The Mexico City Model of Abortion Care

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“We are open in solidarity to American women who need an abortion in Mexico City. Abortion is free and legal here.” — Dr. Oliva López Arellano, Mexico City’s health minister

After the Mexican Supreme Court decriminalized abortion, the ground shook.

On Sept. 7, 2021, news of the ruling rippled out from Mexico City, jolting the predominantly Roman Catholic country. Later that night, the capital shook again, as a nearly minute-long earthquake rattled the country’s southern coast.

The seismic metaphor is fitting for Mexico, where a majority of people believe abortion access 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 position.

In Mexico, access to abortion care is patchy, determined by varying state laws and policies. And over the past two decades, Mexico City has been at the forefront of the country’s fight over 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 to seek abortion care.

So as the United States faces its own prospective patchwork of abortion policy, we wanted to ask Dr. Oliva López Arellano, Mexico City’s health minister: Is the city a model for progressive American states looking to become destinations for abortion care?

The state of abortion in Mexico

For decades, women in Mexico resorted to clandestine clinics, traditional midwives and dubious herbal potions to end unwanted pregnancies. As in countries around the world, many women died every year while receiving illicit abortion care.

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

This momentum built to the Supreme Court ruling last fall. But while abortion was decriminalized at the federal level, it was not necessarily made accessible nationwide.

In Mexico, the practicalities of providing abortions are determined at the state level — leaving conservative states, often strongholds for 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.

A health care destination?

Since 2007, roughly 247,000 abortions have been performed by Mexico City health care providers, according to the city’s Ministry of Health. Of those patients, 31 percent have been women from outside the city or the country. According to the ministry, no pregnant women have died from those abortion services.

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

The invitation stands in stark contrast to the message sent by heavy militarization on the American side of the border. It also is drastically distinct from the law in neighboring Texas, where abortion is banned after about six weeks and residents are incentivized to pursue lawsuits against anyone who “aids or abets” a woman seeking an abortion, with rewards up to $10,000.

Dr. López Arellano knows it is unlikely American women will take her up on 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: Medication abortions now make up the majority of abortion services provided by public clinics. The increasing accessibility of medication abortion has given rise to safely self-administered abortions, a shift that the pandemic accelerated. As a result, it is now often cheaper and more efficient for women to source those pills within the United States or just across the border, instead of traveling to Mexico City.

Still, she believes Mexico City could become a model for American states looking to provide comprehensive health care to both women within their state and those who may need to travel regionally for abortion care — as many women are forced to do in Mexico.

A model for the U.S.

Out of 50 states, 13 have passed so-called trigger laws that would outlaw abortion if the Supreme Court overturns Roe v. Wade, meaning half of American women of reproductive age stand to lose abortion access.

“This is a setback for women’s rights and it is definitely a victory for those who believe women’s bodies need to be controlled by someone else,” Dr. López Arellano said.

Still, she believes this moment could compel progressive mayors and governors to re-examine their abortion policy and consider whether they can provide even more robust support for women.

After the Supreme Court’s draft majority opinion was leaked, governors and mayors in Democratic states were quick to promise to be havens for abortion access, in some cases tweeting less than an hour after the news, and introducing new bills to further strengthen abortion rights.

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

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

It’s a policy which has received resoundingly positive feedback. Women who received abortion care in Mexico City “unanimously” reported positive experiences with counseling, according to one study. Additionally, 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 having access to counseling reduces abortion-related stigma and increases knowledge of abortion laws. “The public debate has shifted because of Mexico City,” she said.

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

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

“We once saw the U.S. as a reference for abortion rights and access, and we took the U.S. as a model for some of the programs and education that we did in Mexico City,” Dr. López Arellano said. “Now, people from all over come to Mexico City to understand and see the model that we have here so that they can replicate it.”

Watching 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, have sex, bear children on her terms, be sovereign — a woman who, in choosing to live her life, risks becoming a criminal and dares to be free.”