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INTRODUCTION: Disrespect and abuse during childbirth have been reported by numerous countries around the world. One of their principal manifestations is the performance of invasive or surgical procedures without the informed consent of women. Non-dignified treatment is the second most common form of this conduct. Five Mexican states have classified obstetric violence as a crime: Aguascalientes, Chiapas, Guerrero, the State of Mexico and Veracruz. The others have not yet done so although it is provided for in their civil and administrative regulations. OBJECTIVE: To analyse whether criminalising obstetric violence has been conducive to the recognition and observance of the reproductive rights of women, based on the records of poor health care complaints filed by women with the Medical Arbitration Commissions (CAMs by their Spanish initials) in two Mexican states. MATERIALS AND METHODS: We conducted an observational qualitative study using a phenomenological approach. Analysis included two states with similar partner demographic and maternal health indicators but different legal classifications of obstetric violence: the Chiapas has criminalized this form of violence while Oaxaca has not. We reviewed the records of obstetric care complaints filed with CAMs in both states from 2011 to 2015, all of them concluded and including full information. RESULTS: Differences were observed regarding the contents of complaints, specifically in the categories of abuse, discrimination and neglect during childbirth. The narratives in the other complaint categories were similar between states. CONCLUSION: After analysing the records of malpractice complaints in Chiapas and Oaxaca, we conclude that the differentiated legal status of obstetric violence has not influenced recognition or observance of the reproductive rights of women. Criminalising obstetric violence has not improved care provided by health personnel.
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BACKGROUND: Data on utilisation of in-facility second-trimester abortion services are sparse. We describe temporal and geographical trends in utilisation of in-facility second-trimester abortion services across Mexico. METHODS: We used 2007-2015 data from Mexico's Automated Hospital Discharge System (SAEH) to identify second-trimester abortive events (ICD O02-O08) in public hospitals across Mexico's 32 states. We described utilisation, calculated rates using population data, and used logistic regression to identify woman- and state-level factors (municipality-level marginalisation, state-level abortion law) associated with utilisation of second-trimester versus first-trimester services. RESULTS: We identified 145 956 second-trimester abortions, or 13.4% of total documented hospitalizations for abortion between 2007 to 2015. The annual utilisation rate of second-trimester abortion remained constant, between 0.5 to 0.6 per 1000 women aged 15-44 years. Women living in highly marginalised municipalities had 1.43 higher odds of utilising abortions services in their second versus their first trimester, when compared with women in municipalities with low marginalisation (95% CI 1.18 to 1.73). Living in a state with a health or fetal anomaly exception to abortion restrictions was not associated with higher utilisation of second-trimester abortion services. CONCLUSIONS: Our results suggest there is a need for all types of second-trimester abortion services in Mexico. To improve health outcomes for Mexican women, especially the most vulnerable, access to safe second-trimester abortion services must be ensured through the implementation of current legal exceptions and renewed attention to the training of healthcare providers.