Evolving capacity and decision-making in practice: adolescents' access to legal abortion services in Mexico City.

The rights of adolescents and young people in international law and agreements have evolved significantly from a focus on protection to a recognition of "evolving capacities" and decision-making ability. Unclear policies and regulations and variations in actual practice may leave providers with little clarity on how to support adolescent decision-making and instead create unintended barriers. This study in Mexico City in 2009 explored whether regulations and clinical attitudes and practice were supporting or hindering the access of adolescent girls aged 12-17 to information regarding abortion and to abortion services. We surveyed abortion clinic directors and staff, and adolescents arranging or just having had an abortion, and sent mystery clients to clinics to ask for information. While providers were generally positive about adolescents' ability to decide on abortion, they had different understandings about the need for adult accompaniment and who that adult should be, and mystery clients seeking information were more likely to receive complete information if accompanied by an adult. Clarification of consent and accompaniment requirements is needed, and providers need to be made aware of them; adolescents should have access to information and counselling without accompaniment; and improvements in privacy and confidentiality in public sector clinics are also needed. These all support complementary concepts of protection and autonomy in adolescent decision-making on abortion.

Decisionmaking regarding unwanted pregnancy among adolescents in Mexico City: a qualitative study.

Adolescents in Latin America and the Caribbean confront difficult decisions when faced with unwanted pregnancies, especially given the region's legal restrictions on and widespread cultural opposition to abortion. Little research has been conducted on pregnancy decisionmaking among young people in this region. This study examines the role of peers, partners, family members, and health-care providers in adolescents' decisionmaking regarding pregnancy continuation or termination in Mexico City shortly after abortion was legalized in 2007. Qualitative in-depth interviews and focus group discussions were conducted in 2009 with participants aged 13-17 who experienced an unwanted pregnancy. Although participants were able to formulate preferences regarding pregnancy resolution, parents' wishes usually prevailed when their wishes conflicted. Peers were generally found to be supportive, whereas the role of partners varied. Results indicate the need for comprehensive sexuality education to promote adolescents' autonomy, mechanisms other than legal mandates to encourage constructive parental involvement, and confidential counseling from health professionals offering options and supporting adolescents'ability to act on their decisions.