India passed the Medical Termination of Pregnancy Act in 1971, making safe abortion services available to women for a wide range of indicators. However, unsafe abortions still accounted for 8% of maternal deaths in 2006 and in 2015 three out of four abortions in India were medical abortions performed outside a health facility. There are also many gaps in the understanding of barriers to safe abortion services in India. This includes: inadequate data on the actual availability of safe abortion services in public and private facilities, and attitudes to abortion; reluctance among health providers to provide safe abortions; and views of the local community on abortion. This study was conducted in two Indian States – Bihar and Tamil Nadu – with very different socio-economic indicators to ascertain the availability of abortion services, present barriers to service provision, and understand the perspectives of key actors and women on the right to safe abortion.