Over half a million clandestine abortions are believed to occur annually in Mexico, many under unfavorable health conditions that lead to the death of several hundred women. Since it first came under scrutiny in the early 1970s, this situation has proved politically sensitive and difficult for both society and state. An uneasy truce has masked over the subject, broken by periodic controversy. The abortion debate became nationwide following several contrasting legal initiatives and high-profile adolescent rape cases as the country entered systemic change in 2000. This paper assesses accessibility to abortion services, the medical demography of abortion, recent attempts to make abortion safer and rarer, the evolution and social construction of the abortion debate, and the strategies and relative influences of the key actors involved. It further examines the international dimensions to this controversy and the barriers to bringing policy more into line with actual abortion practice. Despite increasing political pluralism, societal and elite awareness of existing problems, for now the issue is not judged sufficiently pressing to merit major action due to a host of reasons discussed. On the other hand, incremental changes in post-abortion care have occurred and the question of abortion can no longer be ignored.