After you’ve made the decision to get an abortion, it can be overwhelming to figure out what to do next. You probably have a million questions running through your mind: where do I go? How much will it cost? What can I expect? These are all valid concerns, and trying to find answers can be especially frustrating since people tend to avoid openly talking about abortion. While in an ideal world preventative measures would be 100 percent effective, they’re not – so here’s your guide to getting an abortion.
Reaching out to resources
As soon as you’ve decided that you want an abortion, you should start reaching out to resources because the longer you wait, the more difficult and expensive the process will be. Your general practitioner is one place to start. They might discuss different methods and provide you with resources. That being said, it’s always best to consult with a provider that you trust. Doctors are legally required to keep what you tell them confidential; however, talking with a provider that you trust might lead to less-biased information. Zoey Lichtenheld, of NARAL Pro-Choice Texas, recommends calling unbiased hotlines such as the National Abortion Federation hotline and Backline for information.
There are also plenty of useful online resources. Planned Parenthood has a tool that lets you search for health centers within your state. Each location has its address and contact information listed, as well as a list of the services offered and insurance plans accepted. Abortionclinics.com is a similar resource, although this site lets you search for clinics by the services they provide.
Individual states might have their own online resources. According to Lichtenheld, Texans can use NeedAbortion.org to find clinics, information about how to get in touch with organizations that provide financial or transportation support and answers to common questions.
Waiting period laws & counseling
Another important factor to determine is whether or not your state has a legally mandated waiting period for women seeking abortion. Almost half of U.S. states require a 24-hour waiting period, while others are more restrictive. Alison Dreith, Executive Director of NARAL Pro-Choice Missouri, says that women in the state, in addition to those in Utah, South Dakota and Oklahoma, must wait 72 hours before having an abortion.
Oftentimes, the waiting period will include mandated counseling. According to the Guttmacher Institute, “38 states require that women receive counseling before an abortion is performed.” While some of this counseling simply describes what the procedure will entail, 12 states legally require that the counseling include information on the ability of a fetus to feel pain. Kansas, Indiana, Oklahoma, Missouri, and North and South Dakota require that women be told, “personhood begins at conception.” This, of course, only criminalizes abortion and is not factually accurate.
Dreith says that Missouri’s mandated counseling also include other options for abortion, such as adoption—even if a woman has already made up her mind. Depending on the state you live in, these are things to be prepared for.
Related: Her Story: I Had An Abortion in College
Preparing
Travel
If you live in a state with a waiting period or counseling that you don’t want to partake in, you can always cross state lines into less strict areas. While traveling for this reason is optional, that’s not always the case. In five states—Mississippi, Missouri, North Dakota, South Dakota and Wyoming—there is only one abortion clinic. If you live in one of these states, you should probably be prepared to drive a bit out of the way.
Even states with more than one clinic, such as Texas, make it difficult for women to find resources nearby. “Texans living in areas without an abortion provider have to prepare to travel long distances to get to the nearest clinic—which for many means taking time off work, getting additional money for an overnight stay, and arranging for childcare,” Lichtenheld says. This is true for similar states, particularly those with long waiting periods.
The mandated waiting times aren’t the only thing to counter in when planning a trip, either. “Because of abortion clinic closures, wait times for the initial visit for an abortion have substantially increased—a person trying to get an abortion in Austin may have to wait as long as 23 days,” Lichtenheld says. Before you hit the road, call multiple clinics and make sure that you can plan an appointment within the time you’ll be visiting.
Cost
The price of an abortion depends on many different factors. According to the National Institutes of Health (NIH), the majority of women in the U.S. pay for abortions with state Medicaid and other forms of insurance or out-of-pocket. “Median out-of-pocket costs when private insurance or Medicaid paid were $18 and $0. Median out-of-pocket cost for women for whom insurance or Medicaid did not pay was $575,” NIH says. However, the final cost will vary based on the provider, medical conditions, etc. For example, Lichtenheld says, “If a person is more than 12 weeks into the pregnancy, the cost will be higher and will increase the further along they are in the pregnancy.” This is why it’s important to act as soon as you’re sure you want an abortion.
You should always check with your insurance provider to make sure they cover abortion—first, because you could end up saving a lot of money; secondly, because 25 states ban coverage in private plans through health insurance marketplaces.
If you can’t afford an abortion, don’t worry: you have options. According to Lichtenheld, “If a person does not have the funds to cover the cost of the abortion procedure and the additional expenses if they have to travel to get to a clinic, they can work with their abortion provider to see if there are payment plan options and reach out to their local abortion fund.” Some funds pay for your actual procedure, while others help with traveling costs. Get Help and Fund Abortion Now are great resources.
Types of procedures
Contrary to popular belief, there are multiple abortion procedures—one of them not even being a procedure.
RU-486 or “the abortion pill”
Most commonly known as the abortion pill, this method combines two medicines to end a pregnancy. Though the process varies from state to state, for the most part, it’s used in women who’ve had their last period nine weeks before. Before being administered the abortion pill, you’ll likely undergo lab tests, a physical exam and an ultrasound. You’ll also sign consent forms and be given information on the steps to take after the appointment.
While at the clinic, you’ll be provided with the Mifepristone pill. This prevents the pregnancy from continuing by detaching the pregnancy from the wall of the uterus.
After being administered this pill, you’ll receive Misoprostol to take home with you. This causes the uterus to empty, and is taken 24-48 hours after taking Mifepristone.
According to Planned Parenthood, “More than half of women abort within four or five hours after taking the second medicine [Misoprostol]. For others, it takes longer. Bust most women abort within a few days.”
You’ll go to a second appointment at the same clinic you initially went to, where an ultrasound will be done to determine whether or not the abortion was successful. If it was not (which is rare), you have the option of a surgical abortion.
Side effects
Cramps and bleeding are very common during a medical abortion. According to the Hope Clinic, “Usually you can expect the bleeding to start after the cramping has begun. The bleeding may be very heavy, but many patients say the bleeding wasn’t as heavy as expected. You may pass small or large blood clots (the size of a quarter is very common, but passing a clot two inches round is nothing to be alarmed about). Bleeding, cramping and passing clots are a normal part of the abortion process.” Once the clinic has confirmed the abortion is complete, you might also experience light bleeding over the next two weeks.
If you are ever concerned with the bleeding or any other side effects, do not hesitate to contact the clinic or your general practitioner.
*Warning: Do not attempt to try and order these pills online, as they may not be safe or even effective.
Surgical abortion
According to Lichtenheld, this procedure will vary based on how far along a woman is in her pregnancy.
1st trimester – vacuum aspiration
Upon arriving to the clinic, you’ll undergo a similar initial process as the medical abortion that involves a checkup and ultrasound.
You’ll be given medication for pain, and depending on the practice, maybe offered sedation or a numbing medication for your cervix.
During the procedure, you’ll be laying down on an exam table in a hospital gown. The doctor will open your cervix and insert a tube through the cervix into the uterus. “Either a hand-held suction device or a suction machine gently empties your uterus,” according to Planned Parenthood. This will essentially vacuum the contents of your uterus.
Lichtenheld says that women usually experience some cramping during the procedure “similar to period cramps.”
The procedure does not last long, usually taking around five to 10 minutes. Afterwards, you’ll spend around an hour in a recovery room. Depending on the type of sedation or pain medication you received, you may need to bring someone with you to drive you home.
You’ll typically schedule a follow-up appointment within the next couple of weeks.
Side effects
Cramps and bleeding are also common after having a surgical abortion. According to Planned Parenthood, “It’s normal to have spotting that lasts up to six weeks, heavy bleeding for a few days, [and] bleeding that stops and starts again.” You should not use tampons throughout this period—only pads.
If you are ever concerned with the bleeding or any other side effects, do not hesitate to contact the clinic or your general practitioner.
2nd trimester – dilation and evacuation (D&E)
While most women (92 percent) have abortions within the first trimester of pregnancy, those who do not usually undergo a method known as dilation and evacuation. Second trimester abortions are difficult because clinics may not perform them, whether it is for legal or other reasons. This procedure will be generally more expensive and complicated, maybe even requiring a two-day surgical process.
The initial portion of a D&E abortion is similar to a vacuum aspiration; however, since the pregnancy is further along, the cervix will need to be opened wider so more tissue can pass through. This can be done in a variety of ways, whether it's by taking medication or having dilators inserted prior to the procedure.
If dilators were previously inserted, they will be removed at the time of the abortion. You’ll be provided with pain medication, and maybe even sedation or IV medication. The cervix will be numbed, and the doctor will begin emptying the uterus with medical instruments (such as forceps) and suction machine. Cramping during the procedure is to be expected.
The entire procedure (not including the widening of the cervix) should last up to fifteen minutes. You’ll be in recovery for an hour afterwards.
Side effects
Like with the other procedures, cramps and blood are to be expected. The bleeding described after a first trimester abortion also applies with this procedure. Recovering from a D&E abortion may require a few days of relaxation depending on how you’re feeling. To prevent infection, it’s recommended you avoid having sex or using tampons for a few weeks after the procedure.
If you are ever concerned with the bleeding, other side effects, or your emotional state, do not hesitate to contact the clinic or your general practitioner.
Whether you decide to have a medical or surgical abortion, it’s important to remember that you’re not alone throughout the process. There are so many resources willing to help! You also have no reason to be ashamed, so don’t hesitate to open up to someone you trust.