What is Abortion?

In 2021 there were 214,256 abortions for women resident in England and Wales, the highest number since the Abortion Act came into effect on 27 April 1968, and the numbers have been going up every year since 2016. However, the abortion rate for women aged under 18 has continued to decrease from 15.0 per 1,000 in 2011 to 6.9 per 1,000 in 2020 and further decreased to 6.4 per 1,000 in 2021. The rate has remained stable for women aged 35 or over from 10.6 to 10.5 per 1,000 between 2020 and 2021. 99% of abortions in England and Wales were funded by the NHS in 2021, with 77% of abortions taking place in the independent sector.

According to the Guardian “the record number of abortions that took place in England and Wales last year is a trend that experts said was driven by financial uncertainty caused by Covid-19”.

Their report highlighted that:

• 161 women from Northern Ireland travelled to England or Wales for an abortion last year, even though the procedure was decriminalised in their home country in 2019
• Four-fifths (82%) of those having an abortion gave their marital status as single, although 49% said they were single but had a partner
• Growing numbers of women having a termination were already mothers, 57% last year, up from 51% in 2011

Abortion statistics from 2019 show that 82% of abortions were performed under 10 weeks, increasing from 75% in 2009, and one in three women in the UK will have an abortion by the time they are 45 years old. (MSI)

What is Abortion?

Abortion is when a woman chooses to end a pregnancy; it is also known as a “termination”.

In the UK, abortions can only be carried out under the care of hospitals or licensed clinics, by qualified doctors. It is important to know that you do not need a GP referral to access abortion care, you can simply get in touch with the abortion provider contracted to offer NHS-funded abortion care in your area – organisations such as Brook (for under-25s), MSI Reproductive Choices UK and NUPAS – and arrange an appointment for a telephone consultation. You should not have to wait more than 2 weeks from your first referral to the time of your abortion.

You can of course get a GP referral by speaking to your GP or you can contact a sexual health clinic and ask for a referral. There are also private hospitals and clinics that provide abortion services. Abortion is free on the NHS; however, if you choose to have private treatment, you will have to pay a fee.

If you do not want to tell anyone about the abortion, your details will be kept confidential, and if you are under 16 years, your parents do not usually need to be told. The doctor or nurse may encourage you to tell a parent, carer or another adult you trust, but they will not make you. Any young person, regardless of age, can give valid consent to medical treatment providing they are considered to be legally competent; that is, able to understand a health professional’s advice and the risks and benefits of what is being offered.

When can an abortion be carried out?

In England, Scotland and Wales, you can legally have an abortion up to 23 weeks and 6 days of pregnancy, in line with the Abortion Act 1967. The rules are different in Northern Ireland, as explained below. An abortion can be carried out after 24 weeks in very limited circumstances, for example, if the mother’s life is at risk or the child would be born with a severe disability.

Early medical abortion is provided in the first 10 weeks of pregnancy with most abortions happening in the first 13 weeks of pregnancy.

What are the types of abortion?

There are two ways of ending an unwanted pregnancy: a medical abortion, which involves taking medicines, or a surgical abortion, which requires a surgical procedure. Whenever possible, you should be given a choice of how you would like the abortion to be carried out.

Early medical abortion is provided in the first 10 weeks of pregnancy. It is sometimes known as the abortion pill. This method involves taking two medicines which end a pregnancy. It is not the same as emergency contraception (the morning after pill), which can be taken to try to prevent pregnancy from happening in the first few days after unprotected sex.

Until March 2020 the first of the two medications needed to be administered in a hospital or clinic; however, in 2020 the UK Government approved the use of telemedicine for abortion care, meaning that:

• Women and girls are able to take both pills for early medical abortion up to 10 weeks, in their own homes, without the need to first attend a hospital or clinic.
• Registered medical practitioners (doctors) are able to prescribe both pills for the treatment of early medical abortion up to 10 weeks, via telephone or video link.

After the first 10 weeks of pregnancy, medical abortion can be carried out up to 24 weeks of pregnancy. You will be admitted to a clinic or hospital and be given two medications. The first medication is Mifepristone, which ends the pregnancy, and the second medication is Misoprostol which expels the pregnancy. Early abortion may carry a small risk of failure to end the pregnancy and therefore there may be a need to have another procedure; however, this is uncommon, occurring in fewer than 1 in 100 women.

Surgical dilation and evacuation – that is, a surgical abortion – is available from 15 weeks of pregnancy. It is a minor operation and is usually done under general anaesthetic, meaning you will be asleep during the procedure. It typically takes around 10–20 minutes. You should be able to go home the same day if it all goes well, or you may need an overnight stay in the clinic or hospital.

What happens during an abortion?

Your healthcare team should make sure you have accurate information about the abortion procedure. As well as oral advice, you should be offered printed information that includes what happens locally. You should be given information on the different methods of abortion that can be used at your stage of pregnancy and the possible risks associated with them.

Before your abortion you should be offered:

• A blood test to check your blood group.
• Tests for genital infections, including Chlamydia trachomatis or other sexually transmitted infections.

In some circumstances, you may be offered:

• A blood test to make sure you are not anaemic.
• A cervical smear test.
• An ultrasound scan – before an ultrasound is undertaken, you should be asked whether you wish to see the image or not.

A medical abortion uses medication to end a pregnancy. The treatment involves taking two types of medicine at two different times. You will be given detailed instructions about when and how to use the medication by your healthcare professional. It is the safest treatment option for most people. The first medication you will be given is Mifepristone. This stops the pregnancy from growing by blocking the hormone progesterone and causes the pregnancy to separate from the wall of the womb, which ends the pregnancy.

The second medication is Misoprostol, and is taken 24 to 48 hours later. The second medication causes the cervix (neck of the womb) to soften and open, and causes the womb to contract through cramping and bleeding, so that the pregnancy passes through the vagina to expel the pregnancy. This usually takes between 4 and 6 hours but sometimes longer.

You will be offered pain relief if you are undergoing the treatment in a clinic or hospital. If administering the treatment at home yourself, you can take paracetamol to help with any pain associated with the cramping or speak to the doctor for pain relief advice. You should be given detailed follow-up instructions about what to do if you suspect the abortion has not ended the pregnancy.

A surgical abortion is performed in a clinic or hospital, and you will usually be given a general anaesthetic; the procedure itself usually takes around 10–20 minutes. The opening to the womb, called the cervix, will be gently stretched, the extent to which the cervix needs to be opened depends on the size of the pregnancy.

To make this safer, there are a number of effective ways to soften the cervix beforehand, for example by inserting tablets containing Misoprostol into your vagina. The foetus will be removed using a suction tube. An ultrasound scan should be done at the same time to reduce the risk of complications and make sure that all the pregnancy is removed. You might be able to go home the same day if it all goes well, or you might need an overnight stay in the clinic or hospital. Afterwards, you may bleed a bit for up to three weeks.

What are the risks of an abortion?

Abortion is a very safe procedure, and on average it is much safer than continuing with the pregnancy and giving birth. The earlier into a pregnancy that an abortion is carried out, the safer it is. However, as with any medical procedure, there are risks. Your doctor or nurse should tell you about risks and complications that relate to the specific abortion procedure being offered to you, but if you have any concerns about the risks, let your healthcare team know so that they can tell you more.

Risks at the time of abortion include:

• Excessive vaginal bleeding – you may need a blood transfusion. This happens in around 1 in every 1,000 abortions and occurs in 4 in 1,000 abortions performed after 20 weeks of pregnancy.
• Damage to the cervix – this happens in no more than 1 in every 100 surgical abortions.
• Damage to the uterus – this happens in between 1 and 4 in every 1,000 surgical abortions.
• Damage to the uterus – this happens in fewer than 1 in every 1,000 medical abortions done between 12 and 24 weeks of pregnancy.

You are more likely to get problems in the first 2 weeks after the abortion than at the time of the procedure itself. Up to 1 in 10 women will get an infection after an abortion. Taking antibiotics at the time of the abortion helps to reduce this risk.

If you are not treated, it can lead to a more severe infection known as pelvic inflammatory disease (PID). The uterus may not be completely emptied of its contents and further treatment may be needed. This happens in fewer than 6 in 100 women having a medical abortion and in 1 to 2 in 100 women having a surgical abortion. An operation may be needed to remove the pregnancy tissue within the uterus.

In very rare circumstances, sepsis may occur. Sepsis can be caused by an infection in any part of the body. Sepsis after an abortion is rare, but very serious. Symptoms of sepsis can be like having the flu at first.

If you develop any of the signs below it is important to seek urgent medical advice:

• Feeling dizzy or faint.
• Confusion.
• Slurred speech.
• Extreme shivering.
• Severe muscle pain.
• Being unable to urinate.
• Severe breathlessness.
• Loss of consciousness.
• Cold, clammy and pale or blotchy skin.

What is post-abortion care?

After the abortion you should be offered written information that tells you what you are likely to experience, including:

• Symptoms that you should see a doctor for urgently.
• Symptoms of a continuing pregnancy.
• A 24-hour telephone helpline number that you can ring if you develop pain, bleeding or a high temperature.
• The opportunity to discuss contraception and obtain supplies if you need them and information on where to get help if you want to discuss contraception again later.
• A follow-up appointment, if you wish, within 2 weeks of your abortion – this is particularly important if you have an early medical abortion.
• Further counselling if you experience continuing distress – this happens to a few women and is usually related to personal circumstances.

Everyone will have a different experience after either a medical or surgical abortion has been completed. Usually you will experience some bleeding, ranging from spotting to heavy clots. This can continue up to your next period and may be unpredictable, irregular, or prolonged. It is also normal to have some cramp pains and you can apply a heat pad or (warm) hot water bottle wrapped in a towel or blanket to your lower abdomen.

Pregnancy symptoms will start to settle after a couple of days. Nausea and vomiting are one of the first symptoms to disappear after treatment. It is common to have tender breasts for several weeks. Different feelings may come up for people after an abortion, including relief and sadness. These are all normal things to feel; however, you can arrange post-abortion counselling, either face-to-face or over the phone.

If you have any concerns following your abortion, call your healthcare team or talk to your GP.

Are there any laws around abortion

An 1861 English law made it a criminal offence to procure a miscarriage. In 1945, an exception was added to say abortion could be permitted to preserve the mother’s life. But rape, incest or diagnoses of fatal foetal abnormality, where medical professionals believe the baby will die before, during or shortly after birth, were not grounds for a legal abortion.

In Great Britain, the Abortion Act 1967 was introduced by David Steel MP and supported by the government under a free vote. It legalised abortion on certain grounds, by legalised practitioners, in England, Wales and Scotland. The Act came into effect on 27 April 1968. The Act did not apply in Northern Ireland.

The Human Fertilisation and Embryology Bill came into effect on 1 April 1991, and lowered the gestation limit for abortions from 28 weeks to 24 weeks. This is the currently accepted point at which the foetus is considered viable outside the mother’s body. Abortions can take place in the first 24 weeks of pregnancy in England, Scotland and Wales; however, they have to be approved by two doctors, and they must agree that having the baby would pose a greater risk to the physical or mental health of the woman than a termination.

Abortions after 24 weeks are allowed only if:

• The woman’s life is in danger.
• There is a severe foetal abnormality.
• The woman is at risk of grave physical and mental injury.

In 2017 the Northern Ireland funding scheme was introduced to provide funded abortions in England and Wales for residents of Northern Ireland. In cases of hardship, travel costs were also covered. Abortion in Northern Ireland was decriminalised after a free vote by Westminster MPs in July 2019.

The suspended Northern Ireland Executive did not return by 21 October 2019, meaning the amendment introduced by Stella Creasy MP was passed into law through the Northern Ireland (Executive Formation etc) Act 2019 on 22 October 2019. The Abortion (Northern Ireland) Regulations 2020 came into force on 31 March 2020. The regulations introduce a new legal framework for abortion services in Northern Ireland.

On 30 March 2022, Parliament voted in favour of an amendment to the Health and Care Bill, making the temporary approval allowing home use of both abortion pills for early medical abortions permanent in England and Wales.

In what Countries is Abortion Illegal?

In many counties, abortion has always been a controversial subject. Abortion is completely prohibited and illegal in the following countries:

• Andorra.
• Aruba.
• Curaçao (territory).
• Dominican Republic.
• Egypt.
• El Salvador.
• Haiti.
• Honduras.
• Iraq.
• Jamaica.
• Laos.
• Madagascar.
• Malta.
• Mauritania.
• Nicaragua.
• Palau.
• Palestine.
• Philippines.
• Republic of the Congo.
• San Marino.
• Senegal.
• Sierra Leone.
• Suriname.
• Tonga.

According to data from the World Health Organization (WHO), the legality of abortion across the world actually has little to no effect on abortion rates throughout the world. Legal or not, abortions can, will, and do take place.

Abortion laws in the United States are in flux as of 2022. Abortion was made legal across the entire United States by the Supreme Court’s landmark Roe v. Wade decision in 1973. While each state still had its own set of legal guidelines for abortion, with some being far more restrictive than others, abortion was nonetheless legal in every part of the country.

However, Roe v. Wade was overturned by the then current Supreme Court on 24 June 2022, in a case titled Dobbs v. Jackson Women’s Health Organization. This decision enabled each individual state to legalise or prohibit abortion. As a result, state abortion laws vary more widely than ever. Republican states are tending to revise their laws to make abortion illegal following the 2022 Supreme Court judgment.

Abortions are legal in Canada and require no legally compelling reason (such as rape or health risks) so long as they take place before the gestational limit, which ranges from 12 weeks to 24 weeks + 6 days depending upon province and territory. Abortions were banned in most cases until 1988, when the Canadian Supreme Court reversed the laws that once made abortions illegal. Abortions fall under the services covered by Canada’s national health care system. Provided the abortion is conducted in a regular hospital, the patient is not charged. Abortions performed in private clinics may require the patient to pay medical costs.

Latin America’s largest country Brazil, has not completely outlawed abortion, but it does consider abortion a crime in all but a few select circumstances: when the pregnant woman was raped, when the pregnancy is the result of incest/sexual activity with a family member, or when the woman’s life would be endangered by continuing the pregnancy.

These three exceptions are quite common globally and are found in many countries’ abortion laws. Cuba and Uruguay are the only places in Latin America where women can have abortions during the first 12 weeks of pregnancy regardless of circumstances.

Abortion was recently decriminalised across Australia after New South Wales voted in favour of changing its laws.

In the European Union, there are no common laws on abortion, but in several European countries terminating a pregnancy can still risk punishment. In the Republic of Ireland you can legally have an abortion up to 12 weeks of pregnancy, in line with the Regulation of Termination of Pregnancy Bill 2018.

It is possible to access abortion care in the Republic of Ireland if you are over 12 weeks and there is a risk of serious harm or a risk to the life of the pregnant woman, or if there has been a diagnosis of fatal foetal abnormality. If you are over 12 weeks of pregnancy, you can travel to England for safe and legal abortion care. In line with the Abortion Act 1967, private abortion services are available for women who live in the Republic of Ireland up to 23 weeks and 6 days of pregnancy.