A guide to getting a safe abortion and when the abortion pill is right for you

• The abortion pill is also known as a medical abortion, and it involves taking two different medications.
• An abortion pill can be taken at home and can be prescribed via a telehealth visit.
• Besides a medical abortion, you can get a surgical abortion, which is done by a trained doctor.

Of the millions of people who face unplanned pregnancies each year, around 40% opt to get an abortion.

Many factors influence an individual's decision to have an abortion including a lack of support from a partner or family, an unstable financial situation, and health concerns.

Additionally, women who became pregnant due to contraceptive failure, rape, incest or intimate partner violence may choose to terminate their pregnancy.

In the news: A recent Texas law bans abortions after 6 weeks of pregnancy, which is usually sooner than when most women know they're pregnant. Therefore, many Texan women will have to leave the state for an abortion, seek abortions in-state that are not medically supervised, or remain pregnant against their will.

Ultimately, the decision is 100% yours to make. However prior to having an abortion, its important to know where to access services safely and what to expect during the treatment and/or procedure.

Here we discuss the two ways to interrupt/end a pregnancy - via an abortion pill or through a surgicial procedure - how to access these services safely, and what to expect during each procedure, including cost.

Abortion pill

Related Article Module: Everything you need to know about the abortion pill, according to a gynecologist

The abortion pill (also known as a medical abortion), is non-invasive and recommended for pregnancies up to 10-11 weeks along.

Note: Unlike the abortion pill, emergency contraception, like Plan B, is available over the counter and won't work if you're already pregnant. But it does prevent ovulation if you've had unprotected sex.

Medication abortion is supported by major medical organizations both nationally and internationally.

According to Kelly Culwell, MD, an OB-GYN with her own private practice, a medical abortion is a two-step process.

The first entails taking a single pill called Mifepristone, which stops the pregnancy from growing by blocking your body's production of the hormone progesterone and thinning the lining of the uterus. This pill is typically administered at your doctor's clinic but this can vary depending on state laws. Patients can also safely and effectively take these medications at home.

The second step is that you'll be given Misoprostol pills to take at home 24-48 hours later. These medications work together to create an early miscarriage and can cause bleeding and cramping similar to a heavy period.

Note: In some places, mifepristone is unavailable. In this case, a misoprostol only regimen is acceptable.

At eight weeks or less, the abortion pill method works 94% to 98% of the time. However, its effectiveness wanes the farther along you are.It works about 87% of the time at 10-11 weeks.

You'll need to follow up with your doctor about a week after taking the pills to confirm that the abortion worked by getting blood work done. Some providers will just ask you to do a pregnancy test at home and follow up via a telephone call or a telemedicine visit.

Suction abortion

Suction abortion, also known as an aspiration abortion, is performed at a doctor's office, clinic, or in an operating room setting. It can be performed up to 14 weeks after the first day of your last period.

According to board-certified gynecologist Alexandra Bausic, MD, the cervix may need to be dilated, and then a small tube is inserted into the uterus to remove the contents via a suctioning device.

Culwell notes that this can be performed with local anesthesia or mild sedation to help relieve pain and anxiety.

Dilation and evacuation abortion

According to Culwell, dilation and evacuation (D&E) is the most common abortion procedure done during the second trimester of pregnancy or 15 weeks onward. The cervix is dilated and the pregnancy tissue is removed using suction or other instruments.

"Sometimes it is a two-day procedure to ensure the cervix is open enough to perform the procedure safely," says Culwell. "You will either be given medications to take before the procedure to help open the cervix, or dilators may be placed in the cervix for several hours or the day before the procedure."

Note: If you are going to have a surgical abortion, you will need someone to drive you home. You'll also need your ID and health insurance card, if you have insurance.

Who is eligible for an abortion?

Abortion is legal in all 50 states, but laws regarding eligibility vary state by state.

According to Culwell, some states have requirements that women under a certain age have parental consent, some have mandatory waiting periods between your first counseling visit and receiving the abortion, and some have banned abortion after a certain week of pregnancy. Most of these restrictions have exemptions for certain situations (such as rape or risk to the woman's health).

"Usually, pregnancies before 10 weeks are eligible for medical abortion, and pregnancies before 14 weeks are eligible for surgical procedures," says Bausic.

If you're under the age of 18, note that 37 states require parental involvement in a minor's decision to have an abortion (either consent, notification, or both).

Culwell says many, but not all, OB-GYNs provide abortions in their practices or at hospitals. However, they will likely be able to refer you to a clinic where you can get one.

If you are unsure of where you can get an abortion, Culwell recommends searching the directories on Planned Parenthood or the National Abortion Federation to find a local provider.

Important: Be aware that "crisis pregnancy centers" are not the same as abortion clinics. In fact, their objective may be to persuade women not to terminate their pregnancy. Additionally, they may provide misinformation, and often are staffed with non-medical professionals.

How much does an abortion cost?

Abortion costs have a wide range and depend on which procedure you're having, where it is being performed, and your health insurance coverage.

As a general rule medical abortions tend to cost less, and the cost also tends to increase the farther along you are in your pregnancy.

On average, women pay around $500 for an abortion (surgical or medical) at 10 weeks and $1,195 for an abortion at 20 weeks, according to the data from the Guttmacher Institute.

"When you call to make an appointment, the staff can estimate how much the procedure will cost as well as check to see if your insurance might help cover the cost," says Culwell.

Some state Medicaid programs cover the cost of abortion, but only in situations where the pregnancy was caused by rape or incest, or where the pregnancy is deemed potentially life-threatening.

If you don't have insurance or it doesn't cover abortion, some clinics may provide an income-based sliding scale system, and there are also nonprofit abortion funds that may help to pay for the procedure.

Whichever abortion procedure you choose to have, Culwell says it's critical to go to a reputable facility, clinic, or doctor for your own safety.

Additonal resources

If you're pregnant and thinking about getting an abortion, it's your decision to make. While the methods outlined above are safe and legal, it's normal to have questions about what to expect before and after. Here are few resources to help.

• Exhale textline
• Connect & Breathe post-abortion hotline
• All-Options hotline
• Planned Parenthood post-abortion counseling

Insider's takeaway

How far you are into the pregnancy will not only play into your eligibility for abortion (based on your local state's laws) and the cost but also which type of medical or surgical abortion you choose. Your OB-GYN can help to advise you on the best option for you based on your specific situation.

One of the most common concerns about abortion is that it causes infertility, but Bausic and Culwell both insist that's highly unlikely. According to Mayo Clinic, an elective medical abortion does not appear to increase the risk of fertility issues or future pregnancy complications, as long as it's performed by a licensed and trained medical provider.

If you're concerned about the possible impact of your abortion on your chances of future pregnancy or have further concerns, talk to a health care provider.

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