A Woman’s Guide To Having An Abortion

What is abortion?

Abortion or termination of pregnancy is always one of the most talked-about topics in India. But a lot of people fail to understand that it is the right of a woman. She may choose to carry the baby to term, keep her baby up for adoption or have an abortion. Termination of pregnancy is often an emotional and difficult decision for a woman at any age.

Deciding on whether to terminate pregnancy – wanted, unwanted or unexpected is not easy for a woman. Choosing to have an abortion is a personal decision. Talk to your doctor about the decision and your options 

In recent years, a lot of people in India have aggressively launched campaigns to turn back time on women’s reproductive rights. They portray abortion as an immoral, dangerous and painful process to make women regret their decisions. 

Abortion in India

A survey was conducted by Times Health where people in India were asked what do they think if women should be given the choice over their bodies to decide if they want an abortion and this was the result. [image from TOI]

But we must be thankful that at least there is a framework under which women can legally, and safely, undergo abortions in India. However, access to unbiased and safe abortion is a different ballgame altogether. 

As per the Indian Act, abortion is determined as permissible until the woman is in 22 weeks of pregnancy under the following situations:

  • Continuing the pregnancy may be a health concern for women or may cause injury to them, physical or mental health.
  • Abnormal growth of the fetus where a child born could be severely handicapped.
  • Pregnancy due to rape or sexual abuse.
  • Pregnancy due to failure of contraceptive pills

Challenges faced by Indian women regarding abortion

  • Poor, young and unmarried women are more likely to delay abortion because they are often poorly informed. These women fail to understand the signs of pregnancy, possibility or legality of abortion and the location of safe services.
  • Some abortion centers refuse to perform abortions on young women or ask them to bring their parents to the clinic. This forces many women to turn to secretive and unsafe abortions.
  • Most of the abortions are during the first trimester while others happening in second trimester are due to sex selection.
  • A lot of women do not know that the law requires consent of only woman if she is 18 years and above to terminate her pregnancy. 
  • Unavailability of trained practitioners in the remote locations of India along with poor knowledge about abortion in women contributes to abortion-related death. 

“Approximately, 6 million pregnancies are terminated every year in India and 13 women in India die due to unsafe abortion everyday which contributes to 8% of yearly deaths.”

Common reasons why women choose abortion

There may be several reasons for abortion which may include any of the following: 

  • You do not want a child right now because you are not ready to take the responsibilities
  • Unplanned pregnancy
  • Already have a complete family
  • You are not able to afford to raise a child
  • You have health problems which can make pregnancy complicated
  • Fetus has a problem
  • Relationship problems with your partner (no support)
  • Pregnancy is a result of sexual assault
  • Mentally not prepared
  • Failure of contraceptive pills

Therefore, talking to a medical counselor will make it clear which procedure to follow for abortion, is there any risk involved or how will it affect your health. 

Is abortion right for me?

If you are pregnant and want to get abortion, you are the right person to decide for yourself if the decision is apt or not. You can contact a healthcare provider or an accredited clinic that provides abortion services. You can find a counselor whom you can talk to at such clinics.

What are the tests done before abortion?

Tests are done to diagnose a pregnancy and check your health conditions to see if you need any special treatment. This is irrespective of whether you want to continue your pregnancy or have an abortion. It includes: 

  • Physical test: Blood pressure, heart rate, pelvic examination to check the size of ovaries and fallopian tubes.
  • Lab tests: Urine test, blood test, screening test for STI and PAP test for cervical abnormalities. Also, ultrasound to check the shape and size of the uterus during pregnancy. 

Before going to a doctor, a lot of women get the pregnancy test at home using kits such as Prega News. 

When can abortion be done?

Abortion process depends on which pregnancy week you are into. You may have a choice between medical abortion (medicine to end pregnancy) and surgical abortion. After 9 weeks of pregnancy, surgical abortion is the only option for a woman to terminate her pregnancy.

Notably, abortions are rarely done after late second trimester or you can say 24 weeks of pregnancy. 

If we talk about the risk, it is higher in the second trimester as compared to first trimester. Remember, abortion process must be under the guidance of a doctor or a gynecologist.

What are the types of abortion?

The types of abortion depend upon how far you are along in your pregnancy or pregnancy week. 

  • Medical abortion
  • Methotrexate and misoprostol
  • Vacuum aspiration 1st tri12 week
  • Dilation and evacuation 2nd 14 week
  • Induction abortion 2nd 24 week

Medical Abortion 

It is the type of abortion which prevents the need for surgical treatment. It is the use of combination of abortion pills to end the pregnancy. These are two abortion pills – mifepristone (Mifeprex) and misoprostol (Cytotec).

This method can be used until the 10 weeks of pregnancy. It works for 95-98% of women who take it. 

What to expect

This process involves two visits to the doctor. The medicine is given when you are in the clinic and you are asked to take the second abortion pill after 24 hours. 

Mifepristone blocks the hormone progesterone which stops the placenta’s growth, softens the cervix and makes the uterus ready for labor. Misoprostol is used to start contractions to clear the uterus of all tissue. 

There will be heavy bleeding and cramping after taking misoprostol. You may experience the following symptoms: 

  • Passing small blood clots
  • Vaginal bleeding
  • Nausea
  • Vomiting
  • Tiredness
  • Dizziness
  • Diarrhea

Most of the women pass pregnancy within 4-5 hours after taking both the abortion pills. Sometimes it may take a couple of days to pass on the pregnancy. Your period should start about 4-6 weeks after the abortion. This medical abortion process should not affect your health or ability to become pregnant in the future. 

The cost of abortion pills vary depending on the brand but maybe approximately INR2000/-.

Methotrexate and misoprostol

These abortion pills can be used until 7 weeks of pregnancy. Methotrexate is a cancer drug that stops the cancer cells from multiplying. Both these medicines are taken in the same manner as mifepristone and misoprostol but this process may take longer. 

Usually, doctors prescribe methotrexate and misoprostol to a woman with pregnancy outside the uterus.

It takes a few days or weeks to end the pregnancy. If this process does not work, surgical abortion is needed to terminate your pregnancy. 

Surgical Abortion In First And Second Trimester

Surgical abortion means terminating the pregnancy surgically by removing all the contents of the uterus. There are different surgical abortion methods depending on how many weeks of pregnancy you have passed.

Surgical Abortion

The process of surgically removing the content of the uterus is surgical abortion. There are different procedures used for surgical abortion such as vacuum aspiration, dilation and evacuation. 

This is also known as in-clinic abortion which is typically done upto 14-16 weeks of pregnancy after a woman’s last period. 

Vacuum aspiration or suction abortion

Vacuum aspiration also known as suction abortion is a surgical abortion. Some people choose this as the primary method for abortion. 

It is done during the first trimester or early second trimester which means 12-16 weeks of pregnancy. 

A gentle suction is used in this process to pull out the fetus and placenta out of the uterus. This process takes 10-15 minutes after which you may have to stay in hospital to confirm if the abortion is complete. 

You are advised to avoid sex for atleast a week after the abortion. This procedure does not affect your ability to get pregnant in the future. 

Dilation and evacuation (D&E)

This surgical procedure is usually used for 3 months of pregnancy abortion. It is recommended to women who have delayed getting abortion or for those who choose to end their pregnancy due to the abnormality in the fetus or other medical problem. 

D&E is a combination of vacuum aspiration, forceps and dilation. This process is done in two sittings. On the first day, the doctor dilates the cervix so that it becomes easy to remove the pregnancy tissues. Next day, the doctor uses forceps to take out the pregnancy tissues and fetus. The doctor uses a numbing medicine to prevent pain during the process. A tube is used to suction out the uterus, and a scoop-like instrument called a curette to scrape out the uterine lining. 

The procedure takes 30-40 minutes and you may go home after the complete diagnosis. 

Induction abortion

This procedure is done if the woman crosses the 22nd week of pregnancy and can not get dilation and evacuation. It is done in the second trimester of pregnancy.

During the process, the doctor gives you medicine that puts you into labor so that the uterus contracts to release the pregnancy. The doctor may use suction to clear out the uterus. You may have to stay in hospital for a day as the procedure may take longer. If you experience cramps and severe pain, the doctor may prescribe some sedatives to prevent discomfort. 

Complete recovery takes around 4-6 weeks so avoid sexual intercourse till then. Your periods may resume after a month or two. Consult a doctor how long to wait before trying to conceive again. 

Medical Abortion vs Surgical Abortion

Let us go through the difference between medical abortion and surgical abortion:

Medical AbortionSurgical Abortion
It is a combination of abortion pills that ends pregnancy and shed the uterus lining thereby preventing the need for surgeryIt is invasive and surgical which includes manual vacuum aspiration, machine vacuum aspiration and dilation and evacuation 
Can only be used during early pregnancy (till 10 weeks of pregnancy)Can be used from starting till second trimester of the pregnancy
Usually takes two visits to make sure pregnancy is completely terminated Surgical abortion usually happens in one visit
It does not require sedatives or anesthesiaIt may require general or local anesthesia. Sometimes can be performed without any sedatives too
High success rateHigh success rate
Abortion pills may lead to strong cramps and some women may also experience vomiting and nausea Most women experience some cramping during or after the short procedure
No instruments or suction is used, so you will not be exposed to the chance of cervical injury and uterine perforation Forceps and suction are placed into your vagina and uterus, there is a small risk of cervical injury or uterine perforation that could require further care 
There are no indications that that medical abortion will affect a woman’s ability to get pregnantSimilarly, there is no such indication that shows a woman is affected related to her future ability to be pregnant 

Survey about the history of abortion process

“ Surgical abortions in the 1980s carried a 30 percent or greater risk for subsequent premature births. The discovery of gemeprost and misoprostol to soften the cervix reduced the risk to 10 to 20 percent in the 1990s. And most notably, there has been no link between an abortion and a subsequent premature delivery, starting from the year 2000. Medical abortion use increased from 18 percent to 68 percent from 1992 to 2008. Similarly, the surgical abortions occurring without cervical preparation decreased significantly at the same time, from 31 percent to 0.4 percent.

This suggests that the use of surgical abortion may have been responsible for the increased risk of spontaneous premature birth. The phasing out of this procedure, by the availability of safer methods, in the 1980s and 1990s may have led to the subsequent disappearance of the once existent link between the previous termination of a pregnancy and premature delivery from 2000 onward.” 

That’s the reason why medical abortion is more preferable these days: 

  • Requires no anesthetic;
  • The procedure is non-invasive;
  • You can maintain your privacy than with a surgical abortion;
  • As a non-surgical procedure, there are no surgical risks associated such as wound infection;
  • It feels ‘more natural’, as it is similar to having a heavy period

After abortion care

There are some after-care instructions which every healthcare provider gives to prevent unpleasant side-effects. 

  • Use heating pads to ease cramps.
  • Drink a lot of water if you’re experiencing vomiting or diarrhea.
  • Talk to people how you feel about abortion, as some women may experience emotional changes due to hormonal shift. 
  • If possible, take a rest and recover in the comfort of your own home instead of resuming back to work.
  • Take medication like ibuprofen to lessen cramps and discomfort.
  • Massage your abdomen at the site of the cramps.
  • Wear a tight-fitting bra to relieve breast tenderness.

How safe is abortion?

Majority of the abortion cases do not have complications. They are completely safe. Above all, the best time for terminating the pregnancy is the first trimester where a low-risk medicine and vacuum aspiration can be used. 

Is emergency contraception pill a type of abortion?

Emergency contraceptive pills are pills taken within 4 days after having unprotected sex to prevent pregnancy. They are not abortion pills, which means if you are already pregnant, they won’t end the pregnancy. 

Contraception after abortion

If you have had an abortion and you are still sexually active, talk to your doctor about contraception if you do not want another pregnancy. It is an important step before having sex after abortion. 

Miscarriage or spontaneous abortion

There are a lot of women in India, who choose to undergo abortion process every year. While for some women, it happens on its own. It is known as a miscarriage or spontaneous abortion.

Reasons for spontaneous abortion or miscarriage

The most common cause of spontaneous abortion is chromosomal abnormalities where it becomes difficult for the fetus to develop normally. Some of the reasons may not be in control. Other reasons may be: 

  • Thyroid disorder
  • Diabetes
  • Lifestyle
  • Physical complications
  • Immunological disorders
  • Blood clotting

Myths About Abortion

  • Abortion is dangerous

Fact: Abortion is a very say procedure to end or terminate your pregnancy. However, it is important that abortion must be performed by someone who is trained. 

  • Affects of abortion on future fertility

Fact: Abortion performed by qualified practitioners does not lead to any difficulty getting pregnant in the future. Most women return to their pre-pregnancy fertility immediately following the abortion procedure. A small number of women have a delay in the return of normal menstrual cycles.

  • Abortion causes health risks than continuing pregnancy and going for a childbirth

Fact: Studies have found that early or timely abortions do not increase the risk of miscarriage, preterm delivery, or other complications with future pregnancies.

  • Abortion causes emotional and mental harm

Fact: When the pregnancy is unplanned, it does not give any emotional or mental harm to a woman. Most of the women are very clear about their abortion which is generally about their health-enhancing concerns. So there arises no question about mental or psychological problems. 

  • Abortion causes breast cancer

Fact: There are no proven cases where a woman suffers from breast cancer due to abortion. Therefore, this is not true. 

  • Women prefer abortion pills instead of contraception

Fact: The truth is, women prefer abortion pills when contraceptive pills fail to prevent their pregnancies. As we all know that no contraceptive is 100% effective. This results in medical abortion. 

Abortion related FAQs

There are some common and frequently asked questions which must be answered for a woman who chooses abortion. 

  • How do I calculate my pregnancy?

Most pregnancies last around 40 weeks (or 38 weeks from conception), so typically the best way to estimate your due date is to count 40 weeks, or 280 days, from the first day of your last menstrual period (LMP).

  • How many weeks does a normal pregnancy last?

Pregnancy lasts for about 280 days or 40 weeks. A preterm or premature infant is delivered before 37 weeks of the pregnancy. Extremely preterm infants are born 23 through 28 weeks. Moderately preterm infants are born between 29 and 33 weeks.

  • Can I use tampons after abortion?

Doctors usually suggest not to use tampons for at least a week. 

  • How long it takes to stop bleeding after abortion?

It varies from one week to three weeks depending on the procedure you choose to terminate your pregnancy. 

  • How long it takes for the cervix to close after abortion?

After the abortion, a woman may be prone to infection as it can take some time for the cervix to close. To reduce the risk of infection, women should avoid – using tampons until their next period instead use sanitary pads for any bleeding, avoid having penetrative sex and putting anything in the vagina for 1–2 weeks.

  • What is the maximum time for abortion?

An abortion may be performed up to the time when the fetus is viable outside the mother’s body, which is 24 weeks. 

  • What are the risks of abortion?

Abortion treatment is very safe especially in the early weeks of pregnancy. The treatment and procedure may vary depending on the week of pregnancy a woman is into. 

  • Does the fetus feel anything?

The senses of the fetus are developed until 24 weeks. 

  • Can I travel after the treatment?

Doctors suggest not to travel within 24 hours after the abortion procedure. If you want to travel, make sure you know how to get emergency medical care if needed. If you choose to travel after taking the 2nd medication (misoprostol) of the abortion pill up to 9 or 10 weeks – you may have cramps and bleed heavily during travel.

  • Whom should I approach for abortion?

Abortion is performed by obstetrician-gynecologists with specialized training.

  • Can abortion be done at home?

Millions of women around the world have done safe medical abortions at home. For safety, what is important is that women have access to the medicines and get accurate information on how to use the medicines, what to expect after taking the medicines, and how to identify signs of a possible complication. 

  • Is it safe to use abortion pills?

The abortion pill is a safe & effective way to end an early pregnancy. “Abortion pill” is the common name for using two different medicines to end a pregnancy: mifepristone and misoprostol. Abortion pills can be used only till 10th week of pregnancy.

  • Do I need to take any precaution while taking abortion pills?

You may get heavy bleeding and cramping. Keep yourself hydrated to avoid diarrhea or constipation. 

  • What are the signs of miscarriage?

There are some women who do not get any symptoms while others get the following symptoms:

  • Mild to severe cramps.
  • Pain in your back or abdomen.
  • Loss of pregnancy symptoms, such as nausea or vomiting.
  • White-pink mucus.
  • Passing tissue or clot-like material.
  • How long will I bleed after abortion?

Bleeding after abortion is normal. How long you bleed for depends on the abortion method. Bleeding can vary. You may bleed for a long time or you may not bleed much at all. Bleeding after medical abortion can last for several week while after surgical methods can last for about two weeks. Either can be spotting or heavy. If you have very heavy bleeding you should seek advice straight away.

If you don’t have a period within 4–6 weeks of the abortion see your doctor or clinic as sometimes the pregnancy can continue. This is uncommon.

  • How soon after abortion should I start using contraception?

If you don’t want to get pregnant, you should start using contraception immediately after the abortion. Any method of contraception can be started at this time. If you start contraception immediately you’ll be protected from pregnancy straight away.

  • What to eat and avoid for faster recovery after abortion?

Foods that you must include after abortion are: proteins, low-fat dairy products, iron, fruits and vegetables and grains. Foods to avoid after abortion are: Soy products, artificial sweeteners, junk food, low-fiber starches and high-fat milk and meat.

Review about medical abortion

“I have a friend who was in a committed relationship and soon was going to get married to her boyfriend. A few months before the marriage, she came to know that she was pregnant. But being from a conservative family, she could not tell this to her family. She told her boyfriend about it and they decided to go for abortion as she thought she was not ready for this responsibility.  They looked for online abortion pills but to avoid any risk or complications both decided to get it done at the clinic. 

They started looking for a safe and accredited abortion clinic to terminate this pregnancy of 3 weeks. The search came to an end after consulting a gynecologist at Pristyn Care. The doctor suggested for medical abortion as there was no other complication involved in her pregnancy. She was given all the after-abortion instructions such as dates for her next periods, sexual activities and bleeding after abortion. It’s been 5 years of her marriage and now she has a 2 year old daughter.”

There are lots of resources available to help with any specific concerns or questions related to abortion. Write down and get answers to all your queries about abortion, so that you can get the right treatment at the right time. You can also book an appointment with us. Don’t worry, your privacy is our priority!

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