(10) found that women who were offered contraception and counselling following treatment for complications from abortion were significantly more likely to use highly effective methods of contraception and experienced fewer unplanned pregnancies and repeat abortion during a 12-month follow-up than women who were not provided with counselling and contraceptives. These evidence-based results are encouraging and demonstrate the need for the implementation of postabortion care policies and programmes. Differential access to safe abortion services In countries were abortion is highly restricted, large numbers of beds in obstetric wards are often occupied by women who have experienced complications from unsafe abortion, attesting to the fact that women seek abortions regardless of laws prohibiting abortion services. Access to safe abortion services where these are prohibited by law is primarily a function of the ability to pay and having access to networks of safe, clandestine abortion providers. Poor women and rural women are therefore more likely to receive poor quality abortion care than urban and wealthier women. This differential access to safe abortion care places a disproportionate burden on poor women who are seeking an abortion and on the public health services which divert scarce health care resources to care for them. Social inequalities are an important determinant of access to safe abortion care, regardless of the legality of the procedure. However, few studies have documented the causes and consequences of differential access to safe abortion. A study of women’s health care providers in Nigeria (11), where abortion is highly restricted, found that women of all socioeconomic levels sought abortions but that approximately half of the women obtained abortions from traditional providers with no formal training or self-induced the abortion using a variety of B-Chap 1.indd 6 07/02/2006 13:31:34 7 UNSAFE ABORTION : AN OVERVIEW OF PRIORITIES AND NEEDS substances. Urban women and wealthier women had better access to safe abortion services. Likewise, a study of health providers in South and South-East Asia (12) revealed that approximately one third to one half of poor women in both rural and urban areas resort to uncertified providers of abortion or induce the abortion themselves. Unsafe abortion among adolescents In many countries, adolescents comprise a significant proportion of abortion-seekers. Where abortion is against the law, adolescents are most likely to experience unsafe abortion and its consequences. For example, 59 % of all unsafe abortions in Africa are estimated to occur to women aged less than 25 years (3). Mortality is frequently highest among adolescents since they are slow to recognise the pregnancy, are least able to afford appropriate care, and are most vulnerable to receiving poor quality care and using ineffective methods. The longer it takes for an adolescent to identify and access an abortion provider, the later the gestational age of the pregnancy and the greater likelihood of complications. A number of studies report consistently high levels of unsafe abortion among adolescents in Africa (13,14,15). Studies among different populations of adolescents in Cameroon and Nigeria found that approximately 20 % of adolescents report having had at least one abortion, usually performed by a physician or nurse, and complications were common (13,15,16,17). A study in Uganda (14) estimated that 55% of abortions in one health centre occurred in adolescents aged 17 to 20 years. Of these abortions, 23% resulted in complications and the capacity to manage complications was limited. The increasing gap between menarche and marriage in Africa and increasing levels of sexual activity among youth combined with insufficient family planning services for adolescents contribute to rising levels of unwanted pregnancies. Many questions about adolescent abortion-seekers remain poorly understood. What do we know about the social networks of adolescent girls and about the ways young women choose an abortion provider where abortion services are highly restricted? Where do young women with complications turn to for help? Research priorities: thematic and regional The programme of the consultation encompassed two broad categories of papers: those that address theoretical and medical issues related to research on B-Chap 1.indd 7 07/02/2006 13:31:35 8 INA K.WARRINER preventing unsafe abortion and those that examine regional priorities for unsafe abortion. All contributors were asked to provide priority topics for future research on unsafe abortion and for advocacy efforts to reduce unsafe abortion. Research on unsafe abortion is a multi-faceted challenge. Two articles highlight the need for careful analysis of the dimensions of unsafe abortion, both in terms of documenting the magnitude of unsafe abortion and its consequences and in terms of understanding the trajectories women follow when they resort to terminating an unwanted pregnancy under unsafe conditions. Documentation of the incidence of highly restricted and unsafe abortion provides evidence of the scope of the problem and the gravity of its consequences. Reliable data on abortion also delineates the role of abortion in