By highlighting the limitations of abortion decriminalization, this article examines the discrepancy between legal action and the subsequent failure to achieve practical improvements. Using the South African Choice on Termination of Pregnancy Act (CTOPA) as a reference, the author outlines the origins of transnational legislative strategies for reproductive rights. In providing a comparative analysis between the South African approach to abortion law reform and the approach employed in Nepal, the author suggests an alternative strategy to improve women’s health. Namely, the author advocates mitigating systemic barriers through government-issued guidelines on timely services, medical access and training for physicians and nurses. The article argues that reform movements are most effective with collaboration from government and international NGOs during periods of political transition (e.g., the end of the Apartheid in South Africa). In effect, narrowing the gap between law and practice requires shifting the focus from desired legislative outcomes to the proactive restructuring of healthcare services.