Ever since experiencing some very sub-optimal sex education at the hands of the Catholic school system, I have become a believer in the importance of quality and age appropriate sex education. Sex education should not only encompass puberty, pregnancy, and STIs, but also LGBTIQ issues, sexual violence, and navigating sexual relationships, intimacy, and pleasure.
And, when the time is right, I think both men and women should learn about abortions. The reason for this is straightforward: in both my home country of Australia and the UK, it is estimated that one in three women will have an abortion in their lifetime.
At high school the sum of what I was taught about this common procedure was ‘don’t have one, it’s a sin and you’ll regret it forever’. Even when I was studying medicine, the topic wasn’t covered in much detail. It took until the end of medical school, when I was completing extra training in sexual health, that I decided to do something about this: I went and watched some abortions. They weren’t scary and they weren’t horrific. They were simple, respectful, and – for most women – a huge relief.
There are two different types of abortion: medical and surgical. In a society where there is much fear and misinformation surrounding abortions, providing accurate information about them helps to both demystify the procedure, and decrease stigma. People have the right to know what happens, and so I will briefly explain what both abortion types entail.
Medical abortions are safe and effective before seven weeks gestation, but can be performed up to nine weeks. A medical abortion involves taking two different tablets about two days apart. The first of these is mifepristone, a synthetic anti-progestogen that interrupts the pregnancy. The second of these is misoprostol, a prostaglandin analogue that causes uterine contractions and expulsion of the pregnancy, most often within 4-24 hours of taking it. For most women, having a medical abortion feels like an early miscarriage: they experience cramping and bleeding, and it is possible, though uncommon, for them to see pregnancy tissue pass. Around two weeks after taking misoprostol, a doctor needs to confirm (i.e. via ultrasound) that the termination is complete. If the pregnancy is still ongoing, then a surgical abortion should be performed.
Depending on where you live in Australia, surgical abortions can be performed before 14-24 weeks of gestation (or later in some states if approval is given). In the UK, it can be done up to 24 weeks. While the procedure varies subtly depending on the clinic and the degree of gestation, this is the method used at the clinic I visited and is suitable for pregnancies in the first trimester.
Upon arrival a nurse uses ultrasound to confirm the location and gestation of the pregnancy. This is important as if the pregnancy is ‘ectopic’ (located outside the uterus) a surgical abortion will not appropriate. Following this, the doctor performing the abortion discusses the potential but rare risks of the procedure (surgical abortions are very safe and effective), and prescribes an antibiotic to reduce the chance of infection. The anaethetist then explains the nature of the anaesthetic and assesses the patient’s anaesthetic risk.
Once in the procedure room, the woman is made comfortable, sedated and positioned correctly. Then the abortion begins: the doctor uses a speculum to observe the cervix, graduated dilator rods to make the cervical opening wider, and gentle suction to remove the pregnancy. While under sedation, a woman can also have a Pap smear if she is due, or have an IUD or Implanon inserted for contraception. Once the procedure is complete, the lady is transferred to a single room for recovery before being taken home, and the doctor checks the aspirated tissue to confirm the presence of the tiny pearlescent pregnancy sac. On average, the whole procedure takes less than ten minutes.
Each time I visited the clinic there were nearly twenty women booked for abortions. Even though I knew the statistics, this seemed like a large number because there are many good contraceptive and emergency contraceptive options available. In particular, long acting reversible contraception (or LARCs) such as IUDs and the implant have revolutionised the way we prevent pregnancy: they are cheap, easy to use, can last from three to ten years depending on the device, and are just as or even more effective than sterilisation.
So not only should we talk about abortions, but perhaps doctors and the wider community would benefit from further education about contraception; doctors so they give correct information, and the community so they’re aware of their choices and rights. I believe that access to abortions is imperative and that it’s a woman’s right to have one. But given the excellent contraceptive options available, surely it’s also a woman’s right not to need one in the first place?
