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Evidence from high-income countries suggests that group antenatal care, an alternative service delivery model, may be an effective strategy for improving both the provision and experience of care. Until recently, published research about group antenatal care did not represent findings from low- and middle-income countries, which have health priorities, system challenges, and opportunities that are different than those in high-income countries. Because high-quality evidence is limited, the World Health Organization recommends group antenatal care be implemented only in the context of rigorous research. In 2016 the Global Group Antenatal Care Collaborative was formed as a platform for group antenatal care researchers working in low- and middle-income countries to share experiences and shape future research to accelerate development of a robust global evidence base reflecting implementation and outcomes specific to low- and middle-income countries. This article presents a brief history of the Collaborative's work to date, proposes a common definition and key principles for group antenatal care, and recommends an evaluation and reporting framework for group antenatal care research.

BackgroundMost patients use the internet to search for health information. While there is a vast repository of searchable information online, much of the content is unregulated and therefore potentially incorrect, conflicting, or confusing. Abortion information online is particularly prone to being inaccurate as antichoice websites publish purposefully misleading information in formats that appear as neutral resources. To understand how antichoice websites appear neutral, we need to understand the specific website features of antichoice websites that impart an impression of trustworthiness. ObjectiveWe sought to identify the characteristics of false or misleading abortion websites that make these websites appear trustworthy to the public. MethodsWe conducted a cross-sectional study using Amazon’s Mechanical Turk platform. We used validated questionnaires to ask participants to rate 11 antichoice websites and one neutral website identified by experts, focusing on website content, creators, and design. We collected sociodemographic data and participant views on abortion. We used a composite measure of “mean overall trust” as our primary outcome. Using correlation matrices, we determined which website characteristics were most associated with mean overall trust. Finally, we used linear regression to identify participant characteristics associated with overall trust. ResultsOur analytic sample included 498 participants aged from 22 to 70 years, and 50.1% (247/493) identified as female. Across 11 antichoice websites, creator confidence (“I believe that the creators of this website are honest and trustworthy”) had the highest correlation coefficient (strongest relationship) with mean overall trust (coefficient=0.70). Professional appearance (coefficient=0.59), look and feel (coefficient=0.59), perception that the information is created by experts (coefficient=0.59), association with a trustworthy organization (coefficient=0.58), valued features and functionalities (coefficient=0.54), and interactive capabilities (coefficient=0.52) all demonstrated strong relationships with mean overall trust. At the individual level, prochoice leaning was associated with higher overall trust of the neutral website (B=−0.43, 95% CI −0.87 to 0.01) and lower mean overall trust of the antichoice websites (B=0.52, 95% CI 0.05 to 0.99). ConclusionsThe mean overall trust of antichoice websites is most associated with design characteristics and perceived trustworthiness of website creators. Those who believe that access to abortion should be limited are more likely to have higher mean overall trust for antichoice websites.

BackgroundPeople use the internet as a primary source for learning about medical procedures and their associated safety profiles and risks. Although abortion is one of the most common procedures worldwide among women in their reproductive years, it is controversial and highly politicized. Substantial scientific evidence demonstrates that abortion is safe and does not increase a woman’s future risk for depressive disorders or infertility. The extent to which information found on the internet reflects these medical facts in a trustworthy and unbiased manner is not known. ObjectiveThe purpose of this study was to collate and describe the trustworthiness and political slant or bias of web-based information about abortion safety and risks of depression and infertility following abortion. MethodsWe performed a cross-sectional study of internet websites using 3 search topics: (1) is abortion safe?, (2) does abortion cause depression?, and (3) does abortion cause infertility? We used the Google Adwords tool to identify the search terms most associated with those topics and Google’s search engine to generate databases of websites related to each topic. We then classified and rated each website in terms of content slant (pro-choice, neutral, anti-choice), clarity of slant (obvious, in-between, or difficult/can’t tell), trustworthiness (rating scale of 1-5, 5=most trustworthy), type (forum, feature, scholarly article, resource page, news article, blog, or video), and top-level domain (.com, .net, .org, .edu, .gov, or international domain). We compared website characteristics by search topic (safety, depression, or infertility) using bivariate tests. We summarized trustworthiness using the median and IQR, and we used box-and-whisker plots to visually compare trustworthiness by slant and domain type. ResultsOur search methods yielded a total of 111, 120, and 85 unique sites for safety, depression, and infertility, respectively. Of all the sites (n=316), 57.3% (181/316) were neutral, 35.4% (112/316) were anti-choice, and 7.3% (23/316) were pro-choice. The median trustworthiness score was 2.7 (IQR 1.7-3.7), which did not differ significantly across topics (P=.409). Anti-choice sites were less trustworthy (median score 1.3, IQR 1.0-1.7) than neutral (median score 3.3, IQR 2.7-4.0) and pro-choice (median score 3.7, IQR 3.3-4.3) sites. Anti-choice sites were also more likely to have slant clarity that was “difficult to tell” (41/112, 36.6%) compared with neutral (25/181, 13.8%) or pro-choice (4/23, 17.4%; P

Objective To propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care. Methods In a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012.This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending In live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to Identify correlates of adequate antenatal care and predicted coverage. Findings Based on a population-weighted sample of 9052044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance. Conclusion While basic antenatal care coverage is high In Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care. Objectif Proposer une classification des soins prenataux afin de mesurer Ia continuite des soins et leur caractere adequat: date de debut des soins prenataux, nombre de consultations prenatales et principaux processus de soins. Methodes Lors de notre etude retrospective transversale, nous avons utilise les donnees de 1'enquete nationale sur Ia sante et la nutrition (ENSANUT) realisee au Mexique en 2012. Celle-ci contenait des Informations sur lerecoursaux soins prenataux declare par 6494 femmes lors de leur derniere grossesse ayant abouti a une nalssance vivante. Les soins prenataux ont ete consideres adequats lorsqu'une femme avait eu sa premiere consultation au cours du premier trimestre de grossesse, s'etait rendue au minimum a quatre consultations prenatales et avait beneficie d'au moins sept des huit procedures recommandees lors des consultations. Nous avons utilise une regression logistique ordinale multivariee pour identifier les correlations entre soins prenataux adequats et previsions de Ia couverture de soins. Resultats Sur un echantlllon pondere en fonction de la population de 9 052 044 femmes, 98,4% avaient recu des soins prenataux lors de leur derniere grossesse, mais seulement 71,5% (intervalle de confiance de 95%: 69,7 a 73,2) avaient recu des soins juges adequats. D'importantes differences geographiques ont ete observees entre les Etats au niveau de Ia couverture de soins. La probabillte de beneficier de soins prenataux adequats etait plus forte pour les femmes au statut socioeconomique plus eleve, celles ayant eu une scolarite plus longue et celles disposant d'une assurance maladie. Conclusion Au Mexique, si la couverture en matiere de soins prenataux de base est elevee, les soins adequats restent limites. Les systemes de sante, les gouvernements et les chercheurs, dans leurs efforts pour mesurer et ameliorer les soins prenataux, devraient adopter une definition plus rlgoureuse de ce type de soins afin d'y indure d'importants aspects qualitatifs comme la continuite et les processus de soins. Objetivo Proponer una clasificacion de atencion prenatal para medir la continuidad de la atencion sanitaria segun su idoneidad: momento en que se empieza a recibir atencion prenatal, numero de visitas de atencion prenatal y procesos basicos de atencion. Metodos En un estudio transversal y retrospectivo se utilizaron datos de la Encuesta Nacional de Salud y Nutricion (ENSANUT) realizada en Mexico en 2012, que contenia informacion autodeclarada acerca del uso de atencion prenatal de 6 494 mujeres durante su ultimo embarazo con nacidos vivos. Se considero que la atencion prenatal era adecuada si una mujer realizaba su primera visita durante el primer trimestre de embarazo, hacia al menos cuatro visitas de atencion prenatal y recibia al menos siete- de los ocho procedimientos recomendados durante las visitas. Se utilizo una regresion logistica ordinal multivariable para identificar las correlaciones de la atencion prenatal adecuada y la cobertura prevista. Resultados Segun una muestra ponderada de la poblacion de 9 052 044 personas, el 98,4% de las mujeres recibieron atencion prenatal durante su ultimo embarazo, pero unicamente el 71,5% (intervalo de confianza del 95%: 69,7 a 73,2) recibieron atencion sanitaria prenatal clasificada como adecuada. Se identificaron importantes diferencias geograficas en la cobertura de la atencion sanitaria entre los estados. La probabilidad de recibir una atencion prenatal adecuada era mayor entre mujeres con una mejor situacion socioeconomica, mas anos de escolarizacion y seguro medico. Conclusion Aunque la cobertura basica de atencion prenatal es alta en Mexico, su idoneidad sigue siendo escasa. Los esfuerzos realizados por sistemas sanitarios, gobiernos e investigadores para mediry mejorar la atencion prenatal deberian adoptar una definicion mas rigurosa de la misma para incluir elementos importantes de calidad, como la continuidad y los procesos de atencion., Introduction Optimizing maternal and infant health requires, but is not limited to, the provision of available and accessible health care delivered by skilled health personnel throughout the antenatal period. (1) [...]

Objective To describe causes of maternal mortality in Mexico over eight years, with particular attention to indirect obstetric deaths and socioeconomic disparities. Methods We conducted a repeated cross-sectional study using the 2006-2013 Busqueda intencionada y reclasificacion de muertes maternas (BIRMM) data set. We used frequencies to describe new cases, cause distributions and the reclassification of maternal mortality cases by the BIRMM process. We used statistical tests to analyse differences in sociodemographic characteristics between direct and indirect deaths and differences in the proportion of overall direct and indirect deaths, by year and by municipality poverty level. Findings A total of 9043 maternal deaths were subjected to the review process. There was a 13% increase (from 7829 to 9043) in overall identified maternal deaths and a threefold Increase in the proportion of maternal deaths classified as late maternal deaths (from 2.1% to 6.9%). Over the study period direct obstetric deaths declined, while there was no change In deaths from indirect obstetric causes. Direct deaths were concentrated In women who lived in the poorest municipalities. When compared to those dying of direct causes, women dying of indirect causes had fewer pregnancies and were slightly younger, better educated and more likely to live in wealthier municipalities. Conclusion The BIRMM is one approach to correct maternal death statistics in settings with poor resources. The approach could help the health system to rethink its strategy to reduce maternal deaths from indirect obstetric causes, including prevention of unwanted pregnancies and improvement of antenatal and post-obstetric care. Objectif Decrire les causes de mortalite maternelle au Mexique sur une periode de huit ans, en s'interessant particulierement aux deces dus a des causes obstetricales Indirectes ainsi qu'aux disparites socioeconomiques. Methodes Nous avons realise une etude transversale repetee a l'aide des donnees de l'outil Busqueda intencionada y redasificacion de muertes maternas (BIRMM) 2006-2013. Nous nous sommes bases sur les frequences pour decrire les nouveaux cas, la repartition des causes et la reclassification des cas de mortalite maternelle selon la procedure BIRMM. Nous avons utilise des tests statistiques pour analyser les differences, sur le plan des caracteristiques sociodemographiques, entre les deces pour cause directe et indirecte, ainsi que les differences dans la proportion globale de deces pour cause directe et Indirecte, par annee et par niveau de pauvrete des municipalites. Resultats Un total de 9043 deces maternels a ete examine. Nous avons constate une augmentation de 13% du nombre global de deces maternels Identifies (de 7829 a 9043) et la proportion de deces maternels classes comme deces maternels, tardifs a ete multipliee par trois (passant de 2,1% a 6,9%). Sur la periode etudiee, le nombre de deces dus a des causes obstetricales directes a diminue, mais il n'a ete observe aucun changement dans le nombre de deces dus a des causes obstetricales Indirectes. Les deces pour cause directe etaient concentres chez les femmes vivant dans les municipalites les plus pauvres. En comparaison des femmes decedees de causes directes, les femmes decedees de causes Indirectes avaient eu moins de grossesses et etalent legerement plus jeunes, plus Instruites et plus susceptibles de vivre dans des municipalites plus riches. Conclusion La procedure BIRMM est une approche qui permet de rectifier les statistiques sur les deces maternels dans les zones ayant peu de ressources. Cette approche pourrait permettre de repenser la strategie du systeme de sante en vue de reduire le nombre de deces maternels dus a des causes obstetricales indirectes, avec notamment la prevention des grossesses non desirees et l'amelioration des soins prenataux et post-obstetricaux. Objetivo Describir las causas de la mortalidad materna en Mexico durante ocho anos, con especial atencion a las muertes obstetricas indirectas y a las desigualdades socioeconomicas. Metodos Se realizo un estudio transversal repetido utilizando el conjunto de datos Busqueda intencionada y reclasificacion de muertes maternas (BIRMM) de 2006-2013. Mediante el proceso de la BIRMM, se utilizaron frecuencias para describir nuevos casos, las distribuciones de las causas y la reclasificacion de los casos de mortalidad materna. Se utilizaron pruebas estadisticas para analizar las diferencias en cuanto a las caracteristicas sododemograficas entre las muertes directas e indirectas y las diferencias en el porcentaje del total de muertes directas e Indirectas, por ano y por nivel de pobreza de los municipios. Resultados Un total de 9 043 muertes maternas fueron sujetas al proceso de revision. En general, el numero de muertes maternas Identificadas aumento un 13% (de 7 829 a 9 043) y el porcentaje de muertes maternas clasificadas como muertes maternas tardias se triplico (de un 2,1% a un 6,9%). Durante el periodo de estudio, las muertes obstetricas directas se redujeron, mientras que las muertes derivadas de causas obstetricas Indirectas se mantuvieron sin cambios. Las muertes directas se concentraron en mujeres que vivian en los municipios mas pobres. En comparacion con aquellas que fallecian por causas directas, las mujeres que fallecian por causas indirectas tuvieron menos embarazos y eran ligeramente mas jovenes, tenian una mejor educacion y mas posibilidades de vivir en municipios mas adinerados. Conclusion La BIRMM es un enfoque cuyo objetivo es corregir las estadisticas de mortalidad materna en entornos con pocos recursos. El enfoque podria ayudar al sistema sanitario a reconsiderar su estrategia para reducir las muertes maternas por causas obstetricas indirectas, incluyendo la prevencion de embarazos no deseados y la mejora del cuidado prenatal y postobstetrico., Introduction Maternal mortality--defined as the death of a woman during pregnancy, childbirth or in the 42 days after delivery--is used as an outcome measure for any health system. The indicator [...]

The authors offer a response to a commentary made on their article on coronavirus disease 2019 (COVID-19) vaccination and menstrual cycle disturbances. Topics include the steps they have taken to reduce confounding and increase confidence in their results, which found small menstrual cycle changes that resolved quickly with COVID-19 vaccination; basis of the concept of length-biased sampling; and factors needed in the investigation of cycle-length changes following vaccination.

Objective. To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Materials and methods. Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012. We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth. We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. Results. The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Conclusion. Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico. [ABSTRACT FROM AUTHOR]

The study aimed to identify the most frequent barriers in access to abortions in both clandestine and legal clinical contexts, from the perspective of accompanying persons, namely feminist activists who accompanied women that opted for voluntary abortions with medication. We performed 14 semi-structured interviews with accompanying persons in three regions of Mexico: Baja California and Chiapas, both of which are restrictive contexts, and Mexico City, where elective abortion is legal up to 12 weeks' gestational age. We identified four categories in which the social vulnerabilities of women who elect to undergo abortion intersect, namely lack of information, persistence of stigma, influence of the legal framework, and flaws in abortion care, including in clinics for legal termination of pregnancy (in Mexico City), and poor quality of the services provided, with verbal abuse, conscientious objection, and healthcare provider complaints, and finally the antichoice groups and their strategies. In the three regions, access to abortion clinics is still a privilege reserved for women with the necessary economic, logistic, and socials resources for the procedure in these settings. The existence of a program for legal termination of pregnancy (Interrupción Legal de Embarazo) in only one entity reveals the existence of a legal and health inequality. The study's findings on accompanying persons for women undergoing abortions provide backing for the Mexican government to improve access to safe abortions for all women, especially now that the country's Supreme Court has decreed the procedure's decriminalization and its imminent nationwide legalization.

Background: The Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina., Objective: We assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations., Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1-2 months, and 2-6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women., Results: Our study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P <.001) and were more likely to be multiparous (76.8% vs 60.8%; P <.001) and Latina (80.3% vs 9.5%; P <.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9-6.4) compared with 58.8% (95% confidence interval, 58.6-58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees ( P <.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8-2.1] vs [35.4-35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only.Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8-2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7-39.9) among Latinas enrolled in Traditional Medicaid., Conclusion: Women enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children., (© 2021 The Authors.)

Objective: Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective., Methods: We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication)., Results: The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women., Conclusion: Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.

Objective: To identify sociodemographic and health services factors associated with receipt of immediate post-partum (IPP) contraception and the type of contraceptive method received., Materials and Methods: We used the National Health and Nutrition Survey (Ensanut), 2018-19, which contains information on 4 548 women aged 12-49 years who gave birth. We described receipt of IPP contraception and method type and used multivariable logistic (n=4 544) and multinomial regression (n=2 903) to examine receipt of any modern method and type of method., Results: 65% of women received IPP contraception. 56.8% of adolescents received long-acting reversible contraception (43.7% IUD & 13.1% implant). Being indigenous, having only one child, or receiving care in State Health Services/IMSS-Prospera or private sector facilities were associated with lower odds of receiving IPP contraception., Conclusions: We identify progress in the IPP contraception coverage among adoles-cents. Disparities persist in receipt of IPP contraception by type of health insurance., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.