Recorded presentation

Henry Espinoza, MD, HPH¹, Ana Langer, MD², Luisa Torres-Sanchez, MD, PhD³, and Lizbeth Lopez-Carrillo, PhD³. (1) Regional office for Latin America and the Caribbean, Population Council Mexico, Panzacola 62, Int. 102, Col. Villa Coyoacan, Del. Coyoacan, Mexico, DF, 04000, Mexico, (52 55) 5999 8630, espinozh@paho.org, (2) Population Council, Panzacola 62, Int. 102, Col. Villa Coyoacan, Del. Coyoacan, Mexico, DF, 04000, Mexico, (3) Instituto Nacional de Salud Publica, Av Universidad No. 655, Col. Sta. Maria Ahuacatitlan, Cuernavaca-Morelos, 62508, Mexico

In Mexico, abortion is legally restricted. Nonetheless, half a million unsafe abortions take place each year, causing women’s death, infertility and other sequelae. Approximately 10% of Mexican couples suffer from infertility, and we hypothesized that unsafe abortion was accountable for a significant amount of it. To determine abortion’s contribution to tubal infertility, we conducted a case-control study in four tertiary hospitals in Mexico City with 251 cases and 1004 controls. Two hospital controls and two neighborhood controls were matched to each case by age (±2 years). Cases were infertile women, aged 20-40, with tubal occlusion confirmed by laparoscopy. Controls were fertile women, they had carried a pregnancy to term within the last two years. Participants completed a questionnaire asking about induced abortion. Conditional logistic regression models were used for the analysis. After adjusting for marital status, number of pregnancies and age at first sexual intercourse, and correcting for a differential measurement error, we found that women who had had an induced abortion were not at greater risk of suffering tubal infertility than women with no history of abortion (cases vs. hospital controls: OR=1.57, 95% C.I:0.29-8.65; cases vs. neighborhood controls: OR=0.82, 95% C.I:0.07-8.99). We found early age of sexual debut and history of pelvic inflammatory diseases as risk factors for tubal infertility. The lack of association between a history of induced abortion and tubal infertility was probably due to “safer” abortion practices; or information about induced abortion might have not been always released.

Learning Objectives:

• Recognize the strengths and limitations of a case-control study design with multiple and different types of matched controls to investigate the association between tubal infertility and unsafe abortion in a developing country.
• Discuss the difficulties in studying a sensitive public health issue, such as abortion, in Mexico.

Keywords: Abortion, Developing Countries

Related Web page: www.popcouncil.org/lac/mexico.html

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation