An abortion is the medical process of ending a pregnancy so that it does not result in the birth of a baby.

The pregnancy is ended either by taking an abortion pill or by having a surgical procedure, depending on how many weeks pregnant you are (see How it is performed for more information).

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 (although medical treatment may be needed after a miscarriage).

A difficult decision

There are many reasons why you might decide to have an abortion – for example, because of your personal circumstances, because your health may be at risk, or there is a high probability that the baby will have a medical condition.

The law in the UK makes it legal to have an abortion during the first 24 weeks of pregnancy so long as certain criteria are met (see below).

There are also a few situations when the law states that an abortion may be carried out later (see Abortion - when it is carried out).

The Abortion Act 1967 covers the UK mainland (England, Scotland and Wales) but not Northern Ireland. The law states that:

• abortions must be carried out in a hospital or a specialised 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

NHS abortions

If you want to have an abortion on the NHS, you might find it beneficial to discuss options with a health professional. You will need a referral from two doctors who have to agree that the requirements of the Abortion Act 1967 have been met.

Usually, the first doctor is your GP and the second is a doctor who works at the hospital or clinic where the abortion will take place.

If you do not want to ask your GP to refer you for an abortion, you can go to your local family planning clinic or genito-urinary medicine (GUM) clinic. Some doctors at these clinics can refer women for an NHS abortion, but if they cannot, they must refer you to another doctor.

The law states that a doctor can refuse to certify a woman for an abortion if they have a moral objection to abortion. If this is the case, they should recommend another doctor who is willing to help.

In some areas, women are able to refer themselves to the local Pregnancy Advisory Service, without first getting a referral from a local doctor. It does, however, help to talk to other health professionals such as your GP or contraception clinic nurse as well. You can self-refer for an NHS-funded abortion by calling the BPAS Actionline 08457 30 40 30.

Funding of NHS abortion services differs in various parts of the country. The level of NHS provision ranges from more than 90% of local demand to less than 60%.

In some areas, the NHS will pay for abortions at private clinics, but in other areas you may need to pay for an abortion in a private clinic.

Private abortions

You can contact a private abortion clinic without being referred by a doctor. However, the NHS may not pay for this, and the agreement of two doctors is still required. The clinic will make the arrangements. Costs for abortions in private clinics vary and depend on:

• which organisation or company carries out the abortion
• the stage of pregnancy (earlier abortions are usually less expensive)
• whether an overnight stay is needed
• the method of abortion used

If you are considering having an abortion, it is important to talk to somebody about it as soon as possible.

In the UK, abortion is legal up until 24 weeks, but most are carried out much earlier than this.

In 2009, 189,100 abortions were performed on residents in England and Wales, compared with 195,296 in 2008 (a fall of 3.2%). 

Ninety three per cent of abortions were carried out at under 13 weeks of pregnancy, and 75% at under 10 weeks.

The abortion rate was highest for women aged 19-21 years, and most (94%) of abortions were funded by the NHS.

Personal decision

Making a decision about whether to have an abortion is not easy. Before deciding, discuss your situation with healthcare professionals, 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 a decision that you might later regret.

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 involve your parents or another adult in your decision-making process. If you have an abortion, you have the right for it to remain confidential, regardless of your age.

The Abortion Act 1967

In accordance with The Abortion Act 1967, an abortion must be carried out before 24 weeks of pregnancy. But there are a few situations when the law states that an abortion may be carried out later.

The law states that an abortion is legal after 24 weeks:

• 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 if the child were born, it would suffer from physical or mental abnormalities as to be seriously handicapped.

Generally, an abortion should be carried out as early in the pregnancy as possible (ideally before 12 weeks) and those performed after 24 weeks are rare.

Most abortions (90%) are carried out before 13 weeks and virtually all (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 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. If the exact stage of pregnancy is unclear, an ultrasound scan may be used.

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.

In the UK, under The Abortion Act 1967, abortions can only be carried out in a hospital or specialised licensed clinic.

In most cases, an abortion is carried out as a day procedure, and an overnight stay in hospital is not required.

Before the abortion

When you go for your first appointment, you should be given the opportunity to talk about your situation (if you want to). You will be informed about the different methods of abortion, and which method is suitable for your stage of pregnancy. You should also be advised about related risks and complications.

The doctor or nurse will take your medical history to make sure that the type of abortion you are offered is suitable for you. You will be given a blood test to check your blood group and to see whether you are anaemic. You should also be tested for sexually transmitted infections (STIs), and may be given antibiotics to stop an infection from occurring after the abortion.

There are also a number of things that you may require before having an abortion. These include:

• an ultrasound scan (if there is any doubt about how many weeks pregnant you are)
• a vaginal examination
• a cervical smear test (if appropriate)
• information and advice about which method of contraception you should use after the abortion

Finally, before having the abortion, you will be given a consent form to sign.

Methods of abortion

There are a number of different methods of abortion. The type recommended for you will depend on how many weeks pregnant you are. This is usually calculated by counting the number of weeks from the first day of your last period.

The types of abortion are outlined below.

Early medical abortion (up to 9 weeks of pregnancy)

An early medical abortion involves taking two different medicines 48 hours apart. The effect of the medication will be similar to an early natural miscarriage.

After your initial visit to see the doctor, you will have two more appointments on different days. On your first visit you will be given an abortion pill called mifepristone, which blocks the hormone that makes the lining of the womb suitable for the fertilised egg. After taking the first pill, you will be able to go home and continue your normal everyday activities.

Two days later, on your second visit to the hospital or clinic, you will be given the second medicine, prostaglandin. Within four to six hours of taking prostaglandin, the lining of the womb breaks down and is lost, along with the embryo, through bleeding from the vagina. This part of the process can be painful, but a painkiller can be taken.

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

Vacuum aspiration or suction termination (from 7 to 15 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the foetus from the 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).

The entrance to the womb (cervix) is dilated (opened) to allow access to the contents. To soften the cervix and make it easier to open, a tablet may be placed in the vagina 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 foetus and surrounding tissue.

After a vacuum aspiration abortion, you will usually be able to go home the same day. However, following the procedure you may bleed a little for up to 14 days.

Late medical abortion (from 13 weeks of pregnancy)

As well as being used for early abortion, mifepristone and prostaglandin can be used for abortion later in pregnancy. However, the abortion will take longer, and more than one dose of prostaglandin may be needed. This type of abortion is similar to having a late natural miscarriage.

After the procedure, you can return home the same day, but sometimes an overnight stay in hospital is required.

Surgical dilation and evacuation (from 15 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 foetus.

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

Late abortion (20-24 weeks)

There are two options for a late abortion carried out at 20-24 weeks. Both require an overnight stay in hospital.

• Surgical two-stage abortion:
  – stage one stops the heartbeat of the foetus and softens the cervix
  – stage two (carried out the following day) removes the foetus and surrounding tissue
  – each stage requires a general anaesthetic
• Medically induced abortion:
  – similar to a late natural miscarriage
  – the medicine prostaglandin is injected into the womb, making it contract strongly (as in labour)
  – contractions can last 6-12 hours
  – you will remain awake during the procedure and may be given medicines to control the pain
  – D&E may then be used to ensure that the womb is completely empty

If you bleed heavily, have a lot of pain or a high temperature after an abortion, seek medical help immediately.

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

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

Risks at the time of an abortion

The risk of problems occuring during an abortion is low. However, 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 – occurs in no more than 10 in every 1,000 abortions
• damage to the 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 12-24 weeks

Risks after an abortion

After an abortion, the main risk is infection in the womb, usually caused by a failure to completely remove all of the foetus and associated tissue.

If you have an infection after an abortion, you may bleed heavily from your vagina and have some period-like pain. Antibiotics are usually 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. However, the risk of an infection can be reduced by taking antibiotics at the time of the abortion.

Repeated abortions can cause damage to the entrance of the womb (cervix), and increase the risk of late miscarriages.

After an abortion, you may have some period-type pains, and some vaginal bleeding, which should gradually lessen after a few days. Most women can return to their usual activities within a day or so. However, seek medical attention if you have severe pain or if bleeding has not stopped after 14 days.

Women vary greatly in their emotional response to having an abortion. Research suggests that having an abortion does not lead to long-term emotional or psychological problems. However, some women can feel sad or guilty after an abortion, and post-abortion counselling services are widely available.

After having an abortion, you may be advised not to have sexual intercourse for up to two weeks. Seek advice from your GP, a family planning clinic or a pregnancy advisory service if you have physical or emotional problems after an abortion.