Hesperian Health Guides
Safe Methods of Abortion
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A pregnancy can be removed from the womb by a trained health worker in the following ways:
Abortion by medicine (medical abortion)
Two medicines are used by doctors, health workers, and women , misoprostal and mifepristone, or misoprostal by itself, to cause abortion. This is called medical abortion. These medicines make the womb contract and push out the pregnancy. The mifepristone is swallowed and misoprostal is dissolved in the mouth or in the vagina. Medical abortion is very effective and verysafe. Since nothing is put inside the womb, there is less danger of infection that kills many women who have unsafe abortions. This abortion is safe at home up to 10 weeks of pregnancy and safe in a clinic after that.
More Informationhow to take medicines for abortion
- Know the name and correct dose of medicine or medicines you are using. Never use a medicine you are unsure of. If it is safe, try to discuss using medicines for abortion with a health worker you trust before using these medicines.
- Using medicines for abortion is the best choice up to 10 weeks (70 days) of pregnancy. Start counting after the first day of your last monthly bleeding. You can use medical abortion after that, but the doses may be different and you will have more bleeding, cramping, and nausea. It is safer to do this in a clinic.
Medicines used for abortion
If you have no access to safe abortion, contact Women on Web. They may be able to help.
Mifepristone is available in some countries where abortion is legal. But in many countries it is not available. It is given in pill form, to swallow.
Misoprostol is used for stomach ulcers, and is widely available in many countries. It is often used alone to cause abortion, although it is more effective when used with mifepristone. When misoprostol is used by itself, it is less effective and there are more side effects, especially if used after 9 weeks.
The signs of pregnancy usually disappear after 48 hours. If you continue to feel pregnant, go to a clinic or hospital to be checked. There is a small risk of birth defects if you go on to have the baby.
Danger signs after medical abortion
Also see ‘Complications of Abortion’.
- Heavy vaginal bleeding – soaking more than 2 large pads in 1 hour for 2 hours in a row. Get to a clinic or hospital right away.
- Fever that begins a day after the last misoprostol dose and lasts several days may be a sign of infection (although this is rare with abortion using medicines). See a trained health provider.
Abortion by suction (vacuum aspiration, MVA)
The pregnancy is removed by suction using a special tube (cannula) that is put into the womb through the vagina and cervix. This is done without putting the woman to sleep, though sometimes pain medicine is injected into the. When vacuum aspiration is done by hand (manual vacuum aspiration or MVA), the pregnancy is removed using a special syringe. Otherwise, a small electric machine is used.
MVA is simple and safe, and takes only about 5 to 10 minutes. It is usually done in a clinic or health post, or doctor’s office. This kind of abortion is safe to do during the first 12 weeks (3 months) of pregnancy. After 12 weeks, only use MVA if the woman is in serious danger and you have no other way to help her. MVA causes fewer complications than dilation and curettage (described below).
In some places MVA is used to bring on late monthly bleeding. The woman may not even know if she is pregnant—just that her monthly bleeding has not come. This is called menstrual regulation. MVA is also used to treat bleeding from an incomplete abortion or a miscarriage. (For more information about MVA see A Book for Midwives published by Hesperian.)
Surgical abortion (dilation and evacuation, or D and E)
The pregnancy is scraped out with a curette, a small spoon-shaped instrument that is made especially to go into the womb. Sometimes suction is used as well first but the cervix must first be stretched open which can take some time.
The D and E takes about 15 to 20 minutes, is more painful, and costs more than vacuum aspiration. It is usually done in an operating room, and the woman is often given medicine to make her sleep.
How to tell if an abortion will be safe
It is not always easy to tell if an abortion will be safe. Try to go to the place where the abortion will be done, or ask someone who has been there these questions:
- Have you heard of women getting sick or dying from having an abortion here? If so, go somewhere else.
- Who will do the abortion and how were they trained? Doctors, nurses, health workers, and traditional birth attendants can all do abortions. However, abortions done by someone who is not trained in safe abortion methods and how to prevent infection can be very dangerous.
- Is the room where the abortion will be done clean and neat? If it is dirty and messy, probably the abortion will be also.
- Is there a place for washing hands? A health worker who has no place to wash his or her hands cannot do a clean, safe abortion.
- Do the instruments look like the ones shown at the top of this page, or do they look like something found or made at home? Instruments made at home can cause injury and infection.
- How are the instruments cleaned and made free of germs? Instruments should be soaked in strong disinfectant or boiled in water to kill germs that cause infection.
- Does the cost seem fair? If the cost is very high, sometimes it means the health worker cares only about money, not your health.
- Are other health-care services also provided along with abortions? A good health center will also try to provide other services that women need, like family planning, treatment for STIs, and HIV prevention.
- Where will you be taken if something goes wrong during or after the abortion? There should always be a plan to get you to a hospital in case of emergency.