How To Have a Safe Abortion 2020

This story has been reviewed by Rathika Nimalendran, M.D., a family medicine practitioner and abortion provider based in North Carolina.


Despite everything that’s happened in the past few years—from Brett Kavanaugh’s Supreme Court confirmation to Justice Ruth Bader Ginsburg’s passing—abortion is still legal in the United States.

It’s not always accessible though, and depending on where you live, your state might have laws that restrict access to care by requiring you to jump through lots of logistical hoops.

Here’s where to start if you need a safe abortion—once you’ve found a doctor you trust, they’ll be able to tell you what’s available where you live.

What to do right now

1. Call your doctor. If you have an OB-GYN or primary care doctor you trust and you’ve discussed birth control and/or abortion before, hopefully they’ll share the next steps with you without judgment. Get them on the phone and ask for their direction. Only about 14 percent of OB-GYNS do terminations, so they’ll likely refer you to a clinic.

2. Or call Planned Parenthood (800-230-PLAN or plannedparenthood.org) or The National Abortion Federation (877-257-0012) for a list of clinics nearest to you. If you don’t have a go-to health care provider, these are the most legit resources you can use to get abortion care. Watch out for any organization that offers you a free ultrasound or call themselves a Crisis Pregnancy Center. Those establishments are usually run by anti-abortion organizations and do not provide termination care.

3. If you have insurance, call the number on the back of your insurance card to ask what’s covered. While some plans include abortion coverage, that service is completely banned from insurance providers’ benefits in 11 states. Fifteen other states ban abortion coverage for certain types of plans. Next time open enrollment comes around, you might be able to buy a “rider” that covers abortion. Ask the insurance provider before you sign up.

4. Or, if you don’t have insurance, be sure to ask about payment when you call for a consultation.
Many clinics can offer information about funding options, including abortion funds. If you don’t have cash, many clinics also accept credit cards

5. If you’re set on getting an abortion, book an appointment ASAP. Call the clinic as soon as you know what you want to do (wait times can be long). In some states, you’ll need to schedule two appointments: One for mandatory counseling and another (up to three days later) for the actual procedure.

6. Or, if you’re not quite sure, schedule a time to speak to a licensed, unbiased counselor or health care professional in person (again, NOT someone from a Crisis Pregnancy Center) or over the phone. FWIW, many women who seek counseling at Planned Parenthood end up deciding not to terminate their pregnancy.

7. Confide in someone you trust during this process. “It can be really helpful to have the support of at least one person,” says Rathika Nimalendran, M.D., a family medicine practitioner and abortion provider based in North Carolina. “And, depending on the clinic’s policy, state laws, or the medications you receive, you may need someone to drive you home.”

It’s not like ending a pregnancy is fun. But by three years later, 99 percent of women seeking abortions say they made the right choice, according to researchers who interviewed 667 women. Aspen Baker, who runs the after-abortion talk line, Exhale, says people report “grief, confusion, relief, ambivalence, confidence, and hope. The main question is, ’Is what I’m feeling normal?’” Answer: Yes. To talk to a counselor, call 1-866-4-EXHALE.

10 to 11 weeks

MEDICATION ABORTION

This is often called the abortion pill, but it’s actually two sets of pills: The first, mifepristone, is often taken at the clinic depending on what state you live in (BTW, the Supreme Court is allowing for these to be prescribed by mail during the COVID-19 pandemic). The medication blocks the hormone progesterone, breaking down the uterine lining. The second set, misoprostol, is taken at home up to 48 hours later depending on how far along the pregnancy is. If you’re 9 weeks or less, you can take it by mouth right away or vaginally. If you’re more 9 to 11 weeks, you’ll need to wait 24 to 48 hours.

WHAT TO EXPECT

Post pill no. 2, cramping and heavy bleeding will last 4 to 6 hours. Your clinic will discuss how to manage the pain. You might notice blood clots or the pregnancy tissue — a white-gray meaty material—but it won’t look fetus-like, says Pratima Gupta, MD, a fellow at Physicians for Reproductive Health.

Wait a week before putting anything into your vagina (a tampon, a penis, even bath water) to avoid infection. You’ll have spotting, so stock up on pads. Your clinic may give you different options for follow up, such as a home pregnancy test and nurse phone call, a blood test, or an ultrasound to make sure you’re not pregnant anymore. 97 percent of the time the medications have worked. If not, you may need aspiration.

WHAT IT COSTS

$400 to $800 without insurance.

11 to 14 weeks

ASPIRATION

The most common in-clinic abortion procedure, aspiration (also called a D and C — dilation and curettage), involves stretching the opening of the cervix and emptying the uterus with a suction device. On a case-by-case basis, the doctor may do a sweep with a curette to ensure all the pregnancy tissue is removed. The doctor may also prescribe antibiotics. It takes five to 10 minutes. While it’s more invasive than the abortion pill, you can walk out and be D-O-N-E.

WHAT TO EXPECT

Pain medication is standard, and providers will offer some form of sedation—ranging from numbing at the cervix to an IV drip to (rarely) general anesthesia. Then the doctor dilates the cervix with medication or a series of progressively larger instruments that push it open. Throughout the procedure, you’ll feel pressure. Some women feel painful cramping; others don’t. Still, “there shouldn’t be extreme pain,” says Jennifer Conti, MD. About 10 minutes later, the abortion is complete. If you were sedated, you will feel groggy for a few hours and will need someone to drive you home. You may have to change pads a couple of times a day, says Dr. Conti, and this spotting can last a few days to a couple of weeks. Your doctor may request a follow-up in two to four weeks to make sure you’re back to 100 percent.

WHAT IT COSTS

$400-$1,500 without insurance in the first trimester. The procedure could cost more if you’re further along or if you want to request IV sedation.

13 weeks or more

DILATION AND EVACUATION (D and E)

This is a one-part procedure before 15 weeks. After that, it’s a two-part procedure that could take two days to complete. Because the pregnancy is further along, the cervix must be softened and stretched a few hours or the day beforehand—more so than with aspiration. The abortion itself, which is similar to aspiration but uses different instruments, lasts 10 to 30 minutes.

WHAT TO EXPECT

To open the cervix, your provider will give you misoprostol or insert one or more thin rods made of seaweed (for real) or synthetic material into your vagina, where they gradually expand. It can be uncomfortable, so you’ll get pain meds or possibly something stronger, and antibiotics. Dr. Nimalendren says many D and Es are done in freestanding clinic procedure rooms under IV sedation. Others are done in the operating room with IV or general anesthesia. The procedure may be done in a clinic or operating room depending on the type of anesthesia provided. You may be offered a shot in the abdomen to stop the fetal heartbeat—in case that gives you some peace of mind. Your doctor will remove the pregnancy tissue in portions with specialized medical instruments, such as forceps. As with aspiration, recovery will include some bleeding and cramping for a few days.

WHAT IT COSTS

$800+ without insurance. Fees increase as the pregnancy progresses.

20 weeks or more

INDUCTION TERMINATION

This rare alternative to D and E (aka labor induction) involves delivering the fetus vaginally at a hospital. Women “go through a process similar to labor, with the cervix opening, and possibly pushing to deliver the pregnancy,” explains Dr. Gupta. It is a longer and riskier process than a D and E. So it’s generally only offered from 20 weeks until viability. Dr. Conti notes that induction enables the woman to hold the fetus (if they want to) and allows for a thorough autopsy.

WHAT TO EXPECT

Your provider will offer you an optional shot in the belly. Then she’ll use medications to soften the cervix and induce contractions. Your water will break, and you’ll feel cramping and pain. “You have the option of an epidural,” adds Dr. Conti. The process can take several hours or several days. Barring a medical issue, you can go home a few hours after the fetus has passed. Recovery is similar to that of women who’ve given birth, including vaginal swelling and soreness, spotting, and potentially lactating.

WHAT IT COSTS

$5,000 (approximately). Cost and insurance coverage varies. This is the average cost for an abortion at 20 weeks, according to the Guttmacher Institute.

What to do if you can’t afford any option

Federal and state restrictions make it hard to access an abortion in many parts of the country. Paying for it is often even more difficult than you might expect and, unfortunately, there are far more expenses that go into the process than just the procedure.

Taking time off work, finding child-care, transportation to and from a clinic can get expensive, especially if your closest option has a mandatory in-person waiting period that requires more than one appointment. You might even need a hotel in order to get to the appointment early enough or to stay overnight if you have to make multiple visits. And, at some point, you will need to eat, and get additional sanitary pads.

If you’re struggling to make ends meet, these national organizations are ready to help.

National Abortion Federation (NAF): The NAF Hotline can offer you information on which clinics offering quality care are still open (a constantly changing landscape, thanks to state-based abortion restrictions), and if the best option for you is even in your state at all. They can also potentially assist if funding for your procedure or travel is a barrier, or if additional travel arrangements need to be scheduled, especially if a pregnancy is more advanced or has added complications.

National Network of Abortion Funds (NNAF): NNAF is the first place to contact if you need an abortion but don’t think you have the ability to pay for it. Based on location, the group can help you learn if you live in one of the 16 states where Medicaid will cover the cost of your abortion and if you have the ability to access a local, state-based abortion fund for help too.

Women’s Reproductive Rights Assistance Project (WRRAP): Located in California, WRRAP is another national funding source if you aren’t sure if you can afford a procedure. WRRAP only provides funding to clinics that are in their approved network, so be sure to ask the clinic you schedule with if they work with WRRAP. If they do, the clinic will help you figure out how to proceed.

Additional reporting by Robin Marty and Caitlin Moscatello.

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