ABORTION FACTS BY NHS

Abortion

Overview

An abortion is the medical process of ending a pregnancy so it doesn't result in the birth of a baby.

It's also sometimes known as a termination.

The pregnancy is ended either by taking medications or having a minor surgical procedure.

One in three women will have an abortion in their lifetime.

How to get an abortion

Abortions can only be carried out in an NHS hospital or a licensed clinic, and are usually available free of charge on the NHS.

There are three main ways to get an abortion on the NHS:

contact an abortion provider directly – the British Pregnancy Advisory Service (BPAS), Marie Stopes UK and the National Unplanned Pregnancy Advisory Service (NUPAS) can tell you about eligibility and services in your area
speak to your GP and ask for a referral to an abortion service – your GP should refer you to another doctor if he or she has any objections to abortion
visit a contraception clinic, family planning clinic, sexual health clinic or genitourinary medicine (GUM) clinic and ask for a referral to an abortion service

Waiting times can vary, but you shouldn't have to wait more than two weeks from your initial appointment to having an abortion.

Abortions can also be paid for privately if you prefer. Costs for private abortions vary depending on the stage of pregnancy and the method used to carry out the procedure.

When an abortion can be carried out

Most abortions in England, Wales and Scotland are carried out before 24 weeks of pregnancy.

They can be carried out after 24 weeks in certain circumstances – for example, if the mother's life is at risk or the child would be born with a severe disability.

The length of your pregnancy is calculated from the first day of your last period. If you're not sure how long you've been pregnant, you may need an ultrasound scan to check.

Abortions are simpler and safer the earlier they're carried out. Getting advice early on will give you more time to make a decision if you're unsure.

Deciding to have an abortion

Some women may be certain they want to have an abortion, while others may find it more difficult to make a decision.

The decision to have an abortion is yours alone. But all women requesting an abortion should be offered the opportunity to discuss their options and choices with, and receive support from, a trained pregnancy counsellor.

Impartial information and support is available from:

your GP or another doctor at your GP practice
a counselling service at the abortion clinic
organisations such as the FPA, Brook (for under-25s), BPAS, Marie Stopes UK and NUPAS – but beware of so-called "crisis pregnancy centres" that claim to provide impartial advice but often do not

You may also want to speak to your partner, friends or family, but you don't need to discuss it with anyone else and they don't have a say in the final decision.

If you don't want to tell anyone, your details will be kept confidential. If you're under 16, your parents don't usually need to be told. Information about an abortion doesn't go on your medical record.

What happens during an abortion

Before having an abortion, you'll attend 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 two options:

medical abortion (the "abortion pill") – you take two medications, usually 24 to 48 hours apart, to induce a miscarriage
surgical abortion – you have a minor 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 experience some discomfort and vaginal bleeding for up to two weeks.

Read more about how an abortion is carried out.

Risks of an abortion

Abortions are safest if they're carried out as early as possible in pregnancy.

Most women won't experience any problems, but there is a small risk of complications, such as:

infection of the womb – occurs in up to 1 in every 10 abortions
some of the pregnancy remaining in the womb – occurs in up to 1 in every 20 abortions
excessive bleeding – occurs in about 1 in every 1,000 abortions
damage to the entrance of 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

If complications do occur, further treatment – including surgery – may be required.

Having an abortion won't affect your chances of becoming pregnant again and having normal pregnancies in the future.

In fact, you may be able to get pregnant immediately afterwards and should use contraception if you want to avoid this.

What happens

Abortions can only be carried out in hospitals or licensed clinics.

You won't usually need to stay in the clinic or hospital overnight, but you may need to attend several appointments on different days.

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.

You can also find NHS counselling services near you.

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

Abortions are generally very safe and most women won't experience any problems.

But like any medical treatment, there is a small risk that something could go wrong. The risk of complications increases the later in pregnancy an abortion is carried out.

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.

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