Abortion Pill vs. Surgical Abortion: Which Is Right For Me?

Last updated on 13/07/2020

by the safe2choose team and supporting experts at carafem, based on the 2020 recommendations by The National Abortion Fund (NAF), the 2019 recommendations by Ipas, and the 2012 recommendations by the WHO.

In this table, we are comparing the advantages and disadvantages of an abortion with pills and a manual vacuum aspiration abortion method to terminate a pregnancy.

safe2choose endorses these two safe methods within the first 11 weeks of pregnancy, and it is up to the women to decide which one is best for them according to their budget, availability, gestational age, and personal choice.

Choosing the best abortion method

Medical Abortion (MA) or Abortion with Pills
What is an abortion with pills (medical abortion)?
Definition Medical abortion (sometimes called abortion with pills) is a very safe method of abortion in which a woman uses pills at home to end an unwanted pregnancy.
There are two safe regimens for medical abortion: using Mifepristone in combination with Misoprostol, or using Misoprostol alone. safe2choose endorses both of these methods of medical abortion for pregnancies up to 11 weeks gestation [1], and details can be found here.

Surgical Abortion or Manual Vacuum Aspiration Abortion (MVA)
What is manual vacuum abortion (surgical abortion)?
Definition Manual vacuum aspiration (MVA) is a very safe method of abortion for pregnancies in the first trimester, and/or early second trimester all the way up to 14 weeks of gestation. The gestational age limit for MVA often depends on the clinic, as well as the healthcare provider performing the procedure. [3]
MVA is performed by a trained provider in a clinic. You can find more details about the procedure here.

Medical Abortion (MA) or Abortion with Pills
Advantages and disadvantages of an abortion with pills (medical abortion) [1], [2]
Efficacy95% effective
SafetyVery safe
Pregnancy testUltrasound is not required
Gestational limitCan be used up to 11 weeks gestation
To find out about your gestational age, visit our page Pregnancy Confirmation and Calculator.
LocationTakes place in the privacy of the home or wherever a woman feels comfortable.
Carried byCan be performed by the woman herself.
DurationThe time to completion of the abortion with pills can be a few days to a few weeks.
Side effectsBleeding may be on and off for about 2 weeks or more.
Cramping may be on and off for about 2 weeks.
Complications risksPotential risks include: heavy bleeding, infection, continuing pregnancy, and incomplete abortion.
CostGenerally, MA is less expensive than MVA because it involves purchasing the pills onl. An ultrasound, which can be costly, is not required. The exact cost of MA will vary greatly depending on geographic location and whether or not the pills are available over-the-counter at the pharmacy, or by prescription-only.
Post-abortion care Follow-up in clinic is sometimes recommended to confirm successful MA.
Women should contact their clinic if they experience: heavy bleeding, fevers, severe pain, symptoms of infection or continued pregnancy.
A urine pregnancy test will become negative 4-6 weeks after successful MA.
Generally, women may return to their regular activities as tolerated after MA.
You can find more details on post-abortion care after a medical abortion here.
Contraception care Most forms of contraception can be started immediately after medical abortion, with the few exceptions being the vaginal ring and the IUD.
To find the appropriate contraceptive methods of your choice, visit www.findmymethod.org

Surgical Abortion or Manual Vacuum Aspiration Abortion (MVA)
Advantages and disadvantages of manual vacuum abortion (MVA or surgical abortion) [3], [4]
Efficacy99% effective
SafetyVery safe
Pregnancy testUltrasound is required to date the pregnancy
Gestational limitCan be used up to 10-14 weeks gestation* (*The gestational age limit for MVA often depends on the clinic, as well as the healthcare provider performing the procedure)
To find out about your gestational age, visit our page Pregnancy Confirmation and Calculator.
LocationTakes place in a clinic or hospital.
Carried byNeeds a trained physician to perform the procedure.
DurationThe time to completion of the MVA is minutes.
Side effectsTypically has a shorter duration of bleeding than MA as it lasts from 1 to 2 weeks.
Typically has a shorter duration of cramping than MA, but can be on and off for up to 1-2 weeks.
Complications risksPotential risks include: heavy bleeding, infection, injury to the uterus and surrounding structures, incomplete abortion, continued pregnancy, and death.
CostTypically, MVA will be more costly than MA because MVA requires some testing (ie ultrasound) and a skilled professional to perform the procedure. The exact cost of MVA will vary greatly depending on geographic location and the respective laws involving abortion.
Post-abortion care Follow-up in clinic is sometimes offered after surgical abortion, but it is not required.
Women should contact their clinic if they experience: heavy bleeding, fevers, severe pain, symptoms of infection or continued pregnancy.
A urine pregnancy test will become negative 2-3 weeks after the procedure.
Generally, women may return to their regular activities as tolerated after surgical abortion.
You can find more details on post-abortion care after a manual vacuum abortion here.
Contraception care All forms of contraception can be started immediately after the MVA procedure.
To find the appropriate contraceptive methods of your choice, visit www.findmymethod.org

Authors:

The National Abortion Federation is the professional association of abortion providers North America.

carafem provides convenient and professional abortion care and family planning so people can control the number and spacing of their children.

Ipas is the only international organization solely focused on expanding access to safe abortion and contraceptive care.

WHO is a specialized agency of the United Nations responsible for international public health.


Sources

[1] National Abortion Federation (NAF). Clinical Policy Guidelines for Abortion Care. 2020. Retrieved from: https://5aa1b2xfmfh2e2mk03kk8rsx-wpengine.netdna-ssl.com/wp-content/uploads/2020_cpgs_final.pdf

[2] Gynuity. Providing medical abortion in low-resource settings An Introductory Guidebook. Second Edition. 2009. Retrieved from: https://gynuity.org/assets/resources/clinguide_maguide2nd_edition_en.pdf

[3] World Health Organization (WHO). Safe abortion: technical and policy guidance for health systems, second edition. 2012. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.pdf;jsessionid=F77B761669FC579124C1E9CA2CC3CFDB?sequence=1

[4] Ipas. Clinical Updates in Reproductive Health. 2019. Retrieved from: https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf

We are staying available to support you with your abortion during COVID-19.

We are closely monitoring the situation of coronavirus globally and will keep updating our information and services.

We advise our readers to:

  1. Read our latest blog post on abortion and COVID-19
  2. Follow WHO safety guidelines on COVID-19
  3. Contact our counselors