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.

The paper finds that the experiences of the six settings highlight some pragmatic issues in moving from advocacy and passage of a law to actual implementation. In this context, the author states that public awareness campaigns are critical to de-facto implementation of a change in the law.

The document identifies a framework of activities that are essential to successfully implement less restrictive abortion laws. These 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
• development of data collection and monitoring systems to evaluate the level, quality and impact of these new services
• establishing mechanisms for financing safe services
• developing adequate responses to resistance to the new law.

The document makes recommendations, including:

• targeted use of the Internet and of new social media can help achieve aims to inform the public that restrictions on abortion have been eased and where legal services can be obtained
• providing low-cost procedures, including medication abortion, and increasing use of midlevel providers are of great importance
• public-sector provision is needed to ensure that services are accessible to poor women
• partnerships should be encouraged between Ministries of Health, medical schools and nurse-training colleges to promote training and recruitment in all reproductive health skills areas (including safe abortion)
• attempts must be made to obtain baseline and follow-up estimates of a range of indicators that help to assess the law’s impact.

The paper indicates that successful implementation of abortion law reform can take years, and requires ongoing commitment from government, providers and advocates for women’s health and rights.