Con la ley y sin la ley/With and without the law: Utilization of abortion services and case fatality in Mexico, 2000-2016.

OBJECTIVE: To describe utilization of health services for, and case fatality from, abortion in Mexico. METHOD: A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. RESULTS: The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. CONCLUSION: Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward.

Analysis of maternal and abortion-related mortality in Mexico over the last two decades, 1990-2008.

To document the relative contribution of abortion-related deaths to overall maternal deaths in Mexico, official mortality data were analyzed according to International Classification of Diseases (ICD) codes. During 1990-2008, among 24 805 maternal deaths, 1786 (7.2%) were abortion related. Of these, 13.2% occurred in adolescents and 65% in uninsured women; 60% were probably associated with unsafely induced procedures. The study calculated the number of abortion-related deaths per 100,000 abortion-related hospitalizations, expressed as a modified abortion case-fatality rate. During 2000-2008, this rate was 48 at the national level, with wide variations among states: from 140 deaths in Guerrero to 8 in Baja California Sur per 100,000 abortion hospitalizations. Unsafe abortion continues to represent a significant proportion of all maternal deaths in Mexico.