Patients' experiences of first-trimester abortion services in two public facilities in Mexico City three years after decriminalization Open Access

AbiSamra, Roula (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/z316q205h?locale=en
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Abstract

Background: In 2007, Mexico City decriminalized abortion in the first twelve
weeks of pregnancy. This work describes experiences of patients obtaining legal
first-trimester abortion care through Mexico City's Ministry of Health (MOH).
Aims included comparing satisfaction of medical and surgical abortion patients;
deriving recommendations for program improvement; and measuring pre- and
post-abortion contraceptive use.
Methods: Mixed-methods, secondary data analysis of responses from patients
at two main MOH abortion facilities: surveys of 350 patients and in-depth
interviews with a subset of 20 patients. Survey data were analyzed with tests for
bivariate association and multivariate logistic regression. Interview data were
used in qualitative thematic-content analysis using principles of grounded theory.
Results: Most components of the MOH abortion care protocol were followed. Of
16 appointment components reviewed, 13 were completed for at least four-fifths
of patients. Patients overwhelmingly reported satisfaction with care overall
(97.1%), with no significant differences between medical and surgical abortion
patients. However, qualitative data revealed a need for more sympathetic staff,
reduced wait times, better information on surgical abortion, patient choice of
abortion methods, and counseling that addresses psychosocial issues. Both
medical and surgical abortion methods were acceptable, but few patients were
given the opportunity to choose. Contraceptive uptake was high, especially for
IUDs (63% of respondents, up from 14% who used one in the preceding 12
months); however, few contraceptive methods were discussed or available.
Discussion: Mexico City's newly-created legal abortion program is successfully
addressing most of the basic goals of quality clinical care. Yet quality of care has
non-clinical aspects as well, and our results reveal opportunities for the legal
abortion program to make care excellent and become a model for other providers
in the country. Mixed-methods research on experiences of abortion care can
provide insight that might be overlooked by a purely quantitative study.

Table of Contents

Table of Contents

Introduction................................................................................................1
Materials and Methods..................................................................................4
Results.......................................................................................................9
Discussion, Recommendations and Conclusion...................................................21
References................................................................................................33
Tables......................................................................................................39
Appendix...................................................................................................44

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