A Systematic Bibliographical Review: Barriers and Facilitators for Access to Legal Abortion in Low and Middle Income Countries

Background: There is a complex interplay between women’s preferences, abortion services availability and the context in which these are provided. Even in countries where it is legal, denial of abortion is common, especially in low and middle income countries, forcing women to look for the service elsewhere and bringing serious consequences to the health and wellbeing of many women and their families. This non-systematic review pretends to answer the question: Which are the barriers to and facilitators for the access to legal abortion services in low and middle income countries? Methods: A non-systematic bibliographical review. Inclusion criteria: all quantitative, qualitative and evidence synthesis studies performed in low and middle income countries according to the World Bank classification for 2015 and published in English, Spanish and Portuguese language, between 2005 and 2017. Exclusion criteria: articles evaluating the efficacy of interventions, addressing the knowledge about abortion procedures among health care students and personnel, as well as those that only included sex workers. Results: The database search yield 199 articles in MEDLINE. 24 in Scopus and 38 in Scielo. A total of 22 articles including 15 countries from Africa (n = 6), Asia (n = 5), Central and South America (n = 3) and Europe (n = 1). The legal status of abortion in each of these countries was studied and described. For the analysis of the information, three categories of deepening were established: Laws and policies, Service delivery and Women’s abortion care-seeking behavior. Conclusion: the determinants of access to abortion in low and middle income countries are convoluted as multiple delays and barriers usually overlap. Similarly, stigmatization has a great impact across all the steps of abortion provision. Multiple facilitators were proposed in the three aspects of abortion provision, but they need to be adjusted depending on the context of each country.