{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:30:49Z","timestamp":1781505049001,"version":"3.54.1"},"reference-count":41,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T00:00:00Z","timestamp":1543708800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>When conducted in a legal setting and under safe conditions, abortion is an extremely effective and safe procedure. Tragically, almost half of all abortions that take place in the world are conducted under unsafe conditions, mostly in countries where abortion is illegal or highly restricted. These unsafe abortions are a major cause of maternal death and disability. Restricting a woman\u2019s access to abortion does not prevent abortion but simply leads to more unsafe abortions. Barriers to safe abortion are many but include legal barriers, health policy barriers, shortages of trained healthcare workers, and stigma surrounding abortion. This commentary will consider some recent advances to improve access to safe abortion as well as refinements in abortion methods and service delivery in settings where safe abortion is available that further improve the care and wellbeing of women who seek abortion.<\/ns4:p>","DOI":"10.12688\/f1000research.15441.1","type":"journal-article","created":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T13:00:05Z","timestamp":1543755605000},"page":"1881","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":31,"title":["Recent advances in improving the effectiveness and reducing the complications of 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Gynecol."},{"key":"ref-19","doi-asserted-by":"publisher","first-page":"90-5","DOI":"10.1136\/jfprhc-2014-100924","article-title":"Termination of pregnancy at very early gestation without visible yolk sac on ultrasound.","volume":"41","author":"R Heller","year":"2015","journal-title":"J Fam Plann Reprod Health Care."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"1993-9","DOI":"10.1111\/1471-0528.14904","article-title":"Efficacy and safety of very early medical termination of pregnancy: a cohort study.","volume":"124","author":"I Bizjak","year":"2017","journal-title":"BJOG."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"278-83","DOI":"10.3109\/00016349209021052","article-title":"Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue. 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Foster, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada, 03 Dec 2018, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/7-1881\/v1#referee-response-40740","order":0,"name":"referee-response-40740","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.16827.r40739, Daniel Grossman, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA, 03 Dec 2018, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/7-1881\/v1#referee-response-40739","order":1,"name":"referee-response-40739","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.16827.r40738, Susheela D Singh, Lisa Remez, Guttmacher Institute, New York, NY, USA, 03 Dec 2018, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/7-1881\/v1#referee-response-40738","order":2,"name":"referee-response-40738","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}