Types of In-Clinic Abortion
There are different types of in-clinic abortion methods that can be performed at different stages of a pregnancy. This page details information about each of the procedures.
What is an in-clinic abortion?
1/ Definition of an in-clinic abortion
In-clinic abortion is a safe and 99% effective method for elective abortion, or management of miscarriage, and it is performed in a clinic or hospital, by a trained healthcare provider. 
During the procedure the clinician uses instruments to gradually open (dilate) the cervix, and then uses a method of aspiration to remove the pregnancy from the uterus. The woman is likely to experience cramping during the procedure, and there may be some bleeding on and off for several days or weeks afterward. 
2/ The different methods of in-clinic abortion
There are several safe methods of in-clinic abortion that you can choose from, and it mostly depends on the gestational age of your pregnancy. Because there is some overlap in the gestational ages for different methods of abortion, the decision may also be based on geographic location, availability of equipment, and provider and personal preference. , 
- Manual Vacuum Aspiration (MVA) is a form of uterine aspiration, and is typically used up to 14 weeks gestation
- Electric Vacuum Aspiration (EVA) is a form of uterine aspiration, and is often used up to 15 weeks gestation
- Dilation and evacuation (D&E) methods are commonly used beyond 14 weeks gestation
- Induction abortion, when used, is typically done for pregnancies beyond 16 weeks gestation
- Dilation and Curettage (D&C) is an outdated method of abortion and has largely been replaced by methods of uterine vacuum aspiration and dilation and evacuation (D&E).
safe2choose endorses Manual Vacuum Aspiration (MVA) abortion or Electric Vacuum Aspiration (EVA) abortion for pregnancies in the first trimester or early second trimester, and provides detailed information regarding these methods here.
3/ The use of anesthesia in in-clinic abortion
There are several different types of anesthesia that may be used for in-clinic abortion, and which method is used will often depend on the gestational age of the prengnancy, as well as the availability of anesthetic agents in the clinic. Possible anesthesia methods include :
- Local anesthetic: This is the most common type of anesthetic used for in-clinic abortion. It is a numbing medicine injected next to the cervix to help ease discomfort during the procedure. The woman remains awake and fully alert.
- Moderate/Conscious sedation: This is an anesthetic administered directly into a vein, and it slightly decreases the consciousness level of the woman. She will respond to verbal commands.
- Deep sedation: This is an anesthetic administered directly into a vein, and it significantly decreases the consciousness level of the woman. She will respond to repeated verbal commands.
- General anesthesia: This may use a combination of inhaled or injected anesthetic agents, and it renders the woman unconscious. She will not respond to verbal commands.
What is Manual Vacuum Aspiration (MVA) abortion ?
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.
MVA is performed by a trained provider in a clinic.
During the procedure the clinician uses instruments, including a silent suction device, to remove the pregnancy from the uterus . Most commonly this procedure is performed using local anesthesia while the woman is awake, and it takes typically between 5 and 10 minutes. The woman is likely to experience cramping during the procedure, and there may be some bleeding on and off for several days or weeks afterward. More details can be found here.
What is an Electric Vacuum Aspiration (EVA) abortion ?
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. EVA is performed by a trained provider in a clinic.
During the procedure the clinician uses instruments, including an electric vacuum suction to remove the pregnancy from the uterus.
The primary difference between EVA and MVA is that electricity is used to create suction to remove the pregnancy. Because the EVA requires electricity, it may not be available in low-resource settings. Where available, clinicians may use this method of EVA as the gestational age increases after 10-12 weeks because it allows the clinician to perform the procedure more quickly than the MVA, and thus decreases the procedure duration for the woman. Another significant difference is that there is noise associated with the EVA machine, because it uses electricity. 
What is Dilation and Evacuation (D&E) abortion ?
Dilation and Evacuation (D&E) is a safe method of abortion typically used after 14 weeks of gestation. The availability of D&E depends on the laws or restrictions regarding abortion in different locations around the world. In some places D&E may be available to women who desire abortion for any reason, or it may be limited to women who seek abortion for very specific health indications. Information regarding abortion restrictions by location can be found here.
For D&E, the cervix is softened with agents used to help in dilation. These agents are often administered several hours, or even days, before the procedure. A trained clinician then uses a combination of instruments and electric vacuum aspiration (EVA) to remove the pregnancy. Ultrasound may be used during the procedure. Depending on the gestation of the pregnancy, local anesthetic and/or sedative medications may be used to decrease discomfort for the woman during the procedure. , 
What is Dilation and Curettage (D&C) abortion ?
Dilation and curettage (D&C) is an outdated method of surgical abortion that has largely been replaced by vacuum aspiration abortion methods. This method is no longer recommended.
During a D&C, the cervix is dilated, and then sharp curettes are used to scrape the walls of the uterus to remove the pregnancy. There is an increased risk of complications, as well as pain when D&C is performed as compared to vacuum aspiration. For this reason, the World Health Organization (WHO) recommends that D&C should be replaced by vacuum aspiration abortion, D&E, or abortion with pills whenever possible. , 
What is an Induction Abortion?
Where available, an induction abortion is a method that may be used during the second or third trimester of pregnancy (typically after 16 weeks or more). Sometimes induction abortion is an option for elective abortion, but more often it used when there are health concerns for the mother or the fetus which makes pregnancy termination the safest course possible. The indications for this will vary widely depending on geographic location and respective laws and restrictions.
This method mimics labor, by using medication to cause both cervical dilation and uterine contractions to expel the pregnancy. Because this method of abortion occurs during later gestations, it is always done in a clinic or hospital where the woman can be monitored for the duration of the procedure. Typically, it does not require surgical instrumentation, but surgical intervention is often available if needed. This method of later abortion is less common than D&E, as it often has a more prolonged time to completion 
How much does an in-clinic abortion cost?
The cost of an in-clinic abortion varies widely depending on: geographic location, availability of resources for abortion, location of abortion (clinic or hospital), and gestational age.
Are in-clinic abortions safe?
In-clinic abortion is very safe when performed by a trained clinician. Clinics providing suction and surgical abortions should follow standards and guidelines set by a regional organization, and/or by the recommendations for safe abortion produced by the World Health Organization (WHO). 
These guidelines should address items including (but not limited to):
- who can provide abortion
- management of medications
- cleaning of equipment
- management of biomedical waste
- training and performance of healthcare providers
Women seeking an in-clinic abortion should ensure that the facility they choose uses safe, approved methods of abortion.
In-clinic abortion is about 99% effective. 
What are the potential risks and complications for in-clinic abortion?
While in-clinic abortion is very safe, there are still some risks to the procedure which include: heavy bleeding, infection, injury to the uterus and surrounding structures, incomplete abortion, continued pregnancy, and death.
These risks are very small when the procedure is performed by a trained clinician, but they are important to know when consenting to a surgical or suction abortion. 
What are the side effects of in-clinic abortion?
All methods of the in-clinic abortion procedure are most associated with strong cramps experienced by the woman during the procedure. Often this cramping will improve quickly afterward, but some women may experience cramping on and off for a few days or weeks.
Local anesthesia is often used for suction and surgical abortions, and this helps to numb the area around the cervix to ease some of the pain during the procedure. 
Most women will experience bleeding and cramping during and after an in-clinic abortion. It is also common to experience many different emotions after a surgical abortion, all of which are valid, and if the woman feels like she needs additional help, she should seek counseling care. 
Is in-clinic abortion painful?
The most common pain associated with vacuum and surgical abortions is strong cramps experienced by the woman during the procedure. Often this cramping will improve quickly afterward, but some women may experience cramping on and off for a few days or weeks. The severity of pain often depends on the gestational age, as well as the pain tolerance of the individual woman, because everyone experiences pain a bit differently. 
Post abortion care and contraception after an in-clinic abortion
After an in-clinic abortion, women are often offered a follow-up visit , and while this is not required, each woman should listen to the recommendation of her healthcare provider.
There is no medically proven amount of time that a woman has to wait to do specific activities including: shower/bathing, exercise, sex, or using tampons. Generally, it is advised that at least until the bleeding lightens after the procedure, the woman should: avoid introducing objects into the vagina including tampons and menstrual cups, and avoid intense physical activity. Each woman can return to her normal activities as tolerated, and each woman will be different.
Prior to leaving the clinic, women should be offered information about methods of contraception. Most forms of contraception can be started immediately, however, a discussion should take place regarding each woman and her choice of method. Clinics should provide women with contact information, in case they have questions or concerns after the abortion. 
Reasons that women should seek clinical attention include:
- Heavy bleeding (completely soaking 2 pads per hour for 2 hours in a row or more)
- Fevers (>38C or 100.4F) more than 24 hours after the procedure
- Severe, worsening pelvic pain
- Continued signs of pregnancy (increasing nausea, breast tenderness, etc.) 
To find the appropriate contraceptive methods of your choice, visit www.findmymethod.org
 Weitz, T. A., Taylor, D., Desai, S., Upadhyay, U. D., Waldman, J., Battistelli, M. F., & Drey, E. A. (2013). Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiver. American Journal of Public Health, 103(3), 454-461. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673521/
 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
 Ipas. Clinical Updates in Reproductive Health. 2019. Retrieved from: https://ipas.azureedge.net/files/CURHE19-april-ClinicalUpdatesInReproductiveHealth.pdf