Medical Services, both

Women experiencing complications from a spontaneous or unsafely induced abortion have the right to receive high-quality health care services. Mexico affirmed this right with its endorsement of the 1994 International Conference on Population and Development (ICPD) Programme of Ac-tion, which recognizes unsafe abortion as a public health problem that all governments have the responsibility to ad-dress. Most important, the document states that “In all cases women should have access to quality services for the man-agement of complications arising from abortion. Postabor-tion counseling, education and family planning services should be offered promptly, which will also help to avoid repeat abortions.”1 In this article, we present the results of an operations re-search project carried out between April 1997 and August 1998 in six Mexican Institute of Social Security (IMSS) hos-pitals located in the Mexico City metropolitan area. The study examined the implementation of postabortion care as defined in the ICPD Programme of Action, using a qual-ity of care framework2 for the analysis.* BACKGROUND Abortion is the fourth leading cause of maternal mortality in Mexico, accounting for 8 % of all registered maternal deaths.3 In part, this situation reflects limited access to safe and legal abortion services. Given restrictive legislation and the small number of public health care providers and in-stitutions that offer such services, † many women turn to unsafe practices and practitioners to end unwanted preg-nancies. Complications of spontaneous abortions (mis-carriages) that are not treated appropriately also contribute to abortion-related mortality. Throughout Mexico, approximately 120,000 women re-ceive abortion-related care every year in public-sector facil-ities.4 In 1997, slightly more than 56,000 of these women were treated at IMSS facilities—the most women served among any of the three major social security systems in Mexico.5