ARTICLE / ARTÍCULO 235 SALUD COLECTIVA, Buenos Aires, 9(2):235-246, May - August, 2013 Legislation, knowledge and attitudes of health professionals in Mexico regarding abortion Legislación, conocimientos y actitudes de profesionales médicos en relación al aborto en México García-Núñez, Nubia Naneri1; Atienzo, Erika Elizabeth2; Dayananda, Ila3; Walker, Dilys4 1 Psychologist. Master’s ABSTRACT The purpose of this study is to describe the knowledge and attitudes regarding Degree in Health Sciences. School of Public Health, abortion of a sample of health professionals in Mexico. In particular, we aim to explore Instituto Nacional de Salud their association with the practice of abortion and the care of post-abortion complications, Pública, Cuernavaca, taking into consideration the present legal framework in Mexico. The data come from Morelos, Mexico [email protected] an anonymous and computerized survey applied to participants attending a national meeting of gynecology and obstetrics in Mexico in 2009 (n=418). The attitudes of health 2 Psychologist. Master’s Degree in Health professionals in relation to abortion play a key role in promoting access to both medical Sciences. General Office and surgical abortion services. We did not find a statistical association between living in of Reproductive Health, Instituto Nacional de Salud a largely restrictive federal entity and the practice of abortions, which may be explained Pública. Cuernavaca, by the lack of knowledge that these survey participants had about abortion laws in their Morelos, Mexico federal entity. This lack of knowledge about abortion legislation can hinder a woman’s [email protected] access to these services even when the legal framework such access. 3 Physician. Specialist in KEY WORDS Legislation; Abortion; Abortion, Legal; Delivery of Health Care; Health Obstetrics and Gynecology. Master’s Degree in Health Personnel. Sciences. Brigham and Women’s Hospital. Boston, USA RESUMEN El objetivo de este estudio es describir los conocimientos y actitudes de una [email protected] muestra de profesionales médicos en México con relación al aborto y su asociación con 4 Physician. Specialist in la práctica y la atención a complicaciones derivadas de abortos, tomando en cuenta el Obstetrics and Gynecology. School of Public Health, marco legal vigente. Los datos provienen de una encuesta anónima y computarizada University of Washington, a participantes que acudieron a una reunión de gineco-obstetricia en México en 2009 USA (n=418). Las actitudes de los profesionales de la salud juegan un papel determinante [email protected] para favorecer el acceso a servicios de abortos tanto médicos como quirúrgicos. No se encontró asociación estadística entre vivir en una entidad federativa mayormente restrictiva y la práctica de abortos, lo cual se explica por el escaso conocimiento que los participantes de la encuesta tenían sobre las leyes de aborto vigentes en su entidad. Esta falta de conocimiento sobre la legislación del aborto puede obstaculizar que una mujer tenga este servicio aun cuando el marco legal lo permita. PALABRAS CLAVES Legislación; Aborto; Aborto Legal; Prestación de Atención de Salud; Personal de Salud. Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 236 GARCÍA-NÚÑEZ NN, ATIENZO EE, DAYANANDA I, WALKER D. INTRODUCTION been some setbacks. Conservative groups in many Mexican states responded by seeking modifica- tions to their constitutions in order to define life Post-abortion complications remain a leading as starting from the moment of conception (9), cause of maternal morbidity and mortality at a annulling women’s rights to interrupt pregnancies global scale (1,2). Each year, 5.3 million women even in cases of decriminalized causes (a). undergo unsafe abortions and suffer temporary or In Mexico, abortion legislation is enforced permanent disabilities as a consequence (3). It has at the state level, and Mexico City is the only been estimated that in 2008, 43 million abortions jurisdiction (b) where the interruption of preg- were performed in the world, 49% of which were nancies requested by women is decriminalized; unsafe (4). in the rest of the country, abortion is still legally Unsafe abortions are procedures to interrupt restricted. The only cause deemed legally valid pregnancies carried out by personnel that lack by all federal jurisdictions is pregnancy resulting SALUD COLECTIVA, Buenos Aires, 9(2):235-246, May - August, 2013 training or technical skills, or that are conducted from rape. Other decriminalized causes vary in facilities that do not meet minimum medical widely. Nonetheless, there were 874,747 cases standards (5). This is common in many developing of abortion in 2006 with a rate of 33 per 1000 countries, where legislation prohibits the access women aged 15 to 44 (10). to safe abortion services. In Latin America, for ex- Recent publications have shown that there is ample, the interruption of pregnancies resulting generally a favorable public opinion in Mexico re- from rape is legal in less than half of the coun- garding the executive order that permitted the legal tries (42%) (6), although this practice is prevalent interruption of pregnancies. For example, a recent throughout the region (7). Among developing re- study involving the general population of Mexico gions, Latin America has the highest rate of unsafe City showed an increase in positive opinions on abortions, with 31 abortions per 1000 women 15 this regulation between 2006-2009, as well as to 44 years old. This is equivalent to 4.2 million the opinion that this policy should be extended unsafe abortions and can be compared to some to other jurisdictions (11). This positive opinion is Eastern European countries, where the rate is 5 per expressed not only by the residents of this city, but 1000 women (5). also by residents of states with more restrictive reg- However, in recent years Latin America has ulations. For instance, in a recent opinion survey also seen the implementation of reproductive of the general populations of eight states that had health policies of great importance for the region. introduced initiatives to forbid abortion under all For instance, Uruguay passed Act 18987 in 2012, circumstances, 44% of the respondents agreed decriminalizing the interruption of pregnancies with the mentioned regulation (12). during the first 12 weeks of gestation, despite the However, less restrictive legislation alone rejection of previous similar initiatives. After in- does not guarantee women the access to legal or tense negotiations, Uruguay became the second safe abortion procedures (4). Health professionals country in the region to decriminalize abortions have a fundamental role in assuring safety during requested by women, following only Cuba, where the interruption of pregnancies and attending to abortion has been decriminalized for the past few post-abortion complications (13-15), and therefore decades. their knowledge, opinions, and attitudes are a The Uruguayan legislation has added to the key aspect in facilitating or restricting access to small number of parliamentary initiatives in the abortion procedures. region aiming to decrease maternal mortality by In this sense, a lack of familiarity with the providing access to safe abortions. One of these causes under which abortions should be per- initiatives was introduced in Mexico City in formed may lead to a refusal on the part of health 2007, when the Legislative Assembly reformed professionals to provide this service (16,17). This the Criminal Code and the Health Act and intro- is prevalent in countries such as Mexico, where duced the Legal Pregnancy Interruption Program recent changes in the legislation of many jurisdic- (8). However, despite the unquestionable impor- tions may have contributed to this misinformation. tance of this initiative in Mexico City, there have Generally, negative societal opinions regarding Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International Public License | BY - NC LEGISLATION, KNOWLEDGE AND ATTITUDES OF HEALTH PROFESSIONALS IN MEXICO REGARDING ABORTION 237 SALUD COLECTIVA, Buenos Aires, 9(2):235-246, May - August, 2013 abortion may also influence the attitudes of health in attendance at a national conference orga- professionals (14,16). nized by the Mexican Association of Obstetrics Previous studies on samples of doctors in and Gynecology Specialists [Colegio Mexicano Mexico have shown that professionals with more de Especialistas en Ginecología y Obstetricia] in knowledge of abortion laws hold more positive at- 2009. Although no official records of the numbers titudes toward these practices and are more willing of participants in attendance at this convention to perform abortions in the event of rape (13); most were available, non-official sources have informed of them express that abortion should be legal in that there were about 3000 registered participants, cases of rape, where the life or health of the woman 428 of whom completed surveys. These survey is at risk, or where congenital defects of the fetus respondents constituted the sample for this study. are present (18). Although they approve of abor- During the event, recruiters invited attendants tions in a limited number of circumstances, very to complete the survey. Selection criteria included few professionals are willing to offer abortions to health professionals practicing in Mexico and pro- women (17). A recent qualitative study conducted viding women’s health services,