By Belinda Munyeza.
Women seeking abortion services have many worries around complications that may arise following the procedure, particularly pertaining to fertility and sexual health. Some of these worries are rooted in misconceptions surrounding the procedure or lack of adequate information around abortion procedures and the risks. This is why it is important to discuss what to expect when having or considering having an abortion, from safety to risks, complications, and post-abortion care.
Unsafe Vs. Safe Abortion
Abortions can be considered safe or unsafe. According to the World Health Organisation (WHO) (2012), unsafe abortion is characterized as being carried out by personnel that do not have the necessary skills to perform one, in environments that do not meet minimal medical standards, or both . These characteristics of unsafe abortion can be seen in situations (among others) where counseling services are not provided prior to the procedure, the procedure is performed outside of official health-care facilities, and where there is poor hygiene.
Another sign of unsafe abortion is when it is self-induced by ingestion of unregulated medication/potentially harmful substances . In some countries, such as Zimbabwe, where there are strict abortion laws, this method has unfortunately become more common over the years. According to Pambuka News (2012), many women seeking abortion in Zimbabwe do so by ingesting unregulated mixes of herbs and unknown substances from traditional healers to induce abortion outside of official health-care facilities . Unsafe abortion methods are also a rising issue in South Africa, according to the International Women’s Health Coalition (2016). Low-cost procedures performed outside of health-care facilities are becoming more and more prevalent and are being advertised to women by the unskilled providers who perform them .
By contrast, a safe abortion is one that is performed in an environment where hygiene is maintained; the procedure is performed by skilled medical practitioners through regulated methods; and pre/post-abortion counseling and care is available . These characteristics, in turn, make safe abortion procedures much less risky when it comes to the health implications.
But what are the health implications of abortion procedures in general?
Complications After Abortion
There are many misconceptions that people have about the safety of abortion procedures and how they can affect women’s fertility or sexual health afterward. Many people tend to think abortion leads to issues with future pregnancies or sexual health. However, according to the National Health Service (NHS), abortion procedures are generally safe and they do not affect a woman’s chances of getting pregnant in the future. In fact, the NHS recommends women use contraception right away if they wish to avoid pregnancy after an abortion .
Of course, depending on the abortion procedure (medical or surgical), there are some minor risks to be considered, as with any medical procedure. For instance, with medical abortions, there is a 1 in 1000 chance of heavy bleeding or sepsis due to the procedure which can damage the womb . With surgical abortion, there is also a small risk of infection or injury to the cervix . Both these risks are worth considering as they do have an impact on a woman’s chances of pregnancy moving forward. Generally, however, abortions are not any riskier than any other procedure a woman might undergo, and the chance of complications is low. A report by the National Abortion Federation in America (2006) stated that, on average, 97% of safe abortions performed resulted in no complications, while of the 3% that did, only 0.5% were serious . In 2020, the U.S. National Library of Medicine reported that only 2% of performed safe abortions resulted in complications . As long as the abortion procedure opted for is performed safely, there should be little to worry about when it comes to fertility.
With unsafe procedures, however, there is a higher chance of many complications arising. According to the WHO (2020), unsafe abortions have a high risk of resulting in heavy bleeding, infection, uterine perforation, and damage to the genital tract and internal organs . These are all complications that can reduce fertility as well as cause discomfort and reduce the quality of one’s sexual health after the procedure. For this reason, it is important to avoid unsafe procedures in order to safeguard one’s post-abortion reproductive health.
Sex and Menstruation After Abortion
According to Planned Parenthood, it is quite normal to experience bleeding after an abortion (as long as it is not excessive), and if this bleeding occurs, you should treat it like you would any regular menstrual cycle . This means that you can use pads, tampons, or whatever products you prefer, and you can expect your next menstrual cycle to arrive four–eight weeks after your abortion as the procedure starts a new cycle.
When it comes to sex after your procedure, Planned Parenthood says you can have sex whenever you are ready . However, according to Women Help Women, it is better to avoid it until after bleeding from the procedure stops, which is usually in about two days. If you feel comfortable enough before then, it is advisable to use a condom as it can reduce the risk of infection . Furthermore, it is important to remember that contraception is important to prevent pregnancy if you do not intend to get pregnant.
Overall, abortion procedures are not as risky as we might initially believe and as long as health precautions are taken by the person seeking an abortion, as well as those performing it, reproductive and sexual health, post-abortion, should not be affected.
 “Safe and unsafe induced abortion.” WHO Abortion Information Sheet, 2012, apps.who.int/iris/bitstream/handle/10665/75174/WHO_RHR_12.02_eng.pdf;sequence=1. Accessed March 2021.
 “Our ugly secret: abortion in Zimbabwe, illegal but thriving.” Pambuka News, 2012, www.pambazuka.org/governance/our-ugly-secret-abortion-zimbabwe-illegal-thriving. Accessed March 2021.
 “The High Cost of Legal Abortion in South Africa.” International Women´s Health Coalition, 2016, iwhc.org/2016/07/high-cost-legal-abortion-south-africa/. Accessed March 2021.
 “Risks – abortions.” NHS UK, 2020, www.nhs.uk/conditions/abortion/risks/. Accessed March 2021.
 Dudley, S., Kruse, B. “Safety of Abortion.” National Abortion Federation, 2006, prochoice.org/wp-content/uploads/safety_of_abortion.pdf. Accessed March 2021.
 Sajadi-Ernazarova KR., Martinez CL. “Abortion Complications.” StatPearls Publishing, 2020, www.ncbi.nlm.nih.gov/books/NBK430793/. Accessed March 2021.
 “Preventing unsafe abortions.” WHO, 2020, www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion. Accessed March 2021.
 “What can I expect after having an in-clinic abortion?” Planned Parenthood, 2020, www.plannedparenthood.org/learn/abortion/in-clinic-abortion-procedures/what-can-i-expect-after-having-an-in-clinic-abortion. Accessed March 2021.
[9 ] “Here´s what you should know about sex after medical abortion.” Women Help Women, 2017, womenhelp.org/en/page/999/here-s-what-you-should-know-about-sex-after-medical-abortion. Accessed March 2021.