Health care experiences of HIV-infected women with fertility desires in Mexico: a qualitative study.

Increased access to antiretroviral therapy has enabled Mexican HIV-infected women to resume healthy sexual and reproductive lives and reduce the risk of mother-to-child transmission of HIV infection. However, little information is available on the experiences of HIV-infected women desiring children. In this qualitative study, we conducted in-depth interviews with 31 HIV-infected women in four Mexican cities. The findings indicated that most of the women were given limited information on their pregnancy options. With some exceptions, the women felt they were denied the option to have (or to have more) children and advised to undergo tubal ligations or abortions. The findings of this study indicate that ongoing efforts are needed to promote the reproductive rights of HIV-infected women in Mexico and to ensure that they receive options aligned with their fertility desires.

The female condom: a promising but unavailable method for Dominican sex workers, their clients, and their partners.

Despite evidence of the potential of the female condom as a method that effectively protects against sexually transmitted infections (STIs), HIV, and pregnancy, it is still not widely available. We conducted in-depth interviews with 18 sex workers, 15 male clients, and seven partners in the Dominican Republic to assess the acceptability of the female condom. The majority of the sex workers found the female condom acceptable and welcomed the option of a female-controlled method. Clients and partners of the sex workers were also positive about the female condom and, particularly with regard to pleasure; almost all preferred it to the male condom. These findings suggest that the female condom offers an acceptable option for protection against HIV, STIs, and pregnancy. The positive attitudes of women and men could be developed into messages in marketing campaigns for the female condom, targeting not only vulnerable groups but also the general population.

Use of magnesium sulfate for treatment of pre-eclampsia and eclampsia in Mexico.

OBJECTIVE: To establish a baseline of magnesium sulfate utilization prior to publication of the updated 2006 technical guidelines on pre-eclampsia and eclampsia in Mexico, and to examine barriers to treating pregnant women with magnesium sulfate as perceived by maternal health experts. METHODS: In collaboration with the Federal Ministry of Health, medical charts were reviewed for 87 maternal deaths due to hypertensive disorders that occurred in Mexico in 2005. Evidence was gathered on whether magnesium sulfate had been indicated or administered. In-depth interviews with experts were conducted to identify barriers to treatment utilization. RESULTS: Magnesium sulfate had been used in 37.5% of severe pre-eclampsia and 47.7% of eclampsia cases. Thematic analysis of expert interview data revealed 4 primary barriers to the implementation of evidence-based guidelines and use of magnesium sulfate: lack of knowledge of magnesium sulfate, lack of acceptance, drug-related barriers, and insufficient monitoring or supervision. It was found that magnesium sulfate was not the treatment used for Mexican women who died of pregnancy-related hypertensive disorders in public facilities, and there was suboptimal implementation of evidence-based practices and official guidelines. CONCLUSION: The results highlight barriers to magnesium sulfate use, which constitutes a significant gap in treating women with eclampsia in Mexico.

Barriers to the use of maternity waiting homes in indigenous regions of Guatemala: a study of users' and community members' perceptions.

Maternal mortality among indigenous women in Guatemala is high. To reduce deaths during transport from far-away rural communities to the hospital, maternity waiting homes (MWH) were established near to hospitals where women with high-risk pregnancies await their delivery before being transferred for labour to the hospital. However, the homes are under-utilised. We conducted a qualitative study with 48 stakeholders (MWH users, family members, community leaders, MWH staff, Mayan midwives and health centre and hospital medical staff) in Huehuetenango and Cuilco to identify barriers before, during and after the women's stay in the homes. The women most in need - indigenous women from remote areas - seemed to have least access to the MWHs. Service users' lack of knowledge about the existence of the homes, limited provision of culturally appropriate care and a lack of sustainable funding were the most important problems identified. While the strategy of MWHs has the potential to contribute to the prevention of maternal (as well as newborn) deaths in rural Guatemala, they can only function effectively if they are planned and implemented with community involvement and support, through a participatory approach.

Stories behind the statistics: a review of abortion-related deaths from 2005 to 2007 in Mexico City.

Evidence suggests that restricting abortion does not reduce its occurrence but increases health risk. A qualitative analysis was performed, reviewing the medical charts of 12 women who died from unsafe induced abortions in Mexico City; most deaths occurred before abortion was decriminalized. Women resorted to using unsafe techniques, without medical guidance or under incorrect recommendations by providers, ultimately resulting in the loss of their lives. Postabortion care in private and public health facilities was often inadequate. The cases illustrate the importance of liberalizing abortion laws and improving postabortion care to protect the life and health of women seeking to terminate pregnancy.

Women's experiences with legal abortion in Mexico City: a qualitative study.

In April 2007, elective first-trimester abortion was legalized in Mexico City. As of June 2011, more than 60,000 women from Mexico City and other Mexican states have obtained legal abortions in the city's public hospitals and health centers, with private facilities providing additional abortion services. This study examines women's experiences of abortion services in one public and two private clinic settings in 2008. Twenty-five in-depth interviews were conducted: 15 with women who obtained abortions in a public health center and 10 who obtained the procedure at either of two private clinics. Participants were highly satisfied with services at both public and private sites, although some had to go to more than one site before receiving services. None expressed doubts about their decision to have an abortion, and they felt unanimously that they were treated with respect. Furthermore, participants were pleased with the counseling they received and most accepted a contraceptive method after the procedure.

Experiences and opinions of health-care professionals regarding legal abortion in Mexico City: a qualitative study.

This study examines the experiences and opinions of health-care professionals after the legalization of abortion in Mexico City in 2007. Sixty-four semistructured interviews were conducted between 1 December 2007 and 16 July 2008 with staff affiliated with abortion programs in 12 hospitals and 1 health center, including obstetricians/gynecologists, nurses, social workers, key decisionmakers at the Ministry of Health, and others. Findings suggest that program implementation was difficult because of the lack of personnel, space, and resources; a great number of conscientious objectors; and the enormous influx of women seeking services, which resulted in a work overload for participating professionals. The professionals interviewed indicate that the program improved significantly over time. They generally agree that legal abortion should be offered, despite serious concerns about repeat abortions. They recommend improving family planning campaigns and post-procedure contraceptive use, and they encourage the opening of primary health-care facilities dedicated to providing abortion services.

Opinions of decision-makers on the liberalization of abortion laws in Mexico

OBJECTIVE: In the last decade, important advances were made in the struggle for reproductive rights in Mexico. The goal of this study was to discover the opinions of decision-makers about the grounds for legal abortion as well as to explore their perceptions about further liberalization of abortion laws countrywide. MATERIAL AND METHODS: In-depth interviews were conducted with eight prominent decision-makers working in governmental health, law and social institutions as well as representatives of political parties. RESULTS: Six decision-makers favored a further liberalization of abortion laws. They proposed several strategies to move forward with liberalization. Two decision-makers were against abortion under all circumstances. CONCLUSIONS: Three factors seem to play a key role in the liberalization of abortion: a liberal party governing at the state level, a favorable public opinion and the pressure of NGOs promoting reproductive rights. A state-by-state approach seems more effective for generating changes in abortion laws.

OBJETIVO: En la última década se realizaron avances importantes en la lucha por los derechos reproductivos en México. El objetivo del estudio fue conocer las opiniones de tomadores de decisiones (TD) sobre las causales para un aborto legal, así como explorar sus percepciones sobre la liberalización de las leyes en todo el país. MATERIAL Y MÉTODOS: Se realizaron entrevistas a profundidad con ocho TD de instituciones gubernamentales de asuntos sociales, legales y de salud, así como representantes de partidos políticos. RESULTADOS: Seis entrevistados favorecieron la liberalización de las leyes y propusieron varias estrategias para realizarla. Dos entrevistados estuvieron en contra del aborto bajo cualquier circunstancia. CONCLUSIONES: En la liberalización del aborto, tres factores parecen tener un papel relevante: un partido liberal gobernando estatalmente, una opinión pública favorable y la presión de ONG que promueven los derechos reproductivos. El trabajo estatal parece ser más efectivo para generar cambios en las leyes del aborto.

Introducción de la anticoncepción de emergencia en la Norma Oficial Mexicana de Planificación Familiar (NOM-005-SSA2-1993) / Introducing Emergency Contraception in the Mexican Family Planning Official Norm

Objetivos: Entender el proceso de inclusión de las pastillas de anticoncepción de emergencia (PAE) en la Norma Oficial Mexicana de Planificación Familiar e identificar los factores que influyeron en este cambio. Material y métodos: Se realizaron entrevistas a profundidad con ocho tomadores de decisiones que ocupan cargos de alta jerarquía dentro de instituciones del gobierno estatal y federal. Resultados: El factor que determinó la inclusión de las PAE fue la extensa revisión de la evidencia científica que comprueba que no son abortivas, realizada por expertos del Centro Nacional de Equidad de Género y Salud Reproductiva. Además, el amplio apoyo de organizaciones civiles, la demanda de la población y la visión abierta del Secretario de Salud, contribuyeron de forma importante. La inclusión de las PAE en el cuadro básico de medicamentos fue vista como un paso lógico posterior a su inclusión en la Norma Oficial Mexicana. Conclusiones: La introducción de las PAE en México demuestra la importancia de la evidencia científica en la toma de decisiones. El proceso duró cerca de una década, lo cual refleja problemas en la traducción de los resultados de investigación en políticas públicas. Se deben tomar medidas para agilizar este proceso en beneficio de las mujeres y la sociedad en general.

OBJECTIVES: Understand the process of including Emergency Contraception (EC) in the Mexican Family Planning Norm (NOM) and identify factors that influenced this achievement. MATERIALS AND METHODS: We conducted in-depth interviews with eight prominent decision-makers of state and federal government institutions. RESULTS: The determining factor for the inclusion of EC in the Norm was the external review of scientific evidence, done by experts from the National Centre for Equity of Gender and Reproductive Health, proving that EC pills are not abortifacients. Other important factors that contributed to the inclusion were the ample support of civil organizations, the population's demand and the Minister of Health's support of EC. The inclusion of EC in the essential drug list was perceived as a logical next step after its inclusion in the NOM. CONCLUSIONS: The introduction of EC in Mexico highlights the importance of scientific evidence for decision-making. The process took about a decade, which reflects the complexity of converting research results into public policies. Measures should be taken to speed the processes that benefit women and society as a whole.

Opinions of decision-makers on the liberalization of abortion laws in Mexico.

OBJECTIVE: In the last decade, important advances were made in the struggle for reproductive rights in Mexico. The goal of this study was to discover the opinions of decision-makers about the grounds for legal abortion as well as to explore their perceptions about further liberalization of abortion laws countrywide. MATERIAL AND METHODS: In-depth interviews were conducted with eight prominent decision-makers working in governmental health, law and social institutions as well as representatives of political parties. RESULTS: Six decision-makers favored a further liberalization of abortion laws. They proposed several strategies to move forward with liberalization. Two decision-makers were against abortion under all circumstances. CONCLUSIONS: Three factors seem to play a key role in the liberalization of abortion: a liberal party governing at the state level, a favorable public opinion and the pressure of NGOs promoting reproductive rights. A state-by-state approach seems more effective for generating changes in abortion laws.

[Introducing Emergency Contraception in the Mexican Family Planning Official Norm]. / Introducción de la anticoncepción de emergencia en la Norma Oficial Mexicana de Planificación Familiar (NOM-005-SSA2-1993).

OBJECTIVES: Understand the process of including Emergency Contraception (EC) in the Mexican Family Planning Norm (NOM) and identify factors that influenced this achievement. MATERIALS AND METHODS: We conducted in-depth interviews with eight prominent decision-makers of state and federal government institutions. RESULTS: The determining factor for the inclusion of EC in the Norm was the external review of scientific evidence, done by experts from the National Centre for Equity of Gender and Reproductive Health, proving that EC pills are not abortifacients. Other important factors that contributed to the inclusion were the ample support of civil organizations, the population's demand and the Minister of Health's support of EC. The inclusion of EC in the essential drug list was perceived as a logical next step after its inclusion in the NOM. CONCLUSIONS: The introduction of EC in Mexico highlights the importance of scientific evidence for decision-making. The process took about a decade, which reflects the complexity of converting research results into public policies. Measures should be taken to speed the processes that benefit women and society as a whole.