Penal code was revised in Rwanda in 2012 allowing legal termination of pregnancy resulting from rape, incest, forced marriage,
or on medical grounds. An evaluation was conducted to assess women‘s access to abortion services as part of an ongoing
program to operationalize the new exemptions for legal abortion. Data was collected from eight district hospitals; seven genderbased
violence (GBV) centers and six intermediate courts. Three focus group discussions and 22 in-depth interviews were
conducted with key informants. At hospitals, of the 2,644 uterine evacuation records (July 2012-June 2014), and 312 monitoring
cases (August-December 2014), majority of all uterine evacuations (97% and 85% respectively, for the two periods) were for
obstetric conditions, and induced abortion on medical grounds accounted for 2% vs. 15% respectively. Medical abortion was the
prominent method of uterine evacuation. At the GBV centers, 3,763 records were identified retrospectively; 273 women were
pregnant. Since the legal reform there was only one abortion for a pregnancy resulting from rape. Abortion stigma and court
order requirement are major barriers to access services. The operationalization program has made significant contributions to
make abortion safer in Rwanda but this evaluation demonstrates that further work is required to reach the goal of providing safe
abortion services to all eligible women. Addressing abortion stigma at the community, organizational and structural levels;
further strengthening of service provision; and streamlining legal requirements to protect particularly young women from sexual
violence and making abortion a realistic option for GBV victims are some of the important next steps.