The state of abortion services in five Pacific Island countries: a legislative analysis and scoping review

Unsafe abortions are a leading cause of maternal mortality. This study aimed to conduct a legislative analysis and scoping review to i) describe the abortion laws in Papua New Guinea (PNG), Fiji, Vanuatu, Solomon Islands, and Samoa, ii) identify what safe and unsafe abortion practices and services are available in these countries, and iii) understand women's experiences of accessing these services.

Abortion law data for these five countries were extracted and examined from the Global Abortion Policies Database. A scoping review identified relevant peer-reviewed and grey literature. Studies from all years and all languages were eligible. A systematic search was conducted on 1 December 2024 using Medline (Ovid), Embase (Ovid), and CINAHL (EBSCO) databases. Additionally, we hand-searched Google Scholar and the websites and databases of organisations focused on sexual and reproductive health (SRH) in the selected Pacific Island countries. Two independent reviewers screened studies for eligibility using Covidence software. An expert advisory group of Pacific Islander clinicians guided this review.

The legislative analysis revealed that abortion laws are generally unclear and restrictive in all five countries. Fiji has the most legal grounds for abortion (five), while Vanuatu has the fewest (one). In all five countries, abortion law specifies penalties (imprisonment) for women, providers, and anyone assisting with abortion. The scoping review included 17 articles: 10 from PNG, three from Vanuatu, one from the Solomon Islands, one from Fiji, and two from the Pacific Islands. Studies discussed various abortion strategies and experiences of post-abortion care, but none discussed safe abortion care. Misoprostol use was widely documented to induce abortion. Unsafe abortion methods included using various physical means and consuming traditional herbs. Women lacked control over abortion decision-making and described their experiences seeking post-abortion care for complications.

We found limited evidence surrounding safe abortion services in these five countries. Future research should examine what optimal safe abortion care may look like within these countries' health systems. Concerted advocacy is necessary to drive legislative reform, dismantle barriers, and create an enabling environment for safe abortion services, thereby facilitating the achievement of SRH and rights.