title: Denial of abortion in legal settings.
abstract: 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.
authors.affiliation: Epidemiologist, Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gerdts
authors.affiliation: Senior Technical Advisor/Research Supervisor, Fundación Oriéntame/ESAR, Bogota, Colombia.
authors.forename: Teresa
authors.initials: T
authors.lastname: DePiñeres
authors.affiliation: Director, Groupe Tawhida Ben Cheikh, Tunis, Tunisia.
authors.forename: Selma
authors.initials: S
authors.lastname: Hajri
authors.affiliation: Director, Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Harries
authors.affiliation: Director, Bangladesh Association for the Prevention of Septic Abortion, Dhaka, Bangladesh.
authors.forename: Altaf
authors.initials: A
authors.lastname: Hossain
authors.affiliation: Associate Director, Center for Research on Environment Health and Population Activities, Kathmandu, Nepal.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Puri
authors.affiliation: Survey Researcher, Mathematica Policy Research, Oakland, CA, USA.
authors.forename: Divya
authors.identifier: http://orcid.org/0000-0002-5167-2582
authors.initials: D
authors.lastname: Vohra
authors.affiliation: Associate Professor, Advancing New Standards in Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Diana Greene
authors.initials: DG
authors.lastname: Foster
mesh_terms: D000023:Abortion Applicants; D000028:Abortion, Induced; D000328:Adult; D003105:Colombia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D009390:Nepal; D011247:Pregnancy; D013019:South Africa; D014416:Tunisia
keywords: abortion; medico-legal; misoprostol; unintended pregnancy