Abortion options

Women having an abortion in the U.S. can choose one of two methods: the so-called abortion pill or a surgical procedure. Together, they account for some 850,000 legal abortions performed in the U.S. each year.

For both types, the first step should be to date the pregnancy, typically via ultrasound. Ultrasound can also usually identify pregnancies developing in the fallopian tubes--an emergency requiring immediate treatment.


drug-induced abortion

This involves pharmacologically inducing an early miscarriage and requires taking two drugs. The first, known as RU-486, the code given by its French developers, is sold in the U.S. under the brand name Mifeprex (mifepristone). For use only within the first seven weeks of pregnancy, mifepristone causes the developing embryo to detach from the uterine lining, but not to be expelled from the woman’s body. That job is done by a second drug, Cytotec (misoprostol).

Taken within 6 to 72 hours after mifepristone, misoprostol completely expels the pregnancy in more than 90 percent of users, usually within a day. Almost all women experience cramping, and most feel nauseated. Bleeding, heavy at times, typically continues for about two weeks, but can last as long as a month. A follow-up ultrasound one to two weeks later is necessary to make sure the embryo has been completely expelled. If not, a surgical abortion usually is performed.

In November, the FDA and mifepristone’s manufacturer strengthened safety warnings after reports of three patients' deaths. One death was from a ruptured tubal pregnancy; the others were from infection.


Surgical abortion

Vacuum aspiration, also known as suction curettage, is the standard surgical abortion method in the U.S. for pregnancies in the first trimester, when 88 percent of legal abortions take place.

The cervix is enlarged to a diameter of about a half-inch, either by use of dilating rods or the drug misoprostol. The uterine contents are sucked out using a manual or electrical pump while the woman is under local anesthesia. Some women may have cramps afterward, and also intermittent bleeding for a week or two.


Comparative risks

In the U.S., the fatality risk with mifepristone is slightly less than 1 per 100,000 cases, compared with 0.1 per 100,000 for surgical abortion at 8 weeks or less. Pregnancy itself carries a fatality risk of 11.8 per 100,000.