Post-Abortion Care: Hospitals' Role And Responsibilities

Abortion is a safe procedure, though rare complications can include incomplete abortion, infection, heavy vaginal bleeding, and injury to the uterus and other organs. It can be performed in a clinic, hospital, or at home, depending on the patient's health, the stage of pregnancy, and the region in which they are located. In the United States, abortion laws vary by state, with some states banning or restricting abortion access. In some cases, hospitals have been found to violate the law by denying emergency abortions to women with nonviable, life-threatening pregnancies.

Abortion laws by state

Abortion laws vary significantly across the United States, with almost half of the states likely to enact new laws that are as restrictive as possible. Currently, abortion is illegal in Alabama, with exceptions to preserve the woman's life, physical health, or in the case of fatal fetal abnormalities. There are no exceptions for rape or incest. Performing an abortion is a Class A felony, with up to 99 years in prison, and attempted abortion is a Class C felony, punishable by 1 to 10 years in prison.

Georgia passed an abortion law in 2019 that prohibits abortions after a fetal heartbeat is detected, usually six weeks following the last menstrual period. This law was reinstated after the Dobbs ruling, which overturned Roe v. Wade and eliminated the federal constitutional right to abortion. The Dobbs ruling has resulted in many states creating new abortion restrictions and bans, as well as enforcing existing ones.

Some states, such as Texas, have laws that ban abortion at an early gestational age and allow members of the public to sue abortion providers and those who help others access abortion care. Other states, like Iowa, require survivors of rape and incest to report the incident to law enforcement or a health agency within a specific time frame to qualify for an exception to the abortion ban.

In contrast, some states have enacted laws to protect abortion rights. For example, Colorado voters rejected an initiative to amend the definition of a person to "any human being from the moment of fertilization" in 2008. Instead, they passed the Reproductive Health Equity Act, which assures individuals' fundamental right to make decisions about their reproductive health care, including the right to continue a pregnancy, have an abortion, or use or refuse contraception. Montana also made abortion an explicit constitutional right in 2024, with the Montana Supreme Court ruling that abortion was a right implicitly granted by the state constitution.

Medical abortion

A medical abortion is a non-surgical way to terminate a pregnancy in its early stages, using a combination of medicines. It is a safe and effective procedure that works by stopping the growth of the pregnancy and causing the uterine lining to shed.

The most common regimen involves taking two prescription pills – mifepristone and misoprostol. Mifepristone blocks progesterone, the hormone needed to support a pregnancy. Misoprostol causes cramping and bleeding to empty the uterus. The FDA has approved the use of these drugs for medical abortion as safe and effective up to 10 weeks of gestation, but there is evidence that it is safe beyond this point as well. The drugs may be placed in the vagina, taken by mouth, injected into the uterus, or given through an IV line.

Surgical abortion

The patient will first meet with a female health educator to discuss pregnancy options, the abortion procedure, and birth control methods. The educator will take the patient's blood pressure, pulse, and weight, and the patient may be joined by a support person during this time. After this, the patient will meet with the doctor, who will review their medical history and perform an ultrasound exam to determine the pregnancy's gestation.

Suction aspiration is the most common type of surgical abortion and is usually performed until about 14-16 weeks after the patient's last period. Another type of surgical abortion is dilation and evacuation (D&E), which is performed later in the pregnancy, usually after 16 weeks, and involves using suction and additional medical tools to empty the uterus.

In the second trimester, from 13 to 24 weeks gestation, the procedure may involve additional steps to prepare the cervix, such as administering hormone-blocking tablets to help soften it. These may be taken by mouth or inserted into the vagina and typically take two hours to take effect. A special device may also be inserted into the cervix to help it widen.

Abortion care

Medication Abortion

Medication abortions use a combination of drugs, typically mifepristone and misoprostol, to end an early pregnancy. Mifepristone blocks progesterone, the hormone needed to support a pregnancy, and misoprostol causes cramping and bleeding to empty the uterus. This type of abortion can be done at home and is approved by the Federal Drug Administration (FDA) as safe and effective up to 10 weeks of gestation. However, there is evidence that it is safe beyond 10 weeks. Medication abortions may cause vaginal bleeding that is heavier than a menstrual period, severe cramping, nausea, vomiting, fever, and chills.

Procedural Abortion

Procedural abortions in the first trimester are typically done with vacuum aspiration, also called suction curettage, and are offered up to 13 weeks of pregnancy. Procedural abortions can also be done in the second trimester, which involves taking medications to cause the uterus to contract and pass tissue. This process is usually done in a hospital or clinic and can be completed in 12 to 24 hours. Pain medication is usually given, and regional anesthesia may be an option.

Legal Considerations

It is important to note that laws governing abortion vary by state and country. In the United States, some states have banned all types of abortion care, while others restrict when and how it may be provided. Similarly, in Australia, legal, regulatory, and policy contexts may vary. It is essential to seek information about the specific laws and regulations in your location when considering abortion care.

Post-abortion contraception

Contraception after an abortion is essential to prevent unintended pregnancies. Ovulation can return as early as 8–10 days after an abortion and usually within a month, so contraception should be started as soon as possible within the first month. All contraceptive methods are considered safe and effective when provided immediately after an abortion, and the patient's right to decline or postpone this care should be respected.

The contraceptive implant can be inserted under the skin of the upper inner arm at the time of a surgical termination. Initiation of these progestogen-releasing devices at the time of mifepristone does not appear to reduce the effectiveness of medical abortion, and insertion can occur at the time of prescribing and/or taking mifepristone. When the implant is inserted within the first five days following a surgical or medical abortion, it will be immediately effective.

Contraceptive injections, IUDs, and hormonal contraceptive pills are also considered effective immediately after a surgical abortion and can be provided at that time. If you have the contraceptive injection or start taking the pill more than five days after an abortion, you will need to use additional contraception for one week. An IUD can be inserted straight away after a surgical abortion, even while you are still under anaesthetic or sedation. This is considered acceptable and convenient by many women, as no separate appointment is required, and is one of the most effective options. However, there is a slightly increased risk of an IUD being expelled when inserted right after an abortion.

Hormonal contraception, if initiated within the first five days after a medical or surgical abortion, is immediately effective. Copper-bearing intrauterine devices (Cu-IUDs) are effective immediately when inserted any time after an abortion. Delaying initiation until later may increase the risk of a rapid repeat unintended pregnancy.

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