Safety of Abortion

Abortion is one of the safest types of surgery. Complications from having an abortion in the first three months of pregnancy are considerably less frequent and less serious than those associated with giving birth.

Illegal Abortion Is Unsafe Abortion

Abortion has not always been so safe. Between the late 1800's and 1973, when abortion was illegal in all or most states, many women died or had serious medical problems after attempting to induce their own abortions or going to untrained practitioners who performed abortions with primitive instruments or in unsanitary conditions. Women streamed into emergency rooms with serious complications -- perforations of the uterus, retained placentas, severe bleeding, cervical wounds, rampant infections, poisoning, shock, and gangrene.

Around the world, in countries where abortion is illegal, it remains a leading cause of maternal death. In fact, many of the doctors who perform abortions in the United States today are committed to providing this service under medically safe conditions because they witnessed and still remember the tragic cases of women who appeared in hospitals after botched, illegal abortions.

Evaluating the Risk of Complications

Since the Supreme Court re-established legal abortion in the U.S. in the 1973 Roe v. Wade decision, women have benefited from significant advances in medical technology and greater access to high quality services¹. Generally, the earlier the abortion, the less complicated and safer it is. The safest time to have an abortion is between 6 and 10 weeks from the last menstrual period (LMP).

Serious complications arising from abortions before 13 weeks are quite unusual. About 88% of the women who obtain abortions are less than 13 weeks pregnant. Of these women, 97% report no complications; 2.5% have minor complications that can be handled at the physician's office or abortion facility; and less than 0.5% require some additional surgical procedure and/or hospitalization. Complication rates are somewhat higher for abortions performed between 13 and 24 weeks. General anesthesia, which is sometimes used in abortion procedures, carries its own risks.

In addition to the length of the pregnancy, significant factors that can affect the possibility of complications include:

• the skill and training of the provider;
• the kind of anesthesia used;
• the woman's overall health; and
• the abortion method used.

(See Fact Sheets: What is Surgical Abortion and What is Medical Abortion?)

Complications from Legal Abortion

Although rare, possible complications from an abortion procedure include:

• blood clots accumulating in the uterus, requiring another suctioning procedure, which occur in less than 1% of cases;
• infections, most of which are easily identified and treated if the woman carefully observes follow-up instructions, which occur in less than 3% of cases;
• a tear in the cervix, which may be repaired with stitches, which occurs in less than 1% of cases;
• perforation (a puncture or tear) of the wall of the uterus and/or other organs, which may heal itself or may require surgical repair or, rarely, hysterectomy, which occurs in less than 1/2 of 1% of cases;
• missed abortion, which does not end the pregnancy and requires the abortion to be repeated, which occurs in less than 1/2 of 1% of cases;
• incomplete abortion, in which tissue from the pregnancy remains in the uterus, and requires the abortion to be repeated, which occurs in less than 1% of cases;
• excessive bleeding caused by failure of the uterus to contract, which may require a blood transfusion, which occurs in less than 1% of cases.

Other Complications

Between 13 and 16 weeks, the dilation and evacuation (D&E) procedure is significantly safer and more effective than other second trimester abortion methods. After 16 weeks, the different methods carry about the same complication rates.

One death occurs for every 160,000 women who have legal abortions. These rare deaths are usually the result of such things as adverse reactions to anesthesia, heart attacks, or uncontrollable bleeding. In comparison, a woman's risk of death in carrying a pregnancy to term is ten times greater.

Signs of a Post-Abortion Complication

If a woman has any of the following symptoms after having an abortion, she should immediately contact the facility that provided the abortion:

• severe pain;
• chills or fever with an oral temperature of 100.4 or more;
• bleeding that is heavier than the heaviest day of her normal menstrual period or that soaks through more than one sanitary pad per hour;
• foul-smelling discharge or drainage from her vagina; or
• continuing symptoms of pregnancy.

Doctors and clinics that offer abortion services should provide a 24-hour number to call in the event of complications or reactions that the patient is concerned about.

Preventing Complications

There are some things women can do to lower their risks of complications. The most important thing is not to delay the abortion procedure. Generally, the earlier the abortion, the safer it is.

Asking questions is also important. Just as with any medical procedure, the more relaxed a person is and the more she understands what to expect, the better and safer her experience usually will be.

In addition, any woman choosing abortion should:

• find a good clinic or a qualified, licensed practitioner. For referrals, call NAF's toll-free hotline, 1-800-772-9100 or 1-877-4ProChoice;
• inform the practitioner of any health problems, current medications or street drugs being used, allergies to medications or anesthetics, and other health information;
• follow post-operative instructions; and
• return for a follow-up examination.

Anti-abortion Propaganda

Anti-abortion activists claim that having an abortion increases the risk of developing breast cancer and endangers future childbearing. They claim that women who have abortions without complications will still have difficulty conceiving or carrying a pregnancy, will develop ectopic (outside of the uterus) pregnancies, will deliver stillborn babies, or will become sterile. However, these claims have been refuted by a significant body of medical research. Furthermore, they are not considered warranted by organizations such as the American Cancer Society, the National Cancer Institute, or National Breast Cancer Coalition.

Women's Feelings after Abortion

Women have abortions for a variety of reasons, but in general they choose abortion because a pregnancy at that time is in some way wrong for them. Such situations often cause a great deal of distress, and although abortion may be the best available option, the circumstances that led to the problem pregnancy may continue to be upsetting.

Some women may find it helpful to talk about their feelings with a family member, friend, or counselor. Feelings of loss or of disappointment, resulting, for example, from a lack of support from the spouse or partner, should not be confused with regret about the abortion. Women who experience guilt or sadness after an abortion usually report that their feelings are manageable. The American Psychological Association concludes that there is no scientifically valid support or evidence for the so-called "post-abortion syndrome" of psychological trauma or deep depression. The most frequent response women report after having ended a problem pregnancy is relief, and the majority are satisfied that they made the right decision for themselves.

National Abortion Federation
1755 Massachusetts Avenue NW, Suite 600
Washington, DC 20036
(202) 667-5881

Writers: Susan Dudley, PhD and Stephanie Mueller
Copyright© 2000, National Abortion Federation