Almost all abortions in Scotland are provided within the NHS. Sometimes a woman chooses to fund her procedure privately, but this is uncommon.
If you want to have an abortion through the NHS, you should contact your local abortion service.
NHS abortion after 18 weeks
In some circumstances, women needing abortion after 18 to 20 weeks of pregnancy will be referred to specialist services in England, depending on their health board area.
Your local NHS abortion service should provide help with travel and accommodation costs or the abortion provider in England may provide travel and accommodation for you (you won’t need to pay for this).
Before the abortion
Due to coronavirus risks, the majority of early medical abortions (under 12 weeks gestation) involve an initial consultation by phone.
In some circumstances or if you prefer it you may be asked to attend the clinic for your appointment.
When you're referred for abortion and have your first appointment (also known as the ‘assessment’ appointment), you should be given the opportunity to talk about your situation.
You'll be told about the different methods of abortion and which are suitable for your stage of pregnancy. You should also be told about any related risks.
The doctor or nurse will take your medical history to make sure that the type of abortion you are offered is suitable for you.
If you attend an assessment appointment, a number of other things often happen, including:
If you have a phone or video appointment and the doctor or nurse is satisfied you don't need to be seen in person, you won't need any of these tests.
Before starting treatment, you will be asked to give consent to proceeding with your abortion.
How an abortion is carried out
In most cases, an abortion is provided from an out-patient sexual health clinic, hospital or as a day procedure. An overnight stay in hospital is not usually required.
There are a number of different methods of abortion. The type recommended for you will depend on how many weeks pregnant you are.
Early medical abortion (up to 12 weeks of pregnancy)
Early medical abortion involves taking two different medications, usually around 24 to 48 hours apart. The effect of the medication will be similar to an early miscarriage.
Following your initial assessment appointment by phone or at the abortion service, you'll either:
- be asked to collect your medication from a clinic or hospital
- have your medication delivered to you
- be asked to come to the clinic to take your first set of medication
You'll be given a medication called mifepristone to take first. It blocks the hormone that makes the lining of the uterus (womb) suitable for the fertilised egg.
After taking the first pill, you will be able to continue your normal everyday activities.
If you have a medical condition which might put you at higher risk, are under 16 years old or are homeless, you'll be asked to take the medication in a hospital where you can be monitored by medical staff.
Misoprostol tablets are usually placed under the tongue or between the cheek and gums or inserted vaginally.
It causes the lining of the uterus (womb) to break down and pass through the vagina along with the embryo and blood.
This usually happens within 4 to 6 hours of the medication being taken. This part of the process can be a bit like a very heavy period. It can be painful, but painkillers can be taken, and are provided by the abortion service.
The medicines that are used during an early medical abortion may make you feel quite sick and you may have diarrhoea.
Following the procedure you will bleed, usually for 7 to 14 days, depending on the stage of the pregnancy.
Since the start of the coronavirus outbreak, abortion care providers in Scotland have been able to let women having an early medical abortion take both sets of pills at home if it's appropriate or if you want to.
Guidelines for staff have been produced by the Scottish Abortion Care Providers (SACP) to help them decide where this is appropriate.
This means you can have an appointment with a doctor or nurse remotely by phone or video call.
You can discuss your options, the process, your circumstances, personal details and medical conditions which may need to be taken into consideration.
If you wish to have your abortion at home and meet the criteria for this, you can be prescribed mifepristone and misoprostol to be taken at home.
You'll be given clear instructions on how and when to take your medication. You'll also be told who to contact if you need help or have any complications.
During your appointment and in the medication pack, you will receive clear instructions on how and when to take your medication.
It'll include information about when you should get in touch for help and who to contact – for example if you experience any complications or think you may still be pregnant.
You can either have your medication pack delivered to you, by health board staff or a courier, or you may need to come and collect your pack from a clinic.
Surgical abortion (up to 13 weeks of pregnancy)
Vacuum aspiration, or suction termination, is a procedure using gentle suction to remove the pregnancy tissue from the uterus (womb).
The procedure usually takes 5-10 minutes and can be carried out under a local anaesthetic, where the area is numbed, or sedation, where you are awake but drowsy.
Some women receive a general anaesthetic for the procedure, where they are put to sleep.
The entrance to the womb (cervix) is dilated (opened).
To soften the cervix and make it easier to open, a tablet may be placed in the vagina a few hours before the abortion. The tablet can also be taken orally.
A small, plastic suction tube connected to a pump is then inserted into the womb and used to remove the pregnancy tissue.
After the procedure, you'll usually be able to go home the same day, although you'll bleed for around 7 to 10 days.
Medical abortion from 12 to 20 weeks of pregnancy
Mifepristone and misoprostol can also be used for abortion later in pregnancy.
The abortion will take longer, between six and twelve hours, depending on how many weeks pregnant you are.
More than one dose of misoprostol may be needed.
This type of abortion is similar to having a later miscarriage. You'll be awake and medication will be given to manage any pain.
You can usually return home the same day. Sometimes the pregnancy can take longer to pass and an overnight stay in hospital is required.
Following the procedure you will bleed, usually for 7 to 14 days. Depending on how many weeks pregnant you were, you may notice some other symptoms such as a small amount of fluid leaking from your breasts.
Further information from the National Institute for Health and Care Excellence (NICE)