Women's experiences of legal abortion care provided in Mexico City's public facilities: A mixed-methods study, three years after decriminalization

Introduction: In 2007, Mexico City's legislature decriminalized pregnancy terminations done by twelve weeks' gestation. Over 50,000 procedures have since been provided in designated Mexico City Ministry of Health (MOH) facilities. Objective: The goal of this research was to understand patients' experiences with abortion in the MOH program. Specific aims were to (1) measure characteristics, knowledge, and satisfaction of women who used misoprostol-only medical abortion compared to women who underwent the surgical protocol; (2) understand patients' perceptions of the care they received, of their own abortion experience, and of abortion in general; and (3) derive recommendations for improving the MOH program. Methods: 350 consenting women completed a questionnaire of demographics, steps taken to obtain services, and service satisfaction. A sub-sample of 20 patients also completed in-depth interviews (IDI) regarding their experiences. Statistical analysis includes bivariate and multiple logistic regression techniques to identify predictors of patient satisfaction with each method. Interview data are analyzed using a grounded theory approach. Results: Preliminary quantitative results indicate that patients had a mean age of 25 years, a high-school education, and were single. Approximately 90% had more than one child, and women aged 24-34 favored medical abortion while those aged 15-24 favored surgical abortion. Of the 350 women, 14.4% had attempted to self-induce an abortion prior to obtaining medical care. Attempts to self-induce an abortion during this pregnancy (using any method) was significantly associated with having prior knowledge of medical abortion regimens. Multivariate analysis and IDI findings are expected to be complete in late February.