Abortion

An abortion is the medical process of ending a pregnancy.

The pregnancy is ended either by a medical abortion, which involves taking medication, or a surgical abortion, which involves a small operation. The decision will partly depend on how many weeks pregnant you are (see how it is carried out for more information). Women will usually be able to choose between the two options.

Sometimes healthcare professionals may refer to an abortion as a 'termination of pregnancy' or 'termination'.

An abortion is different from a miscarriage, where the pregnancy ends without medical intervention .

Why abortion might be considered

There are many reasons why you might decide to have an abortion, for example:

• because of your personal circumstances (including your own wellbeing or that of any existing children or anyone else you care for)
• because your health may be at risk
• because there is a high risk that the pregnancy will lead to a baby with serious abnormalities

When abortion can be carried out

The law in Scotland, England and Wales makes it legal to have an abortion during the first 24 weeks of pregnancy, so long as certain criteria are met (see below). The Abortion Act 1967 covers the UK mainland but not Northern Ireland.

The law states that:

• abortion treatment must be carried out in a hospital or a licensed clinic
• two doctors must agree that an abortion would cause less risk to a woman's physical or mental health (or that of her existing children) than continuing with the pregnancy

There are also a number of rarer situations when the law states that an abortion may be carried out later in pregnancy. These include:

• if it is necessary to save the woman's life
• to prevent grave permanent injury to the physical or mental health of the pregnant woman
• if there is substantial risk that the child would be born with serious physical or mental disabilities

Most abortions in Scotland (around 70%) are carried out before a pregnancy reaches nine weeks, and almost all abortions (around 98%) are performed before 20 weeks.

The earlier an abortion is carried out, the easier and safer the procedure is. However, you should take enough time to consider all your options so that you are as comfortable as possible with your decision.

To work out how many weeks pregnant you are, the calculation is usually made from the first day of your last period. However, not everyone will be sure of this date, and all clinics will carry out an ultrasound scan to confirm how many weeks pregnant you are.

Personal decision

Making a decision about whether to undergo abortion may not be easy. Before deciding, you may wish to discuss your situation with healthcare professionals (such as your GP or local sexual and reproductive health service), family members and (if applicable) your partner.

The final decision about whether or not to have an abortion is yours, and you should not be pressured into making that decision.

If you are under 16, you can have an abortion without telling your parents, as long as two doctors believe it is in your best interests and you fully understand what is involved.

However, the doctors will encourage you to discuss your decision with your parents or another adult. If you decide to have an abortion, you have the right for this to remain confidential, regardless of your age.

Further information is available on the BPAS and Marie Stopes websites.

Women vary greatly in their emotional response to having an abortion. You may experience a number of different feelings and emotions. This is quite normal.

If you need to discuss how you are feeling, you can contact a counselling service. You can search using the link below.

Find NHS counselling services near you

NHS abortions

Almost all abortions in Scotland are provided within the NHS. An exception to this is where a woman chooses to fund her procedure privately, but this is uncommon.

If you want to have an abortion through the NHS, you'll usually need to be referred to a specialist service that deals with abortion, usually at a hospital or sexual and reproductive health clinic. You can ask your GP to refer you or you can go to your closest sexual and reproductive health clinic.

Doctors who have a moral objection to abortion, are not obliged to refer you for an abortion. However, if your GP holds these views he/she must tell you this, and arrange for you to see another doctor without delay.

Before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled, and they must both sign the relevant certificate. This will often – but not always – be your GP and the doctor at the clinic where the abortion will take place.

Although it's often very helpful to talk through the options with your GP or a family planning nurse before being referred, it is possible to refer yourself for an NHS abortion in some parts of the country. However, you should always access the abortion service for the NHS Board where you live.

NHS abortion after 18 weeks

In most circumstances, women needing abortion after 18 weeks (or in some areas 20 weeks) of pregnancy will be required to travel to specialist services in England. Your local NHS abortion service may be able to provide help with travel and accommodation costs and will provide you with information if this is the case.

In England, Wales and Scotland abortion is legal up until 24 weeks of pregnancy, although most abortions are carried out much earlier than this.

In rare circumstances, an abortion can sometimes be carried out legally after 24 weeks (see below).

The Abortion Act 1967

In accordance with The Abortion Act 1967, an abortion must usually be carried out before 24 weeks of pregnancy. The law states that:

• abortions must be carried out in a hospital or a specialist licensed clinic
• two doctors must agree that an abortion would cause less damage to a woman's physical or mental health than continuing with the pregnancy

The few situations when the law states an abortion may be carried out after 24 weeks are:

• if it's necessary to save the woman's life
• to prevent severe permanent injury to the physical or mental health of the pregnant woman 
• if there is substantial risk that the child would be born with physical or mental abnormalities and be seriously handicapped

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before 9 weeks where possible. It's rare for an abortion to be performed after 24 weeks.

Most abortions (around 90%) are carried out before a pregnancy reaches 13 weeks, and virtually all abortions (around 98%) are performed before 20 weeks.

The earlier an abortion is carried out, the easier and safer the procedure is to perform. However, you must be given enough time to consider all your options so you're as comfortable as possible with your decision.

To work out how many weeks pregnant you are, the calculation is usually made from the first day of your last period. If the exact stage of pregnancy is unclear, you may need an ultrasound scan.

Personal decision

Making a decision about whether to have an abortion isn't easy. Before deciding, you should discuss your situation with healthcare professionals, family members and, if applicable, your partner. You should consider all options and these can include:

• abortion
• possibly keeping the baby
• more rarely, considering adoption for the baby

Always remember the final decision about whether or not to have an abortion is yours, and you should not be pressured into making a decision you might later regret.

If you are under 16 years of age, you can have an abortion without telling your parents, as long as two doctors believe it's in your best interests and you fully understand what is involved.

However, the doctors will encourage you to involve your parents or another adult in your decision-making process. This increases the amount of support you have available. If you choose to have an abortion, you have the right for it to remain confidential, regardless of your age.

The reasons for an abortion possibly being necessary are set out in The Abortion Act 1967. These are:

• continuing with the pregnancy would be a greater risk to the woman's life than ending the pregnancy
• continuing with the pregnancy would involve a greater risk of injury to the woman's physical or mental health than would ending the pregnancy
• continuing with the pregnancy would be more of a risk to the physical or mental health of any of the woman's existing children
• there is a real risk that the child, if born, would have a serious physical or mental disability

In practice, this gives doctors a great degree of flexibility in referring women for abortions.

However, making the decision to have an abortion is a personal and difficult choice that may be influenced by social, economic and emotional factors.

Therefore a wide variety of counselling, information and advice services are available to help women make the decision that is most appropriate.

Before the abortion

When you are referred for abortion and go for your first appointment (sometimes referred to as the ‘assessment’ appointment), you should be given the opportunity to talk about your situation. You will be informed about the different methods of abortion, and which methods are suitable for your stage of pregnancy. You should also be advised about any related risks.

The doctor or nurse will take your medical history to make sure that the type of abortion you are offered is suitable for you. At the assessment appointment, a number of other things usually happen, including:

• an ultrasound scan to check how many weeks pregnant you are (this may be abdominal or internal/vaginal)
• a blood test to check your blood group and to see whether you are anaemic
• a routine test for sexually transmitted infections (STIs)
• information and advice about which methods of contraception you could use after the abortion

Finally, before starting treatment, you will be given a consent form to sign.

In Scotland, England and Wales, under The Abortion Act 1967, abortion treatment can only be carried out in a hospital or specialised licensed clinic. In most cases, an abortion is carried out in an out-patient clinic or ward or as a day procedure, and an overnight stay in hospital is not usually required.

There are a number of different methods of abortion. The type recommended for you will depend on how many weeks pregnant you are.

Early medical abortion (up to 10 weeks of pregnancy)

Early medical abortion involves taking two different medications, usually around 48 hours apart. The effect of the medication will be similar to an early miscarriage.

Following your initial assessment appointment at the abortion service, you will usually have two more appointments on different days. On your first visit you will be given a medication called mifepristone, which blocks the hormone that makes the lining of the uterus (womb) suitable for the fertilised egg. After taking the first pill, you will be able to go home and continue your normal everyday activities. In some instances (where appropriate) the first medication may be given at the assessment appointment.

On your next visit to the abortion service, you will be given the second medication, which is called misoprostol. This medication is usually inserted vaginally or taken orally. This medication causes the lining of the uterus (womb) to break down, and to be passed along with the embryo and bleeding, through the vagina. This usually happens within four to six hours of the medication being taken. This part of the process can be a bit like a very heavy period. It can be painful, but painkillers can be taken, and are usually provided by the abortion service.

The medicines that are used during an early medical abortion may make you feel quite sick and you may have diarrhoea.

In some cases, you may be able to return home to take the second medication. If this is possible in your case, the team at the clinic will talk to you about it. Otherwise, you would stay in hospital as a day patient until the pregnancy is passed.

Following the procedure you will bleed, usually for 7 to 10 days.

Surgical abortion (from 7 to 13 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the pregnancy tissue from the uterus (womb). The procedure usually takes 5-10 minutes and can be carried out under a local anaesthetic (where the area is numbed) or general anaesthetic (where you are put to sleep). Most women receive a general anaesthetic for the procedure.

The entrance to the womb (cervix) is dilated (opened). To soften the cervix and make it easier to open, a tablet may be placed in the vagina or mouth a few hours before the abortion. A small, plastic suction tube connected to a pump is then inserted into the womb and used to remove the pregnancy tissue.

After a vacuum aspiration abortion, you will usually be able to go home the same day. Following the procedure you will bleed, usually for around 7 days

Later medical abortion (from 9 to 18/20 weeks of pregnancy)

As well as being used for early abortion, mifepristone and misoprostol can be used for abortion later in pregnancy. At this time, the abortion will take longer (usually between six and twelve hours, depending on how many weeks pregnant you are), and more than one dose of misoprostol may be needed. This type of abortion is similar to having a later miscarriage. You will be awake during this procedure, and medication will be given to manage the pain.

After the procedure, you can usually return home the same day. Sometimes the pregnancy can take longer to pass and an overnight stay in hospital is required.

Following the procedure you will bleed, usually for 7 to 10 days. Depending on how many weeks pregnant you were, you may notice some other symptoms such as a small amount of fluid leaking from the breasts.

Later surgical abortion

The following procedures are not currently available in Scotland. If you are over 18/20 weeks pregnant you may need to travel to a specialist clinic in England for one of these treatments, funded by your local NHS service.

Dilation and evacuation (from 18 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure that is carried out under general anaesthetic. The cervix is gently stretched and dilated and forceps and a suction tube are used to remove the fetus and surrounding pregnancy tissue.

The procedure usually takes 10 to 20 minutes to perform and, if you are healthy and there are no complications, you may be able to return home the same day. You will have bleeding for up to 14 days.

Two-stage later surgical abortion (from 20 to 24 weeks of pregnancy)

If you are more than 22 weeks pregnant, the abortion usually requires a two-stage process, carried out under general anaesthetic.

In stage one, an injection stops the heartbeat of the fetus and medication is used to soften the cervix. Stage two is carried out the following day, and involves removal of the fetus and surrounding tissue

Following the procedure you will bleed, usually for up to 14 days. You may notice some other symptoms such as a small amount of fluid leaking from your breasts.

Whilst no clinical procedure is entirely free from risk, abortion poses few risks to a woman's health, particularly when carried out during the first 12 weeks of pregnancy.

Abortion does not usually affect a woman's chances of becoming pregnant and having normal pregnancies in future.

The risk of problems occurring during an abortion procedure is low. There are more likely to be problems if an abortion is carried out later in a pregnancy. The low risks associated with abortions are:

• haemorrhage (excessive bleeding) – occurs in about 1 in every 1,000 abortions
• damage to the cervix (entrance to the womb) – occurs in no more than 10 in every 1,000 abortions
• damage to the uterus (womb) – occurs in up to 4 in every 1,000 abortions during surgical abortion, and less than 1 in 1,000 medical abortions carried out at 12 to 24 weeks

After an abortion

After an abortion, the main risk is infection in the uterus (womb), and can be caused when all of the pregnancy tissue has not been passed or removed.

An infection after abortion may cause you to bleed heavily or have discharge from your vagina, and lower abdominal pain. Antibiotics are used to treat the infection.

If an infection is not treated, it could result in a more severe infection of your reproductive organs, such as pelvic inflammatory disease, which can cause infertility or ectopic pregnancy. The risk of an infection is reduced by taking antibiotics at the time of the abortion.

If you think you may have an infection following abortion, you should immediately contact your GP, local sexual and reproductive health service, or the abortion service you attended.

After having an abortion, you may be advised not to have sexual intercourse, and to avoid using tampons while the bleeding continues. It is advisable that you have a reliable type of contraception before starting to have sexual intercourse again, as your fertility will return to normal very quickly.

Contraception

The most reliable types of contraception are the IUD/IUS (coil) and the implant. The abortion service you attend will give you information on different methods and help you find the right one for you. They can usually also provide most types of contraception on the day of the abortion, or help you get an appointment. You can also talk to your GP or local sexual health service about contraception.

Emotional support

Women vary greatly in their emotional response to having an abortion. Some women feel relieved, others feel sad or guilty, and many women feel a combination of these. Research suggests that having some mixed feelings is normal, and that abortion does not lead to long-term emotional or psychological problems. However, counselling services are available. If you feel you need someone to talk to, seek advice from your GP or local sexual and reproductive health service.

Residents of Northern Ireland can now access abortion services in Scotland for free, on the same terms as people who live in Scotland.

When abortion can be carried out

In Northern Ireland, it's illegal to have an abortion unless the life of the mother is threatened, or continuing the pregnancy would have severe long-term negative consequences for her mental or physical health. It's very rare that a pregnancy is found to meet these conditions.

In Scotland, it's legal to have an abortion up to 24 weeks into pregnancy. The law states:

• abortion treatment must be carried out in a hospital or a licensed clinic
• 2 doctors must agree that the situation meets the legal requirements of the Abortion Act 1967

Usually this'll mean the doctors agree an abortion would cause less risk to a woman's physical or mental health (or that of her existing children) than continuing with the pregnancy.

After 24 weeks, an abortion can be carried out in rare circumstances if:

• it's necessary to save the woman's life
• it'll prevent severe permanent injury to the physical or mental health of the pregnant woman
• there's substantial risk the child would be born with physical or mental abnormalities and be seriously handicapped

Read more about when an abortion can be carried out here

What you need to know

When you arrive in Scotland, the first step is to contact the NHS Board for the area you're in. The procedure for arranging an appointment varies depending on the NHS Board.

Confidentiality

If you come to Scotland from Northern Ireland for an abortion, the procedure can be kept confidential. No paperwork will be sent to your home or to your GP without your consent.

You'll be given a letter outlining the treatment you received that you can give to a doctor if you need emergency care. If you like, the clinic can also send a letter to your GP.

As an NHS patient you have the right to confidentiality. This means you have a right to:

• have your information stored securely
• access your health information
• know how the NHS uses your information
• know how the NHS shares your information
• object to the NHS using your information

Find out more about confidentiality in NHS Scotland

Abortion procedures

The way the abortion procedure is carried out depends on how far along you are in the pregnancy. Scotland doesn't offer 'one day' abortion services.

Abortion procedures are either medical or surgical.

A medical abortion involves taking medication, sometimes referred to as 'abortion pills'.

Surgical abortion involves a minor operation. This can be carried out while you're under sedation, local anaesthetic or general anaesthetic.

Before the abortion

Before the procedure is carried out, you'll attend an assessment appointment. During the appointment you'll be asked to answer questions about your medical history, and some tests will be carried out.

Read more about the assessment appointment here

Early medical abortion (up to 10 weeks of pregnancy)

Early medical abortion involves taking 2 different medications – mifepristone and misoprostol – usually around 48 hours apart. The effect of the medication will be similar to an early miscarriage.

Although patients who live in Scotland can sometimes be given the second abortion medication (misoprostol) to take at home, women who normally live in Northern Ireland will have to return to the clinic to take the second medication.

Read more about early medical abortion

Surgical abortion (from 7 to 13 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the pregnancy tissue from the uterus (womb). The procedure usually takes 5 to 10 minutes and can be carried out under a local anaesthetic (where the area is numbed) or general anaesthetic (where you're put to sleep). Most women receive a general anaesthetic for the procedure.

Read more about surgical abortion

Later medical abortion (from 9 to 18/20 weeks of pregnancy)

As well as being used for early abortion, mifepristone and misoprostol can be used for abortion later in pregnancy. Later medical abortion will take longer (usually between 6 and 12 hours, depending on how many weeks pregnant you are), and more than one dose of misoprostol may be needed. This type of abortion is similar to having a later miscarriage. You will be awake during this procedure, and medication will be given to manage the pain.

Read more about later medical abortion

Later surgical abortion

If you're over 18/20 weeks pregnant you may need to travel to a specialist clinic in England for treatment. If you find out at your first appointment that the Scottish NHS Board can't treat you, they'll refer you to the specialist clinic.

Read more about later surgical abortion

After the procedure

After taking the abortion medication (misoprostol), you should be prepared for the possibility of the following symptoms:

• cramps
• nausea
• diarrhoea

Depending on the procedure you have, it may be a good idea to avoid travelling for 24 hours. You can talk to your doctor about what to expect.

After the procedure, the NHS Board in charge of your care will provide aftercare information, along with a clinic number in Scotland. If you've any concerns after you return to Northern Ireland, you can call the clinic number. You won't get in trouble for seeking emergency care in Northern Ireland.

Counselling

People vary greatly in their emotional response to having an abortion. You may experience a number of different feelings and emotions - this is normal.

The clinic where you have the procedure can tell you:

• who to contact if you need to talk to someone
• about counselling services based in Northern Ireland