Saavedra-Avendano Biani, Schiavon Raffaela, Sanhueza Patricio, Rios-Polanco Ranulfo, Garcia-Martinez Laura, Darney Blair G
National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
International Pregnancy Advisory Services (Ipas-Mexico), Mexico City, Mexico.
PLoS One. 2018 Feb 7;13(2):e0192547. doi: 10.1371/journal.pone.0192547. eCollection 2018.
To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City's public sector first trimester abortion program.
We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007-2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women's characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics.
Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12-17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p< 0.05). In multivariable analyses, all age groups of adult women had significantly lower odds than adolescents of presenting past the limit (aOR = 0.77, aOR = 0.63, aOR = 0.58 and aOR = 0.37 for 19-24, 25-29, 30-39, and > = 40 years' old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02-4.26% across adult age groups).
Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services.
确定与墨西哥城公共部门孕早期堕胎项目中超过孕周（GA）限制（12周）前来寻求堕胎服务因而未获得服务相关的社会人口学因素。
我们使用了2007 - 2015年“合法终止妊娠”（ILE）项目中四个高流量站点的临床数据。我们使用描述性统计来量化因超过孕周限制而未获得堕胎服务的女性比例。我们使用多变量逻辑回归来确定女性特征与超过GA限制之间的关联，并计算关键特征的延迟就诊预测概率。
我们的样本包括52,391名女性，其中8.10%（n = 4,246）因超过GA限制而未获得堕胎服务。青少年（12 - 17岁）占总样本的8.69%，在超过GA限制前来就诊的人群中占13.40%（p < 0.05）。在多变量分析中，所有成年女性年龄组超过限制前来就诊的几率均显著低于青少年（19 - 24岁、25 - 29岁、30 - 39岁和≥40岁的调整后比值比分别为0.77、0.63、0.58和0.37）。居住在墨西哥城且教育水平较高的女性超过GA限制前来就诊的几率较低，并且在所有年龄组中都存在教育梯度。在多变量预测概率模型中，与成年人相比，各个教育水平的青少年因超过孕周限制而未获得堕胎服务的概率显著更高（在小学教育程度的女性中：青少年为11.75%，而成人年龄组为9.02 - 4.26%）。
我们的结果表明，需要持续努力对女性，尤其是年轻和受教育程度较低的女性进行早期妊娠识别教育。此外，所有女性都需要了解孕早期合法堕胎的可及性信息，以确保及时获得堕胎服务。
