Termination of pregnancy

An induced abortion is the intentional termination of a pregnancy. The procedure removes a fetus and placenta from a woman’s uterus. The vast majority of abortions performed in the United States are accomplished through surgery, but recent advances have also made abortion possible through medication.

Abortions may be performed for several reasons. Most often, abortions are performed because a woman does not wish to be pregnant. In the majority of cases, such abortions are performed to terminate a pregnancy after a woman fails to use contraception or the method of birth control has failed. Abortions are also performed to terminate pregnancies that are the result of acts of rape or incest, to prevent the birth of a child with birth defects or because a woman’s health is endangered by the pregnancy.

According to statistics released in 2018 by the Centers for Disease Control and Prevention (CDC), there were approximately 629,898 legal abortions performed in the United States in 2019. From 2010 to 2019, the total number of reported abortions, abortion rate, and abortion ratio decreased 18% (from 762,755). Abortion rates have declined over time due to a number of factors, such as fewer cases of unintended pregnancies and more restricted laws for adolescents. The majority of reported abortions occurred in unmarried women under the age of 25 years.

There are two principal types of elective abortions performed in the United States. They include surgical abortions, which make up the vast majority of abortions in the United States, and nonsurgical abortions.

In surgical abortions, the cervical canal is dilated (enlarged) and a hollow tube is inserted into the uterus. A vacuum machine is then used to suction the tissues of the fetus and placenta from the uterus. In cases of more advanced pregnancy, forceps (instrument resembling pincers or tongs used for extracting tissue) may be used to remove the fetus, and the uterus may be gently scraped.

Surgical abortions can be performed in several different ways. The choice of technique often depends on how far along the pregnancy is at the time of the abortion.

Nonsurgical methods, which include medication, interfere with the development of the placenta and force the uterus to contract, which eventually causes its contents to be expelled. These methods can be used in a pregnancy of 16 weeks or more. Newer protocols for nonsurgical or medical abortions can be used through the first 60 days of a pregnancy.

Almost 90 percent of abortions occur in the first trimester, according to the Alan Guttmacher Institute, a private, nonprofit organization that focuses on sexual and reproductive health research, policy analysis and public education. Fewer than 2 percent are performed after 20 weeks of pregnancy, and just 0.08 percent are performed after 24 weeks.

Controversy has grown over a rarely performed procedure commonly known as partial-birth abortion (clinically referred to as intact dilation and extraction). In this procedure, the physician delivers a baby to the point where only the head remains inside the womb. The physician then punctures the back of the skull and removes the brain before completing delivery. This procedure was banned in 2003. A year later the ban was declared unconstitutional and was heavily appealed until April 2007 when the Supreme Court upheld the banning of partial-birth abortions.

Abortion remains an intensely controversial issue in the United States. Currently, 28 U.S. states require women who want to have an abortion to undergo counseling prior to the procedure, and 24 states require women to wait a specified period of time, usually 24 hours, between the time they receive the counseling and time the procedure is performed. During abortion counseling, women typically receive information to discourage them from having the procedure (e.g., health risks, mental health consequences). As a result, women who consider having this procedure may want to seek outside support from sympathetic family and friends or support groups.

There are several methods that can be used to perform an abortion. These include:

Medication-induced methods

These can be used in early first-trimester abortions and are sometimes used in second-trimester abortions, especially after 16 weeks, when dilation and evacuation carries a high surgical risk, or if the physician is not skilled in performing dilatation and evacuation. This method can be performed in several ways. For example, a woman may receive an injection of hypertonic saline into the amniotic cavity to force uterine contractions that result in an aborted pregnancy. In other cases, a woman may receive doses of prostaglandins (hormone-like substances) either orally or as vaginal suppositories to induce abortion.

In recent years, the antiprogesterone medication mifepristone, also known as RU 486, has been used in these types of abortions. The Food and Drug Administration (FDA) has approved the use of a single dose of mifepristone, followed by a dose of a prostaglandin analogue known as misoprostol two days later. This technique is used more often in Europe than in the United States. However, it does not always remove all retained products of conception, and additional suction and curettage may be required. Mifepristone and misoprostol are increasing in use to terminate a pregnancy that is less than 7 weeks old. Women may safely and effectively take dosages of mifepristone and misoprostol at the same time, rather than up to 48 hours apart, as is typically done, according to a new study. In addition, a second study found the drugs to be safe for late first-trimester abortions. Both studies appear in the April 2007 issue of Obstetrics & Gynecology.

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Some people mistakenly believe that emergency contraceptive pills (e.g., morning-after pill) – which may be taken after sexual intercourse when other contraceptive methods failed or no contraception was used – are a form of induced abortion. However, emergency contraceptive pills do not terminate a pregnancy, but instead prevent it from occurring in the first place.

Some states require that a woman who wishes to have an abortion receive counseling and wait a specified period of time, usually 24 hours, after receiving counseling before having the abortion. Women should follow their physician’s recommendations regarding any preparatory steps that should be taken before the abortion procedure. These may include dietary restrictions or changes in their medication regimen.

Prior to a vacuum aspiration procedure, a woman may need to have her cervix dilated, particularly if the abortion is happening in the eighth week of pregnancy or later. For women having first-trimester abortions, sponge-like devices called osmotic dilators may be inserted into the cervical canal overnight or several hours prior to the procedure to ensure slow dilation. This helps prevent perforation of or injury to the cervix, especially in women who have not previously given birth.

Women having second-trimester abortions usually require a greater amount of cervical dilation. As a result, osmotic dilators may be inserted up to several days prior to the procedure.

A surgically induced abortion will unfold in different ways depending on the procedure being used. In some cases, general anesthesia will be used whereas in others, a local anesthetic or no anesthetic will be needed.

A nonsurgical abortion performed with medication therapy will be administered in a physician’s office after a complete physical examination and thorough medical history have been performed.

In most cases, physical recovery from abortion occurs within a few days. A small amount of vaginal bleeding and mild uterine cramping is not unusual during this time. Use of a heating pad or hot water bottle on the abdomen may relieve these symptoms.

Women should avoid strenuous activity for a few days following an abortion. Tampons may be used after three days, and sexual intercourse may be resumed after two to three weeks. Normal menstrual periods should resume four to six weeks after the operation. The physician may have additional recommendations based on the specific woman and procedure.

All abortion procedures come with some risk of side effects and complications, although most women do not experience physical complications. In general, complications are least likely during first trimester abortions and become more likely in later stages of pregnancy.

Infection is the most common complication associated with an induced abortion. Symptoms that may indicate the presence of an infection include fever, pain, mild bleeding and a tender uterus. Oral antibiotics and drugs that reduce fever are usually effective in controlling such infections. In some cases, suction curettage may be necessary to remove tissue that remains in the uterus that may be causing the complications.

In rare cases, patients may experience a severe infection called a septic abortion. This rarely occurs in legal abortions and is more commonly associated in abortions performed illegally and in unsterile conditions.

Septic abortions can be treated with parenteral antibiotics (taken through injection or intravenously), fluid therapy and removal of the uterus (hysterectomy).

Bleeding is the second most common complication associated with an induced abortion.

Postabortal syndrome occurs when the uterus fails to remain contracted after an induced abortion. It can result in an open cervix or a large uterus that appears softer than expected upon examination. Women who develop this syndrome may experience cramps and bleeding. Postabortal syndrome is usually treated with suction curettage and antibiotic therapy.

Abortions performed through medication may result in pain, nausea, vomiting, diarrhea or prolonged bleeding. In addition, the abortion may not be complete, requiring possible surgical intervention.

Induced abortions may or may not affect a woman’s future ability to have children, depending on circumstances. First- or second-trimester abortions performed without complication do not appear to impact future pregnancies. However, there is a slight increased risk of premature delivery for women who have had more than three first-trimester induced abortions.

Some women who have an abortion experience emotional trauma as a result of the procedure. Mental health professionals (e.g., psychiatrist, psychologist) and support groups may help women who experience such feelings.

There are many myths and misconceptions regarding abortion. The following statistics come from the Alan Guttmacher Institute, a nonprofit organization that focuses on sexual and reproductive health research, policy analysis and public education: