Let's Talk About Abortion

As part of her Let's Talk About Sex campaign, VP Wellbeing & Diversity Henn Warwick looks to open up dialogue on abortion, including information on accessing an abortion, methods of abortion, aftercare, and important changes as a result of Covid-19. The article also highlights the danger and illegality of self-induced abortion - reader discretion is advised.

A note from Henn

As a woman and a Law graduate aspiring to specialise in Medical Law, I see abortion as an essential medical matter rather than a criminal/legal one. I believe no one should be forced to become a mother. Pregnant people should have the right to choose whether or not they want to continue with their pregnancy. This choice should be fully informed and made free of any external influences. The decision to write this article wasn't one taken lightly, but I feel it's time to open the dialogue and talk about abortion. I recognise that everyone has their own opinions on this topic, and those opinions, whether in line with my own or different, are valid. Let's Talk About Sex week aims to challenge the social stigma attached to sex-related topics that some may consider 'shameful' or even feel too uncomfortable to discuss. This article is not attempting to influence any opinions on abortion but instead, it aims to inform students on: general facts; important changes as a result of Covid-19; how to access an abortion; what happens before an abortion; the different methods of abortion; aftercare for an abortion and highlighting the danger and illegality of self-induced abortion - so reader discretion is advised. Please note all recommended services and information is inclusive of women, trans, non-binary and intersex people.

General facts

In the UK, a pregnancy can be terminated up to 23 weeks and six days, so long as two doctors agree that continuing with the pregnancy is likely to cause more harm to the pregnant person's physical or mental health than termination would. In very limited circumstances an abortion can take place after 24 weeks – for example, if there's a risk to life or there are problems with the foetus' development. Late abortions are extremely rare, less than one per cent are carried out after 22 weeks. Abortion is very safe and is actually one of the most commonly performed gynaecological procedures. Every year almost 200,000 terminations take place, this equates to one in five pregnancies ending by termination. Complications following a termination are very unlikely, and in fact carrying a pregnancy to term is riskier. Nine out of ten adults within the UK now identify as pro-choice, thus supporting the right of pregnant people to choose whether they want to continue with their pregnancy.

Abortion & Covid-19

As a result of Covid-19 healthcare providers have adapted their services to support social distancing. If attending a clinic, individuals will be expected to attend appointments alone (unless under the age of 18 or a clinically vulnerable adult) and wear a mask at all times. Entry to any clinic will not be permitted if there are obvious symptoms of coronavirus such as a new continuous cough, a high temperature or loss of smell and taste.

Clinics are attempting to limit the need for face-to-face appointments to ensure safety amongst clients and staff. It is likely that individuals will be able to have their assessment appointment over the phone or via video call. After speaking to a medical professional virtually, an individual may be eligible for an early medical abortion and be able to receive a treatment package in the post, which eliminates any need to travel.

The most local abortion clinic to RHUL campus is BPAS Slough. Unfortunately, as a result of Covid-19 the clinic has temporarily closed - however abortion treatments for pregnancies up to ten weeks gestation may be offered via post or if past ten weeks, termination procedures can be offered at another BPAS clinic. The thought of having an abortion at home may seem strange, but this service was made possible in response to Covid-19. The treatment via post is exactly the same as treatment within a clinic. Previously someone requiring an abortion would take the first abortion pill in the clinic and take the remainder of the medication at home.

How to access an abortion

There are three ways someone can access an abortion:

1. You can request an abortion directly from an abortion care provider. This means you do not need to have an appointment with your GP beforehand. This is known as self-referral. You can self-refer to clinics such as: 

British Pregnancy Advisory Service (BPAS) +44 (0) 3457 30 40 30

MSI Reproductive Choices UK  +44 (0) 345 300 8090

National Unplanned Pregnancy Advisory Service (NUPAS)  +44 (0) 333 004 6666

2. You can speak to your GP and request a referral to a termination service.

It's important to note that a doctor may refer you to a different doctor to request an abortion. This is because a doctor holds the right to have a conscientious objection. This does not mean a doctor can attempt to influence your choice or express their personal beliefs to cause distress.

3. You can contact your local sexual health clinic and ask for a referral to an abortion service.

Find your local sexual health clinic here.

Deciding to have an abortion

Considering an abortion can be a very confusing, stressful and upsetting time. Some people are certain that it's the right choice for them, whereas others may find it a very difficult decision to make. No one else can make that choice, the decision to terminate a pregnancy lies only with the pregnant person. Someone who is considering an abortion may want to discuss their options with people around them, for example, their partner if they have one, friends, or family, however, they do not have to. A termination can be carried out entirely confidentially - it depends entirely on what the individual wants. Anyone who decides they want an abortion will be offered counselling support. Equally, impartial information is available from a GP, an abortion clinic and organisations such as Brook (for under-25s), BPASMSI Reproductive Choices UK and NUPAS.

What happens before an abortion?

A termination usually involves at least two separate appointments. The first appointment is an assessment. Prior to Covid-19, this assessment would be carried out at the abortion clinic or hospital but given the current circumstances, it is more than likely this will take place over the phone. The second appointment will be the termination itself.

During your assessment, you will be given an opportunity to:

  • Talk things through with a medical professional, for example, discuss why an abortion is the right choice and to ensure you are not being forced/influenced into it
  • Talk to a trained counsellor if you think that extra support will help you
  • Understand the different methods of abortion and the risks associated with them 
  • Discuss which method of abortion is the most suitable for you
  • Discuss what to expect before and after the termination
  • Check your blood type through a blood test (and also test for anaemia)
  • Be tested for any sexually transmitted infections including HIV

You will also be asked about your medical history to ensure you are offered the most suitable abortion method. You may:

  • Need to have an ultrasound scan to check how many weeks along you are. This scan should not be performed in an antenatal setting where you may interact with people who are continuing their pregnancy. The scan may be non-invasive, so the medical professional will scan your lower abdomen, or it may need to be internal - meaning the probe is inserted into the vagina. You do not have to look at the scan pictures if you don't want to.

Once the assessment is over, and you are sure you want to continue with the termination, you will be asked to sign a consent form. The clinic will then arrange a date and time for the abortion. You have the right to change your mind at any time, even right up until the start of the abortion.

Methods of abortion

There are two methods of abortion and they are offered dependent on how far along the pregnancy is. Both methods can only be carried out up to 24 weeks (23 weeks and six days). Abortions taking place after 24 weeks are extremely uncommon and are only permitted if there is risk to life or the foetus has development problems.

1. Medical Abortion

  • A medical abortion involves taking two pills - mifepristone and misoprostol. These pills are prescribed by the clinic and are usually administered one or two days apart.
  • The first pill (mifepristone) is taken orally in the presence of a medical professional or at home. Mifepristone actively blocks the main pregnancy hormone from being released into the body. After taking the first tablet you'll be physically able to continue your daily activities, but of course, it would be advised to take time for yourself as this may be a very difficult experience.
  • The second pill (misoprostol) should be administered one or two days later. This pill is likely to be administered by inserting it into your vagina, but you can also absorb the medicine by placing it under your tongue or in-between your cheek and gum. The effect of misoprostol takes on average around 4-6 hours to take effect. The lining of the womb will begin to break down and it will pass through the vagina, it is advised to use sanitary towels to monitor the bleeding.
  • Medical abortions often cause pain, such as cramping as the lining of the womb breaks down, it is advised to take regular pain relief and use a hot water bottle on your lower abdomen. Nausea, vomiting, cramping, heavy vaginal bleeding, and diarrhoea are all common side-effects of a medication abortion. Bleeding following a medical abortion is completely normal, the amount of bleeding will vary from person to person. Some people bleed a lot, some bleed very little. This bleeding can last for serval weeks.
  • Sometimes, more than one dose of misoprostol is used to terminate a pregnancy, and occasionally, the medicine can fail, and an operation may be needed.

2. Surgical Abortion

A surgical abortion involves a minor operation that can be carried out with local anaesthetic (numbing), with sedation (you are awake but relaxed) or general anaesthetic (you are asleep). It is common and completely normal to not remember anything or even be aware of the operation following a general anaesthetic. The kind of anaesthetic or sedation you are offered will depend on how many weeks gestation and your preference. Prior to a surgical abortion (either a few hours or a few days depending on the type of medicine) you will be given medicine to cause the cervix to open (dilate).

There are two types of surgical abortion:

1. Vacuum or suction aspiration

This form of abortion can be used up to 14 weeks of gestation using a local anaesthetic, or 15 weeks using sedation or a general anaesthetic

  • A speculum is inserted into the vagina and the doctor will inject numbing medication into your cervix (if general anaesthetic is used the numbing will be missed). A tube is then inserted into the vagina, and then into the womb through the cervix. The pregnancy is removed by gentle suction.
  • Sometimes, the medical professional may use alternative special instruments to assist with the removal, this depends on how far along many you are.
  • The whole procedure of a vacuum aspiration takes from five to ten minutes and you are usually free to go home a few hours later. You are likely to feel cramping similar to period pains during the procedure.

2. Dilatation and evacuation (D&E)

This form of abortion can be used between 15 and 24 weeks of gestation using a general anaesthetic

  • A small cannula will be placed in your vein which enables the medication to put you to sleep.
  • A speculum is inserted into the vagina followed by narrow forceps inserted into the womb to remove the pregnancy. A tube is then entered into the vagina through to the cervix and gentle suction is used to complete the evacuation.
  • D&E takes from 10 to 20 minutes and you are usually able to go home after 1-2 hours recovery.

Aftercare following an abortion

After a surgical abortion, it is unlikely you will need any further tests or appointments. After medical abortion at home, he may be required to have a special form of pregnancy test or scan to ensure the termination was successful. For both methods of abortion, it is likely that you will feel cramping and have vaginal bleeding. Taking painkillers such as ibuprofen or paracetamol can help with any pain or discomfort and using sanitary pads may be more comfortable than tampons straight after the termination. It's important to note that if you feel ready to have sex, make sure you use contraception as it's common to be fertile immediately after an abortion.

Everyone is different, so everyone will recover at a different pace. Some people may feel relieved and ready to get back to their normal life, others may feel the need to grieve and want to take things slowly. The most important thing is to do what feels the most comfortable for you and seek extra support if you need it.

Self-induced abortions

A self-induced abortion is an abortion involving medication that is sourced by a person on their own using an online site as opposed to attending a clinic. It's very easy to think - 'Why would someone do that?' 'You can easily access an abortion in the UK' but the reality of an unplanned pregnancy can lead to people taking very desperate measures. Picture this, a young student who has discovered they are pregnant but is scared to tell anyone around them. They are afraid their family and friends may judge them or try and force them to continue with the pregnancy. They look on the internet and find websites or anonymous forums offering questionable information about how to end a pregnancy on your own with no one else finding out. They may then stumble across a pharmaceutical site that is unregulated, offering to discreetly deliver abortion tablets to their door within a few days. They see this as a way out and purchase the pills.

The danger of purchasing abortion pills online is very real. These pills may not be genuine and may be extremely harmful. The assessment process that takes place prior to an abortion test to see whether the medicine used in a medical abortion will be suitable, taking these pills without an assessment may lead to serious complications such as blood clots. If you are in a position similar to this, and you are considering buying a pill online I urge you to please speak to someone you trust or contact an abortion service (links below) before taking this step. If you are pregnant and considering abortion, you are not alone. 1 in 3 women in the UK will have an abortion by the time they are 45 years old. Please remember, you can have an abortion and keep it entirely confidential, no one else needs to know. 

Support links

BPAS (abortion care) Actionline

03457 304030

bpas.org

Helpline support for reproductive choice by providing services to prevent or end unwanted pregnancy with contraception or abortion. Puts people in contact with their nearest consultation centre.

**BPAS also offer support for partners of someone who is having an abortion. The decision to terminate a pregnancy lies with the pregnant person but the decision can affect the people around them as well.

Brook Young People’s Information Service

brook.org.uk

Information, support and signposting service for young people under 25 on sexual health, contraception, pregnancy and abortion.

National Unplanned Pregnancy Advisory Service (NUPAS)

0333 004 6666 

nupas.co.uk

Provide a safe and trusted service to ensure informed choices around pregnancy, contraception and sexual health can be made. They offer unplanned pregnancy help along with free NHS and private abortion treatments in locations across the North West, Midlands and South of England.

Marie Stopes Reproductive Choices UK

msichoices.org.uk/abortion-services

Providing specialist advice, support and treatment in clinics throughout the UK. Call for a consultation appointment, available in 48 hours.

Wellbeing Team (RHUL)

supportingyou@rhul.ac.uk

The University’s Wellbeing team provide support to all students with their general wellbeing. The Wellbeing Advisors will help co-ordinate the right support for you or refer you to others within the department for longer-term or more specialised support.

Counselling Service (RHUL)

counselling@royalholloway.ac.uk

The University’s Counselling Service work to the British Association of Counselling and Psychotherapy (BACP) Code of Ethics and Practice and they are a BACP accredited service. They are open to all students to provide therapeutic intervention to support you during your university life.

Sources:  NHS website, BPAS, Abortion Rights, Sexwise