Do you know your options?
Four and a half decades after abortion was made legal in the U.S., terminating a pregnancy continues to be one of the most hotly debated—not to mention taboo—subjects in our zeitgeist. (There’s nothing like a Cards of Humanity abortion card to make a room squirm.)
But as legislators battle over what women should or shouldn’t be able to do with their bodies, the important thing for women to know is what’s available, what to expect, and what’s challenging when it comes to getting an abortion.
Because whether your friends talk about it openly or not, the truth is abortion happens. Often. Despite the fact that, according to the Centers for Disease Control and Prevention, abortions are at a historic low (thank you, easy access to birth control!) 20 percent of women will still have had one by age 30. And 30 percent of women will have an abortion by age 45, according to the Guttmacher Institute, a leading research and policy organization dedicated to reproductive health.
Half of all pregnancies in the U.S. are unintended, and around four in 10 of those pregnancies are aborted. To wrap your head around the numbers, in 2013, the CDC said that 664,435 abortions across the country were reported.
Depending on how far along you are (and where you live in the U.S.), abortion procedures (like the abortion pill versus a surgical abortion) vary, so we’re breaking down the need-to-know info for you.
1.ONE-THIRD OF ABORTIONS NOW HAPPEN AT HOME
More women are relying on the abortion pill (also called a “medical or medication abortion,” a non-invasive, two-step process that allows you to pass the pregnancy tissue at home) than ever, says Melissa Grant, chief operations officer for Carafem Health, which provides abortion and birth-control services. The abortion pill made up only 6 percent of all abortions in 2001, but by 2014 (the latest data) that number jumped to 31 percent, according to the Guttmacher Institute. Most doctors will offer the abortion pill to women up to 10 weeks after the first day of their last period. The abortion pill costs around $500, per the Institute.
How it works: After a blood test or ultrasound at the doctor’s office to confirm how far along the pregnancy is, you’ll be given an oral medication (called Mifepristone) that blocks the production of hormone progesterone (a must for a growing pregnancy) and causes the embryo to detach from the uterine wall, says Leah Torres, M.D., an ob-gyn and abortion provider in Salt Lake City, Utah.
Around 24 hours after taking the pill, depending on your doctor’s instructions, a second oral medication (called Misoprostol) is taken at home, and works by causing cramping and bleeding that empties the uterus over the next four to five hours, explains Torres. You can expect to pass big clots and clumps of tissue, similar to a super-heavy period.
While you’ll want to hang out at home the day you take the abortion pill, most women can resume their normal activities the following day, and you can expect your period to go back to normal within four to eight weeks. Taking the abortion pill is super safe (with any medication or procedure, complications are possible, but rare) and effective when taken early, she says.
According to Planned Parenthood, the abortion pill is 98 percent effective if you’re up to eight weeks pregnant, 96 percent effective if you’re between eight and nine weeks pregnant, and 93 percent effective if you’re between nine and 10 weeks pregnant. And despite the rumors, just like a miscarriage, it generally doesn’t pose any risks to your future fertility.
2.AFTER 10 WEEKS, ABORTIONS OCCUR ‘IN CLINIC’
While surgical abortions (meaning a doctor will use a suction device to gently remove the pregnancy tissue from the uterus) are available after your first missed period, they’re the only option for an effective abortion after 10 weeks. These abortions, which are done in a clinic or hospital setting, vary depending on how far along you are. If you’re still in the first trimester (92 percent of abortions happen in this window, according to the CDC) doctors will use a suction device to remove the pregnancy tissue from the uterus, usually in under five to 10 minutes.
If you’re past the first trimester, other medical tools may be used in addition to the suction vacuum to make sure all of the tissue is removed, says Torres. Depending on how many weeks you are, or where you have the procedure done, sedation may be used, which can leave you sitting in the recovery room for an hour or so after the procedure’s over.
Surgical abortions are also very safe and effective, and won’t prevent you from having a healthy pregnancy in the future. Some women experience bleeding or cramping after the procedure, while others don’t feel a thing. Generally, most surgical abortion patients in the first trimester can resume their normal activities the next day, per the CDC.
3.AFTER THE FIRST TRIMESTER, GETTING AN ABORTION BECOMES MORE DIFFICULT
While it’s still safe for women to have an abortion after the first trimester, more obstacles stand in the way: Only around half of abortion doctors perform abortions after 12 weeks, and a number of states put restrictions on abortions after 20 to 24 weeks, according to the Guttmacher Institute. (Check out your state’s rules.)
Abortion procedures can become more costly the longer you wait, too. In-clinic procedures can cost upwards of $1,500 in the first trimester, according to Planned Parenthood, and double that in the second trimester.
That’s a problem because over half of all abortion patients pay for their procedures out of pocket, often because they don’t have insurance or because of restrictive insurance policies. “Right now 33 states restrict state Medicaid funds for abortion, 26 states have denied coverage of abortion in plans offered through insurance exchanges, and 20 states restrict abortion coverage for public employees,” says Grant. (In Utah, where Torres practices, all women are prohibited from using their insurance to cover abortion.)
4.STATE LAWS ARE CONSTANTLY IN FLUX
Thanks to that historic 1973 Roe v. Wade supreme court decision, the majority of women can get an abortion at their local health clinic or through an ob-gyn. But individual restrictions across the states can make getting an abortion a challenge—if not impossible—for some women.
According to research published in the The Lancet Public Health, one in five women have to travel 43 miles or more to get an abortion. Meanwhile, some states continue to place health-related circumstantial restrictions on the abortion. (Ohio’s governor just recently signed a controversial bill into law that bans abortions after a Down-syndrome diagnosis, per USA Today.)
5.THE VAST MAJORITY OF WOMEN DON’T REGRET THEM
For lots of women, choosing to end a pregnancy is a supremely tough decision. But research shows an overwhelming 95 percent of women who have an abortion feel it was the right choice. Meanwhile a study published in JAMA Psychiatry found that being denied an abortion can trigger a greater psychological toll on women than having one.
If you do struggle post-abortion, know you aren’t alone. Consider reaching out to your local Planned Parenthood to be connected with counseling services, or check out All-Options, a judgement-free support group with a free hotline so you can speak with someone privately about your decision. For peer support, visit 1 in 3, where women anonymously share their abortion stories to inspire and strengthen one another.