The knowledge, attitudes, and practices of Mexican health care providers in relation to abortion
Awarded 2009
Large Research Grants
Dilys Walker, MD
Instituto Nacional se Salud Publica

Introduction: In 2006, Mexico’s annual abortion rate was 33 per 1000 women of reproductive age. Complications from unsafe abortions account for 8-11% of maternal deaths, and unsafe abortion is the fourth cause of maternal mortality. Access to safe abortion services continues to be restricted throughout the majority of Mexico and laws vary among the 32 states. In 2007 landmark legislation was passed decriminalizing abortion in Mexico City and making it legal on demand during the first trimester of pregnancy. Purpose of the study: To describe the knowledge, attitudes and practices (KAPs) of women’s health care providers in relation to medical and surgical abortion, in the setting of the recent legalization of abortion in Mexico City. Methods: Cross-sectional study with an anonymous and self-interviewing survey. Because of the exploratory nature of our study, a non-probabilistic and convenience sampling of health care providers in Mexico was used. Our survey was implemented at the Collegio Mexicano de Especialistas en Ginecologia y Obstetricia – COMEGO (Mexican College of Specialists on Gynecology and Obstetrics) 60th National meeting. The annual meeting took place in the City of Cancún, México, on November 1-5, 2009. For data collection we used Audio Computer-Assisted Self-Interviewing (ACASI) technology. Results: We obtained 424 complete surveys. While abortion is legal nationwide in cases of rape, only 54.3% of participants correctly stated that abortion was legal in this circumstance. Only 31% supported legal abortion based on a woman’s decision to terminate whereas over 80% felt that abortion should be legal when pregnancy results from rape, endangers the life of the mother, and when there are fetal anomalies. 85% of respondents noted unsafe abortions to be a problem in the area in which they practiced. Prior to the legalization of abortion in Mexico City in 2007, 11% and 17% provided medical and surgical abortions nationwide. Now, 15% and 21% provide medical and surgical abortion services, respectively. In addition, 30% of respondents reported being more interested in abortion provision since such law was implemented. However, when respondents were asked what they would do if approached by a women desiring abortion at 8 weeks gestation, 40% reported that they would advise continuation of the pregnancy and advise against abortion in all circumstances. 81% of medical abortion providers reported using regimens that were ineffective to induce abortion (<600-800 mcg misoprostol po/pv, repeated as needed). Interestingly, the majority of medical abortion providers (87%) stated that they would like more training in medical abortion provision. Conclusions: Given the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened.