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Peña M, Flores KF, Ponce MM, Serafín DF, Camarillo Zavala AM, Cruz CR, Salgado IGO, Rosado YO, Socarras T, López AP, Bousiéguez M. Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study. Contraception 2022; 114:67-73. [PMID: 35753406 DOI: 10.1016/j.contraception.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector. STUDY DESIGN A prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one non-clinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7-14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests. RESULTS We conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; six individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311). CONCLUSIONS This study showed that guided self-management telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, particularly those that rely on public sector services.
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Affiliation(s)
- Melanie Peña
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
| | - Karla Figueroa Flores
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Mariana Muñoz Ponce
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Diana Facio Serafín
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Ana María Camarillo Zavala
- Centro de Atención Integral a la Pareja, A.C: Av. Canal de Miramontes # 2342, Coapa, Avante, Coyoacán, 04460 Ciudad de México, Mexico
| | - César Ruiz Cruz
- Medieg: Gabriel Mancera # 803, Col del Valle Centro, Benito Juárez, 03100 Ciudad de México, Mexico
| | | | - Yeni Ochoa Rosado
- Red de Mujeres y Hombres por una Opinión Pública con Perspectiva de Género en Campeche (RedMyH): Calle 55, # 14 int. 2 (entre calle 12 y calle 14) Col. Centro, Campeche, Campeche, Mexico
| | - Tania Socarras
- Planned Parenthood Global: 123 William Street, 10th floor, New York, New York 10038, United States
| | - Adrián Pacheco López
- Centro Nacional de Excelencia Tecnológica en Salud (CENETEC): 450 -13, Juárez, Cuauhtémoc, 06600 Ciudad de México, Mexico
| | - Manuel Bousiéguez
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
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Núñez Medina G. Bayesian spatial modelling of contraception effects on fertility in Mexican municipalities in 2020. GEOSPATIAL HEALTH 2022; 17. [PMID: 35579245 DOI: 10.4081/gh.2022.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
The prevalence and use of contraceptive methods is an essential element to explain the behaviour of fertility and population growth. The objective of this study was to analyse the spatial correlation between the use of contraceptive methods in women of childbearing age and fertility levels observed in Mexico's municipalities in 2020. Data on contraceptive use are from the National Survey of Demographic Dynamics (ENADID) 2018, while fertility rates were estimated from vital statistics and population census data. Three Bayesian spatial models including fixed effects, random effects and spatial effects were employed. The models were estimated using the integral nested Laplace approximation (INLA) package available in the R language. The results reveal the existence of important regional inequalities associated with the use and prevalence of contraceptive methods, which generate marked differences in observed levels of fertility between municipalities.
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