In Asia as elsewhere, strict regulations on who is authorized to provide abortion services and to prescribe or dispense medical abortion adversely impact access, especially for marginalized persons and residents in remote areas. The WHO's 2022 Abortion Care Guideline provides an important framework for states to formulate and implement policies to serve sexual and reproductive rights of access to abortion services. The Guideline calls for decriminalization of abortion services to increase authorization to provide abortion services and to promote self-managed medical abortion. This review examines the legal and policy frameworks of Bangladesh, India, Indonesia, Malaysia, and Nepal against the WHO Guideline. Legal and policy reforms successfully introduced in Bangladesh and Nepal to grow the provider base allow healthcare systems to expand safe abortion. This review outlines further challenges where the WHO Guideline on decriminalization and availability of medical abortion is disregarded and advocates a reproductive justice approach promoting egalitarian access to services even among the most marginalized.