FAQ: Safe abortion care

An illustration of a person holding abortion pills

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Every minute, somewhere in the world a person has an unsafe abortion. This unsafe abortion can lead to terrible consequences for their health, including death. Unsafe abortion is one of the main causes of maternal death worldwide, and the only one that is almost entirely preventable. Every day, our teams around the world witness first-hand the death and suffering caused by unwanted pregnancy and unsafe abortion. That’s how we know: Safe abortion care is essential health care.

Doctors Without Borders/Médecins Sans Frontières (MSF)is committed to providing safe abortion care to reduce avoidable suffering and deaths. Every safe abortion provided is potentially an unsafe abortion and maternal death prevented.

MSF considers access to safe abortion care a critical part of comprehensive reproductive health care, one that reduces maternal mortality and suffering. You can read more about our provision of safe abortion care here.

What is abortion and how common is it?

Abortion occurs when a pregnancy is ended. It can happen spontaneously, also referred to as miscarriage, or as the result of a deliberate intervention.

Abortion is very common: three out of every ten pregnancies worldwide end in abortion. Chances are, someone close to you has had an abortion.

What is unsafe abortion?

According to the World Health Organization, an abortion is unsafe if the person providing the abortion does not have the necessary skills or if the abortion takes place in an environment that does not meet minimal medical standards. Examples we see in our projects include: ingesting traditional remedies or toxic substances such as bleach, battery acid, or chlorine; incorrect administration of medications without the appropriate support; inflicting repeated blunt trauma to the abdomen; and inserting sharp sticks or needles into the body.

What are the medical consequences of unsafe abortion?

Complications from unsafe abortion include severe bleeding, infection, and injury to the genital tract or internal organs. Unsafe abortion can also lead to long-term health consequences such as infertility and chronic pain. At least 22,800 people die from the complications of unsafe abortion each year.

Who is most at risk of unsafe abortion?

Anyone with an unwanted pregnancy who cannot access safe abortion services is at risk of injury or death from unsafe abortion. Barriers to safe abortion include high cost, legal restrictions, stigma, lack of trained or willing providers, and unnecessary requirements.

Poor people, people of color, and people living in remote areas are disproportionately cut off from safe abortion services. The vast majority—97%—of unsafe abortions take place in low- and middle-income countries in Latin America, Africa, and Asia. People trapped in war, crisis, and conflicts often face additional barriers to accessing safe abortion care. 

How can injuries and death from unsafe abortion be prevented?

By providing comprehensive reproductive health care programming, including sex education, contraceptive services, safe abortion care, and post-abortion care.

What is safe abortion care?

An abortion is considered safe if:

  1. The person providing or supporting the abortion is trained and
  2. An evidence-based method that is appropriate to the pregnancy duration is used.

Medication abortion, or an abortion with pills, is an example of a safe, evidence-based method of abortion.

What is an abortion with pills?

In an abortion with pills, a person takes medicines that cause cramping and bleeding to empty the uterus—similar to having a miscarriage. An abortion with pills is over 95 percent effective and is extremely safe, with less than a one percent chance of severe, life-threatening complications. The risk of death from a safe abortion is lower than from a shot of penicillin or from a tooth extraction.  

An abortion with pills can safely be provided in low-resource settings—including those without ultrasound or laboratory testing available. A safe abortion with pills needs only three things: accurate information, quality medications, and mutual respect and trust. Because of this, medication abortion has expanded access to safe abortion care for millions of people around the world—especially in conflict and crisis settings

How does MSF respond?

In order to reduce the maternal death and suffering from unwanted pregnancy and unsafe abortion, MSF offers a comprehensive package of reproductive healthcare services, including contraception, safe abortion care, and post-abortion care. In 2020, we provided more than 30,100 safe abortions in 34 countries around the world. We also provided treatment to 14,700 people for abortion-related concerns and complications.

MSF speaks out publicly  against harmful governmental policies like the Global Gag Rule and other efforts to limit access to care, and shares evidence-based, factual information about safe abortion care. Lastly, we conduct research investigating the severity and treatment of complications from unsafe abortion in conflict-affected settings.

Up to how far along in a pregnancy does MSF provide an abortion? 

MSF guidelines include safe abortion care with pills through 22 weeks of pregnancy. We have provided care beyond 22 weeks on a case-by-case basis.

While abortions beyond 13 weeks of pregnancy (first trimester) compromise only 10-15 percent of the total abortions worldwide, they are responsible for the majority of serious complications and death from unsafe abortion. People who seek abortion beyond 13 weeks are more likely to be young girls, victims of sexual and gender-based violence, have detected their pregnancy later, or have financial or logistical barriers to care. Therefore, second trimester abortion services are a crucial element of safe abortion care and reproductive health care services, especially in humanitarian settings.

What does MSF do in countries where abortion is illegal?

Many people think that abortion is either “legal” or “illegal” in a country, but the reality is not so black and white. Legal frameworks around abortion are complex and nuanced. In any country there might be multiple national statues, criminal codes, legal regulations, court decisions, ministerial guidelines, international treaties, and more. MSF does its best to navigate these complicated legal frameworks while prioritizing patients and their medical needs.

In the majority of countries where MSF works, abortion is permitted to save the life or preserve the health of a pregnant person. From a health perspective, a pregnant person's life and health is in danger anytime they have an unwanted pregnancy and do not have access to safe abortion care, as they would then be at risk of all the complications of unsafe abortion, including death.

What are other barriers to accessing safe abortion care?

Beyond the legal barriers, many people experience shame, social stigma, and negative attitudes about the circumstances that led to their unwanted pregnancy, or to the abortion itself—which in turn can create obstacles to accessing care. Common obstacles include verbal abuse or social rejection from family and friends, misrepresentation, or lack of information about laws regarding abortion, and rejection, stigma, and ignorance within the health system.

What is self-managed abortion?

Self-managed abortion with pills means obtaining and taking abortion pills outside of a medical setting. It most commonly refers to taking abortion medications at home with help from telephone hotlines or online platforms. Self-managed abortion increases access to safe abortion care for vulnerable people and those who live far away from healthcare facilities. It also upholds people’s autonomy and supports them to make decisions about and take the lead in their own care.

Self-managed abortion occurs in all settings, including where abortion is legal and accessible, and may be a preferred option due to increased autonomy, privacy, and confidentiality, among other reasons. It also makes safe abortion care more accessible to people who live far from health facilities, or in areas that do not have abortion providers.

Is self-managed abortion safe?

A self-managed abortion can be just as safe and effective as the more traditional, facility-based approach. Therefore, in recent years, self-management of abortion with pills has gained increased acceptance by the formal health sector as safe and appropriate.

Self-managed abortions are safe if the person has access to accurate information, quality medications, and respectful support throughout the process, if desired. It’s also important to have access to a health care provider or facility on the rare chance there are complications. There is increasing evidence that in-person consultations and medical tests are not necessary for a safe abortion with pills.

Studies have been published in The International Journal of Obstetrics and Gynaecology, JAMA Network, and ScienceDirect.

The best ways to make self-managed abortion safe are by ensuring access to quality medications and providing accurate information about how an abortion with pills works. See here for more information on an abortion with pills.

How does MSF support self-managed abortion?

MSF supports self-care interventions for sexual and reproductive health for a number of different topics, including self-testing for HIV and cervical cancer, self-administration of contraceptives, and self-managed abortion. In terms of self-managed abortion with pills, some MSF teams have worked with community health workers and peer educators to ensure people living in remote areas can access safe abortion care in their communities without having to travel to a health care facility. We are also piloting a telehealth hotline where MSF staff provide information and support for abortion over the phone.

See more FAQs on other topics.

This page was originally published on June 10, 2015.