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Denial of abortion in legal settings
  1. Caitlin Gerdts1,
  2. Teresa DePiñeres2,
  3. Selma Hajri3,
  4. Jane Harries4,
  5. Altaf Hossain5,
  6. Mahesh Puri6,
  7. Divya Vohra7,
  8. Diana Greene Foster8
  1. 1Epidemiologist, Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA
  2. 2Senior Technical Advisor/Research Supervisor, Fundación Oriéntame/ESAR, Bogota, Colombia
  3. 3Director, Groupe Tawhida Ben Cheikh, Tunis, Tunisia
  4. 4Director, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  5. 5Director, Bangladesh Association for the Prevention of Septic Abortion, Dhaka, Bangladesh
  6. 6Associate Director, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
  7. 7Survey Researcher, Mathematica Policy Research, Oakland, CA, USA
  8. 8Associate Professor, Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA
  1. Correspondence to Dr Caitlin Gerdts, Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway St, Suite 1100, Oakland, CA 94612, USA; gerdtsc{at}


Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce.

Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care.

Results The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions.

Conclusions The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.

  • abortion
  • misoprostol
  • unintended pregnancy
  • medico-legal

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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