摘要：In April 2007, the Mexico City, Mexico, legislature passed landmark legislation decriminalizing elective abortion in the first 12 weeks of pregnancy. In Mexico City, safe abortion services are now available to women through the Mexico City Ministry of Health’s free public sector legal abortion program and in the private sector, and more than 89 000 legal abortions have been performed. By contrast, abortion has continued to be restricted across the Mexican states (each state makes its own abortion laws), and there has been an antichoice backlash against the legislation in 16 states. Mexico City’s abortion legislation is an important first step in improving reproductive rights, but unsafe abortions will only be eliminated if similar abortion legislation is adopted across the entire country. In April 2007, the Mexico City, Mexico, legislature passed landmark legislation decriminalizing elective abortion in the first 12 weeks of pregnancy. The law included a provision that abortion services be available to women at Mexico City ( Distrito Federal ) Ministry of Health (MOH-DF) facilities in the city, free of charge for Mexico City residents and on a sliding fee scale for those outside Mexico City. In addition, the law strengthened sexual education curricula in schools and called for widespread access to contraceptive methods. Shortly after being passed, the law was challenged in the Mexican Supreme Court by groups opposed to the legislation, but in August 2008, the Supreme Court voted to uphold the law. 1,2 In Mexico, abortion laws are made at the state level, and before this reform, across all of Mexico’s states and in the Federal District (or Mexico City, the capital), abortion was permitted under very limited circumstances such as in cases of rape, fetal malformation, or when the survival or health of a woman was in danger. Even when abortions were legally permitted, however, numerous barriers made accessing a legal abortion extremely difficult. 3,4 Despite these barriers, abortion was commonly practiced. One study estimated the induced abortion rate in Mexico in 2006 to be 33 abortions per 1000 women aged 15 to 44 years, a comparatively high rate by global standards. 5 However, because of the legal restrictions, the vast majority of abortions in Mexico took place clandestinely, often in unsafe circumstances, sometimes causing severe health consequences for women. From 1990 to 2008, 7.2% of all maternal deaths in Mexico were abortion-related. 6 Another study estimated that in 2006, 149 700 women were hospitalized from complications following induced abortions nationally. 5 Inequity was an important dimension of unsafe abortion in Mexico. A study that used data from the 2006 Mexican National Demographic Survey found the risk of having an unsafe abortion was highest for poor women, those with low levels of education, and those who belonged to indigenous groups. 7 The abortion reform in Mexico City responded to the gravity of this public health problem, delivering a major victory for women’s reproductive rights by departing from the restrictive abortion laws in the rest of the country. The Mexico City abortion law reform is significant not only for Mexico, but also for the entire Latin American and Caribbean region, which continues to have some of the most restrictive abortion laws globally. Virtually all abortions (95%) in the Latin American and Caribbean region are unsafe, and unsafe abortions cause an estimated 12% of all maternal deaths. 8,9 Only a few countries and territories in this region have progressive abortion legislation, including Cuba, Guyana, Puerto Rico, and Uruguay, where first-trimester abortion was decriminalized in 2012. 10,11 We describe developments since this landmark reform was passed, both in Mexico City and in the states of Mexico. We highlight the development of the public sector legal abortion program by the MOH-DF, including important trends in this program. We also discuss the backlash that has occurred since abortion decriminalization.
