by Dana Repka
International Journal of Gynecology & Obstetrics – Wiley Online Library
First published: 12 January 2026 https://doi.org/10.1002/ijgo.70795
Abstract
Unsafe abortion remains a major public health and human rights challenge in Latin America, despite recent reforms that have expanded the legal grounds for abortion in several countries. A central reason for the persistent gap between law and access is the region’s widespread reliance on physician-exclusive provider models, which structurally limit the availability of services, particularly in rural, Indigenous, and primary-care settings where specialists are scarce. Task sharing in abortion care should be understood not as a discretionary efficiency strategy, but as an essential component of States’ obligations under legal rights to health care, equality, life, and scientific progress. A review of global evidence, a comparative analysis of legal and regulatory frameworks in 14 countries, and an in-depth examination of emerging reforms in Mexico, Colombia, Argentina, and Ecuador show that expanding provider eligibility is both clinically safe and normatively required. The conclusion outlines a regional reform agenda for aligning domestic regulations with World Health Organization standards.
From the Introduction
Abortion is a highly safe procedure when performed following recognized clinical standards, yet it continues to generate a disproportionate burden of preventable morbidity and mortality in Latin America. The World Health Organization (WHO) estimates that more than three-quarters of abortions in Latin America are unsafe, and, according to the Guttmacher Institute, at least 10% of all maternal deaths in the region are attributed to unsafe abortions, with nearly 760 000 women treated annually due to related complications.
For decades, the primary way abortion has been regulated in Latin America has been through criminal law. In practice, this means that abortion is treated as a crime by default, which creates a “chilling effect” for everyone involved (pp. 3–8). Women, girls, and other pregnant persons often delay or avoid seeking abortion care in the formal health system (pp. 3–5), while clinicians have strong incentives to refuse or limit these services because they fear the legal consequences of being accused of a crime (pp. 6–8). In this context, fear of prosecution and deep-rooted stigma around abortion work together to make it much more likely that people will resort to unsafe abortions.
Over the last 15 years, several Latin American countries, including Uruguay, Mexico, Colombia, Argentina, Chile, and Ecuador, have reformed their criminal laws to liberalize access to abortion in at least some circumstances; for example, by allowing abortion in more situations (such as in cases of rape or risk to health), by extending gestational limits, or by decriminalizing abortion on request during early pregnancy. These reforms have opened important doors and have improved access to safe and legal abortion for at least some groups of patients (p. 1). However, these legal changes on their own have not been enough to solve the problem of unsafe abortions. Even in countries where abortion is now partially or broadly legal, many patients still find that there is no one willing or authorized to provide it. In these settings, the main bottleneck is no longer whether the law recognizes a legal indication for abortion, but whether there are trained providers available and where they are located.
This gap is particularly visible in countries that reserve abortion provision exclusively to physicians, and often to obstetrician/gynecologists. Specialists tend to be concentrated in large urban centers and tertiary hospitals; they are scarce in rural regions, peri-urban settlements, and Indigenous territories (p. 11). Where laws insist that only these professionals may perform an abortion—even an early medical abortion—the health system structurally underproduces legal services, and the formal right to a safe procedure is transformed into a lottery: patients who cannot travel, take time off work, or afford private care in order to reach these specialized providers continue to rely on clandestine solutions, despite living in jurisdictions where abortion is “legal”. As the present article will show, this is the reality in most Latin American countries that recognize at least some legal grounds for abortion.
Task sharing directly addresses this disconnect between legal reform and effective access. It is a public health strategy that redistributes the tasks involved in abortion care among a broader range of health workers—midwives, nurses, pharmacists, community health workers, and others—thereby increasing the number of professionals who can safely provide abortion care. This has a direct impact on service delivery: it reduces travel and waiting times, shifts appropriate components of care away from physicians, expands availability of services in rural and primary care settings, helps prevent unsafe self-management of abortion, and lowers overall health system costs. Recognizing the public health relevance of this approach, the most recent WHO Abortion Care Guideline explicitly incorporates task sharing as a key recommendation for providing quality abortion care….
Methodologically, this article combines three strands of analysis. First, it draws on a review of peer-reviewed literature, policy reports, and WHO guidance on the implementation and effectiveness of task sharing in abortion care, with particular attention to the roles of midwives, nurses, and other nonphysician providers. Second, it undertakes a comparative legal analysis of abortion-related laws, regulations, and clinical protocols currently in force in 14 Latin American countries that, as of November 2025, recognize at least one legal ground for abortion, focusing on how these instruments define who is authorized to provide abortion services. Third, it examines in greater depth the legislative, regulatory, and policy debates in four countries—Mexico, Colombia, Argentina, and Ecuador—that have recently moved toward more inclusive provider frameworks, drawing on parliamentary records, explanatory memoranda, and policy documents, as well as media interviews with key reform actors where available. This article, therefore, contributes a regional legal analysis of provider eligibility rules, a dimension largely overlooked in global discussions of task sharing and essential to understanding access to abortion care in Latin America.