What are your options if you have an unwanted pregnancy

Between one quarter to one third of Australian people assigned female at birth will experience an abortion in their lifetime. If you are pregnant and do not want to be, it is your choice what you would like to do.

Abortion is healthcare.

Abortion is a human right.

Abortion is your choice, no justification needed.

Choosing the type of abortion is a personal decision. But there are also a few factors and circumstances that can impact on the options available to you, on how you can access an abortion, and on what to expect with the abortion process. This includes the state and territory that you live in, your personal preferences, the availability of resources in rural and remote areas, how far along the pregnancy is, certain medical conditions, and your financial situation.

To better understand the options available to you, it can be helpful to speak to an informed, unbiased, and non-directive service, such as a family planning clinic in your state or territory.

While Sexual Health Victoria (SHV) is Victoria-based, they have some incredibly helpful and general information and resources on unplanned pregnancy and your options.

What are my options if I want to end my pregnancy?

Abortion is a safe and common method to end a pregnancy, with a majority of abortions in Australia performed within the first 14 weeks of gestation. Two types of abortion are currently available in Australia: medical and surgical.

Medical abortions are non-surgical and involve taking a combination of prescribed medications that induce a miscarriage. Medical abortions are available across Australia until nine weeks’ gestation (i.e., less than 63 days from the first day of your last period).

Surgical abortions involve using gentle suction to remove the lining and contents of the uterus (womb) while under light sedation. Surgical abortions for pregnancies that are further along (i.e., more than 12-14 weeks after the first day of your last period) require a more specialised procedure. Surgical abortions can be performed at any stage of a pregnancy, but each state and territory has different pregnancy gestational limitations.

How can I access an abortion?

Depending on your state or territory and the type of abortion needed, you may be able to access an abortion at a general practice (only for medical abortions), a private clinic, a community-based clinic, or a hospital.

All states and territories have 50-150 metre ‘safe access zones’. These are designated zones outside of all abortion service providers where no one is permitted to protest or to intimidate a person who is accessing an abortion or who is working for an abortion service provider.

For people who have limited access to abortion service providers, or who would prefer the privacy of their own home, medical abortion by telehealth (also known as a tele-abortion) may also be available via some clinics and hospitals.

It’s important to always check what abortion services a clinic or hospital can provide before making an appointment. healthdirect is a free government-funded service that can help you find medical or surgical abortion services in your state or territory via their website or 24/7 helpline (1800 022 222).

In Australia, health practitioners who have a conscientious objection to abortion are legally allowed to refuse to provide support or assistance to a person seeking an abortion. But, except for in the Australian Capital Territory (ACT) and Western Australia (WA), it is the law that health practitioners with a conscientious objection must direct the person to a service provider who does not hold a conscientious objection.

If you live in WA, you will need a referral from a general practitioner (GP) before you can visit an abortion service provider. In every other state and territory, you can make an appointment with an abortion service provider without needing to see a GP first.

Regardless of the type of abortion that you are seeking (medical, medical via telehealth, or surgical), you will need to first have a clinical consultation with a health practitioner. This is to ensure that the abortion that you are seeking is right for you and your circumstances and that you are making a fully informed and uncoerced decision.

What should I expect in the clinical consultation appointment?

In the consultation, a health practitioner will take your medical, social, and sexual health history. They will also provide you with information about the procedure (i.e., what is involved, what to expect, and any risks and complications), your other options, and any counselling and support services.

The health practitioner might offer you a referral for counselling during your clinical consultation. But it is up to you if you want to have counselling before and/or after the abortion, and it is never a prerequisite for accessing an abortion.

The health practitioner is likely to request a blood or urine test and an ultrasound (transvaginal or abdominal). These tests and scans are to confirm the pregnancy, to establish how far along you are in the pregnancy, and to exclude the possibility of an ectopic pregnancy (i.e., a pregnancy occurring outside of the uterus). You will not be shown the ultrasound scan unless you ask to see it.

If you’re having a surgical abortion, the blood test will also provide information about your blood group, Rhesus (Rh) status, and haemoglobin level. Your haemoglobin level might affect the choice of anaesthetic offered. Your Rh status will determine if a Rho(D) immune globulin injection might be needed. The ultrasound will also allow the health practitioner to see the shape and form of your cervix (the opening to the uterus) and uterus before the abortion.

The health practitioner might also recommend a sexual health screening for sexually transmitted infections (STIs) and might offer to discuss your contraception options. Some contraception, such as the intrauterine device (IUD) or contraceptive implant (Implanon NXT), can be inserted immediately after a surgical abortion. It is important to know that it is possible to become pregnant again within a few weeks after an abortion, especially if your normal menstrual cycle has resumed.

If you are at a private clinic, your blood tests and ultrasound will be done on the same day. If you are at a GP clinic or attending the consultation via telehealth, you are likely to be referred to a pathology service for an appointment specifically for the blood tests and ultrasound.

Once the tests and ultrasound confirm that a particular abortion is right for you, and you have consented (agreed) to the procedure, the health practitioner will prescribe the medications required for the medical abortion, or they will schedule in the surgical abortion.

What happens during a medical abortion?

A medical abortion involves taking a combination of mifepristone (also known as RU486 or ‘the abortion pill’) and misoprostol to induce a miscarriage.

Mifepristone works by blocking the hormone necessary for the pregnancy to continue. This medication can be taken at the clinic or at home. This first tablet usually does not cause any side effects, and you will be able to continue with your normal activities.

Within 24-48 hours after you take the mifepristone tablet, you will need to take four misoprostol tablets at home (as directed by the health practitioner). This second dose of medication will soften the cervix and help the uterus push out the pregnancy tissue through the vagina.

Most people pass the pregnancy tissue within six hours of taking the second dose of medication. You are likely to experience abdominal cramping and vaginal bleeding similar to a miscarriage 1-24 hours after this second dose, with most people experiencing vaginal bleeding and abdominal cramping for up to 2 weeks afterwards.

Some common side effects of the medication include pain, nausea, vomiting, diarrhoea, dizziness, tiredness, and mild fever. It is important to rest and take any pain-relief medication that you have been prescribed, if and when needed.

Most services and clinics organise a pregnancy hormone blood test 7 days after you have taken your first tablet to check that the hormone level has dropped and that you are no longer pregnant. Other services and clinics might request a follow-up appointment around 1-2 weeks after to make sure that the pregnancy has ended, to check for any complications, and to review your contraception options.

What happens during a surgical abortion?

A surgical abortion can go ahead if you have not had anything to eat or drink for a minimum of six hours beforehand. The procedure itself takes approximately 15 minutes, depending on how far along your pregnancy is. With preparation and recovery, you might be in the clinic for a total of 4-5 hours.

A combination of twilight anaesthetic and local anaesthetic is most commonly used for surgical abortions; this will mean minimal to no pain or awareness during the procedure. The twilight anaesthetic is first given, where you are likely to feel quite drowsy and a floating sensation. A local anaesthetic is then given to numb the cervix. Throughout the procedure, you are likely to be in a dream-like consciousness and may have very little memory of it afterwards.

For earlier pregnancies (i.e., up to 12-14 weeks after the first day of your last period), the medical practitioner will insert a small soft thin tube through the cervix and into the uterus via the vagina and apply gentle suction to remove the lining and contents of the uterus. This type of surgical abortion is known as a suction curette or suction abortion. You will not see the pregnancy tissue.

In more advanced pregnancies (i.e., more than 12-14 weeks after the first day of your last period), the medical practitioner will use a rod (dilator) to gently stretch open the opening of the cervix and apply gentle suction or forceps (surgical tools) to remove the lining and contents of the uterus. This type of surgical abortion is known as dilation and evacuation (D&E). You will not see the pregnancy tissue.

If you have chosen to have an IUD or Implanon NXT inserted, this will be done while you are under sedation after the surgical abortion is complete. Pain relief and antibiotic medicines are sometimes administered at the end of the procedure.

After the procedure, you will be required to stay in the clinic or hospital for approximately an hour to recover. You will be able to go home once the anaesthetic has worn off and you have received your aftercare advice.

It is normal to feel tired or drowsy for several hours afterwards. Most people experience light vaginal bleeding, abdominal cramps, and breast/chest tenderness for a few days after the procedure. Some people may pass some small blood clots. It is important to rest and take any pain-relief medication that you have been prescribed, if and when needed.

For the first week after the procedure, it is recommended that you don’t insert anything into the vagina (i.e., tampons, menstrual cups), don’t have vaginal sex (i.e., no penetration), don’t perform any strenuous activity (i.e., sport or heavy physical work), don’t go swimming, and don’t have a bath.

A follow-up appointment might be recommended for 1-2 weeks after the abortion.

What are the risks?

Both medical and surgical abortions are low-risk and have a high success rate, with serious complications being quite rare. But as all medical and surgical procedures have some risks, it is important for you to know the possible complications to ensure that your decision is informed and to ensure that you have adequate post-abortion care and support.

When abortion is legal and is performed safely and with adequate support, there is no increased risk of infertility, complications or premature birth in future pregnancies, breast cancer, or long-term mental health issues.

Can I have a support person with me?

A support person (i.e., a friend, a partner, a family member, etc) would be able to accompany you into a clinic or hospital. But it is unlikely that they will be permitted to be with you during your consultation appointment or during any medical tests and procedures (i.e., blood tests, ultrasound, or surgical abortion).

If you’re having a medical abortion (in clinic or via telehealth), you will be required to have a support person stay with you from the time you take the second dose of medication (misoprostol) until the miscarriage has happened. You will also be required to be living or staying somewhere that is within 1-2 hours away from a 24-hour emergency medical service for 2-3 weeks from the time you take the misoprostol.

If you’re having a surgical abortion, you will be required to have a support person drive you home. Your support person will be notified when you are ready to be discharged from the clinic or hospital.

What are the costs associated with accessing an abortion?

While there are Medicare rebates for surgical abortions, not all states and territories have low-cost or free abortion services, so out-of-pocket expenses are quite likely. Medical abortion is not covered by Medicare, but some of the medications needed are listed on the Pharmaceutical Benefits Scheme (PBS). Medical abortions tend to be cheaper than surgical abortions, and surgical abortions performed beyond 14 weeks tend to be more expensive. The current process for accessing abortion means that there can be a number of additional costs including for multiple consultations, ultrasounds, blood tests, travel, and accommodation.

This blog post is a brief exploration of this topic and does not replace therapy. At SHIPS, we have practitioners that are knowledgeable and skilled in a variety of areas including sex therapy, relationships and more. If you may benefit from some support, please check out our website resources, or contact us.

We are also always happy to hear feedback about our blog articles. If you would like to share your experience or feel we may have missed something on this topic, please contact us to let us know.