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Guide to Abortion: Abortion Pills vs. Surgical Abortion

Abortion is a common, safe way to end a pregnancy.  Worldwide 25% of pregnancies are ended in abortion.  In the US, close to 1 in 4 women will have an abortion at least once in their lives.  This guide is meant to provide information on abortion, including what to expect during an abortion.

There are many reasons why people may choose to end a pregnancy, including unplanned pregnancy, not wanting to have a baby or being able to afford a baby, not having a partner and not wanting to be a single parent, a poor relationship with their partner, health problems, something being medically wrong with the fetus, as well as other personal reasons.

This article was written by pro-choice advocate Dr. Kirti Patel, MD, MHL a board-certified gynecologist at UMass Memorial Healthcare and Chief Medical Officer of The POV.

The Controversial History of Abortion

Abortion is in the news lately because the right to have an abortion is threatened in many states.  On January 22, 1973, the US Supreme Court sided with an unmarried, anonymous woman “Jane Roe” who wanted to terminate a pregnancy safely and struck down a law in Texas that made it illegal to have an abortion unless a woman’s life was at stake.  That case paved the way to legalizing abortion throughout the country, recognizing the right to make decisions about your body, and helped to make abortion more accessible and safer.  On June 24, 2022, the US Supreme Court voted to overturn Roe v. Wade, immediately rolling back the right to abortion in half of the US states and increasing restrictions in others.  This comes despite the fact that the majority of Americans– 62%--support abortion and feel it should be legal in all or most cases.

The right to make decisions about your own body is under threat, and with that comes an increased risk to health and well-being, including having poorer educational outcomes, increased poverty, and increased mortality (as a result of unsafe abortions and also from pregnancy and childbirth).

There are many barriers to abortion care in the US, including delays in diagnosis of pregnancies, due to limited access to healthcare providers, high expense of abortion care, mandatory waiting times, parental involvement laws, and lack of abortion providers. Abortion rights groups are actively trying to help improve access to safe, legal abortion in the US. This guide to abortion is meant to help educate people at risk of pregnancy on what options are available and how to access this care.

5 Facts About Abortion

  1. The rate of abortions has steadily declined over the last 2 decades, with access to safe, effective birth control, especially long-acting birth control.
  2. Most abortions occur with unmarried parents (85%) and those with one or more children (59%).
  3. Most abortions occur very early in pregnancy (78% at 9 weeks or less, 92% at 13 weeks or less).  Only 1% occur beyond 21 weeks of pregnancy.
  4. 90% of counties in the US have no abortion provider.
  5. Pregnancy dating is calculated using the patient’s last normal menstrual period and confirmed on exam and / or with ultrasound.

Types of Abortion

Abortions can be ‘medical’, which refers to ending a pregnancy using medication or ‘surgical’, which ends a pregnancy through a surgical procedure.

You may have heard of ‘abortion pills,’ which refers to a medical abortion. This is not the same as an emergency contraceptive or Plan B.

Medical Abortion or ‘Abortion Pills’

How does medical abortion work?

In a medical abortion, the pregnancy is terminated using 2 abortion pills, which can be taken at home. A medical abortion is done is before 11 weeks of pregnancy and generally with 2 pills: mifepristone (brand name: Mifeprex) and misoprostol (brand name: Cytotec).  Mifepristone is prescribed by a healthcare provider and taken first, followed by misoprostol, which is usually taken 1-2 days later.  Several hours later, bleeding may begin, and often it will be accompanied with the passage of clots and tissue.

What are the advantages of a medical abortion or abortion pills?

  • Patients can avoid a surgical procedure and anesthesia.
  • The process may feel more “natural” and can occur privately at home.
  • It may be more convenient, especially if able to access a telemedicine provider vs. an in person visit

What to expect during a medical abortion using abortion pills

Bleeding can be fairly heavy at first, with the passage of clots at tissue, and can continue in a lighter way for several weeks after. There can also be a lot of cramping and pain.  Other side effects from the medication can include fever, nausea, vomiting, and diarrhea.

At times, medical abortion can fail, and it becomes necessary to have a second treatment or a surgical abortion. Rare complications can include severe blood loss requiring a blood transfusion and infection.

Surgical Abortion

How does surgical abortion work?

A surgical abortion can be done at up to 15 weeks pregnant via ‘aspiration,’ which requires use of a vacuum device. Beyond that, in the second trimester of a pregnancy, the procedure may require a “D&E”, dilation and evacuation procedure, which requires use of both a vacuum device and forceps to remove the pregnancy, or an “induction” with medication, which induces vaginal passage of the fetus.

Of note:  Treatment of an ectopic pregnancy (not located in the uterus) may be medical or surgical, depending on the circumstances, but if surgical, this procedure generally involves abdominal surgery as well.

Surgical abortion is performed at a healthcare facility, and under anesthesia.  The procedure involves a doctor using special tools to remove the pregnancy tissue from the uterus and is done through a vaginal procedure, so there are no incisions that are made on the body.

What are the advantages of a surgical abortion?

  • Can be done quickly, usually under 15 minutes and with confidence of knowing that the abortion is complete vs. medical abortion, which can take longer, have greater blood loss, and which has a higher risk of being incomplete and needing further care
  • Certain socioeconomic or personal factors may make surgical abortion preferable, such as housing concerns, poor social support, or upcoming travel

What to expect during a surgical abortion

There can be some bleeding for a few weeks after surgery.  Usually this is lighter than with a medical abortion.  Also, patients can have pain and cramping.

Rarely, there is a risk of developing very heavy bleeding, fever or  infection, or a more serious complication such as injury to the uterus or adjacent organs, that can require further emergency care.  

Abortion after care

You may receive pain medication to be used during/after the process.

Patients frequently wonder if they can have sex after an abortion. After an abortion, it is recommended that you avoid putting anything in the vagina or having sex for 2 weeks in order to prevent an infection.  You should also reach out to your provider with any concerning symptoms, such as very heavy bleeding, pain, lightheadedness, dizziness, or fever.

It is important to discuss starting an effective birth control with your provider, as you can get pregnant again immediately after having an abortion.

If your blood type is “Rh negative”, depending on how far along you were when having the abortion, your healthcare provider may recommend that you receive a “Rhogam” shot.  This is given to prevent you from developing antibodies against a potential “Rh positive” pregnancy, as those antibodies can linger and negatively affect your future pregnancies.

If your pregnancy is suspected to have been an ectopic pregnancy, blood levels of the pregnancy hormone may be followed to assure that the ectopic is resolving.

What are the long-term side effects of abortion?

Having an abortion does not cause long-term changes to your body.  It should not be harder to get pregnant in the future or affect any future pregnancies you may have.

Abortion is safe when performed or supervised by a qualified professional

Abortion, both medical and surgical, is a safe process with very low risk of complications. However, it is important, especially during these challenging times, to seek care from a trained healthcare provider at a licensed medical facility. It can be dangerous and even life-threatening to try and end a pregnancy on one’s own or with the help of someone not specially trained to perform abortions.


Planned Parenthood is a helpful resource for further information or when seeking an abortion care provider in your area.

AID Access is able to prescribe medical abortions (abortion pills) in all 50 states via a telehealth appointment.

The POV provides a free guide to choosing and accessing birth control.

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