OVERVIEW
An abortion is a procedure to end a pregnancy.
It’s also sometimes known as a termination of pregnancy.
The pregnancy is ended either by taking medicines or having a surgical procedure.
CORONAVIRUS UPDATE
Abortion services are still open. You can self-refer by contacting an abortion provider directly.
They can explain how their services are working at the moment.
Abortions can only be carried out under the care of an NHS hospital or a licensed clinic, and are usually available free of charge on the NHS.
There are 3 main ways to get an abortion on the NHS:
- you can self-refer by contacting an abortion provider directly – the British Pregnancy Advisory Service (BPAS), MSI Reproductive Choices UK, the National Unplanned Pregnancy Advisory Service (NUPAS) or your local NHS sexual health website can tell you about eligibility and services in your area
- speak to a GP and ask for a referral to an abortion service – the GP should refer you to another doctor if he or she has any objections to abortion
- contact a sexual health clinic (sometimes called family planning or GUM (genitourinary medicine) clinics) and ask for a referral to an abortion service
Waiting times can vary, but you should not have to wait more than 2 weeks from when you (or a doctor) first contact an abortion provider to having an abortion.
You can also pay for an abortion privately (not on the NHS) if you prefer. Costs for private abortions vary depending on the stage of pregnancy and the method used to carry out the procedure.
Most abortions in England, Wales and Scotland are carried out before 24 weeks of pregnancy.
They can be carried out after 24 weeks in very limited circumstances – for example, if the mother’s life is at risk or the child would be born with a severe disability.
Most abortion services will ask to perform an ultrasound scan to work out how many weeks pregnant you are. The length of pregnancy is calculated from the first day of your last period.
Abortions are safer the earlier they’re carried out. Getting advice early on will give you more time to make a decision if you’re unsure.
The decision to have an abortion is yours alone.
Some women may be certain they want to have an abortion, while others may find it more difficult to make a decision.
All women requesting an abortion can discuss their options with, and receive support from, a trained pregnancy counsellor if they wish.
Impartial information and support are available from:
- your GP or another doctor at your GP practice
- a counselling service at the abortion clinic
- organisations such as Brook (for under-25s), BPAS, MSI Reproductive Choices UK and NUPAS
You may also want to speak to your partner, friends or family, but you do not have to. They do not have a say in your decision.
If you do not want to tell anyone, your details will be kept confidential.
If you’re under 16, your parents do not usually need to be told. The doctor or nurse may encourage you to tell a parent, carer or other adult you trust, but they will not make you.
There are organisations, usually known as crisis pregnancy centres, that offer counselling around pregnancy. They do not refer people for abortion, and may not offer balanced or accurate advice.
If you go to a place that offers pregnancy counselling and you’re not sure if they will refer you for an abortion, ask if they refer people for an abortion.
Before having an abortion, you’ll have an appointment to talk about your decision and what happens next.
Whenever possible, you should be given a choice of how you would like the abortion to be carried out.
There are 2 options:
- medical abortion (“abortion pill”) – you take 2 medicines, usually 24 to 48 hours apart, to induce an abortion
- surgical abortion – you have a procedure to remove the pregnancy and normally go home soon afterwards
After an abortion, you’ll probably need to take things easy for a few days. It’s likely you’ll have some discomfort and vaginal bleeding for up to 2 weeks.
Read more about how an abortion is carried out.
Abortion is a safe procedure. Abortions are safest, and happen with less pain and bleeding, when carried out as early as possible in pregnancy.
Most women will not experience any problems, but there is a small risk of complications, such as:
- infection of the womb (uterus)
- some of the pregnancy remaining in the womb
- excessive bleeding
- damage to the womb or entrance of the womb (cervix)
If complications do occur, you may need further treatment, including surgery.
Having an abortion will not affect your chances of becoming pregnant again and having normal pregnancies in the future.
You may be able to get pregnant immediately after an abortion. You should use contraception if you do not want to get pregnant.
Read more about the risks of abortion.
WHAT HAPPENS
BEFORE AN ABORTION
Before having an abortion, you’ll need to attend an assessment appointment at the hospital or clinic. During this assessment, you may:
- discuss your reasons for considering an abortion and whether you’re sure about your decision
- be offered the chance to talk things over with a trained counsellor if you think it might help
- talk to a nurse or doctor about the abortion methods available, including any associated risks and complications
- do a pregnancy test to confirm you’re pregnant – an ultrasound scan may be done to check how many weeks pregnant you are
- be tested for sexually transmitted infections (STIs), your blood type and low iron levels (anaemia)
- be given antibiotics to reduce the risk of an infection developing after the abortion
When you’re sure you want to go ahead with the abortion, you’ll be asked to sign a consent form and a date for the abortion will be arranged. You can change your mind at any point up to the start of the procedure.
METHODS OF ABORTION
There are two main types of abortion:
- medical abortion (the “abortion pill”) – taking medication to end the pregnancy
- surgical abortion – a minor procedure to remove the pregnancy
Medical and surgical abortions can generally only be carried out up to 24 weeks of pregnancy. But in exceptional circumstances an abortion can take place after 24 weeks – for example, if there’s a risk to life or there are problems with the baby’s development. You should be offered a choice of which method you would prefer whenever possible.
MEDICAL ABORTION
A medical abortion involves taking medication to end the pregnancy. It doesn’t require surgery or an anaesthetic, and can be used at any stage of pregnancy. It involves the following steps:
- you first take a medicine called mifepristone – this stops the hormone that allows the pregnancy to continue working; you’ll be able to go home afterwards and continue your normal activities
- usually 24 to 48 hours later, you have another appointment where you take a second medicine called misoprostol – this will either be a tablet that you may swallow, let dissolve under your tongue or between your cheek and gum, or put inside your vagina
- within four to six hours, the lining of the womb breaks down, causing bleeding and loss of the pregnancy – you may have to stay at the clinic while this happens or you may be able to go home
If a medical abortion is carried out after nine weeks, you may need more doses of misoprostol and you’re more likely to need to stay in the clinic or hospital. Occasionally, the pregnancy doesn’t pass and a small operation is needed to remove it.
SURGICAL ABORTION
Surgical abortion involves having a procedure with local anaesthetic (where the area is numbed), conscious sedation (where you’re relaxed but awake), or general anaesthetic (where you’re asleep). There are two methods.
VACUUM OR SUCTION ASPIRATION
Can be used up to 15 weeks of pregnancy. It involves inserting a tube through the entrance to the womb (the cervix) and into your womb. The pregnancy is then removed using suction. Your cervix will be gently widened (dilated) first. A tablet may be placed inside your vagina or taken by mouth a few hours beforehand to soften your cervix and make it easier to open. Pain relief is usually given using medicines that you take by mouth, and local anaesthetic, which is numbing medicine injected into the cervix. You may also be offered some sedation, which is given by injection. A general anaesthetic isn’t usually needed. Vacuum aspiration takes about 5 to 10 minutes and most women go home a few hours later.
DILATATION AND EVACUATION (D&E)
Used from around 15 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy. The cervix is gently dilated for several hours or up to a day before the surgery to allow the forceps to be inserted. D&E is carried out with conscious sedation or general anaesthetic. It normally takes about 10 to 20 minutes and you might be able to go home the same day.
AFTER AN ABORTION
If you have a medical abortion, you may experience shortlived side effects from the medications, such as nausea and diarrhoea. General anaesthetic and conscious sedation medication can also have side effects. For all types of abortion, it’s likely you will experience some stomach cramps and vaginal bleeding, too. These usually last a week or two. Sometimes light vaginal bleeding after a medical abortion can last up to a month. After an abortion, you can:
- take ibuprofen to help with any pain or discomfort
- use sanitary towels or pads rather than tampons until the bleeding has stopped
- have sex as soon as you feel ready, but use contraception if you want to avoid getting pregnant again as you’ll usually be fertile immediately after an abortion
Get advice if you experience heavy bleeding, severe pain, smelly vaginal discharge, a fever or ongoing signs of pregnancy, such as nausea and sore breasts. The clinic will give you the number of a 24-hour helpline to call if you have concerns. You may experience a range of emotions after an abortion. If you need to discuss how you’re feeling, contact the abortion service or ask your GP about post-abortion counselling.
BUYING ABORTION PILLS ONLINE
It’s against the law to try to cause your own abortion. It is possible to buy abortion pills online, but you will not know if these are genuine and they could be harmful. Before doing anything, contact an abortion advice service such as the British Pregnancy Advisory Service (BPAS), who can help you find appropriate care for free and in confidence.
RISKS
POSSIBLE COMPLICATIONS
The main risks associated with an abortion are:
- infection of the womb – occurs in up to 1 in every 10 abortions; it can usually be treated with antibiotics
- some of the pregnancy remaining in the womb – occurs in up to 1 in every 20 abortions; further treatment may be required if this happens
- continuation of the pregnancy – occurs in less than 1 in every 100 abortions; further treatment will be needed if this happens
- excessive bleeding – occurs in about 1 in every 1,000 abortions; severe cases may require a blood transfusion
- damage of the entrance to the womb (cervix) – occurs in up to 1 in every 100 surgical abortions
- damage to the womb – occurs in 1 in every 250 to 1,000 surgical abortions and less than 1 in 1,000 medical abortions carried out at 12 to 24 weeks
Women who have an abortion are no more likely to experience mental health problems than those who continue with their pregnancy. There is also no link between having an abortion and an increased risk of breast cancer.
WHEN TO GET MEDICAL ADVICE
After having an abortion, you’ll probably experience some period-type pains and vaginal bleeding. This should start to gradually improve after a few days, but can last for one to two weeks. It’s normal and is usually nothing to worry about. But you should get advice if you experience any signs of a possible problem, such as:
- excessive bleeding – for example, if you pass large clots or go through two or more sanitary pads an hour for more than two hours in a row
- severe pain that can’t be controlled with painkillers such as ibuprofen
- a high temperature (fever)
- smelly vaginal discharge
- continuing pregnancy symptoms, such as nausea and sore breasts
The clinic will provide you with the number of a 24-hour helpline to call if you experience any problems after an abortion.
EFFECT ON FERTILITY AND FUTURE PREGNANCIES
Having an abortion won’t affect your chances of becoming pregnant and having normal pregnancies in the future. Many women are able to get pregnant immediately afterwards, so you should start using contraception right away if you don’t want this to happen. You should be advised about this at the time you have the abortion. However, there’s a very small risk to your fertility and future pregnancies if you develop a womb infection that isn’t treated promptly. The infection could spread to your fallopian tubes and ovaries – known as pelvic inflammatory disease (PID). PID can increase the risk of infertility or ectopic pregnancy, where an egg implants itself outside of the womb. But most infections are treated before they reach this stage and you’ll often be given antibiotics before an abortion to reduce the risk of infection. Having several abortions is associated with a slightly increased risk of giving birth prematurely, before the 37th week of pregnancy, in future pregnancies. Talk to your doctor or an abortion advice service for more information if you’re concerned about the possible risks of an abortion.