Abortion

Abortion

An abortion is the medical process of ending a pregnancy so that it does not result in the birth of a baby.

It is also sometimes known as a 'termination of pregnancy', or as just a 'termination'.

Depending on how many weeks you have been pregnant, the pregnancy is ended either by taking medication or by having a surgical procedure.

An abortion is not the same as a miscarriage, where the pregnancy ends without medical intervention (although medical treatment may be needed after a miscarriage).

Why an abortion may be needed

There are many reasons why a woman might decide to have an abortion including:

  • personal circumstances - including risk to the wellbeing of existing children
  • a health risk to the mother
  • a high probability that the baby will have a serious abnormality - either genetic or physical

When an abortion can be carried out

Under UK  law, an abortion can usually only be carried out during the first 24 weeks of pregnancy, as long as certain criteria are met (see below).

The Abortion Act 1967 covers the UK mainland (England, Scotland, and Wales), but not Northern Ireland. The law states that:

  • abortions must be carried out in a hospital, or a specialised licensed clinic
  • two doctors must agree that an abortion would cause less damage to a woman's physical or mental health than continuing with the pregnancy

There are also a number of rarer situations when the law states an abortion may be carried out after 24 weeks. These include:

  • if it is necessary to save the woman's life
  • to prevent grave permanent injury to the physical or mental health of the pregnant woman
  • if there is substantial risk that if the child were born, s/he would have physical or mental disabilities

Generally, an abortion should be carried out as early in the pregnancy as possible, ideally before 12 weeksn and ideally before 9 weeks where possible.

NHS abortions

If you want to have an abortion on the NHS, you will usually need to be referred to a specialist service that deals with abortion.

You can ask your GP to refer you or you can go to your local  family planning clinics or genito-urinary medicine (GUM) clinic.

Use the NHS Direct Wales search facility to find your nearest sexual health clinic.

The law states that a doctor can refuse to certify a woman for an abortion if they have a moral objection to abortion. If this is the case, they must recommend another doctor who will be willing to help.

Before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled, and they must both sign the relevant certificate. Usually, one of the doctors will be your GP and the other doctor will work at the hospital or clinic where the abortion will take place.

Although it's often very helpful to talk through the options with your GP or a family planning nurse before being referred, it's possible to refer yourself for an NHS abortion in some parts of the country.

You can self-refer for an NHS-funded abortion by contacting:

The funding of NHS abortion services differs in various parts of the country. The level of NHS provision ranges from more than 90% of local demand, to less than 60%.

In some areas the NHS will pay for abortions to be provided by private clinics but, in other areas, you may need to pay to have an abortion in a private clinic.

Private abortions

You can contact a private abortion clinic without being referred by a doctor. However, the NHS will not pay for this, and the agreement of two doctors is still required. The clinic will make the arrangements.

Costs for abortions in private clinics vary and will depend on:

  • the stage of pregnancy (earlier abortions are usually less expensive)
  • whether an overnight stay is needed
  • the method of abortion used

If you are considering having an abortion, it is important to talk to somebody about it as soon as possible.

When is it carried out

In the UK (England, Wales and Scotland), abortion is legal up until 24 weeks of pregnancy, but most are carried out much earlier than this. In rare circumstances, an abortion can sometimes be carried out after 24 weeks (see below).

Personal decision

Making a decision about whether or not to have an abortion is not easy. Before deciding, you should discuss your situation with healthcare professionals, family members and (if applicable) your partner. You should consider all options and these can include:

  • abortion
  • possibly keeping the baby
  • more rarely, considering adoption for the baby

Always remember that the final decision about whether or not to have an abortion is yours, and you should not be pressured into making a decision that you might later regret.

If you are under 16 years of age, you can have an abortion without telling your parents, as long as two doctors believe that it is in your best interests, and you fully understand what is involved.

However, the doctors will encourage you to involve your parents, or another adult, in your decision making process. This increases the amount of support you have available. If you have an abortion, you have the right for it to remain confidential, regardless of you age.

The Abortion Act 1967

In accordance with The Abortion Act 1967, an abortion must usually be carried out before 24 weeks of pregnancy. The law states that:

  • abortions must be carried out in a hospital or a specialist licensed clinic
  • two doctors must agree that an abortion would cause less damage to a woman's physical or mental health than continuing with the pregnancy

The few situations when the law states that an abortion may be carried out after 24 weeks are:

  • if it is necessary to save the woman's life
  • to prevent grave permanent injury to the physical or mental health of the pregnant woman
  • if there is substantial risk that if the child were born, s/he would have physical or mental abnormalities as to be seriously handicapped.

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before nine weeks where possible. It is rare for an abortion to be performed after 24 weeks.

The majority of abortions (90%) are carried out before a pregnancy reaches 13 weeks, and virtually all abortions (around 98%) are performed before 20 weeks. The earlier an abortion is carried out, the easier, and safer, the procedure is to perform. However, you must be given enough time to consider all your options so that you are as comfortable as possible with your decision.

To work out how many weeks pregnant you are, the calculation is usually made from the first day of your last period. If the exact stage of pregnancy is unclear, an ultrasound scan may be used.

Why is it necessary?

As well as a woman deciding to have an abortion due to her personal circumstances, there are also a number of medical reasons why an abortion may be necessary.

The Abortion Act 1967 states that provided a pregnancy has not exceeded its 24th week, an abortion may be carried out if:

  • continuing with the pregnancy would involve a greater risk to the woman’s life than ending the pregnancy
  • continuing with the pregnancy would involve a greater risk of injury to the woman’s physical or mental health than ending the pregnancy
  • continuing with the pregnancy would involve a greater risk to the physical or mental health of any of the woman’s existing children
  • there is a significant risk that if the child  is born s/he would have a serious physical or mental disability

The Act also makes it clear that two registered medical practitioners must both agree about the above points. In practice, this gives doctors a great degree of flexibility in referring women for abortions and supporting their request to proceed.

Read more about the Abortion Act 1967.

Deciding to have an abortion

However, making the decision to have an abortion can be difficult, and there a number of things that may influence your choice including social, economic and emotional factors. Therefore, a wide range of information and advice services are available to help you make a decision most appropriate for you.

Your GP is one of the best people you can ask for advice about having an abortion. As well as being able to give you information about the procedure itself, they will also be able to discuss all your available options. Any discussion you have with your GP will be completely confidential.

If you do not feel comfortable talking to your GP, you may prefer to contact an organisation such as:

  • Marie Stopes International - one of the UK's leading providers of sexual and reproductive healthcare services; you can call their 24 hour helpline on 0845 300 8090
  • Brook - a national voluntary organisation that provides free and confidential sexual health advice and services aimed specifically at people under 25 years of age; you can use Brook's text service on 07717 989 023 (standard SMS rates apply) or a webchat (IM) service is available on their website.

How is it performed?

In the UK, under The Abortion Act 1967, abortions can only be carried out in a hospital, or in a specialised licensed clinic.

In most cases, an abortion is carried out as a day procedure, and an overnight stay in hospital is not required.

However, in some regions, the second part of early medical abortion (tablet) can be arranged to happen at home (see below).

Before the abortion

When you go for your first appointment, you should be given the opportunity to talk about your situation (if you want to). You will be informed about the different methods of abortion, and which method is suitable for your stage of pregnancy. You will also be advised about related risks and complications.

The doctor or nurse will take your medical history to make sure that the type of abortion you are offered is suitable for you. You will have a blood test to check your blood group and to see whether you are anaemic (have a reduced number of red blood cells). You should also be tested for sexually transmitted infections (STIs). You may be given antibiotics to stop an infection from occurring after the abortion.

Before having an abortion you may also need to have:

  • an ultrasound scan (if there is any doubt about how many weeks pregnant you are)
  • a vaginal (internal) examination
  • a cervical smear test (if appropriate)

If you have never had a vaginal examination before, the healthcare professional examining you will be aware you are anxious and will be as careful as possible. You should let them know if you are anxious and have not been examined internally before.

You may also be given information and advice about which method of contraception to use after the abortion. Finally, before having the abortion, you will be given a consent form to sign.

Methods of abortion

There are a number of different methods of abortion. The method recommended for you will depend on how many weeks pregnant you are. This is usually calculated by counting the number of weeks from the first day of your last period.

Broadly speaking there are two types of abortion - medical and surgical. A medical abortion is carried out using medication while a surgical abortion involves a minor operation.

The methods of abortion are outlined below:

Early medical abortion (up to 9 weeks of pregnancy)

An early medical abortion involves taking two different medicines, 36-48 hours apart. The effect of the medication will be similar to an early natural miscarriage - this means you will have some bleeding and some pain when the abortion happens.

After your initial visit to see the doctor, you will have two more appointments on different days. On your first visit you will be given an abortion pill called mifepristone, which blocks the hormone that makes the lining of the womb suitable for the fertilised egg. After taking the first tablet, you will be able to go home, and can continue with your normal, everyday activities.

Very little will happen while you are waiting for the second part of the treatment. A few women will have mild cramps and a little bleeding, but most will not. If you have heavier bleeding or significant pain, you should contact the hospital or clinic. If it is out-of-hours, you should go to a hospital's accident and emergency (A&E) department.

Two days later, on your second visit to the hospital, or clinic, you will be given the second medicine, prostaglandin. Within 4-6 hours of taking prostaglandin, the lining of the womb breaks down and is lost, along with the embryo, through bleeding from the vagina. This part of the process can be painful, but a painkiller can be taken.

The medicines that are used during an early medical abortion may make you feel sick, and you may have diarrhoea.

In some areas of the UK, the second dose of medication is administered on an outpatient basis and the abortion can be managed at your home. This will be discussed with you if that is offered by the clinic or hospital.

Vacuum aspiration or suction termination (from 7-15 weeks of pregnancy)

Vacuum aspiration, or suction termination is a procedure that involves using gentle suction to remove the foetus from the womb. The procedure usually takes between 5-10 minutes, and can be carried out under a local anaesthetic (where the area is numbed) or general anaesthetic (where you are put to sleep).

The entrance to the womb (cervix) is dilated (opened) to allow easier access to your womb. To soften the cervix, and make it easier to open, a tablet may be placed in the vagina, a few hours before the abortion. Sometimes, an alternative ‘preparing’ tablet is given by mouth.

A small, plastic suction tube, connected to a pump, is then inserted into your womb and used to remove the foetus and surrounding tissue.

After having a vacuum aspiration abortion, you will usually be able to go home the same day. However, following the procedure, you will usually experience some bleeding which can last for up to 21 days. The average length of bleeding is about 9 to 10 days.

In most cases, the bleeding will be quite heavy for 2-3 days before settling down. Some women only bleed for 3-4 days in total. You may experience mild or moderate cramps for which you can take simple painkillers.

Late medical abortion (from 9-20 weeks of pregnancy)

As well as being used for early abortion, mifepristone and prostaglandin can be used for abortion later in pregnancy. However, the abortion will take longer, and more than one dose of prostaglandin may be needed. This type of abortion is similar to having a late natural miscarriage.

After having a late medical abortion, you will usually be able to return home on the same day. However, sometimes an overnight stay in hospital may be required.

In rare cases, a second course of prostaglandin tablets may be required. This will be discussed with you. In a small number of cases (less than one in 20), the placenta or afterbirth does not pass. In this case, you may need to have a small operation under a general anaesthetic to remove the placenta.

Surgical dilation and evacuation (from 15 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure that is carried out under general anaesthetic. The neck of the womb (cervix) is gently stretched and dilated (opened), and forceps and a suction tube are used to remove the foetus and tissue within the womb.

Surgical D&E usually takes between 10-20 minutes to perform and, if you are healthy, and there are no complications, you may be able to return home the same day. The clinic or hospital will advise if you need to stay in hospital overnight. As with vacuum aspiration, you may have some bleeding for up to 21 days.

Late abortion (20-24 weeks)

There are two options for a late abortion carried out between 20-24 weeks. Both require an overnight stay in hospital.

Surgical two-stage abortion:

  • stage one stops the heart beat of the foetus and softens the cervix.
  • stage two (carried out the following day) removes the foetus and surrounding tissue
  • each stage requires a general anaesthetic

Medically induced abortion

  • similar to a late natural miscarriage
  • the medicine prostaglandin is injected into the womb, causing it to contract strongly (as in labour).
  • contractions can last for between 6-12 hours
  • you will remain awake during the procedure and may be given medicines to control the pain
  • D&E may then be used to ensure that the womb is completely empty

Risks

No clinical procedure is entirely free from risk, but abortion poses few risks to a woman's physical health, particularly when carried out during the first 12 weeks of pregnancy.

Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future.

Risks at the time of an abortion

There is a low risk of problems occurring during an abortion. However, there are more likely to be problems if an abortion is carried out later in a pregnancy.

The risks associated with abortions are:

  • haemorrhage (excessive bleeding) occurs in about 1 in every 1,000 abortions
  • damage to the cervix occurs in no more than 10 in every 1,000 abortions
  • damage to the womb occurs in up to 4 in every 1,000 medical abortions during surgical abortion, and less than one in 1,000 medical abortions carried out at 12-24 weeks

Risks after an abortion

After an abortion, the main risk is infection in the womb, usually caused by failing to completely remove all of the foetus and associated tissue.

You can reduce the risks of infection by using sanitary pads until the bleeding stops. It is best to avoid using tampons until your next period. You should also avoid having sex until the bleeding has stopped.

If you have an infection following an abortion, you may have heavy bleeding from your vagina and some period-like pain. Antibiotics are usually used to treat the infection.

If an infection is not treated, it could result in a more severe infection of your reproductive organs, such as pelvic inflammatory disease (PID) which can cause infertility, or ectopic pregnancy (where a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes). However, the risk of an infection can be reduced by taking antibiotics at the time of the abortion.

Repeated abortions can cause damage to your cervix and increase the risk of late miscarriages.

After having an abortion, you may experience some period-type pains and some vaginal bleeding, which should gradually improve after a few days. Most women are able to return to their usual activities within a day or so. However, you should seek medical attention if you have severe pain, the bleeding becomes very heavy or if the bleeding has not stopped after 14 days.

You will usually be advised not to have sex for up to two weeks, or until the bleeding has stopped. Seek advice from your GP, a family planning clinic or a pregnancy advisory service if you experience physical or emotional problems after having an abortion.

Post-abortion counselling

Women vary greatly in their emotional response to having an abortion. You may experience a number of different feelings and emotions.

However, research suggests that having an abortion does not lead to long-term emotional or psychological problems.

If you need to discuss how you are feeling after having an abortion, you can contact a post-abortion counselling service.

It is recommended you seek advice and counselling from a recognised counselling provider, such as the British Pregnancy Advisory Service (BPAS).

You can call their confidential helpline on 08457 30 40 30 or you can email them(info@bpas.org).