Elard Koch|Monique Chireau|Fernando Pliego|Janet L. Stanford|Sami Haddad|Byron C. Calhoun|Paula Aracena|Miguel Bravo|Sebastián Gatica|JM Thorp
Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states
Duke University Hospital|Duke Medical Center|Universidad Nacional Autónoma de México|University of Utah|Universidad Anáhuac|West Virginia University|University of North Carolina at Chapel Hill
h3objectiveh3 test whether association abortion legislation maternal mortality outcomes controlling factors thought influence maternal health h3designh3 populationbased natural experiment h3setting data sourcesh3 official maternal mortality data 32 federal states mexico 2002 2011 h3main outcomesh3 maternal mortality ratio mmr mmr abortive outcome mmrsubaosub induced abortion mortality ratio iamr h3independent variablesh3 abortion legislation grouped less n18 permissive n14 constitutional amendment protecting unborn n17 skilled attendance birth allabortion hospitalisation ratio low birth weight rate contraceptive use total fertility rates tfr clean water sanitation female literacy rate intimatepartner violence h3main resultsh3 10year period states less permissive abortion legislation exhibited lower mmr 383 vs 496 plt0001 mmrsubaosub 27 vs 37 plt0001 iamr 09 vs 17 plt0001 permissive states multivariate regression models estimating effect sizes coefficients mortality outcomes showed independent associations p values 0001 0055 female literacy 0061 1100 skilled attendance birth 0032 0427 low birth weight 0149 2166 allabortion hospitalisation ratio 0566 0962 clean water 0048 0730 sanitation 0052 0758 intimatepartner violence 0085 0755 tfr showed inverse association mmr 14329 mmrsubaosub 1750 direct association iamr 1383 altogether factors accounted rsup2sup 5188 variance among states overall mortality rates statistically independent effect observed abortion legislation constitutional amendment covariates h3conclusionsh3 although less permissive states exhibited consistently lower maternal mortality rates finding explained abortion legislation rather differences explained independent factors appeared favourable distribution states