Abortion

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Abortions in Scotland

An abortion (also known as a termination) is the medical process of ending a pregnancy.

There are 2 types of abortion:

medical, which uses medication
surgical, which involves a small operation

The decision about which type of abortion you have will partly depend on how many weeks pregnant you are.

An abortion is different from a miscarriage, which is when a pregnancy ends without medical intervention.

Why might you have an abortion

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

your personal circumstances
the risk to your own health from a pregnancy
problems with your pregnancy, like serious fetal anomalies that will lead to a baby with serious abnormalities

When can an abortion be carried out

The Abortion Act 1967 covers the UK mainland but not Northern Ireland.

It's legal to have an abortion during the first 24 weeks of pregnancy, so long as certain criteria are met. The law states that 2 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 after 24 weeks 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 96.7%, are carried out before a pregnancy reaches 13 weeks. Almost all, around 99.5%, are performed before 20 weeks.

How to work out how many weeks pregnant you are

To work out how many weeks pregnant you are, you should count the weeks from the first day of your last period.

If you're unsure of this date, clinics will sometimes carry out an ultrasound scan to confirm how many weeks pregnant you are.

Making the decision

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.

Before deciding, you may wish to discuss your situation with healthcare professionals like your local sexual and reproductive health service. You may also want to speak with your family members or a partner.

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 2 doctors believe it's in your best interests and you fully understand what's 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've the right for this to remain confidential, regardless of your age.

Emotional support

Considering and/or having an abortion can cause a wide range of emotions. You may experience a number of different feelings. Some people feel relieved, others feel sad or guilty, and many feel a combination of these. Having some mixed feelings is normal.

Research suggests that abortion does not lead to long-term emotional or psychological problems.

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. You can also contact a counselling service yourself.

Find NHS counselling services near you

Confidentiality

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

NHS abortions

Abortions in Scotland are usually provided by NHS health boards.

If you want to have an abortion through the NHS, you should contact your local abortion service. Appointment arrangements may vary depending on where you live.

NHS health board	Contact and appointment booking information
Ayrshire and Arran	To make an appointment, phone 01563 827025. Lines are open Monday to Friday, 10am to 1pm. Pregnancy and abortions - Sexual Health Ayrshire: SHAYR
Borders	To contact the Termination of Pregnancy clinic directly, phone 01896 826729. Lines are open Monday to Friday, 9am to 5pm. To discuss your circumstances with a medical professional, phone 01896 663700. Lines are open Monday to Friday, 9am to 4pm. Termination of pregnancy (TOP) \| Borders Sexual Health
Dumfries and Galloway	To discuss your options and accessing counselling, phone 0345 702 3687. Lines are open Monday to Friday, 8.30am to 4.30pm. You can self-refer directly by phoning Cresswell Maternity Hospital on 01387 241200. Lines are open Monday to Friday, 8.30am to 4.30pm. Outside of these hours you can leave a message and someone will be in contact. abortion (sexualhealthdg.co.uk)
Fife	Phone 01592 64 33 55 and enter extension 25445 when asked. Lines are open Monday to Friday, 12pm to 4pm. NHS Fife (nhsfife.org)
Forth Valley	To contact the sexual health service, phone 01324 673555. Lines are open Monday to Friday, 9am – 3.30pm. NHS Forth Valley – Abortion
Grampian	To contact the sexual health clinic main reception, phone 0345 337 9900. Lines are open Monday-Thursday, 8.30am-4.30pm, and Friday, 8.30am-3.30pm. To contact Aberdeen unplanned pregnancy services directly, phone 01224 655535. Lines are open Monday-Friday, 9am-2pm. Grampian Sexual Health Services (nhsgrampian.org)
Greater Glasgow and Clyde	For a telephone consultation and advice, phone 0141 211 8620. Abortion (sandyford.scot)
Highland	To contact the service, phone 01463705667 and select option 2. Lines are open Monday-Friday, 8am-5pm. Highland Sexual Health
Lanarkshire	To self-refer to the service, phone 01698 366926. The lines are open Monday to Friday, 9am to 3pm. Termination (lanarkshiresexualhealth.org)
Lothian	To self-refer to the Lothian Abortion Referral Service (LARS), phone 0131 536 2454. Lines are open Monday to Friday, 9am to 3pm. Lothian Abortion Referral Service (nhslothian.scot)
Orkney	Available to Orkney residents only. To make an appointment, phone 01856 888 917. Lines are open Monday to Friday, 9am to 5pm. Nordhaven Clinic - Pregnancy
Shetland	To contact the Maternity department, phone 01595 743012. NHS Shetland: Maternity Department (scot.nhs.uk)
Tayside	To self-refer for an abortion, please phone 01382 496 762. If your call is not answered, please leave a message and someone will get back to you. http://www.sexualhealthtayside.org/
Western Isles	For advice, phone 01851 708305 or 01851 708300. Lines are open Monday to Friday, 9am to 5pm. 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

Assessment appointment

When you're referred for abortion, you'll be asked to attend an assessment appointment.

If you're under 12 weeks pregnant, this is likely to be done by phone. If you prefer, you can request to attend the clinic for an in-person appointment.

If you're more than 12 weeks pregnant, you'll be asked to attend the clinic for your assessment appointment.

During the assessment appointment you'll be asked for your medical history so the medical professional can make sure the type of abortion you're offered is suitable for you.

You'll also be:

offered the opportunity to talk about your situation
told about the different methods of abortion suitable for you
told about the risks of different types of abortion
given information and advice about which methods of contraception you could use after the abortion

Depending on your circumstances, the medical professional assessing you may ask to do some other tests. These might include:

an abdominal or vaginal ultrasound scan to check how many weeks pregnant you are
blood tests to check your blood group and for anaemia
a test for sexually transmitted infections (STIs)

Not everyone needs to have these additional tests.

How an abortion is carried out

There are different methods of abortion. The type recommended for you will depend on how many weeks pregnant you are.

Before undergoing any type of abortion, you'll be asked to give consent to proceed.

Medical abortion

Up to 12 weeks

Early medical abortion involves taking 2 different medications, usually around 24 to 48 hours apart. The effect of these medications is similar to an early miscarriage.

Following your initial assessment appointment, 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'll normally be able to continue your everyday activities. In certain circumstances you may be asked to attend a clinic or hospital where you can be monitored by medical staff while taking the medication.

24-48 hours after taking mifepristone, you'll take the second medication. The second pill is called misoprostol and it's usually placed under the tongue, between the cheek and gums, or inserted vaginally. Your healthcare professional will advise you exactly when and how to take misoprostol.

Misoprostol causes the lining of the uterus (womb) to break down and pass through the vagina along with the embryo and blood.

This usually happens 4 to 6 hours after taking misoprostol. 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.

Both mifepristone and misoprostol can make you feel quite sick. They can also cause diarrhoea. You may be provided with anti-emetics (anti-sickness tablets) by the abortion service.

After a medical abortion you'll usually bleed for 7 to 14 days, depending on how many weeks pregnant you were. You'll be given information about when you should get in touch for help and who to contact if you experience any complications or think you may still be pregnant.

12 to 20 weeks of pregnancy

Mifepristone and misoprostol can also be used for abortion later in pregnancy.

The procedure is the same as with an early medical abortion, but the actual abortion will take longer and you'll need to take the medication at a clinic. It normally takes between 6 and 12 hours, depending on how many weeks pregnant you are. You may also need to take more than one dose of misoprostol.

This type of abortion is similar to having a later miscarriage.

You can usually return home the same day. Sometimes the pregnancy can take longer to pass and an overnight stay in hospital is required.

After a later medical abortion you'll usually bleed for 7 to 14 days, depending on how many weeks pregnant you were. You may also notice some other symptoms like a small amount of fluid leaking from your breasts.

You'll be given information about when you should get in touch for help and who to contact if you experience any complications or think you may still be pregnant.

Further information from the National Institute for Health and Care Excellence (NICE)

Surgical abortion

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 people are offered a general anaesthetic (where you are asleep) for the procedure.

A few hours before surgery, you may be asked to take medication to soften the cervix (entrance to the womb ) and make it easier to open. This tablet is normally placed in the vagina, but can also be taken orally.

During surgical abortion, the cervix is dilated (opened). 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.

At present within Scotland, surgical abortions are generally only offered up to 13 weeks.

Abortion after 20 weeks

In some circumstances, people who need an abortion after 20 weeks of pregnancy will be referred to specialist services in England. Your local NHS abortion service should provide help with travel and accommodation costs.

If you are more than 22 weeks pregnant, the abortion usually requires a two-stage procedure.

In stage 1, you'll be given an injection to stop the heartbeat of the fetus and medication to soften the cervix (opening of the womb).

Stage 2 is carried out the following day. It involves the removal of the fetus and surrounding tissue.

Following the procedure you'll 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 the 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 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 surgical abortions

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 will be used to treat an 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.

You should have a reliable type of contraception arranged before starting to have sexual intercourse again, as your fertility will return to normal very quickly.

Your abortion service will give you information on different methods and help you find the right one for you. You can also talk to your GP or local sexual and reproductive health service about contraception.

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, you should first contact the NHS Board for the area where you're planning to have your abortion. The procedure for arranging an appointment varies depending on the NHS Board.

Contact NHS abortion services in Scotland

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: