Erika Troncoso et al.


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    First Tri deaths: the hidden patterns
    Troncoso, E1; Schiavon, R1; Freyermuth, G2;
    Ramirez, G2
    1 Ipas; 2 Observatorio de Mortalidad Materna, Mexico
    In Mexico, public health sector information systems have
    significantly improved their record keeping and allow us to know
    that termination of pregnancy (TOP) mortality accounts for
    around 10% of maternal deaths in the last 10 years. Given the
    high mortality ratio, maternal deaths are analysed carefully every
    year in the Ministry of Health. The goal of this project was to
    better understand the 2010 TOP related mortality files.
    During 2010, 9.27% of maternal deaths were due to TOP
    (92 cases). Almost 75% of deaths were among women aged 15 to
    34 years, younger than those dying from other causes. Twenty-six
    percent were single compared with 15% for the other causes.
    Ninety percent of women received health care before the death.
    The quality of the information of the TOP cases was poor,
    regularly a maternal mortality case was 11 elements for the
    comprehensive analysis into their file. In the case of TOP deaths,
    only 66% of the files had verbal autopsies, 23% a necropsy report,
    and no one had an official declaration. In some cases, women
    were not aware of their pregnancy, and the diagnosis did not
    consider pregnancy.
    Despite the interest in maternal mortality, TOP has not been
    adequately addresed in the current framework and more questions
    remain after the revision of the files. TOP-related deaths require
    an adequate response from the health systems.

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    Women experiences with legal abortion services in private clinics in Mexico City

    Erika Troncoso (Ipas Mexico), Olivia Ortiz (Ipas Mexico), Raffaela Schiavon (Ipas Mexico)

    Background: Decriminalization of induced abortion during the first trimester of pregnancy in Mexico City has broadened reproductive choices for women since April 2007. The objective of this study was identify the barriers and conditions that impact access to legal abortion (LA) in private clinics.

    Methods: Seventeen semi-structured interviews were conducted with women who received a legal abortion in two clinics in Mexico City.

    Results: The majority of the women interviewed were young, single with higher levels of education.  Three women travelled to Mexico City to obtain a LA. The majority of women sought medical advice prior to arriving at the center and changed their decisions due to unfriendly care and lack of trust. Also, the majority of women obtained information on conditions and facilities offering services through the internet, as well were already aware of the legal changes pertaining to abortion. This allowed them to speak more openly on the subject with those most trusted, and even with healthcare providers when seeking consultation. Other factors that facilitated the experience included: being attended by trained medical personnel in legal and sanitary conditions, receiving comprehensive information about the procedure, and experiencing friendly and non- judgmental treatment by health personnel.  Finally, establishing a personnel bond with one of the healthcare providers helped the process to be more comfortable. In respect to the barriers, the interviewed group identified what close relatives and friends perceived of them, informed by religious beliefs and moral judgments, as important. Other aspects were difficulties finding specific information on the way different methods work, the effects, and lack of economic resources to be treated immediately. Some women stated fear of feeling rejected by health personnel when requesting care. Women stated having distorted information produced and disseminated by the opposition concerning abortion. In addition, they found that some providers passed judgment or they felt hostility from health personnel in other areas, including prolonged waiting periods. However, these factors did not push them to change their decisions. The women stated their need for emotional support, something that was not considered in LA provision of services.

    Discussion: Before arriving at the medical facility, the majority of the women was confronted by many complex and diverse situations and had made decisions as a method of self-defense and survival.  Deciding to have a legal abortion served as an opportunity to change or avoid greater repercussions in the woman’s life.  Legal abortion services must be aware of these situations because they will have an influence on the experience of the services. The analysis shows how women requesting legal abortion used various criteria to determine how much they trusted the service: both the legality and the expectation of care were used in order to determine who would be their health provider. Finally, this study shows the need to do further research on women’s emotional experiences, aiming to identify the factors that put them at risk in the immediate future with an unwanted or unplanned pregnancy.