In our society, it’s not always easy to talk about abortion. People’s opinions on the abortion issue vary, as does the degree of emotion attached to these opinions. Many people feel strongly about aspects of the abortion issue, and conversations easily become polarized and volatile. Still, this doesn’t mean we have to avoid talking about it altogether. This article aims to offer a starting point to dialogue about abortion in a way that is equally sensitive and informed. 

If you yourself have never had or participated in an abortion(s), chances are you know someone who has. One in four women in the US has an abortion before the age of 45 (1). Abortion is not an abstract concept; it’s a commonly lived experience. Recognize, too, that everyone has a different abortion experience. As we learn more about the topic of abortion, we continue to make space for various emotional responses to abortion experiences, even those we don’t expect. 

Whenever we dialogue about any topic, it’s best to be well-informed. This article will give you some basic facts regarding abortion laws, procedures, and process, with citations for further research. Consider this article a launching point. It is not a replacement for your own research, but merely a place to begin by equipping yourself with information and empathy.

What is Abortion?

The term abortion refers to the intentional termination of a pregnancy. If you have ever heard the term spontaneous abortion, this refers to miscarriage, or the sudden loss of pregnancy before 20 weeks. When used on its own, however, the term abortion generally implies that a medical or surgical procedure took place to terminate the pregnancy.

Types of Abortion Procedure

Two categories of abortion exist: medical and surgical. Medical abortion refers to the use of medication, or “abortion pills,” to terminate a pregnancy. Surgical abortion refers to various types of surgical procedures used to extract a pregnancy from the uterus. 

Medical Abortion 

In the US, medical abortion is growing towards being the most popular abortion option (2). Also known as chemical abortion or medication abortion, abortion pills include two medications: mifepristone and misoprostol.

Mifepristone, the first medication, blocks progesterone, a hormone necessary to sustain an early pregnancy. Every month, during the ovulation phase of your menstrual cycle, your body produces progesterone to prepare your uterine lining for a fertilized egg to implant and grow. If you don’t get pregnant during that cycle, progesterone levels decrease, causing your uterine lining to grow thin and break down. This begins your menstrual period. 

If you do become pregnant, progesterone production continues and increases throughout the remainder of your pregnancy. Progesterone thickens the lining of your uterus for early pregnancy. As the pregnancy continues, it maintains the thickened lining to provide nutrients to nourish the growing embryo. (It also prevents your body from ovulating while you are pregnant, suppresses uterine contractions to help avoid preterm labor, and prepares your breasts for breastfeeding.) Without progesterone, a pregnancy cannot survive. 

By blocking progesterone, mifepristone begins the abortion process. 24-48 hours after taking mifepristone, misoprostol is taken to complete a medical abortion. Misoprostol causes uterine contractions and bleeding to expel the pregnancy through the vagina.  

Medical abortion is FDA-approved up to 10 weeks gestation. Once someone has passed 70 days since the first day of her last menstrual period, it is no longer safe to take abortion pills. Additionally, the FDA prohibits certain people from taking abortion pills, including anyone: 

• Experiencing an ectopic pregnancy (a pregnancy outside the uterus) 
• Having problems with the adrenal glands
• Currently being treated with long-term corticosteroid therapy 
• Allergic to mifepristone, misoprostol, or similar drugs   
• Taking anticoagulants (blood thinners) or who has bleeding problems 
• With inherited porphyria
• With an IUD (intrauterine device) in place 

Some risks of medical abortion include (3): 

• Severe bacterial infection or sepsis (can result in death)
• Heavy bleeding requiring surgery or transfusion 
• Incomplete abortion
• Ruptured ectopic pregnancy 
• Ruptured uterus 
• Allergic reaction (anaphylaxis) 

Surgical Abortion 

While medical abortions are often administered via telehealth or self-managed at home, surgical abortions require going into a clinic for the procedure. There are different types of surgical abortion that depend primarily on gestational age, among other factors. 

Surgical abortion is a procedure that ends a pregnancy by removing the fetus and placenta from the womb (uterus). There are two types of surgical abortions: vacuum aspiration and dilation and evacuation (aka D&E). 

Vacuum aspiration involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. Suction is used to remove the fetus and all related pregnancy material from the uterus through the suction tube. Vacuum aspiration can only be done in the first trimester, up to 13 weeks, 6 days. 

Dilation and evacuation involves a provider inserting a speculum into the vagina, much like what you would expect during a pap smear. They will then use dilators to open the uterus (cervix). The provider will use forceps to remove the pregnancy tissue and after the tissue is removed, they will use suction to remove any remaining tissue that may be left behind. This procedure is used in pregnancies that are 14 weeks or greater. In Massachusetts, dilation and evacuation is available up to 24 weeks of pregnancy. 

In some cases, if you are past 24 weeks of pregnancy, the provider will initiate an induction abortion. The provider will first stop the heart rate of the pregnancy. After the heart rate has stopped, the provider will give you medications to induce labor which will expel the contents of the uterus. This may be a two day process, or longer, depending on the gestational age at which you terminate. 

According to the National Library of Medicine, some risks associated with surgical abortions include (4): 

• Damage to the womb or cervix
• Uterine perforation (accidentally putting a hole in the uterus with one of the instruments used)
• Excessive bleeding
• Infection of the uterus or fallopian tubes
• Scarring of the inside of the uterus
• Reaction to the medicines or anesthesia, such as problems breathing
• Not removing all of the tissue, requiring another procedure

Abortion Laws

After the Supreme Court ruled on the Dobbs v. Jackson case in June 2022, decisions regarding abortion laws were returned to the states. As each state now establishes its own abortion laws, some states have greatly increased restrictions on abortion access. Massachusetts, however, is not one of those states. Massachusetts abortion laws allow for pregnancy termination in any stage of pregnancy, although past 24 weeks it requires a physician to determine the abortion is medically necessary. 

Emotional Responses to Abortion

Here we enter a more nuanced aspect of the conversation on abortion. The impact of abortion on mental and emotional health is highly debated. One 2018 Comprehensive Literature Review explored the controversy, concluding that the disagreement is driven by how two perspectives interpret accepted facts. One side emphasizes mental health risks associated with abortion, while the other side emphasizes pre-existing risk factors. The first says mental health is impacted by abortion. The second says it is not. According to this study, however, there are four areas where both sides agree (5): 

1. Abortion is consistently associated with higher rates of mental illness compared to women with no history of abortion. 
2. The abortion experience directly contributes to mental health problems for at least some women.
3. There are risk factors, such as pre-existing mental illness, that place women at greatest risk of mental health problems after an abortion.
4. There is no way to conduct research in this field that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. 

Essentially, this study showed that there are ways we can observe correlations between a history of abortion and mental illness, but we cannot exactly measure how much abortion contributes to those issues, among other factors. Thus, people tend to interpret the information according to what they already believe. 

Whatever you personally believe about abortion and mental health, it is important not to use your own beliefs to minimize someone’s lived experience. Some studies have shown that relief is the most common emotion reported after an abortion, and that relief can be accompanied by feelings such as sadness, guilt, and regret (6). Humans are complicated. Emotions can contradict each other, and it’s possible to feel both relief and regret about the same choice. Yet we cannot disenfranchise what someone feels because it doesn’t fit within our expectation of what “should” happen, one way or the other. 

In light of all this information, let’s remember to be kind to each other! You don’t have to agree with someone to treat them with dignity and respect. Do your research and get good information, AND show kindness to those who disagree with you. We can all do both.

After-Abortion Resources

While everyone’s experience with abortion is their own, it is not uncommon for feelings of pain, grief, and loss to surface after an abortion experience. Any experience of an unexpected or stressful event or a sudden loss can impact our mind and emotions. You may not have expected these feelings, or you may feel like your feelings don’t match the stories you’ve heard about other women’s abortions. If so, be assured that your feelings are valid, and trying to convince yourself that you shouldn’t feel this way won’t change them. Instead, allow yourself space to process and work through them. 

If you would like to talk to someone about your abortion(s), a member of our After-Abortion Care team would be happy to meet with you. Call our office at (508) 438-0144 or email clearpast@clearwayclinic.com to set up a meeting. If you are currently experiencing an unplanned pregnancy, schedule a free ultrasound to confirm viability, receive resources, and understand your options. 

Reviewed by Rebekah B., MSN RN & Amy G., L.I.C.S.W.

1. https://www.guttmacher.org/news-release/2017/abortion-common-experience-us-women-despite-dramatic-declines-rates
2. https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions
3. Mifeprex Label (2016), Table 4
4. Abortion – surgical: MedlinePlus Medical EncyclopediaDifferent types of abortion: When you can have them and the procedures (medicalnewstoday.com)
5.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207970/
6. https://www.ibisreproductivehealth.org/sites/default/files/files/publications/LAI_factsheet_Mental_health_Apr18.pdf