Elizabeth Kravitz, Biani Saavedra-Avendaño, Blair G Darney
{"title":"COVID-19 大流行加剧了墨西哥在获得公共堕胎服务方面的差距。","authors":"Elizabeth Kravitz, Biani Saavedra-Avendaño, Blair G Darney","doi":"10.1136/bmjsrh-2024-202294","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.</p><p><strong>Methods: </strong>We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.</p><p><strong>Results: </strong>We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"COVID-19 pandemic exacerbation of disparities in access to public abortion services in Mexico.\",\"authors\":\"Elizabeth Kravitz, Biani Saavedra-Avendaño, Blair G Darney\",\"doi\":\"10.1136/bmjsrh-2024-202294\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.</p><p><strong>Methods: </strong>We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.</p><p><strong>Results: </strong>We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.</p>\",\"PeriodicalId\":9219,\"journal\":{\"name\":\"BMJ Sexual & Reproductive Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-08-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Sexual & Reproductive Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjsrh-2024-202294\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"FAMILY STUDIES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Sexual & Reproductive Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjsrh-2024-202294","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"FAMILY STUDIES","Score":null,"Total":0}
COVID-19 pandemic exacerbation of disparities in access to public abortion services in Mexico.
Background: We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.
Methods: We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.
Results: We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.
Conclusions: The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.
期刊介绍:
BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.