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Sexual Health Information |
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Many pregnancies (20 to 25% of all pregnancies) end naturally. This is called spontaneous abortion or miscarriage. Therapeutic abortion is the deliberate interruption of a pregnancy.
Is abortion safe?
In Canada abortion is a very safe procedure. The overall complication risk is less than 1%. Abortion is riskier in places where women try to perform an abortion on themselves, or ask someone who is not trained to do it.
Abortion can cause damage to a woman's health, or even death if:
- it is not performed by a skilled practitioner
- it is not performed under sterile conditions.
Is abortion legal?
Abortion is legal in Canada. It may not always be available. In large cities, like Toronto, there are many clinics and hospitals providing abortion services.
When?
Most abortions are done before the woman reaches the 12th week of her pregnancy (counting from the first day of her last period). Far fewer are done after 16 weeks. Most women who have decided to have an abortion want to have it as early as possible after a missed period.
How to decide?
Once a woman has confirmed that she is pregnant, she can go to her doctor or to a Sexual Health Clinic to talk about her choices. If a woman decides to continue with her pregnancy and keep the baby, she will have help finding good prenatal care. If she decides to give the baby up for adoption, she will have help finding an agency. And if a woman decides to end the pregnancy, she will have help finding the best facility for her needs. A counsellor will make sure a woman has all the information available so she can make a decision that is right for her.
Types of abortion?
The type of abortion a woman has depends on where she lives and how far along she is in her pregnancy. It also depends on her. Is she anxious? Will she prefer to be "asleep" during the procedure?
In large cities, like Toronto, almost every type of abortion service is available:
| Type of abortion |
When performed |
What is done |
Additional information |
SURGICAL METHODS
Manual Vacuum Aspiration |
5 to 7 weeks from the first day of the last period |
An injection is used to freeze the cervix. Then, a vacurette (a thin, hollow, plastic tube) is inserted into the uterus. The vacurette is attached to a hand-held suction syringe. The syringe uses gentle suction to remove the pregnancy. |
This procedure is typically done in a clinic. The woman
will be awake. She will receive
medication to relax her and to help with any pain. She can expect to feel: the injection of the freezing into the cervix (like freezing at the dentist), cramps
during the insertion of the vacurette and lower abdominal pressure during the suctioning. The procedure lasts less than 10 minutes. |
| Vacuum Suction Curettage |
5 to 14 weeks from the first day of the last period |
An injection is used to freeze the cervix. The cervix is gradually dilated (opened). Then, a vacurette (a thin, hollow, plastic tube) is inserted into the uterus. The vacurette is attached to an electric suction machine. This machine uses gentle suction to remove the
pregnancy. Then, the wall of the uterus is cleaned (curettage). |
At a clinic, the woman will be awake. She will receive medication to help relax her and help with any pain. She can expect to feel the injection of the freezing into the cervix (like freezing at the dentist), cramps (similar to menstrual cramps) during the dilation (opening) of the cervix, lower abdominal pressure during the suctioning, and a fluttering type of sensation in the uterus during the curettage. The whole procedure takes less than 10 minutes. A counsellor or nurse will talk with the woman during the procedure.
A hospital abortion happens in two parts. The day before the abortion, something is inserted into the cervix to gently open it (dilation). To do this, a laminaria tent (a thin cylinder made of sterilized, compressed seaweed, or a synthetic material) is used. The tent will gradually thicken overnight, slowly dilating the cervix. The woman will feel cramps during the insertion of the tent as well as overnight as the cervix dilates. She will be given medication to take home for this.
The vacuum suction abortion will take place the next day. The woman will either have general anesthetic and be asleep; or she will have "conscious sedation". The woman usually feels nothing during the abortion. However, she can expect to feel cramps in the recovery room once the sedation wears off. She will receive medication for the cramps.
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| Dilatation and Evacuation (D and E) |
Between 14 weeks and up to 20 weeks from the first day of the last period |
One or two days before the abortion (depending on how far the woman is in her pregnancy), a thin cylinder (laminaria tent) will be inserted into the cervix to slowly dilate (open) it. The rest of the abortion is the same as for vacuum suction curettage (see above). |
Same as for Vacuum Suction Curettage |
Medical Abortion
Methotrexate and misoprostol |
Up to 7 weeks from the first day of the last period |
The woman gets a medication called Methotrexate (either by mouth or by injection into the hip muscle). 5 to 7 days later, she inserts Misoprostol tablets into the vagina (at home). |
The injection stops the growth of the pregnancy. The tablets cause the uterus to contract and push out the embryo.
The woman can expect to feel strong cramps after she inserts the Misoprostol tablets. She will get medication for this.
It usually takes 24 hours to expel the embryo. In about 1/3 of the cases, it can take several weeks. If the embryo is not expelled, she will need to have the surgery described above. Follow up is essential.
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Where to go?
Sexual Health Clinics associated with Toronto Public Health provide supportive, non-judgmental counselling and information. Most women are very certain of their decision. All women need time to explore their feelings. For the individual woman, this means thinking about what good mothering means to her; about what her life is like now and whether having a baby now will permit her to be the kind of mother she wants to be. If she is with her partner, she needs to think about their relationship and whether she wants this person to be a parent to her child. Taking the time to do this helps a woman to be confident that her decision will be the right one for her at this time. The decision should be the woman's, without pressure from family, friends or professionals.
There are some organizations that do not believe women should ever have abortions. These organizations have set up clinic-like facilities that offer pregnancy tests. Their staff members try to convince women not to have abortions.
Follow-up?
Following an abortion, many women will immediately decide what method of contraception they want to use. She may want to have an IUD inserted. She may want to start using birth control pills or Depo-Provera. She can discuss hormonal and non hormonal methods of birth control with a counsellor. Part of the pre-abortion counselling session should include information about these and other options. Any of these methods can be started after the procedure, including inserting an IUD.
After an abortion, a woman needs to go back to a Sexual Health Clinic or her healthcare practitioner for follow-up. At this time, she will have a check-up to make sure everything went well with the abortion. She will also have an opportunity to talk about how she is feeling about it. If she has not started to use a method of birth control that works, the counsellor will talk with her about contraception.
Women experience many different feelings after having an abortion. A woman who had an abortion because she felt it was the best decision for her at the time will feel tremendous relief. She will probably have a positive outlook for the future. For women who experience sadness and tears, these are usually very temporary. Some of these feelings are related to hormonal changes similar to those experienced by some women just before their period. For other women, it may have more to do with their circumstances, including their relationships.
Some women, especially those who have later abortions, may experience confusing and conflicting emotions, including a sense of loss. These feelings are all normal, as with any other important life decision or event. Talking through these feelings with a sexual health counsellor, her own doctor, or the counsellor at the clinic or hospital where she had her abortion, can often help. It often helps to be reminded of the reasons she made the decision and why it was the right choice for her at this time.
For more information:
AIDS and Sexual Health InfoLine
416-392-2437
1-800-668-2437
Toronto Health Connection 416-338-7600
Toronto Sexual Health Clinics
Birth Control
Web Links
Links to sites outside the City of Toronto website are provided for convenience and additional general information only. Toronto Public Health does not endorse any advertisements and is not responsible for the content and opinions found on external sites.
The information posted on this site, as well as linked sites, is not a substitute for a professional medical opinion.
Canadian Abortion Rights Action League, Ottawa, Canada
Canada's pro-choice volunteer organization working to ensure that all women have total reproductive freedom to exercise the right to safe, accessible abortion.
National Abortion Federation
This site provides a list of National Abortion Federation (NAF) member providers and clinics in Canada.
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