Access to safe abortion services has never been easy for Latin American women. Reproductive health advocates have often pointed to legal restrictions as a major barrier to access. Most Latin American countries only allow abortions in situations endanger a woman's life or health. Chile, El Salvador and Nicaragua ban them entirely. But even if all Latin American countries removed their legal restrictions, other significant barriers would remain. In Mexico, one of these barriers stems from the training that medical students receive — Mexican medical schools do not provide enough education about abortion or the public health impact it represents.
When the Federal District of Mexico (the district that governs Mexico City) legalized abortion services in April 2007, many progressive advocacy groups cheered. Since then, thousands of women in Mexico City have been provided with safe, effective services. However, abortion services remain highly restricted in the rest of the country, and the lack of appropriate training continues to be a problem.
“Abortion and medical education in Mexico,” a Spanish-language article published in the May/June issue of Salud Pública de México, an international bi-monthly journal published by the Mexican National Institute of Public Health, discusses the lack of proper training for Mexican medical students and explains the effects this lack of training has on women. It also discusses the authors’ and Ipas’s efforts to incorporate sustainable training about reproductive health and rights into the curricula of Mexico’s medical schools.
“In many medical schools, abortion is presented to medical students in a very limited way,” says Debbie Billings, Ipas senior research and evaluation associate and one of the study’s authors. “Abortion is presented in very clinical terms. It’s presented as completely illegal, and it’s definitely not presented as a part of basic reproductive health care. Abortion is very marginalized.”
Billings and the study’s other authors, Deyanira González de León-Aguirre and Rubén Ramírez-Sánchez, discuss four major areas of deficiency in Mexico’s medical training about abortion and reproductive health and rights: medical students do not learn about the diverse reasons women have for choosing to end their pregnancies; they do not learn about how unsafe abortion is a major public health problem; students do not learn about the social and economic disparities that allow access to abortion services for some women and not to others; and students do not receive the training or the clinical practice to provide safe, modern abortion services.
Training deficiencies in reproductive health impose severe limits on the care women receive, Billings says. Many women who are able to obtain abortion services receive them from doctors who may use outdated methods or lack the practice and training to safely provide modern services. Other women may be denied their right to legal services when doctors do not discuss abortion as an option or withhold important information from their patients. In many cases, doctors may not disclose information because they are ignorant to the details of the country’s abortion laws and when abortion services may be legal.
Improving the quality of care that women receive will require dramatically changing the way that doctors and other health-care providers learn to do their jobs — Ipas has been confronting this challenge for the past eight years. In 2000, the study authors, working for Ipas Mexico, started a pilot project to examine and supplement the training provided by medical and nursing schools throughout Mexico.
This project included seminars, discussions and workshops, as well as conversations with professors about expanding their curricula. Seminars with medical students started with abortion as a central theme, accompanied by information about emergency contraception, human rights and medical ethics. By 2005, the project expanded to examine human rights as a core theme that needed to be incorporated into medical and nursing school programs.
Because lack of reproductive health training is a problem throughout Latin America, eventually the project was brought to universities throughout the region: four in Nicaragua, one in El Salvador and four in Mexico. Ipas country teams now work with leading professionals in the academic, medical and human-rights fields to make sure that medical and nursing schools teach about reproductive health and rights.
While these efforts have made progress, the authors conclude that there is still much work to be done:
“Doctors have an essential role to provide women with access to abortions when it is legally allowed. Doctors also have the responsibility to guarantee attention to women suffering from complications of unsafe abortion. For these reasons, incorporating the focus of sexual and reproductive health and rights into the medical education, with a broad perspective that includes comprehensive attention to abortion, is a task that should neither be avoided nor postponed.”
Top of the page
