Thursday, January 7, 2010

[EQ] Exploring the determinants of unsafe abortion: improving the evidence base in Mexico

Exploring the determinants of unsafe abortion: improving the evidence base in Mexico

Angelica Sousa1,*, Rafael Lozano2 and Emmanuela Gakidou2

1Initiative for Global Health, Harvard University, Cambridge, MA, USA

2Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA

Health Policy and Planning, doi:10.1093/heapol/czp061 - December 15, 2009

Available at: http://heapol.oxfordjournals.org/cgi/content/abstract/czp061?ijkey=OA1CVURLq1MxBuk&keytype=ref

 

KEY MESSAGES:


- This paper quantifies for the first time the large socio-economic and geographical inequities in unsafe abortions in Mexico.

- The burden of unsafe abortions is disproportionately born by poor, less educated and indigenous women.
 Women living in the poorest states have a higher risk of having an unsafe abortion.


Background
Despite the realized importance of unsafe abortion as a global health problem, reliable data are difficult to obtain, especially in countries where abortion is illegal. Estimates for most developing countries are based on limited and incomplete sources of data. In Mexico, studies have been undertaken to improve estimates of induced abortion but the determinants of unsafe abortion have not been explored.


Methods
We analysed data from the 2006 Mexican National Demographic Survey. The sample comprises 14 859 reported pregnancies in women between 15 and 55 years old, of which 966 report having had an abortion in the 5 years preceding the survey. We use logistic regression to explore the relationship between unsafe abortion and various socio-economic and demographic characteristics.

Findings We estimate that 44% of abortions have been induced and 16.5% of those were unsafe. We find three variables to be positively and significantly associated with the probability of having an induced abortion: (1) whether the woman reported that the pregnancy was mistimed (OR = 4.5, 95% CI = 1.95?10.95); (2) whether the woman reported that the pregnancy was unwanted (OR = 2.86, 95% CI = ?1.40?5.88); and (3) if the woman had three or more children at the time of the abortion (OR = 3.73, 95% CI = 1.20?11.65). There is a steep socio-economic gradient in the probability of having an unsafe abortion: poorer women are more likely to have an unsafe abortion than richer women (OR = 2.48, 95% CI = 1.09?5.63); women with 6?9 years of education (OR = 0.30, 95% CI = 0.11?0.81) and with more than 13 years of education are less likely to have an unsafe abortion (OR = 0.065, 95% CI = 0.01?0.43), and women with indigenous origin are more likely to have an unsafe abortion (OR = 5.44, 95% CI = 1.91?15.51). Thus, the probability for poor women with less than 5 years of education and indigenous origin is nine times higher compared with rich, educated and not indigenous women. We also find marked geographical inequities as women living in the poorest states have a higher risk of having an unsafe abortion.

Interpretation This analysis has explored the determinants of unsafe abortion and has demonstrated that there are large socio-economic and geographical inequities in unsafe abortions in Mexico. Further efforts are required to improve the measurement and monitoring of trends in unsafe abortions in developing countries.

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[EQ] Health Capability: Conceptualization and Operationalization

Health Capability: Conceptualization and Operationalization

Jennifer Prah Ruger, PhD
School of Public Health, Yale University, New Haven, CT.
January 2010, Vol 100, No. 1 | American Journal of Public Health

Journal URL- Abstract: http://ajph.aphapublications.org/cgi/content/abstract/100/1/41

Also PDF available at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1508006

“…..Current theoretical approaches to bioethics and public health ethics propose varied justifications as the basis for health care and public health, yet none captures

a fundamental reality: people seek good health and the ability to pursue it. Existing models do not effectively address these twin goals.

 

The approach I espouse captures both of these orientations through a concept here called health capability.

Conceptually, health capability illuminates the conditions that affect health and one’s ability to make health choices. By respecting the health consequences individuals face and their health agency, health capability offers promise for finding a balance between paternalism and autonomy. I offer a conceptual model of health capability and present a health capability profile to identify and address health capability gaps…..”

 (Am J Public Health. 2010;100:41–49. doi:10.2105/AJPH.2008.143651)

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.