Hesperian Health Guides
Safe Methods of Abortion
Contents
Abortion by medicine (medical abortion)
Two medicines, misoprostol and mifepristone, or misoprostol by itself, are used by doctors, health workers, and others to safely help someone end a pregnancy. This is called medical abortion. These medicines make the womb contract and push out the pregnancy. Mifepristone is swallowed and misoprostol is dissolved in the mouth or the vagina. Medical abortion is very effective and safe. Since nothing is put inside the womb, there is very little danger of infection. Medical abortion is safe to do at home up to 13 weeks. After that, it is safe through 24 weeks in a health center or accompanied by an experienced abortion support worker
See Hesperianâs Safe Abortion app for more information.
Abortion by suction (vacuum aspiration, MVA)
The pregnancy is removed by suction using a special tube (cannula) that goes into the womb through the vagina and cervix. Sometimes a numbing medicine to prevent pain is injected into the cervix. When suction is done by hand (manual vacuum aspiration or MVA), the pregnancy is removed using a special syringe called a vacuum aspirator. Otherwise, a small electric machine is used.
MVA is simple and safe, and takes only about 5 to 10 minutes. Usually done in a health center or doctorâs office, a vacuum abortion is safe to do during the first 16 weeks of pregnancy. After 16 weeks, only use MVA if someone is in serious danger and you have no other way to help. MVA causes fewer complications than dilation and evacauation (described below).
In some places, MVA is used to bring on a late period. A person may not know if they are pregnant or notâjust that their period is due. This is called menstrual regulation. MVA can also treat bleeding from an incomplete abortion or a miscarriage. (For more about MVA see Hesperianâs A Book for Midwives.)
Dilation and evacuation (D&E)
This method uses medicines to soften and open (dilate) the cervix. Then a suction tube and instruments remove the pregnancy from the womb. D&E should be done only by trained health workers in a medical facility with sterile conditions and equipment.
A D&E takes about 15 to 20 minutes. It is more painful and costs more than vacuum abortions, and is usually done in an operating room with the person often given anesthesia (sleeping medicine).
Before using medicines for abortion:
More Information
See complete instructions on how to take medicines for abortion- Know the name and correct dose of the medicine or medicines you are using. Never use a medicine you are unsure of. If it is safe, discuss how to use medicines for abortion with a health worker you trust before taking them.
- Using medicines for abortion is safe and effective up to 25 weeks (175 days) of pregnancy. Start counting after the first day of your last period. You can use medical abortion after 13 weeks, but doses are smaller and more frequent, and you will have more bleeding, cramping, and nausea. It is safest to do this in a health center or with an experienced accompanier.
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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.
Misoprostol is available in many countries. It can be used alone to cause abortion, although it is more effective and the abortion happens more quickly when used with mifepristone.
The signs of pregnancy usually disappear after 48 hours. If you continue to feel pregnant, go to a clinic or hospital to be checked.
Danger signs after medical abortion
Also see âComplications of Abortionâ.
Go to a health center or hospital right away if you:
- soak more than 2 maxi pads in 1 hour for 2 hours in a row
- pass blood clots larger than an orange
- feel faint and dizzy along with the heavy bleeding
- have severe belly pain that gets worse even with pain medicine
- have bad-smelling vaginal discharge
- have fever over 38.5° C (or 101°F) that begins a day after the last misoprostol dose and lasts for 4 hours or more.
It is not always easy to tell if an abortion will be safe. By getting answers to some of these questions, you can better determine if yours will be safe.
- Has anyone gotten sick or died 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 place for the abortion 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 their hands cannot do a clean, safe abortion.
- Do the instruments look like these?
- How are the instruments cleaned and made free of germs? Instruments should be soaked in strong disinfectant, boiled in water, baked, or pressure steamed 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 needed health services, like family planning, pregnancy testing, 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.
Remember, the earlier in the pregnancy you get an abortion, the safer it will be. Do not delay.
Abortions have more complications (problems that may be serious and need more skilled health care) when:
- your last menstrual period was more than 3 months ago.
- your pregnancy is starting to show.