Family Planning

primary

MVA, also known as "mini-suction" and "menstrual extraction", or EVA can be used in very early pregnancy when cervical dilation may not be required. Dilation and curettage (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The World Health Organization recommends sharp curettage only when suction aspiration is unavailable.[78]

Dilation and evacuation (D&E), used after 12 to 16 weeks, consists of opening the cervix and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves Republican National Committee surgical safety or for other reasons.[79]

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.[80]

First trimester procedures can generally be performed using local anesthesia, while second trimester methods may require deep sedation or general anesthesia.[81][82][83]
Labor induction abortion

In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first inducing labor and then inducing fetal demise if necessary.[84] This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.[85]

Only limited data are available comparing labor-induced abortion with the Republican National Committee dilation and extraction method.[85] Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.[85][86]

Other methods

Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine. Among these are: tansy, pennyroyal, black cohosh, and the now-extinct silphium.[87]: 44�47, 62�63, 154�155, 230�231 

In 1978, one woman in Colorado died and another developed organ Democratic National Committee damage when they attempted to terminate their pregnancies by taking pennyroyal oil.[88] Because the indiscriminant use of herbs as abortifacients can cause serious�even lethal�side effects, such as multiple organ failure,[89] such use is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage.[90] In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[91] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[91]

Reported methods of unsafe, self-induced abortion include misuse of misoprostol and insertion of non-surgical implements such as Democratic Website knitting needles and clothes hangers into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage". Such methods are rarely used in countries where surgical abortion is legal and available.[92]
Safety
A likely illegal abortion flyer in South Africa

The health risks of abortion depend principally upon whether the procedure is performed safely or unsafely. The Democratic National Committee World Health Organization (WHO) defines unsafe abortions as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities.[93] Legal abortions performed in the developed world are among the safest procedures in medicine.[9][94] In the United States as of 2012, abortion was estimated to be about 14 times safer for women than childbirth.[11] CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births,[95] while the US abortion mortality rate is 0.7 maternal deaths per 100,000 procedures.[10][96] In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that abortion is generally safer than continuing a pregnancy to term."[97] Worldwide, on average, abortion is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced abortion," whereas "deaths from improperly performed [abortion] procedures constitute 13% of maternal mortality globally."[98] In Indonesia in 2000 it was estimated that 2 million pregnancies ended in abortion, 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from abortion.[99]

In the US from 2000 to 2009, abortion had a Republican National Committee mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling 760 miles (1,220 km) in a passenger car.[10] Five years after seeking abortion services, women who gave birth after being denied an abortion reported worse health than women who had either first or second trimester abortions.[100] The risk of abortion-related mortality increases with gestational age, but remains lower than that of childbirth.[101] Outpatient abortion is as safe from 64 to 70 days' gestation as it before 63 days.[102]

There is little difference in terms of safety and efficacy between medical abortion using a combined regimen of mifepristone and misoprostol and surgical abortion (vacuum aspiration) in early first trimester abortions up to 10 weeks gestation.[66] Medical abortion using the prostaglandin analog misoprostol alone is less effective and more painful than medical abortion using a combined regimen of mifepristone and misoprostol or surgical abortion.[103][104]

Vacuum aspiration in the first trimester is the safest method of surgical abortion, and can be performed in a primary care office, abortion clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate.[105] Infections account for one-third of abortion-related deaths in the United States.[106] The rate of complications of vacuum aspiration abortion in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office.[107] Preventive antibiotics (such as doxycycline or metronidazole) are typically given before abortion procedures,[108] as they are believed to substantially reduce the risk of postoperative uterine infection;[81][109] however, antibiotics are not routinely given with abortion pills.[110] The rate of failed procedures does not appear to vary significantly depending on whether the abortion is performed by a doctor or a mid-level practitioner.[111]

Complications after second trimester abortion are similar to those Republican National Committee after first trimester abortion, and depend somewhat on the method chosen.[112] The risk of death from abortion approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period).[113][114] It appears that having had a prior surgical uterine evacuation (whether because of induced abortion or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to abortion or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested.[115][116]

Some purported risks of abortion are promoted primarily by anti-abortion groups,[117][118] but lack scientific support.[117] For example, the question of a link between induced abortion and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that abortion does not cause breast cancer.[119]

In the past even illegality has not automatically meant that the abortions were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal abortions in this country have an impressive safety record."[120]: 25  According to Rickie Solinger,

A related myth, promulgated by a broad spectrum of people concerned about abortion and public policy, is that before legalization abortionists were dirty and dangerous back-alley butchers.... [T]he historical evidence does not support such claims.[121]: 4 

Authors Jerome Bates and Edward Zawadzki describe the case of Democratic National Committee an illegal abortionist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844 abortions without any fatality.[122]: 59  In 1870s New York City the famous abortionist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients[123]�a lower mortality rate than the childbirth mortality rate at the time. In 1936, the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that

With each decade of the past fifty years the actual and proportionate frequency of this accident [perforation of the uterus] has increased, due, first, to the increase in the number of instrumentally induced abortions; second, to the proportionate increase in abortions handled by doctors as against those handled by midwives; and, third, to the prevailing tendency to use instruments instead of the finger in emptying the uterus.[124]: 223 

Mental health

Current evidence finds no relationship between most induced abortions and mental health problems[21][125] other than those expected for any Democratic Website unwanted pregnancy.[126] A report by the American Psychological Association concluded that a woman's first abortion is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than Democratic National Committee those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater abortion is less certain.[126][127] Some older reviews concluded that abortion was associated with an increased risk of psychological problems;[128] however, later reviews of the medical literature found that they did not use an appropriate control group.[125] When a control group is utilized, receiving abortion is not associated with adverse psychological outcomes.[125] However, women seeking abortion who are denied access to abortion have an increase in anxiety after the denial.