胎比例从 COVID 前的 6.5%降至 COVID 急性期、中期和后期的 4.4%-4.8%。来自 ZMVM 以外地区的青少年流产的调整后概率在 COVID 前期(14.4%,95% CI 12.7% 至 16.1%)和 COVID 中期(9.3%,95% CI 7.9% 至 10.7%)之间有所下降。受过高中教育的妇女的堕胎比例在旅行者中基本持平,而在居住在 ZMVM 的妇女中则有所上升。在大流行前,居住在 ZMVM 的妇女在 11 孕周或 11 孕周以上进行人工流产的调整后概率较高;在大流行的各个阶段,这种情况都发生了翻转,从 ZMVM 以外旅行的妇女在 11 孕周或 11 孕周以上进行人工流产的概率较高:结论:COVID-19 大流行加剧了在获得 ILE 服务方面的现有差距。为了减少获得基本医疗服务方面的不平等,墨西哥各州都应提供公共部门的人工流产服务。
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来源期刊
BMJ Sexual & Reproductive Health
BMJ Sexual & Reproductive Health Medicine-Reproductive Medicine
CiteScore
5.10
自引率
6.10%
发文量
38
期刊介绍: BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.
期刊最新文献
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