The Mexico City Model of Abortion Care

“We are open in solidarity with American women who need an abortion in Mexico City. Abortion is free and legal here. – Dr. Oliva López Arellano, Minister of Health of Mexico

After the decriminalization of abortion by the Supreme Court of Mexico, the ground shook.

On September 7, 2021, news of the decision spread in Mexico City, rocking the predominantly Roman Catholic country. Later that night, the capital shook again, as an earthquake lasting almost a minute shook the country’s southern coast.

The seismic metaphor fits Mexico, where a majority of people think access to abortion should be illegal. The issue has bitterly divided states across the country, to the point that President Andrés Manuel López Obrador has refused to take a stand.

In Mexico, access to abortion care is unequal, determined by different state laws and policies. And over the past two decades, Mexico City has been at the forefront of the country’s fight for abortion access, unlike many rural states. Since abortion was legalized in Mexico City in 2007, tens of thousands of women have traveled to the city for abortions.

As the United States grapples with its own potential patchwork of abortion policy, we wanted to ask Dr. Oliva López Arellano, Mexico City’s Minister of Health: Is the city a model for progressive U.S. states looking to become destinations for abortion care?

For decades, Mexican women have relied on clandestine clinics, traditional midwives and questionable herbal potions to end unwanted pregnancies. As in countries around the world, many women die every year while receiving illicit abortion care.

That changed in 2007, at least for some women in the country, when the Mexico City legislature legalized abortion in the first three months of pregnancy. It was a decisive vote that set the capital apart from the rest of the Mexican states, inspired nationwide court battles, and led to social clashes between religious conservatives and liberals. Over the next few years, as you heard on Tuesday’s episode of The Daily, activists and lawyers successfully lobbied for the procedure to be decriminalized in the states of Oaxaca, Hidalgo and Veracruz.

This momentum led to the Supreme Court’s decision last fall. But while abortion has been decriminalized at the federal level, it has not necessarily been made accessible nationally.

In Mexico, the practicalities of abortion are determined at the state level – leaving conservative states, often strongholds of the Roman Catholic Church, to regulate or limit access. As a result, Mexico City has become a destination for women seeking abortion care over the past 15 years.

Since 2007, about 247,000 abortions have been performed by health care providers in Mexico City, according to the city’s health ministry. Of these patients, 31% were women from out of town or country. According to the ministry, no pregnant women have died as a result of these abortion services.

Now, the city government invites American women to access its free services, if abortion care is no longer available where they live. “We are open in solidarity with American women who need an abortion in Mexico City. Abortion is free and legal here,” Dr. López Arellano said in an interview today.

The invitation contrasts sharply with the message sent by the heavy militarization on the American side of the border. It’s also radically different from the law in neighboring Texas, where abortion is banned after about six weeks and residents are encouraged to sue anyone who “aids or encourages” a woman to have an abortion, with rewards of up to at $10,000.

Dr. López Arellano knows that American women are unlikely to take up the offer en masse. In the United States, more than half of all abortions are now administered with medication. In Mexico City, the share is even higher: medical abortions now make up the majority of abortion services provided by public clinics. The increasing accessibility to medical abortion has given rise to safe self-administered abortions, a change that the pandemic has accelerated. As a result, it is now often cheaper and more effective for women to obtain these pills in the United States or just across the border, instead of traveling to Mexico City.

Still, she thinks Mexico City could become a model for US states looking to provide comprehensive health care to women in their state and those who might need to travel to the region for abortions – as many women are. obliged to do so in Mexico.

Of 50 states, 13 have passed so-called trigger laws that would ban abortion if the Supreme Court overturns Roe v. Wade, which means half of American women of childbearing age are at risk of losing access to abortion.

“It’s a setback for women’s rights and it’s certainly a victory for those who believe that women’s bodies should be controlled by someone else,” said Dr López Arellano.

Still, she thinks this moment could force progressive mayors and governors to re-examine their abortion policies and consider whether they can provide even stronger support for women.

After the Supreme Court’s majority draft opinion leaked, Democratic state governors and mayors quickly pledged to be safe havens for abortion access, in some cases. Tweeter less than an hour after the news, and introducing new bills to further strengthen the right to abortion.

However, Dr. López Arellano believes the support needs to go even further, modeling Mexico City’s approach to comprehensive abortion care. “It is not enough to provide medical support for abortion,” she said. “We need to accompany women with counseling throughout the process and provide psychological support as well.”

Women seeking abortion care in Mexico City have access to both a medical professional to answer their questions and a counselor to help them manage the psychological impacts of the procedure.

It is a policy that has received overwhelmingly positive feedback. According to one study, women who received abortion care in Mexico City “unanimously” reported positive experiences with counseling. Also, after speaking with a professional about the services available to them, most women accepted a contraceptive method after their procedure.

Dr. López Arellano believes that access to counseling reduces abortion stigma and improves knowledge of abortion laws. “The public debate has changed because of Mexico City,” she said.

Mexico City is one of only two states in the country where a majority of people now agree that abortion should be legalized — a recent shift in attitude she attributes, at least in part, to her city’s approach to de-stigmatize abortion conversations through counseling.

Overcoming stigma is a particular challenge for reproductive rights activists in the United States, where views on abortion are comparatively polarized but are more supportive of abortion access overall.

“We once looked to the United States as a benchmark for abortion rights and access, and we’ve taken the United States as a model for some of the programs and education we’ve put in place. in Mexico City,” said Dr López Arellano. “Now people from all over are coming to Mexico City to understand and see the model we have here so they can replicate it.”

Viewing recommendation: “Happening,” a new film that explores the intimate effects of abortion in a state where the act is criminalized. Our film critic recently wrote that it “shows you a woman who desires, desires to learn, to have sex, to have children on her terms, to be sovereign – a woman who, in choosing to live her life, risks becoming a criminal and dare to be free.”

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