Kravitz Elizabeth, Saavedra-Avendaño Biani, Darney Blair G
Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Ipas LAC, Mexico City, Mexico.
BMJ Sex Reprod Health. 2025 Jul 10;51(3):e2. doi: 10.1136/bmjsrh-2024-202294.
We describe clients in Mexico City's public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.
We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on state.
We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the ZMVM.
The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.
我们描述了墨西哥城公共堕胎项目“合法终止妊娠”（ILE）在新冠疫情期间的服务对象，并检验疫情是否加剧了获得服务方面的不平等。
我们对2019年1月1日至2022年6月30日期间ILE项目中的所有堕胎案例进行了队列研究。我们按疫情阶段（新冠疫情前、急性期、中期和后期）比较了墨西哥城大都市区（ZMVM）内外的患者，并使用按州聚类的线性概率模型评估了按居住地（ZMVM内与ZMVM外）划分的服务对象特征（青少年年龄、教育程度、妊娠周数）的变化。
我们纳入了45031例堕胎案例。从ZMVM外前来堕胎的女性比例从新冠疫情前的6.5%降至急性期、中期和后期的4.4%-4.8%。从ZMVM外前来的青少年堕胎的校正概率在新冠疫情前为14.4%（95%CI 12.7%至16.1%），到疫情中期降至9.3%（95%CI 7.9%至10.7%）。在前来堕胎的女性中，高中文化程度女性的堕胎比例基本保持平稳，而在ZMVM内居住的女性中这一比例有所上升。在疫情前，ZMVM内居住的女性在妊娠11周及以上时前来堕胎的校正概率更高；而在整个疫情阶段，情况发生了反转，从ZMVM外前来的女性在妊娠11周及以上时前来堕胎的概率更高。
新冠疫情加剧了在获得ILE服务方面现有的差距。为减少在获得基本医疗服务方面的不平等，墨西哥所有州都应提供公共部门堕胎服务。
