Harvard Initiative for Global Health, Cambridge, MA 02138, USA.
Health Policy Plan. 2010 Jul;25(4):300-10. doi: 10.1093/heapol/czp061. Epub 2009 Dec 15.
Despite the realized importance of unsafe abortion as a global health problem, reliable data are difficult to obtain, especially in countries where abortion is illegal. Estimates for most developing countries are based on limited and incomplete sources of data. In Mexico, studies have been undertaken to improve estimates of induced abortion but the determinants of unsafe abortion have not been explored.
We analysed data from the 2006 Mexican National Demographic Survey. The sample comprises 14 859 reported pregnancies in women between 15 and 55 years old, of which 966 report having had an abortion in the 5 years preceding the survey. We use logistic regression to explore the relationship between unsafe abortion and various socio-economic and demographic characteristics.
We estimate that 44% of abortions have been induced and 16.5% of those were unsafe. We find three variables to be positively and significantly associated with the probability of having an induced abortion: (1) whether the woman reported that the pregnancy was mistimed (OR = 4.5, 95% CI = 1.95-10.95); (2) whether the woman reported that the pregnancy was unwanted (OR = 2.86, 95% CI = -1.40-5.88); and (3) if the woman had three or more children at the time of the abortion (OR = 3.73, 95% CI = 1.20-11.65). There is a steep socio-economic gradient in the probability of having an unsafe abortion: poorer women are more likely to have an unsafe abortion than richer women (OR = 2.48, 95% CI = 1.09-5.63); women with 6-9 years of education (OR = 0.30, 95% CI = 0.11-0.81) and with more than 13 years of education are less likely to have an unsafe abortion (OR = 0.065, 95% CI = 0.01-0.43), and women with indigenous origin are more likely to have an unsafe abortion (OR = 5.44, 95% CI = 1.91-15.51). Thus, the probability for poor women with less than 5 years of education and indigenous origin is nine times higher compared with rich, educated and not indigenous women. We also find marked geographical inequities as women living in the poorest states have a higher risk of having an unsafe abortion.
This analysis has explored the determinants of unsafe abortion and has demonstrated that there are large socio-economic and geographical inequities in unsafe abortions in Mexico. Further efforts are required to improve the measurement and monitoring of trends in unsafe abortions in developing countries.
尽管不安全堕胎已被确认为全球卫生问题，但可靠的数据难以获取，尤其是在堕胎非法的国家。大多数发展中国家的估计数都基于有限的和不完整的数据来源。在墨西哥，已经进行了一些研究来改善对人工流产的估计数，但对不安全堕胎的决定因素尚未进行探讨。
我们分析了 2006 年墨西哥全国人口调查的数据。样本包括年龄在 15 至 55 岁之间的 14 859 例报告妊娠，其中 966 例报告在调查前 5 年内曾堕胎。我们使用 logistic 回归分析来探讨不安全堕胎与各种社会经济和人口统计学特征之间的关系。
我们估计，44%的堕胎是人工诱导的，其中 16.5%是不安全的。我们发现有三个变量与人工流产的可能性呈正相关：(1) 妇女报告说妊娠时间不合适(比值比=4.5，95%可信区间=1.95-10.95)；(2) 妇女报告说妊娠是不想要的(比值比=2.86，95%可信区间=-1.40-5.88)；和(3) 妇女在堕胎时已有 3 个或更多子女(比值比=3.73，95%可信区间=1.20-11.65)。堕胎的安全性存在陡峭的社会经济梯度：较贫穷的妇女比较富裕的妇女更有可能进行不安全堕胎(比值比=2.48，95%可信区间=1.09-5.63)；受教育 6-9 年的妇女(比值比=0.30，95%可信区间=0.11-0.81)和受教育 13 年以上的妇女不太可能进行不安全堕胎(比值比=0.065，95%可信区间=0.01-0.43)，而土著妇女更有可能进行不安全堕胎(比值比=5.44，95%可信区间=1.91-15.51)。因此，与富有、受过教育和非土著妇女相比，教育程度较低、贫穷且为土著的妇女进行不安全堕胎的可能性高 9 倍。我们还发现，在墨西哥，堕胎的安全性存在明显的地域不平等，最贫穷的州的妇女堕胎风险更高。
本分析探讨了不安全堕胎的决定因素，并表明在墨西哥，不安全堕胎存在较大的社会经济和地域不平等。需要进一步努力来改善发展中国家对不安全堕胎趋势的衡量和监测。
