provision of family planning services and counselling, and referral for other reproductive health care needs. In many regions of the world, women who seek emergency treatment for abortion complications, such as bleeding, infection and injuries to the reproductive tract system, often receive services of poor quality with outdated equipment that do not address their multiple health needs. They may be discharged without counselling on postoperative recuperation, family planning, or other reproductive health issues. Women who have had an induced abortion for an unintended pregnancy may have a repeat abortion unless they receive appropriate family planning counselling and services. Five strategies for improving the quality of postabortion care have emerged from the operations research literature: upgrading clinical care, providing family planning information and services, expanding access to postabortion care, planning for comprehensive postabortion services, and involving male partners. Huntington reviews the evidence supporting these five strategies and concludes with a discussion of future research priorities in the field of postabortion care operations research, where, amongst other improvements to ensure safe and humane services for women requiring postabortion care, programmes to scale up postabortion services in the context of decentralization are urgently needed. Regional needs and priorities on unsafe abortion Unsafe abortion is of particular concern in regions where abortion is highly restricted or where the implementation of safe abortion services is weak. The consultation focused on the three regions of the world where the level of unsafe abortion is particularly high and the effect of unsafe abortion on health systems is acute: Africa, South Asia and South-East Asia, and Latin America and the Caribbean. In addition, although abortion is provided without restriction in Eastern Europe, the high level of abortion and relatively poor quality of abortion care pose public health concerns. In Africa, unsafe abortion is a health issue of enormous proportions. Each year, over 30 000 African women die from an unsafe abortion. Hord and her co-authors review the evidence for unsafe abortion in Africa and identify four priority areas for action to reduce the health burden posed by unsafe abortion. A number of factors contribute to high levels of unsafe abortion in Africa, including low levels of contraceptive use, poor-quality reproductive health services, B-Chap 1.indd 10 07/02/2006 13:31:35 11 UNSAFE ABORTION : AN OVERVIEW OF PRIORITIES AND NEEDS and restrictive abortion laws that limit the availability of safe abortion services and postabortion care. Ways to reduce unsafe abortion in the region include significant improvements in access to services through the implementation of existing abortion laws and policies, decentralization of services, and the involvement of the private health care sector. Badly needed are improvements in the poor quality of abortion and postabortion services, and an increase in the availability of services for adolescent girls who make up a significant proportion of abortion-seekers in Africa. Finally, reforming restrictive and punitive abortion laws would reduce maternal mortality and morbidity from unsafe abortion in Africa. Access to abortion in the Asian region varies and reflects diverse laws and policies, ranging from extremely liberal to extremely restrictive, although the overall trend is towards liberalization, as reflected in the recent change in abortion laws in Nepal. Unsafe abortion is considered rare in China, where abortion is legal, but because of the large number of women of reproductive age in other countries in the region, Asia is home to over one half of the world’s unsafe abortions (1). Over three fourths of the abortions in South Asia and nearly two thirds of the abortions in South-East Asia are highly restricted and most of these are unsafe. Morbidity and mortality from medically unsafe abortions remain unacceptably high in South and South-East Asia. Ganatra’s article reviews the status of unsafe abortion in the South and South-East Asian region, focusing on access to services, characteristics and motivations of abortion-seekers, decision-making and pathways to abortion, morbidity and mortality, postabortion care (PAC), and concepts of safe abortion amongst abortion-seekers. The paper defines a key research agenda to address the complexities of unsafe abortion in the region, as well as areas of priority action for programming and advocacy efforts. In many countries of the region, abortion is legal and services are available, yet both providers and clients are often unaware of the abortion laws and policies. Ganatra calls for efforts to increase awareness of abortion policies among providers and clients and to ensure that policies ensuring safe abortion services are fully implemented. Unsafe abortion rates are highest in the Latin American and Caribbean region, where there are an estimated 26 unsafe abortions per 1000 women of reproductive age. The high rate of unsafe abortion is not surprising, since access to legal abortion is highly restricted throughout the region and abortions are performed, in many cases, unsafely. Palma and her co-authors review the incidence of abortion and policies towards abortion in the Latin American and Caribbean region. The chapter also explores the relationship