We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV)
unmet need for contraception (15−17%)
high HIV prevalence
poor abortion access for rape survivors
fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH
over-reliance on donor funding (Eswatini
Lesotho)
no national CAC guidelines or guidance on legal abortion access
poor data collection and management systems
shortage and inequitable distribution of staff
few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV
stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion
inadequate research
contradictions in abortion legislation (Botswana)
inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change.