背景:我们描述了墨西哥城公共堕胎计划中的客户,InterrupciónLegaldeEmbarazo(ILE),在COVID-19大流行期间,并测试大流行是否加剧了获取方面的不平等。
方法:我们在2019年1月1日至2022年6月30日的ILE计划中对所有流产进行了队列研究。我们比较了墨西哥城都会区(ZMVM)内外大流行阶段的患者(前,acute-,COVID中期和晚期),并评估客户特征的变化(青少年年龄,教育,孕周)按居住地(ZMVMvsZMVM外部)使用状态聚类的线性概率模型。
结果:我们包括45031例流产。从ZMVM以外旅行的妇女的堕胎比例从COVID前的6.5%下降到急性期的4.4%-4.8%,COVID中期和晚期。从ZMVM外部旅行的青少年的调整后概率在COVID之前下降(14.4%,95%CI12.7%至16.1%)和中COVID(9.3%,95%CI7.9%至10.7%)。受过高中教育的妇女的堕胎比例在旅行者中保持相当平稳,而它在居住在ZMVM的人中上升。在大流行前居住在ZMVM中的妇女中,在11个孕周或更长时间出现的调整概率较高;在所有大流行阶段,在从ZMVM以外旅行的人中,出现11周或更长时间的可能性更高。
结论:COVID-19大流行加剧了谁可以获得ILE服务的现有差距。减少获得基本卫生服务方面的不平等,所有墨西哥州都应提供公共部门堕胎服务。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.