Abortion Care

Induced abortion ends a pregnancy with medication or a medical procedure.

About 1 in 4 women in the United States will have an abortion by age 45.

Most abortions happen as a procedure in a health care professional’s office. Some abortions happen in a surgical center or hospital. Others are completed at home with you taking medications, sometimes called abortion pills.

The type of abortion you may have depends on many factors, including your health and how far along your pregnancy is. It also may depend on where in the country your abortion care is provided. Each abortion experience is different.

Before an abortion, a health care professional should ask questions about your health. You may have a physical exam. An ultrasound exam may be done to help confirm how many weeks the pregnancy is. The health care professional should talk about

• how the abortion will happen

• any risks that may come with the procedure

• instructions about how to care for yourself at home after the abortion

It’s important to know that in most cases abortion does not affect future health. Abortion does not increase the risk of breast cancer, depression, or infertility.

If you are pregnant, you have several options:

• You may choose to become a parent.

• You may choose to make an adoption plan.

• You may choose to have an abortion.

Read Pregnancy Choices: Raising the Baby, Adoption, and Abortion to learn about all of these options.

You may want support when making decisions. You can consider talking with your partner, a family member, trusted friend, counselor, obstetrician–gynecologist (ob-gyn), or another health care professional. There also are local and national resources that you can reach out to. See the Resources section below.

In the United States, more than 8 in 10 abortions occur in the first trimester. Abortion during the first trimester is a safe procedure.

Procedural abortion in the first trimester typically is done with vacuum aspiration. Abortion with vacuum aspiration usually is offered up to 13 weeks of pregnancy.

To start, a speculum is placed in the vagina to hold it open. A numbing medication may be given to help block sensation in the cervix. The cervix may need to be dilated (opened) for the procedure. The cervix can be opened with medication or dilators (rods). Most first-trimester procedures require dilation before the procedure starts. Most procedures also will include dilation during the procedure.

A thin, plastic tube is inserted through the cervix and into the uterus. The tube is then attached to a suction or vacuum pump, which removes the pregnancy.

Your health care professional should take steps to ensure you are comfortable during the procedure. Pain medication may be recommended but is not always necessary. Antibiotics may be given to help prevent infection.

You will go home the day of your procedure if there are no complications. You can expect to have soreness or cramping for a few days afterward. You may be offered a prescription for pain medication or you can take over-the-counter pain medication. Bleeding and spotting may last for up to 2 weeks. This is normal.

A medication abortion uses medications to end a pregnancy.

A medication abortion requires two steps. First, you take a medication called mifepristone. This medication helps stop a pregnancy from growing. About 1 to 2 days after the mifepristone you take a medication called misoprostol. Misoprostol causes cramping and bleeding. This causes the uterus to empty. Your health care professional should explain how to take these medications.

Depending on where you live, you may be able to request abortion medication from your health care professional during a telehealth visit. This is a visit done by phone or video chat.

For some, a medication abortion may cause vaginal bleeding that is much heavier than a menstrual period. The bleeding may be like a miscarriage. There may be severe cramping. There also may be nausea, vomiting, fever, and chills.

Your health care professional should explain what to expect in terms of pain, bleeding, and passing the pregnancy. You may be offered a prescription for pain medication or you can take over-the-counter pain medication. Also, you should have a follow-up plan with your health care professional to be sure that the abortion is complete. Follow-up may be an in-person appointment or a phone call.

A second-trimester abortion is one that takes place after 13 weeks of pregnancy. It can be done with a procedure or with medication. Abortion with medication is often called induction abortion. Most women who have a second-trimester abortion have a procedural abortion. Procedural abortion in the second trimester is done with dilation and evacuation (D&E).

In the United States, about 1 in 10 abortions occur between 13 and 20 weeks of pregnancy.

You may need to start the process of dilating (opening) the cervix before the procedure starts. There are different ways to dilate the cervix before a procedure, including using medication or dilators (rods). Sometimes, this may require you to visit your health care professional the day before your procedure.

On the day of the procedure, dilators are removed if they were placed. The cervix may be dilated more if needed. A suction device and instruments are used to remove the pregnancy. Suction may then be used to remove any remaining tissue. No incision is needed.

Your health care professional should take steps to ensure you are comfortable during the procedure. You may receive some type of anesthesia. Pain medication may be recommended. Antibiotics may be given to help prevent infection.

You will go home the day of your procedure if there are no complications. You can expect to have soreness or cramping for a few days afterward. You may be offered a prescription for pain medication or you can take over-the-counter pain medication. Bleeding and spotting may last for up to 2 weeks. This is normal.

Medication abortion usually is done in a hospital or clinic where you can be monitored throughout the procedure. Medical abortion in the second trimester usually takes 12 to 24 hours to be completed.

The medications used may be placed in the vagina, taken by mouth, injected into the uterus, or given through an intravenous (IV) line. These medications cause the uterus to contract and pass tissue. Medication to relieve pain usually is given. Regional anesthesia, such as an epidural block, may be an option.

The medications usually cause the abortion to begin within 12 hours. The abortion usually is complete within 12 to 24 hours, although the timing can vary. The medications may cause side effects such as nausea, fever, vomiting, and diarrhea. Medications to manage these side effects can be given as needed. Talk with your health care professional about whether you can go home the same day.

Abortion is a safe procedure. Major complications requiring hospitalization are rare. As with any medical procedure, there are risks. These risks can include:

• Incomplete abortion—In rare cases, the pregnancy is not removed completely. When this happens, a follow-up procedure or more medication may be needed. Incomplete abortion is more likely to happen with medication abortion than with a procedure.

• Infection—Your health care professional may prescribe antibiotics to prevent infection. Antibiotics also can be used after an abortion to treat an infection if one develops.

• Heavy vaginal bleeding or hemorrhage—Some bleeding during and after an abortion is normal. If you have heavy bleeding, call your health care professional.

• Injury to the uterus and other organs—During a procedural abortion, the uterus, bowel, or bladder can be injured. If this happens, additional surgery at a hospital may be needed to repair the injuries. Rarely, the uterus or cervix can rupture (tear) during a second-trimester medication abortion. The risk of these complications during a second-trimester abortion is less than 1 in 1,000. The risk increases the longer a woman has been pregnant.

Some side effects may develop soon after an abortion, including

• abdominal pain and cramping

• nausea

• vomiting

• diarrhea

• vaginal bleeding

• headache

• dizziness

You and your health care professional should talk about what medications you can take for pain. Ibuprofen or acetaminophen may be an option. You may get a prescription for stronger pain relief if needed.

In most cases, it is safe to go back to normal activities soon after an abortion. Your health care professional should explain if you need to limit your activity.

Call your health care professional if you have

• severe abdominal or back pain

• heavy vaginal bleeding (soaking two maxi-pads per hour for 2 hours in a row)

• foul-smelling discharge from the vagina

• a fever (temperature above 100.4°F)

Periods usually return 4 to 6 weeks after an abortion. You can get pregnant even before your period returns.

Some birth control methods can be started right away, even the same day as an abortion. The options include

• birth control implant

• birth control injection

• birth control pills

• patch

• vaginal ring

• intrauterine device (IUD)

The IUD and implant can be placed right after a procedural abortion. With a medication abortion, the implant can be placed at the time of the first abortion pill or you can get an IUD once your abortion is complete.

A cervical cap or a diaphragm can be used starting about 6 weeks after a second-trimester abortion. This gives the cervix time to return to its normal size. Condoms can be used any time after an abortion to prevent pregnancy and sexually transmitted infections (STIs).

Abortion has been legal in the United States since 1973, but health care professionals are not required to provide abortion care. If your health care professional does not provide abortion care, you should be referred to a professional who will. There also are local and national resources that can help you find abortion care. See the Resources section below.

In some states, there are special rules and waiting periods before having an abortion. Most states require a minor’s parents or legal guardian to be involved before the minor can have an abortion. If a minor cannot or does not want to have their parents or guardian involved, court approval may be required before the abortion. To learn about abortion laws in your state, go to www.guttmacher.org/state-policy/explore/overview-abortion-laws.

Also, some state laws may require your health care professional to present you with false information regarding the risks of abortion care. Remember, abortion does not increase the risk of breast cancer, depression, or infertility.

All-Options Counseling
www.all-options.org/find-support/talkline
Talkline: 888-493-0092
Hotline that provides conversation with peers about abortion, adoption, parenting, infertility, or pregnancy loss. Volunteer staff are not licensed health care professionals or mental health specialists.

National Abortion Federation
https://prochoice.org/patients/naf-hotline
Hotline: 800-772-9100
Referral line: 877-257-0012
Organization that offers confidential consultation, options counseling, and referrals to abortion providers. NAF also offers limited financial assistance to help pay for abortion care.

National Council for Adoption
https://www.adoptioncouncil.org
Organization that provides education on adoption and resources for everyone connected by adoption, including birth parents, adoptive parents, adopted people, and adoption professionals.

Antibiotics: Drugs that treat certain types of infections.

Bladder: A hollow, muscular organ in which urine is stored.

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm. The implant releases a hormone to prevent pregnancy.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Depression: Feelings of sadness for periods of at least 2 weeks.

Dilation and Evacuation (D&E): A procedure that can be used after 12 weeks of pregnancy. The cervix is opened and the contents of the uterus are removed using instruments and a suction device.

Epidural Block: A type of pain medication that is given through a tube placed in the space at the base of the spine.

Hemorrhage: Heavy bleeding.

Induced Abortion: An intervention to end a pregnancy so that it does not result in a live birth.

Infertility: The inability to get pregnant after 1 year of having regular sexual intercourse without the use of birth control.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Intravenous (IV) Line: A tube inserted into a vein and used to deliver medication or fluids.

Menstrual Period: The monthly shedding of blood and tissue from the uterus.

Miscarriage: Loss of a pregnancy that is in the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Regional Anesthesia: The use of drugs to block sensation in a region of the body.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Speculum: An instrument used to hold open the walls of the vagina.

Trimester: A 3-month time in pregnancy. It can be first, second, or third.

Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vacuum Aspiration: Removal of the contents of the uterus using a suction device.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.