Abortion

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.

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.

In England, Wales and Scotland abortion is legal up until 24 weeks of pregnancy, although most abortions are carried out much earlier than this.

In rare circumstances, an abortion can sometimes be carried out legally after 24 weeks (see below).

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 an abortion may be carried out after 24 weeks are:

• if it's 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 the child would be born with physical or mental abnormalities and 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's rare for an abortion to be performed after 24 weeks.

Most abortions (around 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 you're 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, you may need an ultrasound scan.

Personal decision

Making a decision about whether to have an abortion isn't 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 the final decision about whether or not to have an abortion is yours, and you should not be pressured into making a decision 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 it's 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 choose to have an abortion, you have the right for it to remain confidential, regardless of your age.

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 don't feel comfortable talking to your GP, you may prefer to contact an organisation such as:

• Marie Stopes UK – one of the UK's leading providers in sexual and reproductive healthcare services. Call their 24-hour advice line 0345 300 8090 for any information you may need regarding your sexual health, pregnancy, contraception and abortion.
• Brook – a national voluntary organisation that provides free and confidential sexual health advice and services aimed specifically at people under 25 years of age; Brook currently provide a text and webchat service 9am-3pm Monday to Friday 
• the Family Planning Association (FPA) – a UK charity that provides sexual health information; you can contact the FPA's confidential helpline on 0845 122 8687 if you live in Northern Ireland