Impact of abortion reform on maternal mortality: A critical literature review in four countries

Unsafe abortion and inadequate post-abortion care are significant contributors to maternal mortality, which continues to be a major cause of death among women of reproductive age in many countries. However unsafe abortion and its associated morbidity and mortality are not inevitable. Unsafe abortion is more likely in settings where there are strong legal prohibitions or where more liberal laws have not translated into access to safe and comprehensive services. Data from a critical literature review of published studies are examined to assess the effect on abortion-related maternal mortality of reformed policies and practices in a variety of countries, including: Turkey, Romania, South Africa and Bangladesh. Parameters explored for their potential impact on changes in maternal mortality include: abortion law reform, provision of safe services, regulation of quality of care, availability of safe abortion technologies, inclusion of training in medical curricula for physicians and mid-level providers, and women's access to information and support. A discussion will follow concerning implications of the critical literature review on guidance for continued reduction of maternal mortality, particularly in restrictive environments.