Illustration by Marta Pucci
What is actually considered an abortion?
Everything you need to know about abortion, the different ways a pregnancy can end, and real-life examples of why safe pregnancy requires access to abortion care.
Top things to know about what defines an abortion
Abortion is a safe and common way that many pregnancies end.
Abortion can be completed with a simple procedure, medications, or a combination of both.
Any reason you no longer want to be pregnant is a valid reason to choose abortion.
Pregnancy ends in abortion for many people with both wanted and unwanted pregnancies
Abortion is common, safe, effective, and life-saving (1,2). As a Board Certified Obstetrician Gynecologist (OBGYN) who cares for all pregnant people, regardless of their pregnancy outcomes, this is the most important thing I can tell anyone about abortion care. If you’re considering an abortion, or you’ve had an abortion, you are not alone. About one in four women* in the United States will have at least one abortion (3) and many people who have an abortion are already parents (4).
But, what exactly is considered an abortion? Well, it turns out that it’s not that simple to define. While different governments might have specific legal definitions for abortion, miscarriage, and ectopic pregnancy, it’s important to understand that these definitions do not reflect the complexity and reality of pregnancy. While there is not one agreed upon medical definition of abortion (1,5–7), this article will explain what might be considered an abortion, how abortion is similar or different to other pregnancy outcomes, why these definitions are important, why people choose abortion, and what to do if you need an abortion.
Important clarifications about some ways pregnancy can end
Before we discuss types of abortion, it’s important to know some common medical terms.
Induced abortion
Induced abortion is what we typically mean when we say “abortion”. Induced abortion is the intentional ending of a pregnancy, through a procedure, medications, or a combination of both (5).
Terms like “elective abortion” or “therapeutic abortion” are stigmatizing, medically inaccurate, and should no longer be used.
Spontaneous abortion (Miscarriage)
Spontaneous abortion is when a pregnancy ends on its own, or begins to expel from the uterus on its own, usually before 20 weeks of pregnancy (8).
Spontaneous abortion is also called miscarriage or early pregnancy loss. Pregnancy loss after 20-weeks is commonly referred to as stillbirth (9).
An ectopic pregnancy is a pregnancy growing either outside of the uterus or in an atypical location inside the uterus. Some locations of ectopic pregnancies can include: fallopian tube, ovary, cervix, prior cesarean scar, uterine cornua, uterine muscle, abdominal cavity, or even the liver (10–15).
Why do these definitions matter?
As access to induced abortion becomes more restricted, understanding the overlap between abortion, miscarriage, and ectopic pregnancy becomes increasingly important.
All abortion bans fundamentally endanger all pregnant people, regardless of whether or not they want an abortion, because abortion bans also restrict care for people experiencing miscarriage and ectopic pregnancy (23).
What are the different types of abortion?
Procedural abortion
Procedural abortion is also known as surgical abortion, aspiration abortion, uterine aspiration, suction abortion, vacuum aspiration, dilation and currettage (D&C), dilation and evacuation (D&E), or intact dilation and extraction (D&X). Simply defined, procedural abortion is when surgical instruments are used to remove the pregnancy tissue from the uterus through the cervix (16). There is no cutting or incision with procedural abortion and you won’t need stitches afterwards. The same procedures that are used for induced abortion are also used for miscarriage and stillbirth.
Aspiration abortion (D&C, suction abortion, vacuum aspiration, uterine aspiration)
Most procedural abortions are done by using only gentle suction to remove the pregnancy, typically up to 14-16 weeks gestation (16).
Although an abortion using only suction should be called either an aspiration abortion, vacuum apiration, uterine aspiration, or suction abortion, many people still refer to this as a dilation and curretage, or D&C.
Technically, D&C is when sharp curettage is used, with or without suction (17). A sharp curettage is a small, spoon-shaped instrument that scrapes the endometrial lining (uterus lining).
In practice, true D&C should only be used on a non-pregnant uterus when a sample of the endometrium is needed for biopsy, and vacuum aspiration without curettage should be used for abortion (17–19).
Aspiration abortion can be completed safely with a manual vacuum aspirator (MVA) or an electric machine vacuum (20).
D&E
After about 14-16 weeks, small forceps in addition to suction are used to remove the pregnancy in a procedure called dilation and evacuation, or D&E (21).
Medication abortion
Medication abortion is when medicines, rather than instruments, are used to expel the pregnancy from the uterus (21). There isn’t one single type of medication abortion, but rather several different medications that can be taken many different ways to complete a medication abortion. Although medication abortion is typically offered up to 11-12 weeks, different medication abortion protocols can be used throughout pregnancy.
Some methods of medication abortion include (21,22):
Mifepristone with misoprostol
Misoprostol alone, taken over multiple doses
Methotrexate with misoprostol (least effective)
Oxytocin (usually reserved for later abortion)
Real-life examples of abortion
Abortion bans rely on legal and political definitions, which don’t reflect what can really happen in pregnancy. Below are some examples of scenarios where an (induced) abortion ban might also restrict care for miscarriage or ectopic pregnancy. These real-life scenarios underscore that safe pregnancy also requires access to abortion care.
Miscarriage and heavy bleeding when there’s still cardiac activity
A person is 9-weeks pregnant, their cervix is open, and they are having heavy bleeding with cramping. An ultrasound shows the pregnancy still has cardiac activity. This person is in the early stages of having a miscarriage, and because of their heavy bleeding, requests a procedural abortion to treat the ongoing miscarriage. However, the person lives in a state where the government defines miscarriage strictly as a pregnancy without cardiac activity and abortion is banned after cardiac activity is detected. Even though this person is having a miscarriage with heavy bleeding, they might be denied a procedural abortion until there is no longer a heartbeat. Waiting results in more bleeding and the person requires a blood transfusion.
Outcome: Although this person was experiencing a miscarriage, an abortion ban resulted in refusal of timely care and a blood transfusion.
Ectopic pregnancy where it’s inaccurately defined
A person is 14-weeks pregnant with a history of two previous cesarean sections. At their first ultrasound, the pregnancy is seen implanted into the prior c-section scar. This is diagnosed as a c-section scar ectopic pregnancy. The patient requests early treatment to save their life and prevent them from needing a hysterectomy (removal of the uterus). The patient lives in a state where ectopic pregnancy is not accurately defined and induced abortion is illegal. The patient is refused treatment for their ectopic pregnancy and is forced to continue the pregnancy. At 28-weeks, the growing pregnancy ruptures the prior scar and the patient has an emergency surgery.
Outcome: Although this person was experiencing an ectopic pregnancy, an abortion ban resulted in stillbirth, blood transfusion, removal of their uterus, and permanent injury to their bladder.
Ongoing miscarriage
A person is 17-weeks pregnant and presents to the hospital with leaking water. An ultrasound and exam shows the amniotic sac (bag of water around the fetus) has ruptured, but the pregnancy still has a heartbeat. This is diagnosed as previable rupture of membranes, or an ongoing miscarriage. The patient requests treatment to prevent an infection and save their life. The patient lives in a state where the government defines miscarriage strictly as a pregnancy without cardiac activity and abortion is banned after cardiac activity is detected. The patient is refused treatment for their pregnancy loss and told to go home and return when they have a fever or until the heartbeat is no longer detected. The patient returns one week later in septic shock and dies despite emergency treatment.
Outcome: Although this person was experiencing a miscarriage, an abortion ban resulted in their death.
What are the reasons people might choose abortion?
Although this seems like a complex question with many possible answers, from my clinical experience, the most important reason to choose abortion is very simple. Abortion is a good option for you if you no longer want to be pregnant.
The reasons you might not want to be pregnant anymore might or might not be more complex, but they are unique to you and your life. Maybe it’s not the right time in your life to be pregnant - you just started a new job, you’re finishing school, or any number of reasons that pregnancy isn’t great for you right now. Maybe it was the right time, but now your life circumstances have changed halfway through your pregnancy – you lost your housing, your partner left, you no longer have a job, or your support system fell through. Maybe you’ve developed a serious medical condition. Maybe your prior pregnancy was traumatic. Maybe you just don’t want to be pregnant.
As a physician, it’s not my role to judge or analyze those reasons - only you know what’s best for your life. My role as a healthcare provider is to describe your options without bias, discuss any possible risks, and offer you all the information I can to help you make the best decision for yourself. Ultimately, any reason you feel you no longer want to be pregnant is a valid reason to choose abortion.
* We recognize that abortion is not exclusive to people who identify as women. However, the research and data referenced in this article studied “women” and was not inclusive of all people who have abortions.
