What factors can impact women’s likelihood to present for abortion after the legal gestation age limit?

Tuesday, April 24, 2018

Three Mexican women

In low- and middle-income countries where abortion has been decriminalized, little research has been done into the question of how many women are unable to access abortion care because they present for treatment past the legal gestational age limit, and which factors might make late presentation more likely. A new study examines these questions and finds that young age, lower levels of education and residing further from legal abortion care all impact women’s likelihood to present late and, therefore, be refused abortion services.

In Mexico, abortion law is determined at the state level. First-trimester abortion was decriminalized in Mexico City in 2007, but remains highly restricted in Mexico’s other 31 states. First-trimester abortion is available from both private providers and from the public program, Interrupcion Legal de Embarazo (ILE). The ILE program provides free abortion care to Mexico City residents and sliding-scale fee care to non-residents.

Using data from four high-volume sites in the ILE program, the researchers found that of the 52,391 women included in the study’s sample, 8% presented for care after Mexico City’s legal gestational age limit of 12 weeks. The researchers, including Raffaela Schiavon, who was country director of Ipas Mexico when the study was conducted, found that adolescents were greatly overrepresented among the women presenting late.

There were disparities, too, in educational attainment among the women who presented past the gestational age limit—a lower proportion of those women had greater than a high school education compared to women who presented within the legal gestational age range.

Women who presented past the gestational age limit were also slightly less likely than those who received care to live in Mexico City.

The study’s findings can inform education and advocacy efforts toward a focus on early recognition of pregnancy—especially among adolescents—in order to ensure that women are able to take advantage of legal and free, but time-sensitive, first-trimester abortion in Mexico City.