dealing with unplanned pregnancy: your abortion questions answered

by John Illman and Jo Carlowe

your abortion questions answered | help and info

Unplanned pregnancy is very common – the latest figures suggest that almost half of all pregnancies fall into this category.

Faced with an unplanned pregnancy, women must decide whether to keep the baby, have an abortion, or put the child up for adoption. Of the last two choices, abortion remains by far the most popular. In 2006 193,700 abortions were carried out – compared with 186,400 in 2005, a rise of 3.9%. By contrast last year (March 2007) just 150 babies were given up for adoption by their mothers.

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Deciding what action to take following an unplanned pregnancy can be difficult and very emotional. Talking to people you can trust and obtaining accurate information can help.

In this article we answer some frequently asked questions about abortion, and also have some advice if you're thinking about adoption.

frequently asked questions

is abortion legal?

It is legal in Britain under the 1967 Abortion Act, but in Northern Ireland only in exceptional circumstances. Current guidance is unclear and many women in Northern Ireland travel to England for help. Confidential counselling, information and support is available from fpa Northern Ireland.

Under current legislation, two doctors are required to give their written consent before an abortion can proceed. Usually, this is done as a formality. However, this may soon change.

However, for this to happen the 1967 Abortion Act would have to be amended. The Act is due to go through Parliament soon – although a date has yet to be fixed.

For amendments to occur they will first have to go through something called the Human Tissues and Embryos Bill. The Bill mostly focuses on embryo research but abortion law is likely to be debated during the passage of the Bill. So far The Bill has been debated in the House of Lords but not the House of Commons. It is a matter of watch this space, although any changes recommended in the Bill are unlikely to come into force until early 2009.

what is the legal time limit for abortion?

Up to 24 weeks. It is safer when it is carried out in early pregnancy. Most abortions are carried out before 13 weeks and almost all before 20 weeks (weeks of pregnancy are calculated from the first day of the last normal period.) If there is a substantial risk to the woman's life there is no time limit. MPs recently rejected calls to lower the 24-week legal limit for an abortion in England, Wales and Scotland.

how do I go about getting an abortion?

Abortion is available free on the NHS. You can either see your GP or go direct to a family planning or sexual health clinic for an NHS abortion. But the number of NHS abortions varies from area to area, and you may have to go private and contact specialist abortion providers. These include the British Pregnancy Advisory Service and Marie Stopes (see help and info). Current costs start from around £450 but go up above £1,500 in the later stages of pregnancy.

will a hospital or clinic tell my GP if I have an abortion?

Many do so routinely so that your medical records can be updated, but this is not a legal requirement. Tell the hospital or clinic if you do not want them to inform your GP.

if I am under 16, do I have to tell my parents?

No, so long as the doctors involved believe you fully understand what is involved, and that it is in your best interests. They will encourage you to involve your parents or a supportive adult, but you don't have to.

do I need my partner's agreement?

It is best to come to a joint decision, but you can go ahead without your partner's knowledge or agreement. Whenever partners have tried to prevent an abortion they have failed.

what if my doctor won't refer me for an abortion?

If your doctor does not believe in abortion, he or she can refuse to help, but they should always refer you to another doctor. The General Medical Council's 'Duties of a Doctor' specifies that doctors must ensure that 'personal beliefs do not prejudice patient care'. If you feel your doctor has not managed your abortion request appropriately you should inform your local Primary Care Trust.

how long will I have to wait?

The government's Sexual Health Strategy suggests that women should not have to wait more than 3 weeks but this standard is not always met. Expected waiting times vary from NHS region to region and in some cases may take up to 8-10 weeks. You should seek advice and visit your doctor as early as possible. The fpa (formerly the Family Planning Association) is lobbying for abortions to be carried out within 72 hours of an initial consultation.

where will the abortion be done?

In either an NHS hospital or a private clinic, usually, without an overnight stay. This may soon change. The House of Commons Science and Technology Committee has recommended that nurses and midwives with suitable training should be allowed to carry out all stages of early medical abortions involving the use of drugs and early surgical abortions. They also recommend that women should be allowed to have early abortions (abortion induced by the second of two pills – see below) at home. However, for this to happen amendments to the Abortion Act will need to go through Parliament.

what will happen beforehand?

You'll have the chance to talk things through and ask questions. You will also receive a blood test and be asked to sign a consent form. In addition, you may have tests for sexually transmitted infections, an ultrasound scan, a vaginal examination and a cervical smear test.

what happens during the abortion?

this depends on how many weeks you are into your pregnancy:

• Early medical abortion (up to nine weeks). This procedure mimics an early natural miscarriage. Two appointments are necessary on two separate days. On the first visit, tablets of 'mifepristone' are given to block the pregnancy hormones. On the second visit, 'prostaglandin tablets' or vaginal pessaries are given. This causes the uterus (womb) to expel the pregnancy, which usually happens during the next four to six hours.
• Vacuum aspiration or suction termination (from 7 to 15 weeks of pregnancy). The passage through the cervix (entrance to the womb) is dilated – gently stretched and opened. The contents of the womb are removed with a suction tube passed through the cervix. This takes five to ten minutes and can be carried out under local or general anaesthetic.
• Medical abortion (from about 12 weeks of pregnancy). The same drugs that are used in early abortion are used but usually more than one dose is given and the abortion takes longer. This is like having a late natural miscarriage.
• Surgical dilatation and evacuation (D&E) (from about 15 weeks of pregnancy). The cervix is dilated and the pregnancy removed in fragments using a suction tube and forceps. This usually needs a general anaesthetic. You may be able to go home the same day if you are healthy and the pregnancy is less than 18 weeks.

Abortion after 20 weeks is uncommon and will involve one of the following two procedures. You will need to spend one or two nights in hospital.

• Surgical two-stage abortion (from 20 to 24 weeks). A surgical two-stage abortion involves two procedures performed under general anaesthetic: firstly the cutting of the umbilical cord and a second procedure to remove the contents of the womb.
• Medical induction (from 20 to 24 weeks).During a medical induction the fetal heart is stopped and drugs are used to induce premature labour.

is abortion safe?

Abortion is generally safer than having a baby, especially if performed early in the pregnancy. One or two out of every hundred women who have abortions have an infection treated with antibiotics. Around 10 per cent of women may experience pain or bleeding in the first month after an abortion. In one per cent of cases the abortion may need to be repeated because fragments of the pregnancy have remained in the uterus.

how will I feel afterwards?

You may feel relieved, have mixed feelings or feel sad. Such natural reactions come and go. A lot depends upon how comfortable you were with your initial decision to have an abortion.

will abortion affect my chances of having a baby in future?

There is no harm to future fertility from a trouble-free abortion. Fertility can be affected by injury to the womb or serious infection, but this rarely happens. You should have a check-up within two weeks.

what happens if I would prefer to have the baby adopted?

Adoptions are arranged by the social services department of your local authority and by a few voluntary adoption agencies (see our article on adoption for comprehensive information). It is useful to inform the maternity staff of your decision as most hospitals employ social workers who can advise you. Although preparations for the adoption can begin before your child is born nothing will be definitely arranged until after the birth. You will be completely free to change your mind.

After the birth, your baby may be looked after by a temporary foster carer or go straight to adoptive parents. Your social worker will have discussed this with you.

The British Association for Adoption and Fostering (see help and info) will be able to tell you which adoption agencies work in your local area.

Although the number of children adopted has fallen steadily over the last few decades, the number of adoptions of children aged one to four is on the increase. In 2006, 53 per cent of all children adopted were aged 1 to 4 compared with 27 per cent ten years ago. Some 2,100 1 to 4 year-olds were adopted in 2006 according to the British Association for Adoption and Fostering. However, the number of older children adopted has fallen. In 2006 39 per cent of adopted children were aged 5 to 14 compared to 63 per cent in 1996.

the facts about abortion

Despite what many people think, the British abortion rate is lower than many other developed countries including the USA, Sweden and most Eastern European States. And the number of abortions has remained reasonably static over the last half decade. In 2006 (the most recent year for which full statistics are available) 193,700 abortions were performed compared with 186,400 in 2005, a rise of 3.9%.

Figures from the Office for National Statistics reveal that in the year 2000 teenage pregnancy rates had fallen – 41,339 women under 18 became pregnant, compared with 42,028 in the previous year. In 2000:

• More than 8,000 girls under 16 got pregnant
• More than 44% of those under the age of 18 had abortions
• About 90% of teenage abortions were carried out before 13 weeks.

However, figures from the Department of Health suggest that the number of abortions performed on women under the age of 18 is creeping up again – with more girls (under 18 year-olds) requesting an abortion in 2006 than in 2005.

we've been there

Zara's story

Zara was shocked when her pregnancy test showed up positive just before her 18th birthday. She and boyfriend Darren had always been careful and normally used condoms, but they'd had unprotected sex when Persona – an ovulation predictor kit she bought from a chemist, which is designed to show when it is OK to have sex without getting pregnant – showed it should be safe.

'Straight away I felt I didn't want this to happen. I want kids eventually but it was just so wrong at that time.' She was just beginning A-level exams and hoped to go to university. She knew immediately that she wanted an abortion – and Darren agreed – but arranging it was easier said than done.

Like so many teenagers, Zara found out the hard way about unwanted pregnancy. Britain has one of the highest teenage pregnancy rates in Europe. Yet obtaining an abortion can be full of difficulties and delays.

Zara turned to her family doctor (GP) first. She was five weeks pregnant but the doctor wanted her to wait another three weeks to see whether she would change her mind. 'Having known for three days, I was already a wreck,' she says. 'His exact words were "I am not sure I am going to be able to do such a damaging thing."'

She knew she could not tell her parents – although she was then living at home – and realised she would have to arrange an abortion herself privately. She telephoned the local Brook clinic who made her an appointment straight away to confirm the pregnancy and discuss the options. 'It was such a difference,' she says. 'It was very, very quick. Within a week I had had the abortion.'

Zara had the operation under local anaesthetic – so she was not put to sleep – and was in and out of the clinic the same day. She had a surgical abortion where the contents of the womb are removed using gentle suction. Although it hurt more than she had expected, it was similar, she says, to 'bad period pain'. Afterwards she felt 'relieved' but also angry that she had been made to wait.

Partner Darren was supportive throughout. 'I thought it was a good decision to make,' he says. 'It was the right decision and we thought about it very carefully.'

Now 19, Zara, is studying at university in London. She has never, she says, regretted her decision to go ahead with an abortion. 'The only thing I regret is letting myself get pregnant.'

Becky's story

Becky, 17, came up against similar obstacles after a condom split on New Year's Eve. 'At first it was hard to come to terms with,' she says. 'I just cried for what seemed like ages, not knowing what to do or where to turn.' She was certain she did not want to have a baby. 'I felt that I was too young and wanted to carry on my education – I was getting really good grades and hoping to go to university.'

Asked whether it was easy to get help Becky says, 'NO. NO WAY!' She was too afraid to tell her parents. She did not want to see her own doctor, partly because her mother's friend worked there. So she and boyfriend Neil went to see his doctor instead. After filling in various forms, the doctor said there was nothing he could do.

'We went back to Neil's house and I just sat on his bed and broke down in tears,' she says. 'He managed to stay calm and went and got the Yellow Pages.' They found a local family planning clinic, which booked her an appointment for that afternoon and organised an NHS abortion.

Staff at the clinic were 'friendly and helpful'. A counsellor and a doctor talked through the options. She had the abortion two weeks later in an NHS hospital. Becky chose a 'medical abortion' which involves taking tablets to bring on a miscarriage.

She too was relieved afterwards. 'At first I felt like a huge weight had been lifted off my shoulders. I was just glad it was all over. A couple of weeks after, I got a bit emotional, but was still sure I'd done the right thing.'

But she is also angry the NHS made her wait. 'I was only five weeks when I found out I was pregnant and was angry that NHS waiting lists put me through the worst three-week-long wait of my life.'

(December 2002, updated February 2008)

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