Evidence, rigor, and strategy: Building a program of research to inform abortion policy in Latin America
Awarded 2015
Junior Investigator Grants
Blair Darney, PhD, MPH
Oregon Health & Science University

Objectives: To assess late presentation for care, gestational age, and disparities in traveling for care in Mexico City’s public abortion program, called ILE. To replicate a recent publication (Koch et al) purporting to show that restrictive abortion laws are associated with reduced maternal mortality in Mexico. Methods: We extracted data from clinical charts and used existing registry and administrative data and quantitative methods. Results: Adolescents and women with lower levels of education are at risk for presenting past the gestational age limit in the ILE program. Gestational age estiamtes using last menstrual period and ultrasound are very similar. Women who are able to travel for abortion services are more educated than the average in their localities; the is unmet demand for abortion services where abortion is not legal on demand. The Koch et al study has several flaws in methodology and interpretation. Less restrictive abortion laws are not associated with lower maternal mortality; maternal mortality is decreasing across Mexico. Conclusions: Target information about the availability of legal first trimester abortion and timely assistance to access abortion services, including earlier recognition of pregnancy, to younger and less educated women. Lack of ultrasound technology should not be a barrier to providing first trimester abortion services. Travel time, living where abortion is illegal, and lower SES represent substantial barriers to accessing legal abortion. We need rigorous evidence about the health impacts of increasing access to safe abortion worldwide. Rigorous evidence about the health impacts of increasing access to safe abortion worldwide is needed.