With recent laws restricting and expanding access to abortion care across the country, the word "abortion" comes across my social media and news feeds multiple times a day. Unfortunately, there's also a slew of misinformation out there about abortion, and more specifically, the types of abortions available to people. As a result, it can be pretty difficult to separate fact from fiction, medicine from politics, and obtain information, support, and the funds to access the care you want or need.
To find out more about the different abortion care options, and clear up some prevailing and common myths, Romper spoke to Dr. Diane Horvath, M.D., a Baltimore-based OB-GYN, abortion provider, fellow at Physicians for Reproductive Health, and medical director at Whole Woman’s Health. According to Horvath, there are a number of types of legal abortion procedures available to people who want or need them, depending on where a person lives, how far along in in their pregnancy they are, and their specific medical history.
Abortion is an incredibly common medical procedure — a reported one in four women will have an abortion before they're 45, according to the Guttmacher Institute. And the majority of Americans support access to abortion in all or most cases — 60% of Americans now say that abortion should be legal in all or most cases, a 24-year high, according to an ABC News/Washington Post poll. Still, because this form of reproductive health care has been highly-politicized, it can be difficult for people to obtain facts-based, judgement-free information about their medical options. But learning about the different types of abortion from an abortion provider on the front lines of abortion care can help you make an informed decision about your health care if and/or when you ever need or want to end a pregnancy:
You may have seen the phrase "spontaneous abortion" in a news report or on a medical history form, but according to the American College of Obstetrics and Gynecology, spontaneous abortion does not refer to an abortion procedure. Rather, the terminology is used in the medical world interchangeably with miscarriage and early pregnancy loss in the first trimester. "The word 'spontaneous' differentiates it from an induced abortion," Dr. Horvath tells me, 'which is when either a procedure or medication is used to end a pregnancy."
When most people think about abortion, the image that comes to mind is going to a clinic that provides abortion to have a procedure. According to Horvath, that procedure is known as a surgical abortion, but this option is not as invasive or risky as it might sound.
"Surgical abortion, which is also called in-clinic abortion, is typically a short, five-minute procedure in an office setting," Dr. Horvath tells Romper. "Another word you might hear people use to refer to a surgical abortion is aspiration abortion."
A surgical abortion typically involves numbing your cervix, dilating it with medication or a series of thin rods, inserting a thin tube, and using suction and/or a surgical tool to remove your pregnancy, per the Planned Parenthood website.
The same site notes that an in-clinic abortion is one of the safest medical procedures you can get (Abortion is 14 times safer than giving birth, 40 times safer than a colonoscopy, and a person is more likely to experience complications from a wisdom tooth extraction than an abortion procedure.) In other words, the risk of serious complications is rare and depends on how far along you are in your pregnancy or if you received anesthesia. "A person having an in-clinic abortion is offered various medications to help with discomfort, and most often a follow-up visit is not needed," Dr. Horvath explains.
Unfortunately, as the Guttmacher Institute reports the number of clinics providing surgical abortions fell from 839 to 788 between 2011 and 2014, leaving 90 percent of counties and 39 percent of women of reproductive age without access to a provider.
If you find out you're pregnant early on, most patients are able to choose between an in-clinic abortion or medication abortion (sometimes called the abortion pill, medical abortion, or RU486), Dr. Horvath says. This option allows people to take a medication in office, and then complete the abortion process in the comfort of their own home. "Medication abortion usually involves two different medications, and the experience is similar to having a miscarriage," Dr. Horvath tells me. "People having medication abortions leave the clinic with a plan for discomfort and follow up."
Per Planned Parenthood Federation of America's website, medication abortions — using mifepristone and misoprostol, two oral medications — are available up to the 10th week of pregnancy, but are most effective at eight weeks gestation or earlier — a reported 94 to 98 per 100 people who get the procedure will successfully terminate their pregnancy, compared to 91 to 93 people at nine to 10 weeks pregnant. The same site notes that if it doesn't work the first time, you may be able to take the medication again or have a surgical abortion at a health care center.
While surgical abortions are still the most common in the U.S., the Guttmacher Institute notes that medication abortions represent a growing number of abortions and accounted for 31 percent of all abortions in 2014, up from just 6 percent in 2001.
Multifetal Pregnancy Reduction
A multifetal pregnancy reduction is a medical procedure offered to a person carrying multiples to reduce the total number of fetuses they are carrying, according to the American College of Obstetricians and Gynecologists.
"In certain circumstances when a person is pregnant with multiple fetuses — usually triplets or more — the health of the pregnant person and the pregnancy can be threatened," Dr. Horvath says. "When this situation occurs, a patient may discuss with their physician reducing the number of fetuses to increase the chances that the pregnancy will progress safely and result in a healthy delivery instead of a pregnancy loss."
The ACOG's committee opinion on multifetal pregnancy reduction provides guidance to physicians regarding offering this care, and recommends that pregnant people carrying three or more fetuses receive information and be able to make choices about pregnancy reduction themselves.
"Because these circumstances are so medically complex, it's absolutely essential that decisions about management of high-risk pregnancies are made by patients and their health care providers, not by politicians," Dr. Horvath says.
According to Dr. Horvath, many terms commonly used to describe abortion options, such as "elective abortion," "therapeutic abortion," and "late-term abortion" are outdated, not medically accurate, and often politically charged. Instead, Dr. Horvath prefers to use either "spontaneous abortion" or "induced abortion."
"Spontaneous abortion can mean a miscarriage that passes out of a pregnant person's body, or a pregnancy that stops growing and requires medication or a procedure to remove it," she says. "An induced abortion is either a procedure or a series of medications that are used to end a pregnancy. The medical process in these latter two experiences are the same."
Abortion Later In Pregnancy
The correct terminology to describe terminating a pregnancy in the late second- or third-trimester is "abortion later in pregnancy," Dr. Horvath says. It is not "late-term" abortion, as that is not a medically accurate. "Late-term" means pregnancies that go beyond 41 weeks, and no one is having an inducted abortion after 41 weeks. So-called "late-term" abortions simply do not exist.
According to the Boulder Abortion Clinic's website, a health clinic that provides abortions later in pregnancy, surgical abortions that occur in the second- and third-trimester of pregnancy are similar to surgical abortion procedures that happen earlier in pregnancy, but extra steps are taken to reduce risks to the patient. The website notes that the procedure involves injecting medication into the fetus to stop the heart, while the patient receives local anesthesia.
Thin rods, called laminaria ,are then inserted into the patient's cervix to stretch it — a process that can take two or three days. Once the cervix is stretched sufficiently, the OB-GYN and abortion provider will break the patient's amniotic sack to induce abortion. The same site notes that procedures "may require that the physician perform a surgical evacuation of the uterus ("dilation and evacuation" or "D & C") using instruments such as forceps to remove the fetus and placenta."
As the Washington Post reports, these procedures are rare and done for health reasons or because of a fetal anomaly. Anti-abortion laws that restrict access to abortion care also cause an increase in abortions later in pregnancy, according to a 2019 study from the Texas Policy Evaluation Project.
"There are numerous complex circumstances in which someone may need an abortion later in pregnancy, and it's important to note that bans on abortion at any stage of pregnancy harm people who need this care," Dr. Horvath tells me. "Whatever the reason for needing an abortion later in pregnancy, patients deserve to get expert, compassionate health care and they shouldn't need to jump through political hoops to get it."