Overview

An abortion is the medical process of ending a pregnancy.

The pregnancy is ended either by a medical abortion, which involves taking medication, or a surgical abortion, involving a small operation.

The decision will partly depend on how many weeks pregnant you are.

Women will often be able to choose between the two options.

Abortions in Scotland are usually provided by NHS health boards. Coronavirus (COVID-19) has led to some changes in how services are delivered. However, abortions are treated as essential healthcare and all boards are still providing abortions.

Sometimes healthcare professionals may refer to an abortion as a 'termination of pregnancy' or 'termination'.

An abortion is different from a miscarriage, where the pregnancy ends without medical intervention.

Read how an abortion is carried out

Why abortion might be considered

There are many reasons why you might decide to have an abortion, including:

  • your personal circumstances, your own wellbeing, your children or others you may care for
  • your health may be at risk
  • there's a high risk the pregnancy will lead to a baby with serious abnormalities or serious fetal anomalies

When abortion can be carried out

It's legal to have an abortion during the first 24 weeks of pregnancy, so long as certain criteria are met. The Abortion Act 1967 covers the UK mainland but not Northern Ireland.

The law states:

  • abortion treatment must be carried out in a hospital or a place approved by Scottish Government Ministers
  • two doctors must agree that an abortion would cause less risk to a woman's physical or mental health (or that of her children) than continuing with the pregnancy

The law states an abortion may be carried out later in pregnancy when:

  • it's necessary to save the woman's life
  • it's to prevent grave permanent injury to the physical or mental health of the pregnant woman
  • there's substantial risk of the child being born with serious disabilities

Most abortions in Scotland, around 81%, are carried out before a pregnancy reaches 9 weeks and almost all, around 99%, are performed before 18 weeks.

The earlier an abortion is carried out, the easier and safer the procedure is. However, you should take enough time to consider all your options to be as comfortable as possible with your decision.

Your stage of pregnancy

To work out how many weeks pregnant you are, the calculation is usually made from the first day of your last period.

However, not everyone will be sure of this date.

If you are unsure or if you may have medical risk factors, clinics will sometimes carry out an ultrasound scan to confirm how many weeks pregnant you are.

Personal decision

Making a decision about an abortion may not be easy.

Before deciding, you may wish to discuss your situation with healthcare professionals, such as your GP or local sexual and reproductive health service, family members and your partner, if you have one.

The final decision about whether or not to have an abortion is yours, and you shouldn't be pressured into making that decision.

If you're under 16

You can have an abortion without telling your parents, as long as two doctors believe it is in your best interests and you fully understand what is involved.

However, the doctors will encourage you to discuss your decision with your parents or another adult.

If you decide to have an abortion, you have the right for this to remain confidential, regardless of your age.

Counselling services

Women vary greatly in their emotional response to having an abortion.

You may experience a number of different feelings and emotions. This is normal.

If you need to discuss how you're feeling, you can ask your NHS health board’s abortion service to refer you for counselling.

You can do this before or after your abortion or contact a counselling service yourself.

Find NHS counselling services near you

NHS abortions

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 health board Contact and appointment booking information
Appointment arrangements may vary depending on the NHS Board.
Ayrshire and Arran Please phone 01563 827025 to make an appointment (Monday to Friday 10am to 1pm).

Pregnancy and abortions - Sexual Health Ayrshire: SHAYR
Borders
Sexual Health – 01896 663700 Mon-Fri 9am-1pm. Direct referral – 01896 826729 Mon-Fri 9am-5pm. This is for women who are happy to be seen directly in the TOP clinic.

Termination of pregnancy (TOP) | Borders Sexual Health
Dumfries and Galloway
Phone 0345 702 3687 to speak to staff Monday to Friday 08.30am to 4.30pm.

abortion (sexualhealthdg.co.uk)
Fife
Phone 01592 64 33 55 and enter extension 25445 when asked. Line open between 8am and 4pm Monday to Friday.

Sexual Health Fife: Pregnancy (scot.nhs.uk)
Forth Valley Contact the service by phoning 01324 673555, Monday to Friday, between 8am – 5pm.

NHS Forth Valley – Abortion
Grampian
Main reception: phone 0345 337 9900 (Monday-Thursday 8.30am-4.30pm, Friday 8.30am-3.30pm)

Unplanned pregnancy:

• Aberdeen: phone 01224 655535 (Monday-Friday 9am-2pm)

• Elgin, Dr Gray's: phone 01343 567459

Grampian Sexual Health Services (nhsgrampian.org)
Greater Glasgow and Clyde
Please phone 0141 211 8620 for a telephone consultation and advice.

Abortion (sandyford.scot)
Highland Phone 01463 888300

Highland Sexual Health
Lanarkshire
To self-refer to the service phone 01698 366926. This referral line is open Monday – Friday, 9am – 3pm.

Termination (lanarkshiresexualhealth.org)
Lothian
Women across Lothian can self-refer for abortion by phoning Lothian Abortion Referral Service (LARS) - phone 0131 536 2454 (Mon- Fri 9-3 pm).

Lothian Abortion Referral Service (nhslothian.scot)
Orkney
Phone 01856 888 917 to make an appointment.

Nordhaven Clinic - Pregnancy
Shetland
Please phone the Maternity Department on 01595 743012 and someone will phone you back.

NHS Shetland: Maternity Department (scot.nhs.uk)
Tayside
You should phone the sexual health service for advice and referral, on 01382 425 542.

You can find information on sexual health services in Tayside at http://www.sexualhealthtayside.org/
Western Isles
Phone 01851 708305 or 01851 708300 for advice. In some cases, you may need to be referred to the mainland (Inverness or Glasgow) for an appointment.

Termination of Pregnancy (TOP) Western Isles – Cool2Talk

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.

Coronavirus arrangements

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)

Later surgical abortion

If you're over 18 to 20 weeks pregnant you may need to travel to a specialist clinic in England for one of the later abortion treatments, funded by your local NHS service.

The following procedures are not currently available in Scotland.

Dilation and evacuation (from 18 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure that is carried out under general anaesthetic. The cervix is gently stretched and dilated. Forceps and a suction tube are used to remove the fetus and surrounding pregnancy tissue.

Dilation and evacuation is not currently offered in Scotland.

Two-stage later surgical abortion (from 20 to 24 weeks of pregnancy)

If you are more than 22 weeks pregnant, the abortion usually requires a two-stage procedure, carried out under general anaesthetic.

In stage one, an injection stops the heartbeat of the fetus and medication is used to soften the cervix.

Stage two is carried out the following day and involves removal of when the fetus and surrounding tissue is removed.

Following the procedure you will bleed, usually for up to 14 days. You may notice some other symptoms, such as a small amount of fluid leaking from your breasts.

Risks in an abortion

Abortion poses very few risks to a woman's health, particularly when carried out during the first 12 weeks of pregnancy.

Abortion doesn't usually affect a woman's chances of becoming pregnant and having normal pregnancies in future.

The risk of complications during an abortion procedure is low. There are more likely to be issues if an abortion is carried out later in a pregnancy. The low risks associated with abortions are:

  • haemorrhage (excessive bleeding) which happens in about 1 in every 1,000 abortions
  • damage to the cervix (entrance to the womb), no more than 10 in every 1,000 abortions
  • damage to the uterus (womb) happens in up to 4 in every 1,000 abortions during surgical abortion.

After an abortion

After an abortion, the main risk is infection in the uterus (womb). This can be caused when all of the pregnancy tissue has not been passed or removed.

An infection after abortion may cause you to bleed heavily or have a discharge from your vagina and lower abdominal pain. Antibiotics are used to treat the infection.

If an infection isn't treated, it could result in a more severe infection of your reproductive organs. This could include pelvic inflammatory disease, which can cause infertility or ectopic pregnancy.

The risk of an infection can be reduced by taking antibiotics at the time of a surgical abortion.

If you think you may have an infection following abortion, you should immediately contact your abortion service for advice.

After an abortion, you may be advised not to have vaginal sex, and to avoid using tampons while the bleeding continues.

It is advisable that you have a reliable type of contraception before starting to have sexual intercourse again, as your fertility will return to normal very quickly.

Contraception

The most reliable types of contraception are the IUD/IUS (coil) and the implant.

The abortion service you attend will give you information on different methods and help you find the right one for you.

They can sometimes also provide most types of contraception on the day of the abortion if you have an in-person appointment or help you get an appointment.

You can also talk to your GP or local sexual and reproductive health service about contraception.

Emotional support

Women vary greatly in their emotional response to having an abortion.

Some women feel relieved, others feel sad or guilty, and many women feel a combination of these.

Research suggests that having some mixed feelings is normal, and that abortion does not lead to long-term emotional or psychological problems.

However, counselling services are available.

If you feel you need someone to talk to, seek advice from your abortion service, your GP or local sexual and reproductive health service.

Northern Ireland residents coming to Scotland for an abortion

Residents of Northern Ireland can access abortion services in Scotland for free, on the same terms as people who live in Scotland. If you are in Northern Ireland and want to travel to Scotland for an abortion, the first step is to contact the NHS Board for the area you're planning to have your abortion. The procedure for arranging an appointment varies depending on the NHS Board.

Confidentiality

If you come to Scotland from Northern Ireland for an abortion, the procedure can be kept confidential.

No paperwork will be sent to your home or to your GP without your consent.

You'll be given a letter outlining the treatment you received so you can give it to a doctor if you need emergency care. If you like, the clinic can also send a letter to your GP.

As an NHS patient you have the right to confidentiality. This means you have a right to:

  • have your information stored securely
  • access your health information
  • know how the NHS uses your information
  • know how the NHS shares your information
  • object to the NHS using your information

Find out more about confidentiality in NHS Scotland

Symptoms after taking medication

After taking the abortion medication (misoprostol), you should be prepared for the possibility of the following symptoms:

  • cramps
  • nausea
  • diarrhoea

Depending on the procedure you have, it may be a good idea to avoid travelling for 24 hours.

You can talk to your doctor or nurse about what to expect.

After the procedure, the NHS Board in charge of your care will provide aftercare information, along with a clinic number in Scotland.

If you've any concerns after you return to Northern Ireland, you can call the clinic number.

You won't get in trouble for seeking emergency care in Northern Ireland.

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