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Abortion laws in countries of the Caribbean region range from the most restrictive to the most liberal in the world. Based upon in-depth interviews with health professionals, this inter-island case study in the Northeast Caribbean examines the relation between abortion laws and their applications in Anguilla, Antigua, Saint Martin, Sint Maarten and St. Kitts. Although elective pregnancy terminations are legally available only in Saint Martin, the research revealed that physicians also on the other islands are providing safe abortions in hospitals and private offices in transgression of the law, and that those services are tolerated by governments and legitimized by European norms. However, the research likewise demonstrated that criminal laws and the stigma attached to abortion hinder access to services and quality care. Women avoid stigma at home by seeking services on nearby islands and some try to avoid doctors, high fees and public exposure by inducing their own abortion with the drug misoprostol. Doctors get training, legitimacy and legal back-up from European and US hegemony, all of which women use without themselves gaining institutional access to information, legitimacy or legal practice.