All About Abortion
If a pregnancy has occurred, once you’ve made one of two choices – choosing to remain pregnant, or to terminate your pregnancy -- there are three more basic choices to make. Parenthood, abortion or adoption are all equally viable, legal (in many locations) and valid choices, any of which may be the best choice for someone at a given time, and no one of those choices is any universally better, simpler or easier to make than another.
When a person becomes pregnant and does not want to remain pregnant or become a parent, they have the option of abortion, medical procedures which terminate pregnancy.
While opposition to abortion is actually relatively new (even the Catholic church was relatively supportive of early abortion as little as around two hundred years ago and before that time), abortion itself is not new; we have documentation of abortions as early as 500 BC, and every reason to strongly suspect it existed well before that time. We also know that even when abortion is not legal or regulated that many people still (and do still in places where it is not currently legal) terminate their pregnancies, but they have to endanger their health or their lives to do so.
Legal abortion is performed within a clinic, hospital or doctor’s office, usually on an outpatient basis, and most often within the first trimester of pregnancy. Legal abortion procedures are safe: statistically, health risks are far greater for carrying a pregnancy to term and delivering than for abortion.
There are NO long-term health problems that have yet been validly and accurately found to be associated with legal medical or surgical abortion.
Unloading a Loaded Issue
With abortion still so controversial among many people and politicians, it can be tough to choose it, or even think clearly and objectively about abortion as a choice.
All sorts of people have had or do have abortions, across all racial, economic, age, marital and other social lines. According to the Alan Guttmacher Institute:
- about 80% of women who abort are over 18 and unmarried
- by the age of 45 about one in every three women will have had an abortion
- the majority of women who have abortions -- about 6 in 10 -- are already mothers
- the majority of women who have abortions do intend to bear and rear children in the future
- the majority of women who have abortions subscribe to religious beliefs, and 70% or more of those women are members of Judeo-Christian and Catholic religions
According to ChildTrends Databank, the vast majority of teen pregnancies are unintended, and close to half of those unintended pregnancies end in an abortion. The Alan Guttmacher Institute also points out that the reasons teens give most frequently for having an abortion are concern about how having a baby would change their lives, inability to afford a baby now and feeling insufficiently mature to raise a child. Family Planning Perspectives published a 1989 study of teenagers who sought pregnancy tests which found that, counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term.
No matter what you believe, how you feel about abortion -- especially when the possibility or event is actual and personal, rather than an abstract idea -- may not be simple or line up predictably with your beliefs. Some people who generally are not comfortable with abortion as a whole may decide to have one in a given situation because they simply feel it is best. Some who are comfortable with abortion for others, or who have had abortions before, may, in a certain situation, feel it is not the right choice for them. Plenty of people who do want children have an abortion at some point because they just don’t feel capable or able to rear their children adequately at any given time, due to relationship, financial, lifestyle, health or emotional issues. Currently and historically, the reason most people have abortions is due to the economics of time and money: in other words, because they know or feel they do not have adequate funds or time to care for a child in the way a child needs to be cared for. If you’re choosing abortion, ANY reason you feel it is the right choice for you is a valid choice, and you’re always allowed to change how you feel about abortion in general when it’s no longer general, but about your pregnancy: what seems most right for you in that situation is more important than how you feel, or feel you should feel, about abortion overall.
Few reproductive choices are easy, but right now, it can be more difficult to choose abortion as an option because of all the personal and political biases against it. For that reason, it’s important that if you DO choose abortion -- just as is the case if you choose to parent or put a child up for adoption -- it is because you want to and feel it is the best choice you can make.
Legal abortions are both safe and effective. At this time, there are two main options for legal abortion in most areas: medical abortion or surgical abortion.
People who want to choose abortion have around six weeks to five months after pregnancy occurs before they are outside the window for safe, legal abortion. The later that choice is made, the fewer options are available, and the more potentially difficult or risky an abortion may become.
Following are the bare basics about standard abortion procedures.
Medical abortion is sometimes called RU486, M&M or “the abortion pill.” It is not as widely available as surgical abortion but is available from many abortion providers. Medical abortion is effective up to around 60 days after the last menstrual period, or up until around 10 weeks of pregnancy. It does not require surgery, but instead, is a combination of medications (usually mifepristone and misoprostol) given and supervised by a clinician, which cause a termination identical to a miscarriage. The drugs do several things: they stop embryonic cells from multiplying and dividing as they need to to continue a pregnancy, block hormones which would support a developing pregnancy, and cause uterine contractions which empty the contents of the uterus.
An injection or oral medication of one drug is given in the doctor or clinician's office, while the other is inserted a day to a few days later into the vagina or mouth at home. From a few days to a week after the first dose, the embryo and other products of conception pass out through the vagina. The experience will be very similar to a miscarriage: there will be heavy cramping and bleeding, and what is expelled may contain large blood clots and/or the small, grayish-looking gestational sac created by the blastocyst. It does not contain the embryo: that is so small at the time medical abortion can be performed that it is unlikely to be able to be seen. Cramps and bleeding are usually stronger and more intense than during a menstrual period. Side effects can include nausea, headaches, vomiting or bowel problems as well as continued spotting for a week or two, sometimes more. For a person having a medical abortion, it is vital to arrange for someone else – their partner, a friend, family – to be on call, for emotional support, for anything they materially need during the process, or to be able to get them to an emergency room quickly should their side effects be profound.
Medical abortions must be coupled with follow-up visits to the provider to assure a complete termination did occur and that a patient is in sound health afterwards.
Medical abortions are not quite as effective as surgical abortions -- they're around 95 - 98% effective at terminating a pregnancy -- so occasionally an additional surgical abortion will be necessary to successfully terminate a pregnancy.
Surgical abortions -- which are nearly always 100% effective -- can be performed from the time a pregnancy is confirmed until around the end of the second trimester, but second trimester abortions only account for less than around 10% of all abortions, and it is obviously ideal, for someone who wants to terminate, to do so earlier rather than later, physically and emotionally. What type of surgical abortion -- manual vacuum aspiration (MVA), dilation and curettage (D&C) or, more commonly now, dilation and evacuation (D&E) -- depends on the length of the pregnancy and the specific situation. All are currently legal in the U.S. and Canada.
• Manual and/or vacuum aspiration (MVA) or electric vacuum aspiration (EVA) can be done within the first trimester, up to about 13 weeks of pregnancy. It is what is most often used for abortions now, and manual aspiration can be used as soon as four weeks from the last menstrual period. During an aspiration, an injection first numbs the cervix with a local anesthetic.
With some abortion providers, a person can elect to have conscious IV sedation -- to be awake, but very relaxed or groggy, and some IV sedatives also help reduce pain -- or a general anesthetic -- which will put them to sleep before and during the procedure -- if they like. Clinics will provide an oral analgesic and often a mild oral sedative in advance of the procedure for those who do not want conscious sedation or a general anesthetic.
Whether or not you want to be asleep, sedated or alert is usually a matter of availability and personal preference, based on what you want intellectually or emotionally (some people want to be fully present, others want the opposite), what type of procedure you're having, and/or if a doctor determines one or the other will be safer for you. For instance, people who feel very nervous or upset in medical or gynecological situations, or who are already dealing with more than one crisis (such as a rape, domestic violence or having to terminate a wanted pregnancy due to a maternal or fetal health problem) may feel and do best with conscious sedation or GA. People who feel like sedation doesn't allow them a wanted awareness or level of control, who want to be very alert soon after a procedure or who prefer to manage their pain or anxiety in alternative ways may prefer to go without. Some people may recover or feel back to normal more quickly without sedation and/or general anesthesia (while for others it makes no difference), just because those have their own set of side effects (including nausea, sore throat, vomiting or insomnia) and it can take some people longer than others to clear sedation medications from their bodies.
The cervix is dilated -- with slim rods designed to gradually widen the cervical opening -- and then a flexible tube is inserted through the cervix. That tube is either attached to an aspirating machine with a gentle vacuum, or, for very early abortions, a hand-held syringe may be used. The contents of the uterus are removed through the tube with gentle suction. The entire procedure takes around five minutes.
• Dilation and evacuation (D&E) can be done from about six weeks after the last menstrual period through the second trimester. Some abortion providers only use D&E for later term abortions.
Local anesthetic and an oral analgesic are usually used, but conscious sedation or a general anesthetic (being put to sleep) are also available through some providers. The opening of the cervix is stretched with cervical dilators, just like with the vacuum aspiration procedure. Another sort of dilator may also be used (called lams or lamanaria), made of soft fibers which absorb moisture from the person’s body, and expand overnight to enlarge the opening in the cervix. Sometimes a drug, misoprostol, may be used with the dilators to soften the cervix. Depending on what is used, how far along you are and individual clinic policies and practices, you may be sent home overnight with a dilator or dilators in place, and with antibiotics to prevent infection. If so, you’ll need to return the next day for the second part of the procedure.
After the cervical opening is dilated, a suction process will take place. With a suction curettage or dilation and curettage (D&C), there’s a final step, which is to be sure the uterus has been completely emptied by using a curette -- a small metal loop -- to gently scrape the uterine walls. D&Cs are being used less often now for abortions due to advancements in the suction tools and machines as well as ultrasound technology to assure the uterus has been emptied completely. D&C procedures are also sometimes used for other things unrelated to abortion, such as for those with PCOS, after miscarriage, and sometimes to resolve unexplained vaginal bleeding.
This process -- not including the time it takes for dilation, which can add one or two extra days for dilation -- takes around ten to fifteen minutes.
Late-term abortions -– which are very inaccurately sometimes called partial-birth abortions -- are rare. When they are elective -– within the legal window for them to be elective in a given location -- that is generally because a person either did not realize they were pregnant until very late in the game (which is more common than many people think), because they were unable to afford or access abortion earlier on, because they were pressured not to have an abortion they wanted earlier and other related reasons. But overall, late-term abortions are advised by doctors due to health issues of the mother of fetus – in which a continued pregnancy would put the life or health of one or both at a high risk -- and those procedures are also often done when a fetus is stillborn, to prevent the mother the physical and emotional pain of having to deliver a child which is no longer alive or who will not live. In the U.S., before the ban on late-term abortions, the procedure was incredibly rare, only a fraction of a percent of all abortions performed were performed after 24 weeks of pregnancy (most medical organizations have agreed that fetal viability is only established after 24-27 weeks).
Both medical and surgical first trimester abortion cost about the same: currently around $450 - to over $1,000 in the United States. The later in a pregnancy one has an abortion, the greater the cost.
Some insurance policies, or federal or medical aid may cover some abortion costs, but often only when an abortion is medically necessary rather than elective, in other words, when a pregnancy puts the life of mother or child in danger. Some states and countries do, however, provide funds or coverage for elective abortions for low-income people. Many abortion providers provide abortion services with a sliding fee scale based on your income. There are also some grassroots sources for financial assistance for abortion for those who want an abortion but cannot come up with all the funds to do so themselves. For information on abortion funds, check out the National Network of Abortion Funds.
If you are simply curious or interested from an academic standpoint about herbs which have been used for abortion or contraception, you can have a look at Willa Shaffer’s Midwifery & Herbs, or Jeannine Parvati’s Hygieia: A Woman's Herbal. However, in the interest of your health, safety and in you being able to effectively terminate a pregnancy, I strongly advise you do not use those sources to attempt to self-abort.
- the sexual partner who is equally responsible for your pregnancy
- your close friends
- parents or other supportive adults
- by selling or auctioning off – like via eBay – anything valuable you have which is not as valuable to you as not being pregnant anymore, or by having a minor garage sale
- through odd jobs you can be paid cash for, like babysitting, housecleaning, dogwalking or carwashing
If you gather funds from multiple sources, you may find that getting the cash you need is doable.
It's understandable when you're pregnant and really don't want to be to feel very desperate. But if you're considering doing something unsafe, either as a way to get the money to pay for an abortion, or in terms of attempting to abort or miscarry yourself, please put your safety, health and well-being first. There always are sound, safe ways to raise funds or get an abortion, and there are always people and places who are trustworthy who you can ask for help. Putting yourself or your health in danger is much more likely to do you harm than good.
What to Expect During an Abortion
• You should be treated with care and respect. Your privacy should be respected in every way. Any question you have at any point in the process should be answered to your satisfaction. Generally, neither of these are problems with abortion providers: providers and their staff take both of these issues very seriously, and many people will state that the care they got during an abortion was the best healthcare they ever had in their lives.
• Throughout the process you will be given counseling, where all of your procedure will be explained, and you can also talk about how you are feeling about it or express any special needs or concerns. If you want counseling just to sort through your options, many clinics provide what is called "options counseling," to help you make your decision. It’s important to be aware that you ALWAYS can opt out of the procedure at any time before it begins, and staff at your clinic or doctor’s office should make that clear. If you know from the onset that you want more involved counseling because you are not sure about abortion yet, you can make an appointment for that options counseling all by itself: you don’t have to schedule an abortion to receive it. Just know that at most clinics, it's standard policy that if you decide on abortion, you will not be able to get it on the same day you have had options counseling.)
• You should be helped to feel as emotionally and physically safe and secure as possible, and that includes security for the clinic. The office or clinic where you have an abortion should be clean and sanitary. Your counselor, nurse and/or doctor should explain your entire procedure to you, be willing to answer any -- and I do mean any -- questions you have at any time before, during or after the procedure. If you want someone with you, you may be allowed that, though because of health, legal and safety issues, that person may only be permitted to stay in the waiting room.
What an Abortion Feels Like
Abortion should not be highly painful, though everyone's pain threshold differs, and differences will also often be found based on the specific procedure and what medications are being used to manage pain and/or anxiety.
Medical abortion will cause cramping at home that can be very uncomfortable, though pain medications are generally given to help manage that pain. During surgical abortion, a person is likely to also experience cramping, usually greater than menstrual cramps, and may feel some strong “pricks,” inside the pelvis, not unlike the sensation you feel in your mouth when a dentist gives you an anesthetic injection. For those having a procedure past 12 weeks who are using cervical inserts (lamanaria), having them put in can be painful, and it is also common to have cramps or discomfort while they are in. Those who are more nervous, uncertain, scared or conflicted about an abortion are likely to experience more pain or discomfort than those who are more relaxed and/or resolved.
So, you'll want to do all you can to be as relaxed as you possibly can (and if you're very nervous or scared, that's one sound reason to consider sedation or general anesthesia), and to be sure -- and abortion providers will always want to assure this as well -- that an abortion is what is wanted. Too, the earlier you can have an abortion procedure, the simpler the procedure, and the less painful it usually is. Be sure to also use your pain medications provided as needed, or, if you prefer alternate kinds of pain management, like acupressure or acupuncture, be sure those services are arranged in advance and will be available to you.
Common side effects that many people will experience following abortion procedures include bleeding or spotting, cramping (and again, you'll usually be given pain meds to help with that), nausea, sweating, feeling faint and, like those who have given full-term birth, depression. Less frequent side effects may include heavy or prolonged bleeding, blood clots, infection due to retained products of conception, dilators or infection caused by an STI or bacteria being introduced to the uterus, which can cause fever, pain, abdominal tenderness and possibly scar tissue. If after an abortion side effects persist for more than a few days or are severe, call your abortion provider or your doctor immediately. Even if you’re not sure if a side effect is normal, or if you just need your mind set at ease, always feel free to call your abortion provider and ask anything you need to: don’t worry about bothering them. It’s their job to care for you throughout.
Your provider will give you detailed instructions about how to care for yourself after an abortion, including instructions for any medications (like a standard antibiotic to prevent infection) they may give you, and you will also schedule a post-abortion checkup with them, usually for a few weeks after your procedure.
Be sure if you’re having an abortion procedure to try and schedule at least a day or two for your recovery, where you can chill out, and not do anything too taxing. It’s often advised that you still stay somewhat active, but this isn’t the time to go run a marathon. If you can arrange to have someone else around to check in on you and run any errands you might need – whether it be getting you more menstrual pads for bleeding, or renting you your favorite movies to cheer you up – that can be a real lifesaver.
Massaging your uterus – between your hips, just under your navel – can help with cramping and can also help to prevent clotting. You’ll want to avoid tub bathing, hot tubs or swimming, and will also not want to use tampons or menstrual cups to manage bleeding: have washable or disposable pads handy instead. You will also want to hold off on sexual activity until after your check-up. It’s typical to have some bleeding or spotting for a few weeks, and don’t worry if your menstrual period doesn’t show up right when you’d expect: it’s normal for it to take a cycle or two to get back on track. It’s also typical for any pregnancy symptoms you were having to last another few days or so after an abortion, so you don’t need to worry that you’re still pregnant because those symptoms didn’t pass right away.
Additionally, if you want to take a pregnancy test after an abortion to assure you're not pregnant, know that it'll often be a while -- from a few weeks to a couple months -- before you get a negative result, even though you are no longer pregnant.
It’s very normal, after any pregnancy ends, whether it ends with childbirth or by terminating the pregnancy, for people to deal with some depression or tough feelings, which can very in degree. Besides any emotional conflicts, pregnancy causes some pretty big hormonal changes in your body, and when a pregnancy ends, by it by birth or abortion, there’s another bunch of big hormonal changes, and that often causes mood changes, sometimes pretty big ones. Obviously, if you have any mixed feelings about your abortion – or if you have an abortion you really didn’t want to have – you’ll likely have to deal with more sadness than usual. If you don’t feel sad or blue, that’s okay, too, and it doesn’t mean you’re insensitive or that there is something wrong with you. Plenty of people feel -- understandably -- very relieved and at peace after an abortion, too.
So, just be prepared to give yourself good care, physically and emotionally, and to honor whatever it is that you’re feeling.
Many credible journals, like the Journal of American Medicine, have stated that there is no data to support the notion that abortion is more emotionally traumatic than any other reproductive option. A press release from the American Psychological Association, which has done a thorough review of all studies since 1989 on the matter, found that "there is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women."
We have no logical reason, or any sound data, to assume that any one choice is more or less traumatic: in fact, many studies support that the majority of people who freely choose abortion for themselves have positive, rather than negative, psychological responses long-term.
There are some factors which are known to increase the possibility of emotional distress and trauma from abortion, including being of a very young age, lack of support from partners or community (which includes the world-at-large), pressure or coercion to abort, anxiety or distress before the procedure, moral or religious conflicts with abortion, preexisting mental illness or depression, having survived sexual abuse or assault, low self-esteem and those whose coping style involves lack of responsibility.
In other words, the sorts of factors we know to make ANY reproductive choice more likely to be traumatic for a person. In fact, the factors above are very similar to the at-risk indicators usually listed for those who give birth and are more likely to suffer from postpartum depression. So, remember, if you or someone you know is pregnant and making a reproductive choice, it is vital that a pregnant person's choice is just that – the option they feel is best for them, first and foremost, and which they choose on their own – and that emotional support throughout is crucial.
Where to Find Sound Help
If you’re in the process of making a reproductive choice, at some point, you’re going to need to go somewhere where you can get hooked up with what services you need to make whatever choice it is, be it parenting, adoption or abortion. It’s also often helpful to have someone to talk about options with who is objective, or isn’t invested in the choice you make because they aren’t an immediate part of your life and don’t have an agenda of their own.
Research your clinic and counseling options to find help best suited to you. You’re best going to a center or clinic which provides a number of different services and which makes clear that ALL possible choices are acceptable, rather than pushing any one choice. General sexual healthcare clinics -- which provide a number of sexual health services, like GYN exams, STI screenings, prenatal care and abortion -- are smart places to go. You can also talk to your gynecologist or general physician. School guidance counselors or student services centers may also offer reproductive option counseling. Any center or clinic you go to should be offering pretty extensive interviews and counseling before offering you services, and laying out what your choices are, to help you evaluate them. Any center or clinic you go to for counseling, once you’ve made your choice, should be wholly supportive of whatever it is. If your gut tells you something is amiss, or you find that a counseling service is making you feel bad or pressuring you in any way, trust your instincts, get out of there and find somewhere else to go.
Remember that you get to make this choice yourself, and come to whatever conclusions you do about what’s best for you. You are the expert when it comes to your own reproductive choices, and what is right for you is all about you, not anyone else. No reproductive choices are ever that easy, because being pregnant is a very big deal, and every choice carries risks of both wanted and unwanted consequences. But one thing you can be sure of is that you are most likely to feel best about the choice that you feel is the best one for you, based on your unique circumstances and needs, to make.
For more information on abortion access, procedures and issues, check out the Feminist Women’s Health Center’s (where I also work) very informative page.
This piece is excerpted and adapted from Chapter 13 of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College. For information on your other options – parenting or adoption – refer to the other portions of that chapter in the book, or, check out these wonderful resources online:
- Backline: a non-profit organization with a toll-free Talk Line dedicated to addressing the broad range of experiences and emotions surrounding pregnancy, parenting, abortion and adoption.
- The Pregnancy Options Workbook
- The Childbirth Connection: evidence-based information, guidance, and support to show you how to maintain and enhance maternal and fetal health during pregnancy, and help you make informed decisions.
- Birth Mom Buds: provides peer counseling, support, encouragement, and friendship to pregnant people considering adoption as well as people who have already placed children for adoption.