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Sanchez-Morales JE, Rodriguez-Contreras JL, Ruiz-Lara L, Ochoa-Torres B, Zaragoza M, Padilla-Zuniga K. Cost Analysis of Surgical and Medical Uterine Evacuation Methods for First-Trimester Abortion Used in Public Hospitals in Mexico. Health Serv Insights 2022; 15:11786329221126347. [PMID: 36171763 PMCID: PMC9511298 DOI: 10.1177/11786329221126347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from years before the abortion legislation. This study estimated the costs, from the health system’s perspective, of surgical and medical abortion methods commonly used by women who undergo first-trimester abortion in Mexico. Methods: Data were collected on staff time, salaries, medications, consumables, equipment, imaging, and lab studies, at 5 public general hospitals. A bottom-up micro-costing approach was used. Results: Surgical abortion costs were US$201 for manual vacuum aspiration and US$298 for sharp curettage. The cost of medical abortion with misoprostol was US$85. The use of cervical ripening increases the costs by up to 18%. Staff comprised up to 72% of total costs in surgical abortions. Hospitalization was the area where most of the spending occurred, due to the staff and post-surgical surveillance required. Conclusions: Our estimates reflect the costs of “real-life” implementation and highlight the impact on costs of the overuse of resources not routinely recommended by clinical guidelines, such as cervical ripening for surgical abortion. This information will help decision-makers to generate policies that contribute to more efficient use of resources.
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Affiliation(s)
| | - Jose Luis Rodriguez-Contreras
- Division of Medical Equipment Management, Ministry of Health, Health Institute for Welfare (INSABI), Mexico City, Mexico
| | | | | | - Mara Zaragoza
- Ipas Central America and Mexico (Ipas CAM), Mexico City, Mexico
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Vasquez Ladron de Guevara M, Ilozumba O, Brandell KR, Gemzell-Danielsson K, Gomperts R. Reasons for using telemedicine medical abortion in Mexico and Chile. BMJ Sex Reprod Health 2022; 48:233. [PMID: 34937775 DOI: 10.1136/bmjsrh-2021-201280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Onaedo Ilozumba
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Peña M, Flores KF, Ponce MM, Serafín DF, Camarillo Zavala AM, Cruz CR, Salgado IGO, Rosado YO, Socarras T, López AP, Bousiéguez M. Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study. Contraception 2022; 114:67-73. [PMID: 35753406 DOI: 10.1016/j.contraception.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector. STUDY DESIGN A prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one non-clinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7-14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests. RESULTS We conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; six individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311). CONCLUSIONS This study showed that guided self-management telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, particularly those that rely on public sector services.
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Affiliation(s)
- Melanie Peña
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
| | - Karla Figueroa Flores
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Mariana Muñoz Ponce
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Diana Facio Serafín
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Ana María Camarillo Zavala
- Centro de Atención Integral a la Pareja, A.C: Av. Canal de Miramontes # 2342, Coapa, Avante, Coyoacán, 04460 Ciudad de México, Mexico
| | - César Ruiz Cruz
- Medieg: Gabriel Mancera # 803, Col del Valle Centro, Benito Juárez, 03100 Ciudad de México, Mexico
| | | | - Yeni Ochoa Rosado
- Red de Mujeres y Hombres por una Opinión Pública con Perspectiva de Género en Campeche (RedMyH): Calle 55, # 14 int. 2 (entre calle 12 y calle 14) Col. Centro, Campeche, Campeche, Mexico
| | - Tania Socarras
- Planned Parenthood Global: 123 William Street, 10th floor, New York, New York 10038, United States
| | - Adrián Pacheco López
- Centro Nacional de Excelencia Tecnológica en Salud (CENETEC): 450 -13, Juárez, Cuauhtémoc, 06600 Ciudad de México, Mexico
| | - Manuel Bousiéguez
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
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Küng SA, Ochoa B, Ortiz Avendano GA, Martínez López C, Zaragoza M, Padilla Zuniga K. Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico. ACTA ACUST UNITED AC 2021; 17:17455065211029763. [PMID: 34263683 PMCID: PMC8287640 DOI: 10.1177/17455065211029763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.
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Affiliation(s)
| | - Beatriz Ochoa
- Ipas Central America and Mexico, Mexico City, Mexico
| | | | | | - Mara Zaragoza
- Ipas Central America and Mexico, Mexico City, Mexico
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Sorhaindo AM. Creativity, serendipity, and collaboration: Cross-cutting features of successful task-sharing in comprehensive safe abortion care. Int J Gynaecol Obstet 2021; 150 Suppl 1:49-54. [PMID: 33219999 PMCID: PMC7539976 DOI: 10.1002/ijgo.13011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Limited capacity to deliver comprehensive safe abortion care and shortages in trained healthcare providers contribute to a lack of access to safe services. The World Health Organization published guidelines and recommendations on expanding health worker roles through task-sharing as one way to address disparities. A multicountry case study was conducted in six diverse contexts (Bangladesh, Colombia, Ghana, Mexico City in Mexico, Sweden, and Tunisia) to determine the cross-cutting strategies that enabled inclusion of a broader range of healthcare workers in comprehensive safe abortion care. Five strategies emerged: leveraging of favorable contexts, policies, and guidelines; use of evidence for advocacy; building upon existing task-sharing; mitigation of negative responses to abortion and task-sharing; and collaboration across sectors. The findings suggest that there are potential opportunities for stakeholders to employ these strategies in many contexts to broaden health worker roles in comprehensive safe abortion care.
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Affiliation(s)
- Annik M Sorhaindo
- Independent Consultant in Reproductive and Sexual Health, Mexico City, Mexico
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Sorhaindo AM, Ganatra B. Expanding health worker roles and decentralizing safe abortion and postabortion care: Experiences in diverse settings. Int J Gynaecol Obstet 2020; 150 Suppl 1:1-3. [PMID: 33219995 DOI: 10.1002/ijgo.13012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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