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Mailman School of Public Health

The Harriet and Robert Heilbrunn Department of Population and Family Health

intro | reproductive anatomy and physiology | contraception | pregnancy, childbirth and lactation
abortion | maternal mortality | sexually transmitted infections


Table of Contents

Introduction Methods of Abortion


Despite the availability of highly effective methods of contraception, unintended pregnancies occur in the United States and throughout the world. In addition, when a fetus is diagnosed with a severe disability, some couples will elect to terminate a pregnancy.

According to the World Health Organization,19 there are an estimated 46 million pregnancies each year that end in abortion worldwide. If performed by trained health care providers, abortion is safer than carrying a pregnancy to term. The chance of developing a major complication following a safe abortion is one in 200.20

Each year, nearly 20 million of the 46 million abortions that occur are considered unsafe, and result in about 13% (67,000) of the pregnancy-related deaths annually.

The risk of death following an unsafe abortion is several hundred times higher than that of an abortion performed legally and safely. In developing countries, where abortion is often illegal or highly restricted, abortion mortality rates are hundreds of times higher than rates in developed countries (see Table 1 below). Laws that make abortion illegal do not eliminate abortions; they make abortions unsafe.

Table 1: Abortion-Related Deaths


Deaths per 100,000 abortions

Developing 1




South & Southeast Asia


Latin America




1. Excluding China. Source: The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide, New York : AGI, 1999, p. 35.

Abortion in the United States

Abortion became legal in the United States in 1973 as a result of the U.S. Supreme Court case Roe v. Wade. That case declared that, through the end of the first trimester, the abortion decision and procedure must be left to the judgment of the pregnant woman and her physician. However, states retained the right to regulate abortion in the second and third trimesters.

Abortion in the United States has not always been legal. Historically illegal abortion was associated with high rates of morbidity and mortality. In 1930, abortion was listed as the official cause of death for almost 2,700 women.21 From 1950-1960, it is estimated that there were 200,000 to 1.2 million illegal abortions per year.

Following the Roe v. Wade decision, the public health benefits of legalized abortion emerged almost immediately; abortion-related complications and death decreased dramatically. In 1973, the risk of maternal death resulting from an abortion was 3.4 deaths per 100,000. In 1977, it fell to 1.3. The greatest level of decline in mortality rates occurred during the first trimester of pregnancy. Currently the death rate from abortion in the United States is 0.6 per 100,000 procedures, eleven times safer than carrying a pregnancy to term.22

The text box below provides a picture of the current status of abortion in the United States and is excerpted from “Overview of Abortion in the United States” developed by Physicians for Reproductive Choice and Health (PRCH) and the Alan Guttmacher Institute (AGI) in January 2003.23


For more information about abortion in the United States, visit

For more information about preventing usafe abortion worldwide, visit:
Ipas or search:


Methods of Abortion

The type of abortion procedure that a particular woman may have depends on the duration of the pregnancy, that is, the number of weeks since the first day of the woman's last menstrual period (LMP); the woman's health status, the availability of the procedure in the geographic area, and the personal preference of the woman.

Methods of abortion are categorized into those that can be performed during the first trimester, and those that are performed during the second trimester. First trimester methods include: vacuum aspiration (manual and electrical), medical abortion, and dilation and curettage (not currently recommended if other procedures are available). Second trimester procedures include: Dilation and Evacuation (D & E) and Instillation.

First Trimester Abortion Procedures

Manual Vacuum Aspiration (MVA)

  • Used during early pregnancy (5-9 weeks).
  • Outpatient procedure in which a small flexible plastic cannula (tube) attached to a hand held syringe is inserted into the uterus.
  • The contents of the uterus are emptied by gentle suction created by a hand-held syringe.
  • Local anesthesia is generally used.
  • Less than 1% complication rate.
  • MVA successfully ends first trimester pregnancies 99.5% of the time and carries a minor complication rate of 0.01%. For the 0.5% times the procedure fails, it is repeated.

Electrical Vacuum Aspiration (EVA)

  • Used during pregnancy up to 13-14 weeks.
  • An outpatient procedure in which a plastic or metal cannula attached to an electric pump is inserted into the uterus after the cervix is dilated.
  • The contents of the uterus are emptied by the suction created by the mechanical pump.
  • Local or general anesthesia can be is used.
  • Takes less than 15 minutes
  • Less than 1% complication rate.

Medical Abortion

  • Consists of taking medication either orally or administering it vaginally - does not involve surgery or anesthesia.
  • Can provide women and medical providers with greater privacy because they do not have to go to an “abortion facility” for the procedure.
  • Some women feel a greater sense of control because they can decide where and under what circumstances they can terminate a pregnancy.
  • Can be difficult for women who are unable to have the privacy they need at home.
  • In a small percentage of cases (about 5 in 100 women), the medication may not end the pregnancy and a surgical abortion must be performed.
  • Several different formulations are available. The most commonly used methods are described below:
1) Mifepristone (RU-486) with Misoprostol
  • FDA (Food and Drug Administration) approved in U.S. in the year 2000.
  • Approved for use for up to 49 days (7 weeks) following LMP.
  • Evidence based regimen being used for to 63 days (9 weeks) LMP.
  • Mifepristone blocks the action of progesterone which is needed for placental attachment. Misoprostel stimulates synthesis of prostaglandins (hormone which produces uterine contractions).
  • Mifepristone is usually given in medical provider office and Misoprostel taken one-to-three days later at home.
  • Support person is recommended along with medical provider telephone availability.
  • Anti-inflammatory medication (Motrin) for pain relief
  • POC (products of conception) are usually passed within 24 hours.
  • Medical follow-up in one-to-two weeks to confirm abortion completed.
  • Misoprostol is teratogenic (e.g. will cause birth defects).
  • Availability of back-up surgical abortion is needed.
2) Methotrexate with Misoprostol
  • Used during first seven weeks from LMP.
  • Methotrexate is administered orally or by injection in medical provider office. Methotrexate stops cell division.
  • Misosoprostol is administered vaginally three-to-seven days later.
  • Side effects include nausea, vomiting diarrhea, headache, fever or chills.
  • Medications are teratogenic (e.g. will cause birth defects).
  • 94-96% effective
  • Used widely and successfully for treatment of ectopic pregnancy

For more information about medical abortion, visit
Center for Reproductive Health Research & Policy, Early Medical Abortion: Issues for Practice, 2001

Second Trimester Abortion Procedures

Dilation and Evacuation (D & E)

  • Method of choice for second trimester abortion from approximately 13-24 weeks.
  • Combines vacuum aspiration with the use of forceps
  • Cervical dilation required using either laminaria or other osmotic dilators (natural or synthetic substances that expand slowly and gently by absorbing moisture and thus dilate the cervix).
  • More advanced pregnancies may require two days to allow osmotic dilators to take effect.
  • Can be performed on an outpatient basis equipped to administer general anesthesia.
  • Safe and effective when performed by experienced providers.
  • Risk increases as pregnancy progresses.

Instillation Procedures

  • Uterine contractions are induced by injecting saline or prostaglandin into the amniotic fluid through the abdomen.
  • Can take a long time and be emotionally difficult for women.
  • Must take place in a hospital
  • Not recommended if D & E is available.
  • Mortality rates for D & E are 2.5 times lower than instillation methods.24

continue to... Maternal Mortality