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Harm reduction is an evidence-based public health and human rights framework that prioritizes strategies to reduce harm and preserve health in situations where policies and practices prohibit, stigmatize and drive common human activities underground. The best-known application of a harm reduction model is in the field of HIV, where needle exchange programs and safe injection centers have been shown to be highly effective in preventing HIV/sexually transmitted infection. We propose that promoting the use of misoprostol for abortion using a harm reduction approach could dramatically increase access to safer abortions. The principles of harm reduction — neutrality, humanism and pragmatism — present a conceptual framework for making misoprostol information and care available directly to women and make the case for why it is imperative that we do so.