What Are the Different Types of Abortion?

Know How Far Along You Can Be to Safely and Legally Have an Abortion

Young woman patient with gynecologist in the office
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An abortion is a procedure in which a woman, assisted by members of the medical community or not, terminates her pregnancy, generally within the first few months, before the embryo is old enough to live outside of the womb.

Two types of abortion procedures are legally available to women in the United States to terminate a pregnancy: so-called medication abortions, which are drug-induced, and surgical abortions, which require out- or inpatient surgery.

The risk of complications from abortion is today very small. A fraction of a percentage of abortion patients have complications that require hospitalization—less than 0.3 percent have long-term risks. Abortions are also decreasing in frequency: approximately 926,000 abortions (14.6 per 1,000 women ages 15–44) were performed in 2014, down 12 percent from 2011.

Trimesters and Abortions

A woman's (and her doctor's) choice on how to terminate a pregnancy depends on the availability of abortion services along with the length of pregnancy. Most women facing an unplanned pregnancy who opt for an abortion do so early on. Roe v. Wade, the landmark Supreme Court decision making abortions legal in the United States, established ground rules for the ability of individual states to regulate (surgical) abortion access to women, based on how far the pregnancy has progressed.

  • First trimester (first three months): The states cannot regulate abortions beyond requiring that the procedure is performed by a licensed doctor in medically safe conditions. In 2014, the last year that the U.S. Center for Disease Control provided statistics on abortion, 88 percent of U.S. abortions took place during the first trimester.
  • Second trimester: The states may regulate abortion if the regulations are reasonably related to the health of the pregnant woman. Ten percent of abortions occurred in the second trimester in 2014.
  • Third trimester: The state's interest in protecting the potential human life outweighs the woman's right to privacy, and the state may prohibit abortions unless an abortion is necessary to save her life or health. Two percent of all abortions take place during the third trimester.

    Medication Abortions

    Medication abortions do not involve surgery or other invasive methods but rely on medications to end a pregnancy.

    A medication abortion involves taking the drug mifepristone; often called the "abortion pill"; its generic name is RU-486, and its brand name is Mifeprex. Mifepristone is not available over the counter and must be provided by a healthcare professional. A woman seeking a medication abortion can obtain one through a doctor's office or clinic and should expect two or more visits to complete the process, as another drug, misoprostol, must be taken to terminate the pregnancy first. In many cases, mifepristone may be taken at home following a provider visit.

    Mifepristone is prescribed in the first trimester and is FDA-approved for use up to 70 days (10 weeks) after a woman's last period. In 2014, medication abortions made up 31 percent of all nonhospital abortions, and 45 percent of abortions before nine weeks of gestation.

    Surgical Abortion: First Trimester

    All surgical abortions are medical procedures that must be done in a health care provider's office or clinic. Two surgical abortion options are available to women during the first trimester.

    D&A (dilation and aspiration): Dilation and aspiration abortions, also known as vacuum aspirations, involve using gentle suction to remove fetal tissue and empty the woman's uterus.

    This procedure can be performed on a woman on an outpatient basis for up to 16 weeks after her last period.

    D&C (dilation and curettage): D&C abortions combine suction with the use of a spoon-shaped instrument called a curette to scrape the uterine lining to remove any remaining tissue. This procedure can be performed again on an outpatient basis during the first trimester.

    Second-Trimester Abortions

    Second-trimester abortions must take place in a hospital setting, and they generally require a hospital stay and are far more frequently regulated by the states.

    D&E (dilation and evacuation): D&E abortions are typically performed during the second trimester (between the 13th and 24th weeks of pregnancy). Similar to a D&C, a D&E involves other instruments (such as forceps) along with suction to empty the uterus.

    In later-second-trimester abortions, a shot administered through the abdomen may be necessary to ensure fetal demise before the D&E begins.

    As of June 2018, D&E abortions have been banned in two U.S. states (Mississippi and Texas); both states allow exceptions in the case of life or severe physical health threats to the woman. Legislation to ban the procedure is currently temporarily or permanently enjoined in six others.

    D&X (dilation and extraction): About 0.2 percent of the abortions performed per year occur during later-term pregnancies, and are called dilation and extraction (D&X) procedures, or partial birth abortions. Used mainly for medical reasons when the health or life of the mother is at risk as a result of the pregnancy, the fetus is dismembered and removed from the womb.

    D&X abortions are banned in 20 states; enforcement of the state laws is permanently or temporarily enjoined by court order in most other states. Exceptions are made for life endangerment or health reasons in three of the 20 states banning the process; 10 states allow D&X only if the woman's life is endangered.

    A Bit of Historical Background

    Prior to the 19th century, abortion was not legally regulated, but by the 1890s, abortion was legally restricted in almost every country in the world. Those laws were first established in the imperial countries of Europe—Britain, France, Portugal, Spain, and Italy—and quickly spread to their colonies or former colonies. The laws were instituted for three stated or unstated reasons:

    • Abortion was dangerous and abortionists were killing a lot of people.
    • Abortion was considered a sin or a form of transgression.
    • Abortion was restricted to preserve fetal life in some or all circumstances.

    In the United States, abortion was criminalized in the 1880s, but that didn't stop abortions. A wide range of dangerous and ineffective abortifacients such as pennyroyal pills, ergot, and slippery elm was available everywhere from barbershops to gas stations to shoeshine parlors. By the 1960s, women had an underground referral service known as "Jane," and a political action group known as the Redstockings. Eventually, that activism led to Roe v. Wade.

    Availability of Abortions World Wide

    Today, abortions are regulated in different ways in different countries and cultures. National constitutions include abortion rules in at least 20 countries, and other regulations are set in high court decisions, customary or religious laws, confidentiality among health professionals, medical ethics codes, and clinical and other regulatory guidelines.

    But laws and policies can be sabotaged, and access to abortion can be restricted by public shaming and demonstrations at clinics, bureaucratic obstacles such as unnecessary medical tests, required counseling even if women feel no need for it, having to wait to make an appointment, or having to obtain consent from a partner, parent, or guardian.

    By the end of the 20th century, abortion was legally permitted to save the life of the woman in 98 percent of the world's countries.

    In 2002, globally, abortions were legal under the following circumstances:

    • 63 percent of countries allow abortions to preserve the woman's physical health.
    • 62 percent to preserve the woman's mental health.
    • 43 percent in the case of rape, sexual abuse, or incest.
    • 39 percent for fetal anomaly or impairment.
    • 33 percent for economic or social reasons.
    • 27 percent on request.

    Some countries permit additional grounds for abortion, such as if the woman has HIV, is under the age of 16 or over the age of 40, is not married, or has many children. A few also allow it to protect existing children or because of contraceptive failure.

    Global Rules and Restrictions

    The right to abortion is commonly used as a political football for politicians, a hot button for and against women, and as a result, countries change their laws with administrations, swinging from very permissive to very restrictive in the space of a few months.

    In the U.S., attitudes toward abortion in the various states range from extremely hostile—10 states have between six and 10 different regulations affecting women's access—to supportive, with 12 states having no more than one regulation. The number of states supportive of abortion rights fell from 17 to 12 between 2000 and 2017. In Australia, each state and the Capital Territory has a different law, ranging from very liberal to very restrictive. In Canada, abortions have not been restricted since 1988 and are available on request with no stipulations throughout the country.

    In Chile, El Salvador, Honduras, and Peru, abortion is severely legally restricted. In Africa, the Maputo Protocol is legally binding in 49 signatory countries, which calls for safe abortions "in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother and fetus."

    Sources

    "The Abortion Pill." Mifepristone.com. 2010. Web.

    "The Abortion Pill." Planned Parenthood n.d. Web.

    "Bans on Specific Abortion Methods Used After the First Trimester." Guttmacher Institute. June 2018. Web.

    "Fact Sheet: Induced Abortion in the United States." Guttmacher Institute. January 2018. Web.

    Armitage, Hannah. "Political Language, Uses and Abuses: How the Term 'Partial Birth' Changed the Abortion Debate in the United States." Australasian Journal of American Studies 29.1 (2010): 15–35. Print.

    Berer, Marge. "Abortion Law and Policy Around the World in Search of Decriminalization." Health and Human Rights 19.1 (2017): 13–27. Print.

    Daniel, H., et al. "Women's Health Policy in the United States: An American College of Physicians Position Paper." Annals of Internal Medicine 168.12 (2018): 874–75. Print.

    Gillette, Meg. "Modern American Abortion Narratives and the Century of Silence." Twentieth-Century Literature 58.4 (2012): 66387. Print.

    Hayler, Barbara. "Abortion." Signs 5.2 (1979): 30723. Print.

    Kumar, Anuradha. "Disgust, Stigma, and the Politics of Abortion." Feminism & Psychology. (In press 2018). P rint.

    White, Katharine O., et al. "Second-Trimester Surgical Abortion Practices in the United States." Contraception 98.2 (2018): 95–99. Print.

    Types of Abortion Key Takeaways

    • In the U.S., there are four types of surgical abortion and one type of medication abortion that are legal for women and their doctors to use.
    • The availability of those methods is dependent on state and local regulations, as well as how long a woman has been pregnant and why the pregnancy should be terminated.
    • World regulations of abortions vary considerably, from very restrictive to very supportive.