Making Abortion Services Accessible in the Wake of Legal Reforms: A Framework and Six Case Studies

• This report examines the processes that followed passage of abortion law reforms in Cambodia, Colombia, Ethiopia, Mexico City, Nepal and South Africa and identifies a framework of activities that are essential to successfully implement less restrictive abortion laws.

• Essential activities include strategic publicity of the change in the legal status of abortion; formulation and dissemination of detailed medical guidelines for the provision of legal procedures; introduction of legal abortion services; and development of data collection and monitoring systems to evaluate the level, quality and impact of these new services.

• Campaigns to publicize the new abortion laws were undertaken in most of the six settings, but the scale and success of the dissemination efforts varied considerably. n The existence, scope and public availability of guidelines also vary across settings. The most comprehensive and widely available guidelines exist in Ethiopia and Colombia.

• Limited health service infrastructures in all setttings have challenged the rollout of abortion services. Rollout has been relatively successful in South Africa, Ethiopia and Nepal, partly due to the support of international nongovernmental organizations.

• The revised law in South Africa has been followed by a dramatic reduction in abortion-related maternal deaths. Some evidence suggests the incidence of abortion-related complications has declined in Ethiopia and Nepal. The narrow terms of the change in Colombia’s law preclude a notable impact on the incidence of abortion or related outcomes. Impact in Mexico City and Cambodia cannot yet be reliably assessed.

• Other activities often required for successful implementation of new laws include establishing mechanisms for financing safe services and developing adequate responses to resistance to the new law.

• Successful implementation of abortion law reform can take years, and requires ongoing commitment from government, providers and advocates for women’s health and rights.