Attitudes towards abortion among medical trainees in Mexico City public hospitals

Women's opinions on the legalisation of abortion in Chile 2009-2013

Chile is one of only four countries in the world where there is no explicit legal exception to prohibitions on abortion, and where the criminalisation of abortion endangers women's health and may be misaligned with public opinion. In this study we explored attitudes towards the legalisation of abortion and differences in levels of support across time. Among Chilean women in 2009 and 2013, we examined: (1) an additive index indicating support for legalisation of abortion in several situations and (2) support for each situation separately. We investigated the demographic characteristics associated with support for legalisation using multivariate regression. Over 70% of women supported the legalisation of abortion in cases of risk to the woman's life, rape and foetal malformation, and support was higher in 2013 compared to 2009 (β = 0.28; 95% CI: 0.12, 0.44). Women with increasing education and those attending church services less frequently were more likely to support the legalisation of abortion (β = 0.27; 95% CI: 0.11, 0.43), while those affiliated to a religion other than Catholicism (β =  - 0.32; 95% CI:  - 0.48,  - 0.16) were less likely to do so. Our study is the first to examine public opinions on abortion in Chile and differences in levels of support across time periods. Results indicate that current policies may not reflect trends in public opinion.

On abortion: exploring psychological meaning and attitudes in a sample of Mexican gynecologists

Elective abortion has become an issue of ethical and political debate in many countries including Mexico. As gynecologists are directly involved in the practice of abortion, it is important to know the psychological meaning that the term 'elective abortion' has for them. This study explores the psychological meaning and attitudes toward elective abortion of one hundred and twenty-three Mexican gynecologists. We used the semantic networks technique, which analyzed the words the participants associated with the term 'elective abortion'. The defining words most frequently used by participants implied a negative sanction. There were important differences by gender and religiosity: male gynecologists, as well as those with strong religious beliefs (mainly Catholics), revealed a more negative psychological meaning and more negative attitudes than females or physicians with weak religious beliefs. A contribution of the present study is that it highlights the importance of psychology to enhancing understanding of the issue of elective abortion.

Exploring abortion knowledge and opinion among lawyers, an important yet overlooked stakeholder group in Mexico

Lawyers are important actors shaping the abortion debate in Mexico. Of 250 private and public sector criminal lawyers surveyed from four regions, the majority knew about abortion laws in their states. At least 80% agreed with abortion in cases of rape, risk to a woman's life or health, and fetal malformations. Overall, 61% agreed with the Mexico City law and 84% would defend a woman denied a legal abortion. In multivariate analysis, being very knowledgeable of abortion laws was a significant predictor of more "progressive" abortion opinions, support for the Mexico City law, and support for the health indication.

Exploring the determinants of unsafe abortion: improving the evidence base in Mexico

BACKGROUND

Despite the realized importance of unsafe abortion as a global health problem, reliable data are difficult to obtain, especially in countries where abortion is illegal. Estimates for most developing countries are based on limited and incomplete sources of data. In Mexico, studies have been undertaken to improve estimates of induced abortion but the determinants of unsafe abortion have not been explored.

METHODS

We analysed data from the 2006 Mexican National Demographic Survey. The sample comprises 14 859 reported pregnancies in women between 15 and 55 years old, of which 966 report having had an abortion in the 5 years preceding the survey. We use logistic regression to explore the relationship between unsafe abortion and various socio-economic and demographic characteristics.

FINDINGS

We estimate that 44% of abortions have been induced and 16.5% of those were unsafe. We find three variables to be positively and significantly associated with the probability of having an induced abortion: (1) whether the woman reported that the pregnancy was mistimed (OR = 4.5, 95% CI = 1.95-10.95); (2) whether the woman reported that the pregnancy was unwanted (OR = 2.86, 95% CI = -1.40-5.88); and (3) if the woman had three or more children at the time of the abortion (OR = 3.73, 95% CI = 1.20-11.65). There is a steep socio-economic gradient in the probability of having an unsafe abortion: poorer women are more likely to have an unsafe abortion than richer women (OR = 2.48, 95% CI = 1.09-5.63); women with 6-9 years of education (OR = 0.30, 95% CI = 0.11-0.81) and with more than 13 years of education are less likely to have an unsafe abortion (OR = 0.065, 95% CI = 0.01-0.43), and women with indigenous origin are more likely to have an unsafe abortion (OR = 5.44, 95% CI = 1.91-15.51). Thus, the probability for poor women with less than 5 years of education and indigenous origin is nine times higher compared with rich, educated and not indigenous women. We also find marked geographical inequities as women living in the poorest states have a higher risk of having an unsafe abortion.

INTERPRETATION

This analysis has explored the determinants of unsafe abortion and has demonstrated that there are large socio-economic and geographical inequities in unsafe abortions in Mexico. Further efforts are required to improve the measurement and monitoring of trends in unsafe abortions in developing countries.

Physicians' agreement with and willingness to provide abortion services in the case of pregnancy from rape in Mexico

BACKGROUND

In Mexico, abortion is not penalized when a woman gets pregnant as a result of rape, yet access to abortion services is limited. Understanding physicians' opinions about abortion is critical to creating strategies that will broaden women's access to services.

STUDY DESIGN

Multivariate logistic regression was performed using data collected from a sample of 1206 physicians in Mexico. The influence of independent variables on two outcomes was analyzed: physicians' agreement with abortion being legal in the case of pregnancy caused by rape and willingness to provide abortion services in such cases.

RESULTS

Physicians who had performed legal abortions, knew about existing abortion legislation and practiced general or family medicine were significantly more likely to agree that abortion should be legal when pregnancy is caused by rape and were more likely to be willing to provide abortion in the case of rape. Physicians who held a negative attitude towards women who seek abortion and those with greater church attendance were less likely to agree with the legality of abortion.

CONCLUSIONS

Physicians are among the most important gatekeepers to women's access to safe abortion services. A majority of Mexican physicians agree that abortion should not be legally penalized under certain circumstances. Yet, many also hold negative attitudes towards women who seek abortion. Physicians' support for women's access to safe abortion services is key to ensuring that such services will exist in Mexico.

Abortion opinion research in Latin America and the Caribbean: a review of the literature

Abortion laws in Latin America and the Caribbean (LAC) are highly restrictive and may not reflect public opinion on the issue. This article synthesizes the survey literature on attitudes toward abortion in the region. We searched standard computer indexing services and polled colleagues at regional meetings to identify every methodologically sound quantitative study of abortion opinion in LAC published between 1985 and 2005. Of the 26 studies that met inclusion criteria, none was conducted in the Caribbean, 11 were conducted in Brazil, 11 in Mexico, 3 in Argentina, and 1 in Colombia. The majority of populations surveyed support abortion under a greater number of circumstances than are permitted in their respective countries, particularly in cases of rape and threat to life or health. Future abortion opinion surveys should ask about support for the legality of abortion rather than about abstract acceptance of abortion, and questions should be worded carefully to capture the complexities of the public's views on this issue.

Changing opinions of Mexican geneticists on ethical issues

BACKGROUND

The discussion of ethical issues in the practice of medical genetics is quite recent in Mexico. However, in the present report we were able to compare the results obtained with the same instrument in two surveys performed with a 12-year interval.

METHODS

A semistructured questionnaire including 52 questions that explore many different situations in the form of case vignettes related to ethical dilemmas was sent on two occasions to geneticists certified by the Mexican Board of Human Genetics. The first survey was performed in 1993, obtaining a response rate of 72% (64 individuals) and the second in 2005 with a 61% response rate (86 individuals). The areas explored were fairness of access to genetic services, full disclosure of all relevant information, respect for parental choices, protection of patients' privacy, use of prenatal diagnosis only for information about the health of the fetus, voluntary vs. mandatory screening and patients' confidentiality vs. the defense of third party interests.

RESULTS

All questions analyzed in the paper were answered by at least 80% of the geneticists surveyed, although in many instances their experience with the situation explored was limited. The complete results of the 2005 survey are given in the text and tables, whereas the 1993 results are used mainly for comparison and given in full only when practical. There was a tendency to answer general questions one way and later change opinions when confronted with specific cases. There was a clear paternalistic attitude and a generalized opinion that one of the goals of medical genetics is to diminish the proportion of individuals with genetic diseases, not for eugenics reasons, but to avoid suffering of the patients and their families.

CONCLUSIONS

Comparison of both surveys clearly shows a tendency towards increasing respect for privacy and autonomy of the patients.

Strategies used by low-income Mexican women to deal with miscarriage and "spontaneous" abortion

This study focuses on lowest income Mexican women attended for abortion-related complications in a public hospital. The objective was to investigate the women's experience of having a so-called "spontaneous" abortion and their related strategies to avoid stigmatization. Four strategies emerge from women's testimonies: presenting themselves as women who "play by the rules," pleading ignorance of the pregnancy, stating that they had already accepted their pregnancy, or presenting the abortion as the result of an accident. Women use these strategies to deflect any blame to which they might be subjected and as a means of dealing with the stigma attached to a behavior that transgresses social norms regarding reproduction. Far from being passive receptors of the social imperative, which makes motherhood compulsory, women oscillate strategically within the margins of a seemingly uniform normative discourse and thereby ensure their moral survival. The authors discuss results within the framework of praxis theory.

Constructing access to legal abortion services in Mexico City

For the last three decades, government and health institutions have recognised that unsafe abortion is an important social and public health problem in Mexico. Although the Penal Code in every state defines at least one situation in which abortion is legal, access to legal abortion services is restricted for women throughout Mexico. In August 2000, the Mexico City Legislative Assembly reformed the Penal Code to include a wider range of grounds on which abortion is legal and added regulations to ensure access to legal abortion services in cases of rape and forced artificial insemination. The Mexican Supreme Court upheld the constitutionality of the reforms in January 2002. This paper describes a collaborative project between Ipas Mexico and the Mexico City Department of Health to provide legal abortions in cases of rape and to ensure that comprehensive health services for survivors of sexual violence are available and accessible. It describes a model of care being introduced into 15 public general and maternal-child health hospitals in Mexico City through a programme of multi-disciplinary consciousness-raising workshops and training courses on sexual violence and legal abortion. Few health care providers have had prior training in service provision for survivors of sexual violence or abortion service delivery. Workshop participants showed a high level of willingness to participate in legal abortion services for survivors of sexual violence when and if they are receive solid institutional support.