In this table, we are comparing the differences between an abortion with pills and a vacuum aspiration abortion (manual or electric) method to terminate a pregnancy.
It is up to the women to decide which one is best for them according to their budget, availability, geographic location, gestational age, and personal choice.
Choosing the best method of abortion
| Medical Abortion (MA) or Abortion with Pills | In-clinic Abortion or Vacuum Aspiration Abortion | ||
|---|---|---|---|
| What is an abortion with pills (medical abortion)? | What is a vacuum aspiration abortion (in-clinic 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 13 weeks gestation [1], and details can be found here. |
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]Electric Vacuum Aspiration (EVA) is a safe and very similar method to Manual Vacuum Aspiration (MVA). EVA can be used for pregnancies in the first trimester, and/or early second trimester. The primary difference between Electric Vaccum Aspiration (EVA) abortion and Manual Vacuum Aspiration (MVA) abortion is that electricity is used to create suction to remove the pregnancy. Because EVA requires electricity, it may not be available in low-resource settings.
MVA and EVA are performed by a trained provider in a clinic. You can find more details about the procedure here. |
|
| Medical Abortion (MA) or Abortion with Pills | In-clinic Abortion or Vacuum Aspiration Abortion | ||
|---|---|---|---|
| Advantages and disadvantages of an abortion with pills (medical abortion) [1], [2] | Advantages and disadvantages of vacuum aspiration abortion (procedure abortion) [3], [4] | ||
| Efficacy | 95% effective | 99% effective | |
| Safety | Very safe | Very safe | |
| Pregnancy test | Ultrasound is not required | Physical exam is required, and ultrasound may be required depending on the clinic. | |
| Gestational limit | Can be used up to 13 weeks gestation To find out about your gestational age, visit our page Pregnancy Confirmation and Calculator. |
Can be used up to 14 weeks gestation for MVA and 15 weeks gestation for EVA*. (*The gestational age limit for vacuum aspiration 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. |
|
| Location | Takes place in the privacy of the home or wherever a woman feels comfortable. | Takes place in a physician’s office, clinic or hospital. | |
| Carried out by | Can be performed by the woman herself. | Can be safely provided by physicians, nurse practitioners, nurse midwives, physician’s assistants (PAs), and others who are adequately trained. | |
| Duration | The time to completion of the abortion with pills can be a few days to a few weeks. | The time to completion of the vacuum aspiration is minutes. | |
| Side effects | Bleeding may be on and off for about 2 weeks or more. Cramping may be on and off for about 2 weeks. |
Bleeding may lasts from 1 to 2 weeks. Cramping may be on and off for up to 1-2 weeks. |
|
| Complications/risks | Potential risks include: heavy bleeding, infection, continued pregnancy, and incomplete abortion. | Potential risks include: heavy bleeding, infection, injury to the uterus and surrounding structures, incomplete abortion, continued pregnancy. | |
| Cost | Generally, abortion with pills is less expensive than vacuum aspiration abortion because it involves purchasing the pills only. 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. | Typically, vacuum aspirations (in-clinic abortion) are more costly than a medical abortions because it sometimes requires some extra testing (i.e. ultrasound) and a skilled professional to perform the procedure. The exact cost of vacuum aspiration will vary greatly depending on geographic location and the respective laws involving abortion. | |
| Post-abortion care | Follow-up in clinic is sometimes recommended to confirm successful medical abortion. 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. |
Follow-up is sometimes offered after an in-clinic 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 an in-clinic abortion. You can find more details on post-abortion care after a manual vacuum aspiration abortions here. |
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| 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 |
All forms of contraception can be started immediately after the a vacuum aspiration abortion procedure. To find the appropriate contraceptive methods of your choice, visit www.findmymethod.org |
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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.
The National Abortion Federation is the professional association of abortion providers in 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.
[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://www.ipas.org/wp-content/uploads/2023/09/Ipas-Clinical-Updates-in-Reproductive-Health-CURHE23b.pdf
Protocol Misoprostol only PDF