Abstract
In countries where induced abortion is legally restricted, as in most of Latin America, evaluation of statistics related to induced abortions and abortion-related mortality is challenging. The present article reexamines recent reports estimating the number of induced abortions and abortion-related mortality in Mexico, with special reference to the International Classification of Diseases (ICD). We found significant overestimations of abortion figures in the Federal District of Mexico (up to 10-fold), where elective abortion has been legal since 2007. Significant overestimation of maternal and abortion-related mortality during the last 20 years in the entire Mexican country (up to 35%) was also found. Such overestimations are most likely due to the use of incomplete in-hospital records as well as subjective opinion surveys regarding induced abortion figures, and due to the consideration of causes of death that are unrelated to induced abortion, including flawed denominators of live births. Contrary to previous publications, we found important progress in maternal health, reflected by the decrease in overall maternal mortality (30.6%) from 1990 to 2010. The use of specific ICD codes revealed that the mortality ratio associated with induced abortion decreased 22.9% between 2002 and 2008 (from 1.48 to 1.14 deaths per 100,000 live births). Currently, approximately 98% of maternal deaths in Mexico are related to causes other than induced abortion, such as hemorrhage, hypertension and eclampsia, indirect causes, and other pathological conditions. Therefore, only marginal or null effects would be expected from changes in the legal status of abortion on overall maternal mortality rates. Rather, maternal health in Mexico would greatly benefit from increasing access to emergency and specialized obstetric care. Finally, more reliable methodologies to assess abortion-related deaths are clearly required.
Acknowledgments
This study was conducted on behalf of the Chilean Maternal Mortality Research Initiative (CMMRI), which is an independent collaborative research project conducted by researchers from the following institutions: Faculty of Medicine, University of Chile; Center for Women’s Health Research, University of North Carolina Chapel Hill; Department of Obstetrics and Gynecology, West Virginia University, Charleston, West Virginia; Universidad Popular Autónoma del Estado de Puebla UPAEP; Department of Obstetrics and Gynecology, Duke University; and Institute of Molecular Epidemiology (MELISA), Center of Embryonic Medicine and Maternal Health, Universidad Católica de la Santísima Concepción. Finally, we are indebted to the reviewers for the careful and thorough review of the preliminary version of the manuscript.
Disclosure
EK, PA, SG, and MB are co-authors of the research articles quoted in references.Citation6,Citation16,Citation19 AH and BC declare that no competing interests exist.