The Limits of Reproductive Rights in Improving Women\u27s Health

South Africa\u27s Choice on Termination of Pregnancy Act (CTOPA) is heralded as one of the most progressive abortion laws in the world. The law permits unfettered access to government-funded abortion services for all women through the twelfth week of gestation, stating in its preamble that every woman [has] the right to choose whether to have an early, safe and legal termination of pregnancy according to her individual beliefs. Despite increased availability of legal abortions\u27 (and the inclusion of rights to reproductive health care and decision-making in South Africa\u27s Constitution), the number of illegal terminations in South Africa does not appear to have decreased significantly since liberalization. Although there have been lower rates of maternal mortality associated with illegal abortion, indications of maternal morbidity -- illness or negative health effects -- remain high. The purpose of this Article is to explore this gap between law and practice, and to highlight some of the limitations of decriminalization and liberalization agendas for those advocating on behalf of reproductive rights. By describing the South African experience of abortion law reform, this Article maps the origins of transnational legislative strategies for reproductive rights. It questions how shifting focus might help address abortion care delivery in countries with diverse histories and needs. Strategies focused on liberalizing access to abortion may be well suited to a project in which the primary and most important aim is to create a rights-based framework. Yet they may not respond to implementation problems, help ensure delivery of health services, or take account of the unique context of service delivery