We address the puzzle of left governments and abortion policy reform during Latin America’s pink tide. Contrary to expectations, left government abortion reforms in this period have ranged from full legalization to supporting absolute prohibition. Confirming previous scholarship, we argue that abortion reform is influenced by public opinion, level of secularization, the strength of feminist mobilization vis-à-vis conservative religious mobilization, and ideology of government. However, while left government is a necessary condition for abortion policy liberalization, it is not a sufficient one: type of left party is crucial. Institutionalized partisan lefts are more likely to liberalize than populist left governments.