Abortions are legal throughout the world, but there are different laws in different countries.
- 61 countries, including much of Europe, allow abortions without any restrictions
- 26 countries have banned restrictions altogether, with no exceptions.
- The remaining countries allow abortions with some restrictions.
In India, abortion is legal during the first and second trimesters of pregnancy with most abortions being done in the first trimester of pregnancy. The first trimester refers to the first 12 weeks of pregnancy. Third-trimester abortions are done when the mother’s or the baby’s life is in danger.
Type of abortion by trimester
Medical abortion is performed through two pills-mifepristone and misoprostol. This method can be used when the baby’s gestational age is ten weeks. However, medical abortion is not advisable for everyone and in the following cases:-
- If pregnancy is implanted outside the uterus.
- If one’s allergic to mifepristone and misoprostol
- If one has a bleeding disorder
- If one has severe kidney, liver, or lung disease.
- If an intrauterine device is in place
- If one is taking corticosteroid drugs for a long time
Mifepristone is given by a healthcare professional in the hospital. This medicine blocks the hormone progesterone, which the embryo needs for implantation and growth.
Misoprostol can be taken at home. It usually takes a few hours up to 4 days after the first pill. Misoprostol makes the uterus contract to push the products of conception out of the body. One may develop cramps and bleed heavily 1 to 4 hours after taking misoprostol.
Other symptoms seen are:-
- Passing small blood clots
- Nausea and vomiting
In most females, abortion occurs within 4-5 hours after taking the pills. In others, the process may take two days. The average menstrual cycle returns within 4 to 6 weeks after the abortion. Ovulation starts three weeks after taking the pills.
Methotrexate and misoprostol
Methotrexate and misoprostol are abortion methods for the first seven weeks of pregnancy. Methotrexate is an anticancer medicine. It stops the multiplication of the cells in the embryo. Misoprostol contracts the uterus to release its contents. This method usually takes longer than mifepristone and misoprostol and is therefore rarely used for planned abortions. Doctors mainly advise this combination when the pregnancy is ectopic which can be a life-threatening situation.
This method should not be used in women who have:-
- Liver, kidney, or inflammatory bowel disease
- History of seizures
- Females taking blood thinners
- Females allergic to methotrexate and misoprostol
- Females having severe anaemia
- Females having an intrauterine device.
It can take a few days or weeks for the abortion to finish. In 1-2% of people, the medicine won’t work. Common side effects of this combination are:-
- Nausea and vomiting
- Low-grade fever
Abortion should not affect the ability to get pregnant in future.
Vacuum aspiration is done during the first trimester or early second trimester of pregnancy. It is otherwise known as suction evacuation. Some women prefer suction evacuation ad the primary method for abortion. Others need it after the failure of medical abortion. However, this method may not work for females who have:-
- An abnormally shaped or functioning uterus
- Blood clotting disorders
- Pelvic infection
- Serious health problems
Vacuum aspiration uses gentle suction to pull the fetus and placenta out of the uterus. Although it is not a painful procedure, one may experience cramps as the uterus contracts when the tissue is removed. The procedure hardly takes 5-10 minutes. The side effects associated with this procedure are:
- Bleeding or spotting
Dilation and evacuation
Dilation and evacuation is a procedure that is used in the second trimester, usually after the 14th week of the pregnancy. This procedure is recommended for those who have delayed getting an abortion or for someone who chooses to end a pregnancy because of abnormalities.
Dilation and evacuation use a combination of vacuum aspiration, forceps, dilatation, and curettage. This procedure is done for two days. On the first day, the doctor dilates the cervix to make removing the products of conception easier. On the second day, the doctor uses forceps to remove the fetus and placenta, a tube to suction out the uterus, and a scoop like an instrument called curettage to scrape out the uterine lining. This procedure can be a painful one. Side effects include cramps, bleeding, and nausea. Periods should start after 4-8 weeks of the procedure.
Is emergency contraception a type of abortion?
Emergency contraception is usually taken within five days of unprotected sex. They can prevent you from getting pregnant. Emergency contraception is not an abortion pill. If one is already pregnant, it can not cause abortion.