Termination of pregnancy

Termination of pregnancy (abortion) is the ending of a pregnancy by medical or surgical means.

Abortion laws and access to legal abortions vary globally. The issue is contentious and political. Nevertheless, worldwide one in four pregnancies end in abortion annually. It is estimated that 25 million of these abortions are 'unsafe'.

Unsafe abortions are defined as as procedures carried out by individuals who are:

Legislation

The legality of abortion, albeit within limited circumstances, was enshrined in British case law in 1936 by the Bourne decision. Through the 1967 Abortion Act (Legislation.gov.uk, 2023), the legality of abortion was applied to more situations (British Pregnancy Advisory Service (BPAS), 2023a)

Abortion is legal when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith:

1. That the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
2. That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
3. That the continuance of the pregnancy would involve risk to the life of the

Treatment

The two methods of abortion are surgical and medical.

Medical abortion

Medical abortion involves the use of two medications:

1. Mifepristone
2. Misoprostol

Mifepristone inhibits progesterone. Progesterone is required to maintain the lining of the womb in order for pregnancy to continue. Mifepristone therefore breaks down the lining of the womb.

1 to 2 days later, misoprostol is taken. Misoprostol causes contraction of the womb and softening of the cervix.

This causes cramps, pain and bleeding, resulting in the loss of pregnancy similar to miscarriage.

Medical abortion can be used up to 24 weeks. The tablets can also be taken at home, unless the pregnancy is more than 10 weeks. 

If the pregnancy is more than 10 weeks or there are concerns about bleeding or infection, the process needs to be within the hospital.

Heavy bleeding can occur as a result of these medications. There is a risk that the pregnancy

Risks of abortion

Serious complications are rare and abortion carries fewer risks than pregnancy. There are fewer risks and complications the earlier in the pregnancy the abortion is carried out. Risks include:

• excessive bleeding
• damage to cervix and uterus
• post abortion infection
• retained products
• failure of abortion

These complications happen rarely and should they occur, treatment via medical or surgical means may be required (NHS, 2020). 

Anti-D prophylaxis

Women with rhesus D negative blood type who are exposed to rhesus D positive blood during pregnancy are at risk of rhesus disease in subsequent pregnancies. Rhesus disease is a condition whereby the body forms antibodies against the rhesus D positive blood of a fetus (following previous exposure). Therefore, women who are rhesus D negative having an abortion after 10 weeks’ gestation should be offered anti-D prophylaxis. This should also be considered for women having surgical abortions earlier than 10 weeks gestation (NICE,

Resources

Amnesty International. Key Facts of Abortion. 2021.
https://www.amnesty.org/en/what-we-do/sexual-and-reproductive-rights/abortion-facts/ (accessed 10 January 2023)

British Pregnancy Advisory Service. Britain’s abortion law. 2023a
https://www.bpas.org/get-involved/campaigns/briefings/abortion-law/ (accessed 10 January 2023)

British Pregnancy Advisory Service. The abortion pill. 2023b
https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/ (accessed 10 January 2023)

Legislation.gov.uk. Abortion Act 1967, c87, Section 1. 2023.
https://www.legislation.gov.uk/ukpga/1967/87/section/1 (accessed 10 January 2023)

National Institute for Health and Care Excellence. Abortion Care. 2019
https://www.nice.org.uk/guidance/ng140/chapter/Recommendations#choice-of-procedure-for-abortion (accessed 10 January 2023)

NHS. Conditions, Abortion, 2020.
https://www.nhs.uk/conditions/abortion/ (accessed 10 January 2023)

Royal College of Obstetricians and Gynaecology. Information for you, Abortion Care. 2023.
https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-abortion-care.pdf (accessed 10 January 2023)