The passage of a liberalized abortion law is one of many changes that must take place if women are to gain access to safe and legal services. A study of the process following legal reforms in six settings in Asia, Africa and Latin America confirms that the practical work of establishing safe abortion services can take years and requires resources and commitment. Where these efforts have been undertaken and information on trends in abortion-related illness and death is available, evidence is beginning to demonstrate that liberalized laws are followed by improved health outcomes for women.