Today is International Safe Abortion Day, and let’s face it, it’s never been so important to talk about – and fight for – access to safe abortions, especially as anti-abortion campaigners strain for relevance in the UK.
Since Roe v Wade (the legal precedent which conferred the right to abortion) was overturned in the US, women and pregnant people in America increasingly face criminalisation if they seek vital reproductive care. Since 1 January 2022, the UK charity Abortion Support Network has been contacted by people from 48 different countries – all of whom have needed some form of support when accessing reproductive healthcare. A new report from the charity shows that the amount of financial support required to help people access abortions has risen by a whopping 264% in four years.
While the attack on females’ reproductive rights continues, there has also been a lot of misinformation and lack of knowledge swirling about what happens during the abortion procedure itself.
GLAMOUR speaks to reproductive health researcher Maria Lewandowska on what a woman in the UK can expect during an abortion. Maria, based at the London School of Hygiene and Tropical Medicine, is an expert in the SACHA (Shaping Abortion for Change) Study – one of the most significant research projects on abortion to be carried out in the UK. The project aims to gather information that will directly impact clinical policy and practice and will help shape abortion care for the future.
Here, Maria helps answer all of our questions about the procedure…
What happens before an abortion?
After someone finds out they’re pregnant, they will have an appointment with a healthcare practitioner, which is now often by video or phone.
You can find your nearest clinic via the British Pregnancy Advisory Service (BPAS), MSI Reproductive Choices and National Unplanned Pregnancy Advisory Service (NUPAS), all of which also provide further resources for abortion care.
Maria states that “during that appointment, the healthcare practitioner will discuss why someone is considering abortion and whether the person is confident of their decision; they will discuss the abortion methods available, and the patient will be offered a chance to speak to a counsellor”.
This consultation can include additional elements, such as offering to test for STIs and other tests if they are medically needed. “Ultrasound used to be a routine part of pre-abortion care, but nowadays, it is usually no longer necessary unless there are medical indications for it,” Maria notes.
What are the two main methods of abortion?
The two main methods are medical and surgical abortion.
Medical abortion is carried out using two medications – mifepristone and misoprostol, taken 24-48 hours apart. Maria notes that medical abortions “account for an increasing proportion of all abortions in the UK, and in 2020 that was 85% of all (210,860) abortions in England and Wales”.
Early medical abortions, meaning the first ten weeks of pregnancy, can be carried out at home – which was “supposed to be a temporary Covid-related measure” from March 2020. “Thankfully, it has been decided by the governments in England, Scotland and Wales that it will stay as a permanent measure, as it is safe, more convenient, discreet and comfortable for many,” Maria explains.
Meanwhile, a surgical abortion is a procedure where the contents of the womb are removed mechanically.
Maria explains that vacuum aspiration is usually used up to 14 weeks of pregnancy, which “involves applying suction to remove the pregnancy”.
After 14 weeks of pregnancy, another method called dilatation and evacuation (D&E) is used. That involves removing the pregnancy through the cervix with surgical instruments. Both surgical methods can be done under sedation or general anaesthetic.
What happens during a medical abortion?
Maria explains that people requiring a medical abortion will likely not have a special appointment. Instead, “they will have a consultation over the phone, and then, if there are no contraindications, a kit for medical abortion will be posted to them”. This consultation method stemmed from the beginning of the COVID pandemic and is set to continue in the future.
That kit contains: “the abortion pills mifepristone and misoprostol, pain management, instructions; contraception, an STI test if requested; and a pregnancy test to use a few weeks after the procedure to make sure it was successful”.
On the first day, the person will swallow mifepristone. After 1-2 days, they will insert misoprostol tablets into their vagina or between their cheeks and gums. Usually, the person will experience bleeding and period-like pain for a few hours, leading to pregnancy loss. Some people may need further doses of misoprostol to get the pregnancy to pass.
After three weeks, the person does a pregnancy test in the kit, and if that is negative and there are no issues, then the abortion is successful. If this still doesn’t work, an operation is needed to remove it. Maria advises that “specific instructions on what to look out for and how to manage the pain and bleeding are always issued by the abortion clinic. There is also always a phone number to call in case of any doubts”.
What happens during a surgical abortion?
There are two methods of surgical abortion, which involve an operation to remove the pregnancy from the womb.
These procedures can be carried out by local anaesthetic (numbing the cervix), conscious sedation (relaxed but awake), deep sedation or general anaesthetic (asleep).
The type of anaesthetic or sedation depends on your circumstances and how many weeks pregnant you are.
Before any method of surgical abortion, you will need to take medicine to soften and open the cervix up to a few hours or one to two days before the operation.
- During a vacuum or suction aspiration, which can usually be used up until 14 weeks of pregnancy, a tube is inserted into the womb through the cervix, and the pregnancy is removed using suction. This procedure takes a maximum of ten minutes, and women can go home a few hours later.
- During a dilatation and evacuation procedure, also usually used up until 14 weeks, an instrument called forceps is inserted through the cervix and into the womb to remove the pregnancy. This procedure is carried out under sedation or general anaesthetic and takes up to twenty minutes. Maria explains: “The patient should plan to be in the clinic for the whole day – that is to account for cervix preparation and recovery time; the treatment takes about 10-20 minutes.”
What happens after the procedure?
You may need to take a special kind of pregnancy test after a medical abortion to ensure that the pregnancy has been terminated.
Side effects of both types of abortion include stomach cramps and vaginal bleeding, which can last up to a month after a medical abortion.
However, Maria reassures that in a medical abortion, once the pregnancy passes, the pain should noticeably decrease. “After a surgical abortion, the person can experience cramping for about a week,” she adds.
You may take ibuprofen or paracetamol to relieve pain and discomfort after an abortion. Sanitary towels or pads are recommended over tampons until the bleeding stops.
You can return to normal activities, such as exercising as soon as you feel comfortable. The next menstrual period usually begins 4-6 weeks after the treatment. You can also have sex as soon as you feel ready, but “fertility can return immediately after the abortion, which means that it is important to talk to the healthcare provider about contraception that can be used afterwards,” Maria adds.
When to seek help?
Signs of infection could include temperature, flu-like feelings or unusual vaginal discharge, so ensure to call the number of the 24-hour helpline provided to you by your clinic. Or contact your GP or 111.
Get advice if your pain or bleeding does not get better after a few days or if you still feel like you are pregnant.
Your GP or abortion clinic will also be able to provide you with counselling services if you need emotional support.
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