Safe abortion

Abortion occurs when a pregnancy is ended. It can happen spontaneously, also referred to as miscarriage, or as the result of a deliberate intervention.

An abortion is considered safe if it’s carried out by a trained professional using a method recommended by the World Health Organization (WHO) and appropriate to the pregnancy duration. If any of these conditions is not met, the abortion is unsafe.

Unsafe abortions are mainly categorized categories for unsafe abortions areas “less safe” and or “least safe.” “Less safe” abortions involve either an outdated, unsafe method or a lack of access to proper information; “least safe” abortions involve both. Examples we see in our projects include inserting sharp sticks or needles into the uterus; ingesting harmful substances such as bleach, battery acid, or chlorine; using external force on the abdomen; and using medications incorrectly and without appropriate support.

Safe abortion care can be provided either with medications or with an outpatient procedure.

Medication abortion, meaning an abortion with pills, involves two drugs: mifepristone and misoprostol. Mifepristone blocks progesterone, one of the main hormones of pregnancy, while misoprostol causes the uterus to contract and push out the pregnancy in a process similar to miscarriage. If mifepristone is not available, then misoprostol alone can also be used to induce an abortion.  Misoprostol is widely available around the world since it is also used to treat other complications of pregnancy, including spontaneous miscarriage and post-partum bleeding.

An abortion with pills is over 95% effective and is extremely safe, with less than a 1% chance of severe complications. The risk of death from a safe abortion is lower than from an injection of penicillin or from carrying a pregnancy to term. An abortion with pills is so safe that most of the time, women and other pregnant people can take the medications at home without routine follow-up—they need to seek care only if they have a question or problem. Abortion does not cause infertility, mental health problems, or problems with future pregnancies.

Providing or supporting an abortion with pills doesn’t require any special technology or medical interventions. According to the World Health Organization, routine blood tests, ultrasound, and follow-up are unnecessary; a safe abortion with pills requires only accurate information, quality medications, and mutual respect and trust. Because of this, medication abortion has expanded access to safe abortion care for millions of people around the world—especially in low-resource and crisis settings.

Manual vacuum aspiration (MVA) is a simple outpatient procedure that involves inserting a narrow plastic tube into the uterus and safely removing the pregnancy using suction. MVA can be performed by many different kinds of health care workers (including doctors, nurses, and midwives) and in basic health care centers (without surgical services) until 14 weeks of pregnancy. It can also be used to treat abortion-related complications such as incomplete abortion.

Anyone with an unwanted pregnancy who cannot access safe abortion services is at risk of injury or death from unsafe abortion. Barriers to safe abortion, like high cost, legal restrictions, stigma, and objections from health care providers all contribute to higher rates of unsafe abortion. The risk of complications also increases when unsafe abortions are performed later in pregnancy.

Abortion shines a light on social injustices and inequities. Poor women, women of color, women living in remote areas, and people in neglected communities are disproportionately cut off from safe abortion services. Women, girls, and others trapped in war, crisis, and conflicts often face additional barriers to accessing abortion care.

When safe abortion care is inaccessible, many women and girls turn to dangerous methods of ending their pregnancies, regardless of safety and legal restrictions. Major life-threatening complications include hemorrhage (severe bleeding), infection and sepsis (severe body-wide blood infection), perforation of the uterus, and injury to the genital tract or other internal organs. People who access abortion medications on the black market may also suffer complications due to low-quality drugs, incorrect dosing, or inadequate information. Even if effective at terminating the pregnancy, unsafe abortion can lead to long-term health consequences such as infertility, chronic pain, and emotional and psychological trauma.

Much of the mortality associated with unsafe abortion is due to delayed treatment. Abortion-related stigma often plays a big role in these delays: women may be afraid to seek care for complications from unsafe abortion because they fear being reported to the authorities, treated badly by health care providers, and/or seen by someone they know. 

Once at the hospital, those who undergo unsafe abortions may require blood transfusions to treat heavy blood loss, antibiotics to treat infection and sepsis, major reparative surgery of internal organs, or even a hysterectomy (removal of the uterus).

Prevention begins with reducing the number of unsafe abortions, which in turn requires access to health services—such as sexuality education and contraceptive care—aimed at preventing unwanted pregnancies. However, education and contraception alone are not enough: people who can become pregnant also need access to timely, confidential, and safe abortion care services. Reducing barriers to obtaining these services is essential to saving lives and preventing injuries and disability.

Abortion is still partly criminalized in many countries, although nearly all of them make exceptions to save the woman’s life and, in the majority of countries where MSF works, to preserve her health. Legal frameworks around abortion are complex and nuanced, and can be difficult for patients and medical providers to navigate. Legal limitations are especially concerning given clear evidence that they do not lower the number of abortions but instead make unsafe abortion more likely. Given this mounting evidence, in recent years many countries have revised their laws to permit abortion under a broader set of circumstances, with the result that maternal deaths have decreased. For example, since South Africa's post-apartheid government adopted the Choice of Termination of Pregnancy Act (CTOP) in 1996, deaths from unsafe abortion have dropped by 91%.

Beyond the legal barriers, many women experience shame, social stigma, and negative attitudes about the circumstances that led to their unwanted pregnancy, or to the abortion itself—which in turn can create obstacles to accessing care. Common obstacles include verbal abuse or social rejection from family and friends, misrepresentation or lack of information about laws regarding abortion, and rejection, stigma, and ignorance within the health system.

The onset of the COVID-19 pandemic created other powerful barriers to access. In response to the pandemic, many governments deprioritized sexual and reproductive health, leading to funding cuts and thousands of clinic closures around the world as resources were diverted for COVID-19 activities. Lockdowns, curfews, travel bans, and loss of safe public transportation options also made it difficult or impossible for many to access safe abortion care.