Psychosocial profiles of women who legally terminated a pregnancy in Mexico City
##plugins.themes.bootstrap3.article.main##
Abstract
Introduction. Reproductive autonomy enables a person to freely decide their life plan, including sexual and reproductive health. However, its exercise can be constrained by health determinants and other structural conditions. Knowing the background of women who undergo a Legal Interruption of Pregnancy (LIP) helps identify patterns of inequality and their impact on the exercise of reproductive autonomy.
Objective. To analyze the profile of women who legally terminate a pregnancy in Mexico City.
Method. Latent class analysis, with the participation of 274 women who terminated a first trimester pregnancy at a public facility.
Results. Model of two latent classes: adult (68.34%) and young women (31.65%). Stigma was the predictor variable for class; the higher the score, the lower the probability of belonging to the adult group (p = .019). Adult women were characterized by having lower educational attainment, engaging in unpaid activities, having at least one child, and having had previous abortions, having experienced intimate partner violence in the past twelve months and reporting that their partners did not agree with the interruption of their pregnancy. Young women were students, partnered and reported that their partners had agreed with them to request an abortion.
Discussion and conclusion. Despite the legal changes effected, stigma is still present in the abortion demand and access, particularly for women with certain characteristics. It would be useful to include interventions to reduce stigma in counseling, using an approach based on previous experience.
References
Bearak, J., Popinchalk, A., Ganatra, B., Moller, A.-B., Tunçalp, Ö., Beavin, C., Kwok, L., & Alkema, L. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. The Lancet Global Health, 8(9), e1152-e1161. doi: 10.1016/S2214-109X(20)30315-6
Belfrage, M., Ortiz Ramírez, O., & Sorhaindo, A. (2020). Story Circles and abortion stigma in Mexico: a mixed-methods evaluation of a new intervention for reducing individual level abortion stigma. Culture, Health & Sexuality, 22(1), 96-111. doi: 10.1080/13691058.2019.1577493
Biggs, M. A., Brown, K., & Foster, D. G. (2020). Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PloS One, 15(1), e0226417. doi: 10.1371/journal.pone.0226417
Biggs, M. A., Gould, H., & Foster, D. G. (2013). Understanding why women seek abortions in the US. BMC Women’s Health, 13(1). doi: 10.1186/1472-6874-13-29
Centro Nacional de Equidad de Género y Salud Reproductiva. (2022). Lineamiento Ténico para la Atención del Aborto Seguro en México. Access date August 10, 2023
Chibber, K. S., Biggs, M. A., Roberts, S. C. M., & Foster, D. G. (2014). The Role of Intimate Partners in Women’s Reasons for Seeking Abortion. Women’s Health Issues, 24(1), e131-e138. doi: 10.1016/j.whi.2013.10.007
Cleeve, A., Faxelid, E., Nalwadda, G., & Klingberg-Allvin, M. (2017). Abortion as agentive action: Reproductive agency among young women seeking post-abortion care in Uganda. Culture, Health & Sexuality, 19(11), 1286-1300. doi: 10.1080/13691058.2017.1310297
Cockrill, K., Upadhyay, U. D., Turan, J., & Greene Foster, D. (2013). The Stigma of Having an Abortion: Development of a Scale and Characteristics of Women Experiencing Abortion Stigma. Perspectives on Sexual and Reproductive Health, 45(2), 79-88. doi: 10.1363/4507913
Collado Miranda, M., & Mora-Ríos, J. (2020). Estigma y aborto: experiencias de mujeres y personal de salud en los servicios de ILE en la Ciudad de México. En L. Cedeño Peña, & O. Tena Guerrero (Eds). Interrupción embarazo desde la experiencia de las mujeres: aportaciones interdisciplinarias (pp. 95-127). México: CEICH - UNAM.
Cordero-Oropeza, R., García-Méndez, M., Cordero-Oropeza, M., & Corona-Maldonado, J. J. (2021). Characterization of alcohol consumption and related problems in university students from Mexico City. Salud Mental, 44(3), 107-115. doi: 10.17711/SM.0185-3325.2021.015
Cullen, P., & Korolczuk, E. (2019). Challenging abortion stigma: framing abortion in Ireland and Poland. Sexual and Reproductive Health Matters, 27(3), 1686197. doi: 10.1080/26410397.2019.1686197
Encuesta Nacional de la Dinámica Demográfica [ENADID]. (2018). INEGI. https://www.inegi.org.mx/programas/enadid/2018
Figueroa-Lara, A., Aracena-Genao, B., Reyes-Morales, H., & Lamadrid-Figueroa, H. (2012). Factors associated with the seeking of legal induced abortion services in Mexico City in 2010. Salud Pública de México, 54(4), 401-409. doi: 10.1590/s0036-36342012000400010
Finer, L. B., Frohwirth, L. F., Dauphinee, L. A., Singh, S., & Moore, A. M. (2005). Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110-118. doi: 10.1363/psrh.37.110.05
González-Forteza, C. Solís Torres, C., Jiménez Tapia, A., Hernández Fernández, I., González-González, A., Juárez García, F., Medina-Mora, M. E., & Fernández-Várela Mejía, H. (2011). Confiabilidad y validez de la escala de depresión CES-Den un censo de estudiantes de nivel medio superior y superior, en la Ciudad de México. Salud Mental, 34(1), 53-59.
Goodman, S. H. (2020). Intergenerational Transmission of Depression. Annual Review of Clinical Psychology, 16, 213-238. doi: 10.1146/annurev-clinpsy-071519-113915
Grace, K. T., & Anderson, J. C. (2016). Reproductive Coercion: A Systematic Review. Trauma, Violence, & Abuse, 19(4), 371-390. doi: 10.1177/1524838016663935
Hanschmidt, F., Linde, K., Hilbert, A., Riedel‐Heller, S. G., & Kersting, A. (2016). Abortion stigma: a systematic review. Perspectives on Sexual and Reproductive Health, 48(4), 169-177. doi: 10.1363/48e8516
Helfferich, C., Hessling, A., Klindworth, H., & Wlosnewski, I. (2014). Unintended pregnancy in the life-course perspective. Advances in Life Course Research, 21, 74-86. doi: 10.1016/j.alcr.2014.04.002
INEGI. (2022). Encuesta Nacional sobre la Dinámica de las Relaciones en los Hogares[ENDIREH] 2021. Retrieved from https://www.inegi.org.mx/programas/endireh/2021/
Kirkman, M., Rowe, H., Hardiman, A., Mallett, S., & Rosenthal, D. (2009). Reasons women give for abortion: A review of the literature. Archives of Women’s Mental Health, 12(6), 365-378. doi: 10.1007/s00737-009-0084-3
Lara, M. A., Navarro, C., Navarrete, L., Cabrera, A., Almanza, J., Morales, F., & Juárez, F. (2006). Depressive symptoms in pregnancy and associated factors in patients of three health institutions in Mexico City. Salud Mental, 29(4), 55-62.
Major, B., Appelbaum, M., Beckman, L., Dutton, M. A., Russo, N. F. & West, C. (2009). Abortion and mental health: Evaluating the evidence. American Psychologist, 64(9), 863-890. doi: 10.1037/a0017497
Major, B., Cozzarelli, C., Cooper, M. L., Zubek, J., Richards, C., Wilhite, M., & Gramzow, R. H. (2000). Psychological responses of women after first-trimester abortion. Archives of General Psychiatry, 57(8), 777-784. doi: 10.1001/archpsyc.57.8.777
Makleff, S., Wilkins, R., Wachsmann, H., Gupta, D., Wachira, M., Bunde, W., Radhakrishnan, U., Cislaghi, B., & Baum, S. E. (2019). Exploring stigma and social norms in women’s abortion experiences and their expectations of care. Sexual and Reproductive Health Matters, 27(3), 50-64. doi: 10.1080/26410397.2019.1661753
Martin, L. A., Hassinger, J. A., Seewald, M., & Harris, L. H. (2018). Evaluation of abortion stigma in the workforce: development of the revised abortion providers stigma scale. Women’s Health Issues, 28(1), 59-67. doi: 10.1016/j.whi.2017.10.004
Monroy Cazorla, L., Vidal Uribe, R. S., & Saade Hazin, A. (2009). Análisis de Clases Latentes. Una técnica para detectar heterogeneidad en poblaciones. Cuaderno Técnico 2. Centro Nacional de Evaluación para la Educación Superior, A.C. (Ceneval)
Moreno López, M., Flores Celis, K., González-Forteza, C., Saltijeral, M. T., Schiavon, R., Collado, M. E., Ortiz, O., & Ramos Lira, L. (2019). Relationship between perceived stigma and depressive symptomatology in women who legally interrupt pregnancy in Mexico City. Salud Mental, 42(1), 25-32. doi: 10.17711/SM.0185-3325.2019.004
Norris, A., Bessett, D., Steinberg, J. R., Kavanaugh, M. L., De Zordo, S., & Becker, D. (2011). Abortion stigma: a reconceptualization of constituents, causes, and consequences. Women’s Health Issues, 21(3), S49-S54. doi: 10.1016/j.whi.2011.02.010
Orihuela-Cortés, F., Álvarez del Río, A., Lagunes-Córdoba, R., & Marván, M. L. (2023). Stigma toward women who have had an induced abortion and associated variables. Women’s Reproductive Health, 10(2), 303-314. doi: 10.1080/23293691.2022.2094738
OʼDonnell, A. T., O’Carroll, T., & Toole, N. (2018). Internalized stigma and stigma-related isolation predict women’s psychological distress and physical health symptoms post-abortion. Psychology of Women Quarterly, 42(2), 220-234. doi: 10.1177/0361684317748937
Ramos-Lira, L., & Saltijeral Méndez, M. T. (2008). ¿Violencia episódica o terrorismo íntimo? Una propuesta exploratoria para clasificar la violencia contra la mujer en las relaciones de pareja. Salud Mental, 31(6), 469-478. Retrieved from http://www.scielo.org.mx/scielo.php?script=sci_abstract&pid=S0185-33252008000600007&lng=es&nrm=iso&tlng=es
Ramos-Lira, L., Flores Celis, K., Moreno López, M., Saltijeral, M. T., & Wagner, F. (2023). Depression and associated psychosocial factors following a legal abortion in Mexico. Revista Latinoamericana de Psicología, 55, 64-72. doi: 10.14349/rlp.2023.v55.8
Ramos-Lira, L., Saltijeral-Méndez, M. T., Romero-Mendoza, M., Caballero-Gutiérrez, M. A., & Martínez-Vélez, N. A. (2001). Violencia sexual y problemas asociados en una muestra de usuarias de un centro de salud. Salud Pública de México, 43(3), 182-191. doi: 10.1590/S0036-36342001000300002
Reyna, C., & Brussino, S. (2011). Revisión de los fundamentos del análisis de clases latentes y ejemplo de aplicación en el área de las adicciones. Trastornos Adictivos, 13(1), 11-19. doi: 10.1016/S1575-0973(11)70004-6
Schiavon, R., & Troncoso, E. (2020). Inequalities in access to and quality of abortion services in Mexico: Can task-sharing be an opportunity to increase legal and safe abortion care? International Journal of Gynecology & Obstetrics, 150(S1), 25-33. doi: 10.1002/ijgo.13002
Secretaría de Salud de la Ciudad de México [SEDESA]. (2022). Interrupción Legal del Embarazo. Estadísticas Abril 2007‒31 de diciembre 2022. Ciudad de México: Secretaría de Salud de la Ciudad de México. Retrieved from http://ile.salud.cdmx.gob.mx/wp-content/uploads/ILE_WEB_may_2023.pdf (Access date August 10, 2023)
Singer, E. O. (2018). Lawful sinners: reproductive governance and moral agency around abortion in Mexico. Culture, Medicine, and Psychiatry, 42(1), 11-31. doi: 10.1007/s11013-017-9550-y
Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes. Studies in Family Planning, 41(4), 241-250. doi: 10.1111/j.1728-4465.2010.00250.x
Sorhaindo, A. M., Juárez-Ramírez, C., Olavarrieta, C. D., Aldaz, E., Mejía Piñeros, M. C., & Garcia, S. (2014). Qualitative evidence on abortion stigma from Mexico City and five states in Mexico. Women & Health, 54(7), 622-640. doi: 10.1080/03630242.2014.919983
Sorhaindo, A. M., Karver, T. S., Karver, J. G., & Garcia, S. G. (2016). Constructing a validated scale to measure community-level abortion stigma in Mexico. Contraception, 93(5), 421-431. doi: 10.1016/j.contraception.2016.01.013
Steinberg, J. R., Tschann, J. M., Furgerson, D., & Harper, C. C. (2016). Psychosocial factors and pre-abortion psychological health: The significance of stigma. Social Science & Medicine, 150, 67-75. doi: 10.1016/j.socscimed.2015.12.007
Stockman, J. K., Lucea, M. B., & Campbell, J. C. (2013). Forced sexual initiation, sexual intimate partner violence and HIV risk in women: A global review of the literature. AIDS and Behavior, 17(3), 832-847. doi: 10.1007/s10461-012-0361-4
Strunin, L., Díaz-Martínez, A., Díaz-Martínez, L. R., Kuranz, S., Hernández-Ávila, C., & Fernández-Varela, H. (2015). Changes in alcohol use among first year university students in Mexico. Substance Use & Misuse, 50(1), 106-113. doi: 10.3109/10826084.2014.960591
Suprema Corte de Justicia de la Nación. (2022). Acción de Inconsticionalidad 148/207. Pub. L. No. 148/2017. Access date March 30, 2023.
Upadhyay, U. D., Dworkin, S. L., Weitz, T. A., & Foster, D. G. (2014). Development and validation of a reproductive autonomy scale. Studies in Family Planning, 45(1), 19-41. doi: 10.1111/j.1728-4465.2014.00374.x
Valdez-Santiago, R., Villalobos, A., Arenas-Monreal, L., Flores-Celis, K., & Ramos-Lira, L. (2020). Abuso sexual infantil en México: Conductas de riesgo e indicadores de salud mental en adolescentes. Salud Pública de México, 62(6), 661-671. doi: 10.21149/11924
Wollum, A., Makleff, S., & Baum, S. E. (2021). Exploring experiences responding to the individual level abortion stigma scale: Methodological considerations from in-depth interviews. Frontiers in Global Women’s Health, 2, 678101. doi: 10.3389/fgwh.2021.678101
