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If a pregnancy has occurred, once you’ve made one of two choices – remaining pregnant, or terminating your pregnancy, there are three basic choices to manage it. Parenthood, abortion or adoption are all equally viable, legal (in most locations) and valid choices, any of which may be the best choice for a woman at a given time, and no one of those choices is any simpler or easier to make than another.
When a woman becomes pregnant but does not want to remain pregnant or become a parent, she has the option of abortion, a medical procedure which is performed to terminate a 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.
Legal abortion is performed within a clinic, hospital or doctor’s office, usually on an outpatient basis, and almost always 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 found to be associated with legal medical or surgical abortion.
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 women have had or do have abortions, across all racial, economic, age, marital and other social lines. According to the Alan Guttmacher Institute:
According to ChildTrends Databank, the vast majority of teenage 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 women 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 women 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 women 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.
Women who choose abortion have around six weeks to three months after pregnancy occurs before they are outside the window for safe, legal abortion, The later that choice is made, the fewer the options available, and the more traumatic or risky an abortion may become.
Following are the bare basics about standard abortion procedures.
Medical abortion is sometimes called RU486 or “the abortion pill.” It is not as widely available as surgical abortion but is now 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 drugs (usually mifepristone and misoprostol or methotrexate and misoprostol) given and supervised by a clinician, which causes a termination much like 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 of one drug is performed in the doctor or clinician's office, while the other is inserted a few days later into the vagina at home OR the drugs are given orally, with one dose administered in the office, and the other a few days later 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 early miscarriage: there will be heavy cramping and bleeding, and what is expelled may contain large blood clots and/or the 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 woman having a medical abortion, it is vital for her to arrange for someone else – her partner, a friend, family – to be on call for her, for emotional support, for anything she materially needs during the process, or to be able to get her to an emergency room quickly should her side effects be profound.
Medical abortions must to be coupled with follow-up visits to the provider to assure a full termination did occur and that a woman 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. A woman can also elect to have a general anesthetic -- which will put her under completely during the procedure -- if she likes, and clinics will usually provide an analgesic in advance of the procedure. However, women often heal faster when they only elect to use local anesthesia, and you may find that it’s easier to emotionally process an abortion which you were awake during because you will have been aware of exactly what went on during the procedure.
The cervix is then dilated -- with slim rods designed to slowly stretch 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 just a few 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 is used, but painkillers or a general anesthetic can usually also be requested. 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, made of soft fibers which absorb moisture from the woman’s body, and expands 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 women with PCOS, after miscarriage, and sometimes to resolve unexplained vaginal bleeding.
This process -- not including the time it takes for dilation or if a night has passed in between -- takes around ten 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 woman either did not realize she was pregnant until very late in the game (which is more common than many people think), because a woman was unable to afford or access abortion earlier on, because a woman was pressured not to have an abortion she wanted 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 will be. 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 women. 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 women who want an abortion but cannot come up with all the funds to do so themselves. For information on abortion funds, see our page for 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.
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.
• You should be treated with care and respect. Your privacy should be respected in every way. Generally, neither of these are problems with abortion providers: providers and their staff take both of these issues very seriously, and many women 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, and your counselor should respect whatever pace you need, even if you come in for an abortion and decide you do not want to go through with the procedure that day. 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. (And 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 all by itself: you don’t have to schedule an abortion to receive abortion/pregnancy counseling, and it's ideal for a clinic if, when you know you're unsure, you do make an appointment just for counseling, rather than a procedure, as it can back up the clinic and make the wait for those who know they want a procedure longer.)
• 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 are often allowed that, though because of health, legal and safety issues, that person may only be permitted to stay in the waiting room.
Abortion should not be highly painful. Medical abortion may cause cramping at home that can be very uncomfortable, and heavy bleeding will occur. During surgical abortion, a woman is likely to also experience cramping, usually greater than menstrual cramps, and may feel some strong “pricks,” inside her pelvis, not unlike the sensation you feel in your mouth when a dentist gives you an anesthetic injection. Women who are more nervous, uncertain, scared or conflicted are likely to experience far more pain or discomfort than those who are more relaxed and resolved. So, you'll want to do all you can to be as relaxed as you possibly can, 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 tends to be.
Common side effects that many women will experience following the abortion procedures include spotting, cramping, nausea, sweating, feeling faint and, like women 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 moderately 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.
It’s very normal, after any pregnancy ends, whether it ends with childbirth or by terminating the pregnancy, for women to deal with some depression, 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 women 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 for women than any other reproductive option. We have no logical reason, or any sound data, to assume that any one choice is more or less traumatic for all women: in fact, studies support that the majority of women 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 women 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 woman. In fact, the factors above are very similar to the at-risk indicators usually listed for women 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 woman’s choice is just that – the option she feels is best for her, first and foremost, and which she chooses on her own – and that emotional support throughout is crucial.
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 this great group of links from Choice Linkup or the Feminist Women’s Health Center’s very informative page.
This piece is excerpted and adapted from Chapter 12 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:
 | The Story of Jane: The Legendary Underground Feminist Abortion Service author: Laura Kaplan asin: 0226424219 |
 | Abortion: A Positive Decision author: Patricia Lunneborg asin: 0897892437 |
 | The Choices We Made: Twenty-Five Women and Men Speak Out About Abortion asin: 1568581882 |
 | Choice: True Stories of Birth, Contraception, Infertility, Adoption, Single Parenthood, and Abortion author: Karen Bender asin: 1596920629 |
 | S.E.X.: Spelling Out All You Need to Know About Your Sexuality author: Heather Corinna asin: 1600940102 |
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