SCIENCE
ABORTION
Medical Abortion (Abortion Pill)
Medical abortion (also called medication abortion) is the termination of an early pregnancy using drugs rather than a surgical procedure. In the United States, the FDA-approved regimen is used through 10 weeks’ gestation and involves mifepristone followed by misoprostol. ( 1 )
Mifepristone blocks progesterone, a hormone necessary to maintain the uterine lining in early pregnancy, disrupting the conditions needed for the pregnancy to continue. Misoprostol is taken afterward, typically within 24–48 hours, and causes uterine contractions that expel the pregnancy tissue. ( 2 ) This process is often completed outside a clinical setting under medical guidance.
Common physical effects include heavy bleeding and strong cramping, along with symptoms such as nausea, vomiting, diarrhea, fever, chills, headache, and dizziness (American College of Obstetricians and Gynecologists 2020). While serious complications are considered uncommon, documented risks include excessive bleeding, infection, and incomplete abortion, which may require further medical treatment. ( 3 )
Individuals experiencing complications or uncertainty are advised to seek care from a licensed medical professional. If you have taken the first abortion pill and are reconsidering your decision, it may not be too late, help may still be available. Click the button below to find out more.
Suction Aspiration (Vacuum Aspiration)
Suction aspiration (also called vacuum aspiration) is a common abortion method used primarily in the first trimester, typically up to 13 weeks of gestation. ( 4 ) The procedure involves gently dilating the cervix and inserting a thin tube (cannula) into the uterus. Suction is then applied to evacuate the uterine contents, including the developing baby. ( 5 ) The aspiration itself usually lasts only a few minutes, and the procedure is commonly performed on an outpatient basis.
Documented risks include bleeding, infection, and injury to the cervix or uterus (World Health Organization 2022). In some cases, retained pregnancy tissue may occur and require additional medical treatment. Large medical reviews note that while complications can occur, serious complications following aspiration abortion are uncommon. ( 6 )
Manual Vacuum Aspiration (MVA) is a variation of suction aspiration that uses a hand-held syringe to generate suction rather than an electric pump (Ipas 2019). Both methods rely on vacuum pressure to evacuate the uterus, with the primary difference being the source and strength of the suction. ( 7 )
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Dilation and Evacuation (D&E)
Dilation and Evacuation (D&E) is a surgical abortion procedure used in the second trimester, typically beginning around 13 weeks of gestation. ( 8 ) The process involves cervical preparation, during which the cervix is gradually softened and dilated using medications and/or osmotic dilators. ( 8 ) Depending on gestational age and clinical circumstances, this dilation may occur on the same day or require one to two days to achieve adequate opening. Once sufficient dilation is achieved, the clinician uses suction and surgical instruments, including forceps, to remove pregnancy tissue (the baby) from the uterus. ( 9 )
Because D&E is performed later in pregnancy, it is a more invasive procedure and carries recognized medical risks. Documented complications include heavy bleeding, infection, cervical injury, and uterine perforation, with the likelihood of complications increasing as gestational age advances. ( 10 ) Large clinical studies indicate that serious complications are uncommon when the procedure is performed in a medical setting, but the increasing complexity of the procedure later in pregnancy underscores the physical demands and medical seriousness of second-trimester abortions.
Induction Abortion
Induction abortion, sometimes called labor-induction abortion, is a procedure most often used in the second trimester of pregnancy and sometimes later. Instead of surgery, medications are used to start labor, leading to the delivery of the baby. ( 11 ) Because this method closely resembles childbirth, it can carry significant physical and emotional weight, especially when done later in pregnancy, near the point when a baby may be able to survive outside the womb with medical care.
In later pregnancies, doctors may first give an injection to stop the baby’s heart before labor begins. Medical guidance explains that this step is not usually used early in pregnancy but may be done later to prevent the rare situation in which a baby is delivered showing signs of life. Medications commonly used for this purpose include digoxin or potassium-based drugs. When digoxin is used, it can take several hours for the heart to stop. The exact approach depends on how far along the pregnancy is, the medical setting, and local laws or policies. ( 12 ) ( 13 )
After this, the cervix is softened and opened using medications or small absorbent rods, a process that can take many hours. Additional medications are then given to start contractions. The baby and placenta are delivered in a process similar to labor and birth. Doctors carefully monitor the mother afterward to watch for complications. ( 14 )
Because induction abortion involves labor, it carries risks similar to childbirth. These can include heavy bleeding and infection. In some cases, the placenta does not come out completely and must be removed by a doctor. Rarely, serious complications such as injury to the uterus can occur, especially in women with prior uterine surgery. ( 15 )
Medical organizations also acknowledge that, in rare cases, a baby may be born alive during a later induction abortion, particularly as the pregnancy approaches 22 weeks or beyond. For this reason, doctors are expected to discuss this possibility ahead of time and be prepared to respond if it occurs.
Partial-Birth Abortion (D&X)
Intact dilation and evacuation (intact D&E)—sometimes referred to in U.S. political debate as dilation and extraction (D&X) or “partial-birth abortion”—was a variation of second-trimester abortion that required more advanced cervical dilation than standard D&E procedures. ( 16 ) Medical authorities have explained that this level of dilation was typically achieved over many hours or days using osmotic dilators, such as laminaria or synthetic dilators, and sometimes medications to soften and open the cervix. ( 17 )
Once sufficient dilation was achieved, the procedure involved removing the baby, often in a breech (feet-first) position. In cases where the fetal head could not pass through the cervix intact, medical guidance describes the “possible decompression of the calvaria (skull)” to allow completion of the delivery. After fetal and placental removal, standard medical practice included examining the uterus and often performing suction to ensure it was fully evacuated and to reduce the risk of complications.
Because the fetus could be partially delivered at the time the final step occurred, the procedure became highly controversial. In 2003, Congress passed the Partial-Birth Abortion Ban Act ( 18 ), defining the prohibited act as the deliberate vaginal delivery of a living fetus to a specified point followed by an act intended to end the fetus’s life.
The vote exposed sharp partisan divisions. In the House, the bill passed 281–142: 218 Republicans voted in favor and 4 opposed, while 63 Democrats supported the bill and 137 opposed it. In the Senate, it passed 64–34, with near-unanimous Republican support and opposition from the Democratic caucus. ( 19 )
In 2007, the Supreme Court upheld the law in Gonzales v. Carhart, the first time it approved a nationwide ban on a specific abortion method. ( 20 ) The procedure remains ethically significant because it occurred at stages of pregnancy when fetal development is advanced and survival after extremely premature birth may be possible in some cases. ( 21 )
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Page Citations & Notes
1. U.S. Food and Drug Administration. “Information about Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation.” FDA, January 17, 2025. Referenced for: medication abortion in the United States using mifepristone with misoprostol through 10 weeks’ gestation, and for mifepristone’s role in blocking progesterone.
2. American College of Obstetricians and Gynecologists. “Medication Abortion Up to 70 Days of Gestation.” ACOG Practice Bulletin, no. 225, October 2020. Referenced for: misoprostol being taken after mifepristone to cause uterine contractions and expel the pregnancy tissue, along with common side effects such as cramping, bleeding, nausea, vomiting, diarrhea, fever, chills, headache, and dizziness.
3. American College of Obstetricians and Gynecologists. “Medication Abortion Up to 70 Days of Gestation.” ACOG Practice Bulletin, no. 225, October 2020. Referenced for: recognized but uncommon serious complications of medication abortion, including excessive bleeding, infection, and incomplete abortion that may require additional treatment.
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4. World Health Organization. “Abortion Care Guideline.” Geneva: World Health Organization, 2022. Referenced for: vacuum aspiration as a common procedural abortion method used primarily in early pregnancy, generally under 14 weeks’ gestation.
5. International Planned Parenthood Federation. “Appendix 3: How to Perform Dilatation and Evacuation.” Referenced for: the procedural description of cervical dilation, insertion of a cannula, and suction evacuation of uterine contents.
6. Upadhyay, Ushma D., et al. “Incidence of Emergency Department Visits and Complications After Abortion.” Obstetrics & Gynecology 125, no. 1 (2015): 175–83. Referenced for: the page’s statement that serious complications after aspiration abortion are uncommon in large medical reviews.
7. Ipas. “Steps for Performing Manual Vacuum Aspiration (MVA) Using the Ipas MVA Plus® and Ipas EasyGrip® Cannulae.” Referenced for: manual vacuum aspiration as a variation using a hand-held syringe/aspirator rather than an electric pump.
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8. American College of Obstetricians and Gynecologists. “Second-Trimester Abortion.” ACOG Practice Bulletin, no. 135, June 2013. Referenced for: D&E as a second-trimester abortion procedure, typically beginning around 13 weeks, involving cervical preparation followed by evacuation.
9. Society of Family Planning / Ipas. “Dilatation & Evacuation (D&E) Reference Guide.” 2018. Referenced for: the use of osmotic dilators and medications for cervical preparation, and for the description of D&E as evacuation with a combination of vacuum aspiration and forceps.
10. American College of Obstetricians and Gynecologists. “Second-Trimester Abortion.” ACOG Practice Bulletin, no. 135, June 2013. Referenced for: documented complications including hemorrhage, infection, retained tissue, cervical laceration, and uterine perforation, with risk generally increasing as gestational age advances.
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11. Borgatta, Lynn, and Nathalie Kapp. “Labor Induction Abortion in the Second Trimester.” Contraception 84, no. 1 (2011): 4–18. Referenced for: induction abortion as a medication-based procedure used most often in the second trimester, in which labor is started and the fetus and placenta are delivered.
12. Royal College of Obstetricians and Gynaecologists. “The Care of Women Requesting Induced Abortion.” RCOG Evidence-Based Clinical Guideline, November 2011. Referenced for: later-pregnancy use of feticide before medical abortion to reduce the risk of live birth, and for potassium chloride as a recommended method in that context.
13. Society of Family Planning and Society for Maternal-Fetal Medicine. “Induction of Fetal Asystole Before Abortion.” 2024. Referenced for: digoxin and potassium chloride as agents used to induce fetal asystole before later abortion procedures.
14. World Health Organization. “Abortion Care Guideline.” Geneva: World Health Organization, 2022. Referenced for: cervical softening/opening with medications or osmotic dilators, followed by medications to induce contractions and delivery.
15. American College of Obstetricians and Gynecologists. “Second-Trimester Abortion.” ACOG Practice Bulletin, no. 135, June 2013. Referenced for: complications of induction abortion including hemorrhage, infection, retained placenta/tissue, and rare uterine injury or rupture.
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16. American College of Obstetricians and Gynecologists. “Statement on the D&X Procedure.” As quoted and discussed in the federal legislative record surrounding the Partial-Birth Abortion Ban Act of 2003. Referenced for: the page’s description of intact dilation and extraction / intact D&E as requiring greater cervical dilation than standard D&E and involving more intact extraction.
17. Royal College of Obstetricians and Gynaecologists. “The Care of Women Requesting Induced Abortion.” RCOG Evidence-Based Clinical Guideline, November 2011. Referenced for: extensive cervical preparation over many hours or days using osmotic dilators and/or medications in later abortion procedures.
18. Partial-Birth Abortion Ban Act of 2003, S. 3, 108th Cong. “Content Details.” GovInfo. Referenced for: the federal statutory definition of the prohibited act and the page’s legal discussion of “partial-birth abortion.”
19. U.S. House of Representatives, Office of the Clerk. “Roll Call 530 XML.” October 2, 2003; United States Senate. “Roll Call Vote 402.” October 21, 2003. Referenced for: the House vote of 281–142 and Senate vote of 64–34 on the conference report for the Partial-Birth Abortion Ban Act.
20. Gonzales v. Carhart, 550 U.S. 124 (2007). “Case Text.” Referenced for: the Supreme Court’s 2007 decision upholding the federal ban.
21. Mehler, Kathryn, et al. “Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care.” JAMA Pediatrics 170, no. 7 (2016): 671–77. Referenced for: the page’s point that survival may be possible in some cases at extremely early gestational ages near the border of viability.
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