[Population and health. Reproductive health in adolescents]. / Poblacion y salud. Salud reproductiva en adolescentes.

PIP: The young age structure of the Mexican population and the large number of adolescents, estimated at 20.1 million in 1990, indicate a high potential demand for sex education and reproductive health services. The 4.9 million women 15-19 years old represented 23.5% of the reproductive-age female population. Adolescent fertility has declined slowly, to a rate of 84/1000 women 15-19 years old in 1986, but the absolute number of births is still increasing. In 1987, 14.1% of women ages 15-19 and 53.3% ages 20-24 had at least 1 child. The arrival of the first child occurs soon after the union. Surveys in 1976, 1982, and 1987 showed that in all educational groups, the first birth is occurring at ever younger ages. In 1987, 35% of births to mothers ages 15-19 and 30% to those 20-24 were premarital. In 1976, only 17% of births to mothers 15-19 years old were premarital. Adolescents become sexually active at young ages and lack adequate contraceptive protection. Reasons given by adolescents for not using contraception include the belief that pregnancy is impossible, the unplanned nature of sexual relations, lack of knowledge of contraceptive methods, and fear of side effects. A 1988 Mexico City survey found that 1% of females and 3% of males 15-25 years old had contracted sexually transmitted diseases. The same survey indicated that young people lack knowledge of the transmission and prevention of sexually transmitted diseases. Clear and timely instruction in management of sexuality is needed from the fifth or sixth grades of primary school so that adolescents will be informed of methods to avoid pregnancy and about the responsibilities and risks of early pregnancy.^ieng

[Family planning and perinatal mortality in the Instituto Mexicano del Seguro Social (IMSS)]. / Planificacion familiar y mortalidad perinatal en el IMSS.

PIP: Despite government efforts in Mexico to reduce maternal and infant mortality through proper medical care, mortality rates remain high. Family planning potentially contributes to reducing mortality of mothers and infants by reducing fertility levels and allowing optimal timing of births. A recent epidemiological study based on a probabilistic sample of newborns in Mexican Institute of Social Security hospitals in metropolitan Mexico City, Guadalajara, and Monterrey allowed evaluation of the association between reproductive risk due to age, parity, and birth interval and perinatal mortality. The analysis demonstrated that rates of perinatal mortality associated with extremely long or extremely short birth intervals in women at high reproductive risk due to pre-pregnancy nutritional status, obstetrical or chronic degenerative pathology, or reproductive pattern were much higher than in low risk births. But when women at reproductive risk had intervals of 1-5 years between the end of one pregnancy and the beginning of the next, their children were at similar risk to those of mothers with no reproductive risks. Good prenatal care reduced the perinatal mortality risk substantially for infants of high-risk mothers, but a negative effect persisted for long intervals. Good birth spacing mitigates the negative influence of pathological conditions associated with age and high parity.^ieng

A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSS's family planning services.

PIP: A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The results indicate that the IMSS family planning program considerably reduced the demand on its maternal and infant care services. As a consequence of its family planning program, IMSS was able to divert a total of 318 billion pesos (1983 currency) from maternal and infant care to payments for pensions and general health services. In other words, for every peso that IMSS spent on family planning services to its urban population in 1972-1984, the agency saved 9 pesos. Consistent findings lend credence to estimates of the demographic impact of the IMSS family planning program on its urban population. Among the IMSS urban population, sterilization accounts for 57% of the prevalence rate. Another measure of the demographic impact is the decline in the total fertility rate from 6.5 children per woman in 1972 to 2.93 in 1985. The cost data for this analysis are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states.