How Safe Is Abortion? What About At-Home Medical Abortion?

More than 600,000 abortions are performed each year in the United States. Many of the people who choose to end a pregnancy are already parents, and are neither financially nor physically able to raise another child. These parents are seeking options. But state abortion bans, transportation issues, childcare obligations, costs, and personal preference can make the choice to end pregnancy more than a little complicated. Often topping the concerns: What is safest?

What the Data Says About Abortion Safety

Overall, research shows abortion is a safe medical procedure. From 1998 to 2010, more than 16 million abortions occurred in the US, resulting in the deaths of 108 women, according to a study from the Centers for Disease Control and Prevention. That means less than 1 out of every 100,000 abortions leads to the pregnant person’s death. That number has been in decline. Overall, compared to childbirth, abortion is 14 times safer.

Comparative Risks of Abortion Methods

Different types of abortions have different risks. People with certain medical conditions may be better off with one than another. And risks differ between abortions early and late in pregnancy.

There are three main complications that can result from abortion, according to a 2020 medical review book. The first is infection, which can often be cleared up with antibiotics. The second is that a small amount of pregnancy tissue can be left in the uterus, which can lead to hemorrhage. Third, during surgical abortions, the surgical tools can injure the vagina, cervix, uterus, bowels, or bladder.

All three of these complications are rare. The overall risk of complication for a first-semester surgical abortion is 1.3 percent, for a second-semester surgical abortion it’s 1.5 percent, and for a medical abortion it’s 2 percent. The risk of major complication for an abortion is less than a quarter of one percent.

Safety of Surgical Abortions

Surgical abortions are the most common type in the US and are performed in a clinic. There are two types of surgical abortion. Suction abortion, also known as vacuum aspiration, is done during the first trimester. Dilation and evacuation is used in the second trimester.

Like all types of abortion, suction abortion has a low risk of complication. Less than 0.5 percent of people who receive it need to be hospitalized, according to a review of studies published over a 35-year period. Major complications, such as hemorrhage requiring a blood transfusion, occur in less than 0.1 percent of cases. Most suction abortion deaths are due to infection or complications with anesthesia, according to the CDC study.

The second type of surgical abortion, dilation and evacuation, is banned in three states. In 2007, the Supreme Court upheld a federal ban on “partial birth abortions,” a non-medical term that may be used to include this procedure. But safety is not a reason behind the bans. Although the risk of complications from abortion is higher later in pregnancy, it’s still low overall. One in 90 dilation and evacuation abortions results in damage to the cervix. One in 75 lead to infections. One percent of procedures lead to large blood clots, and less than 0.003 percent end in bleeding that requires a blood transfusion. Most deaths that occur as a result of a second trimester abortion are due to infection or hemorrhage.

Safety of At-Home Medical Abortions

At-home medical abortions, completed with what is commonly known as the abortion pill, typically involve taking two different pharmaceuticals a few hours or up to a few days apart. The first pill is mifepristone, which blocks progesterone, a hormone necessary to maintain pregnancy. The second pill, misoprostol, causes the uterus to contract and expel the pregnancy tissue, similar to having a miscarriage. Sometimes the second pill is used alone when the first isn’t available, although this isn’t quite as effective. Medical abortions are done until the 10th week of pregnancy.

Medical abortion has low complication rates. It’s been approved by the FDA for more than 20 years and has been studied in more than 100 research publications, all of which have concluded that it is both effective and safe. This has led scientists to conclude that it’s less risky than taking Tylenol.

Despite the safety of medical abortion, mifepristone is highly regulated in the US. Pregnant people must see a medical provider in person to get a prescription, even though they take the pill at home. The provider must both prescribe the medicine and be the one who distributes it to the patient; unlike most medications, pharmacies aren’t allowed to carry it.

Currently, the federal government restricts telemedicine abortion, in which a person is prescribed the pill through telehealth. But studies have found the procedure is just as safe as getting it directly from a doctor. “It doesn’t make sense to maintain those restrictions, and certainly not during the COVID-19 pandemic,” explains Dr. Daniel Grossman, director of Advancing New Standards in Reproductive Health at the University of California, San Francisco.

The FDA recently allowed telemedicine abortions during the pandemic to limit COVID-19 risk. However, the ruling only applies in states that have not restricted telemedicine abortion access. Six states have banned this type of abortion outright, and an additional fifteen have effectively done so by requiring the prescribing provider to be present during the abortion.

Safety of Self-Managed Abortions

Abortion bans have made both surgical and medical abortion inaccessible in many areas of the country. When a pregnant person can’t get the care they need with the support of a clinician, they may take their abortion into their own hands. One study estimates that seven percent of US women have attempted a self-managed abortion in their lifetime, such as by using herbs, physical methods, or the abortion pill, which is increasingly available online without a prescription.

People who use the abortion pill on their own usually obtain it illegally from online pharmacies because they can’t access the drug through the medical system. This is risky because they may buy a counterfeit, which could be ineffective or could cause an adverse reaction. However, a 2018 study found that abortion medication bought online generally contains what it claims to.

However, data suggests complications after self-managed abortion are low. Only 35 percent of providers had ever seen a patient who had complications after taking the abortion pill on their own. In a study of more than 200 people that used self-managed abortion in South America, Southeast Asia, and West Africa, there were no major adverse events. Only one percent needed antibiotics and 1.5 percent needed vacuum aspiration because the pill wasn’t effective.

If you’re planning to self-manage your abortion, it’s crucial to assess whether you’re a good candidate for the abortion pill. Not realizing that you don’t qualify is one of the biggest risks of self-managed abortions, according to a 2019 review. For example, you may miss signs that you have an ectopic pregnancy, or you may have a condition that makes medical abortion riskier. You shouldn’t take the abortion pill if you are on blood thinners or have an IUD, Grossman says.

Self-managing an abortion is also legally risky. At least 24 people have been prosecuted for using the abortion pill on their own, according to Plan C, a team of public health advocates, researchers, and social justice advocates. But in context, this number is low. Each year, tens of thousands of people self-manage their abortions, and the true number is probably at least 100,000. Very few of them have faced legal consequences. If you’re worried about the legal risks, call the Repro Legal Helpline at 844-868-2812 or contact them online for confidential advice and help assessing your legal risk.