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When you can have an abortion

An abortion is the medical process of ending a pregnancy. It’s also known as a termination.

The pregnancy ends either by:

  • taking medication
  • having a minor surgical procedure

An abortion is available for free through the HSE if you live in the Republic of Ireland.

If you live outside the Republic of Ireland, you can have an abortion in the Republic of Ireland. But you will have to pay for it.

When an abortion can be carried out

You can have an abortion if your pregnancy is no more than 12 weeks.

12 weeks of pregnancy means 84 days since the first day of your last period.

After 12 weeks, you can only have an abortion in certain circumstances.

The earlier an abortion is carried out, the simpler and safer it will be.

Getting support early on will also give you more time to make a decision if you’re unsure whether you want to have an abortion or not.

You can get free and confidential advice on all your options from My Options, a new HSE support service.

You can call My Options on freephone 1800 828 010 (from outside of Republic of Ireland call +353 1 687 7044)

3-day wait

You can have an abortion up to 12 weeks (84 days) of pregnancy. But you need to begin the process earlier than that.

This is so a GP or doctor can certify that you are no more than 12 weeks pregnant. There must be at least 3 days between being certified and having the abortion procedure. This is the law.

For example, if you are certified on a Monday, the earliest you can have an abortion is Thursday. Or if you are certified on a Wednesday, the earliest you can have an abortion is Saturday.

This delay of at least 3 days can give you time to decide for sure if you want to go ahead with the abortion.


You need to get ‘certification’ from a GP or doctor before you have an abortion. This is the law.

A GP or doctor needs to certify that you will be no more than 12 weeks pregnant at the time of the abortion. They will do this check during your pre-abortion consultation.

You should have this consultation to get certified as early as you can. This is because there may be a delay in certifying that you are no more than 12 weeks pregnant. This delay can happen if your GP or doctor needs to refer you for an ultrasound scan.

You should also keep in mind that there may be delays in getting an appointment with your GP or doctor. They may not be able to see you at short notice. This could delay an abortion.

Abortion after 12 weeks — exceptional circumstances

After 12 weeks, you can only have an abortion in exceptional circumstances.

These are when continuing the pregnancy:

  • puts your life at risk
  • risks serious harm to your health
  • is likely to lead to the death of the foetus either before or within 28 days of birth because of a problem with its development

Working out how many weeks you are pregnant

The length of your pregnancy is the number of days since the first day of your last period.

9 weeks of pregnancy means 63 days since the first day of your last period.

12 weeks of pregnancy means 84 days since the first day of your last period.

If you’re not sure how long you’ve been pregnant, you may need an ultrasound scan to check. Your GP or doctor can refer you.

Ultrasound scan

Your doctor may refer you for an ultrasound scan if:

  • you do not know how many weeks pregnant you are
  • your cycle is irregular
  • your doctor is concerned about an ectopic pregnancy

This will help you and your doctor decide what abortion method is best for you.

There are two ways to answer the question “how late can you get an abortion?”: You can go the political route, or you can look at it from a medical standpoint.

“State rules typically make 20 to 24 weeks the upper limit , but that’s not really about health concerns and what would be safe versus unsafe,” says Susan Wysocki, a nurse practitioner and board member of the American Sexual Health Association. “Those rules were made by politicians and not physicians. That’s an important thing to recognize.”

The Centers for Disease Control and Prevention reports that more than 600,000 abortions took place in the U.S. in 2013 (the most recent year for which data is available). Mortality rates for women undergoing legal abortions are extremely low, with the CDC calculating a fatality rate of just .65 deaths per 100,000 legal abortions between 2008 and 2012. To compare, the CDC reports that there were 17.8 pregnancy-related deaths per 100,000 births in the U.S. between 2009 and 2011. And according to research from the Guttmacher Institute, a first-trimester abortion carries less than a .05 percent risk of major complications requiring hospital care.

But with many state laws limiting when a woman can get an abortion, it’s hard to understand how later-term abortions could actually affect a woman’s health. Is an abortion at 22 weeks just as safe as one at 14 weeks? It depends on various factors. Wysocki breaks things down by trimesters for us below. Here’s what you need to know:

Learn more fascinating facts about the female anatomy:

​ ​

Related: Everything You Need to Know About the Abortion Pill

First Trimester (1-12 weeks)

According to a 2013 report by the CDC, 91.6 percent of abortions are performed within the first 13 weeks of pregnancy. And according to Wysocki, “Surgical abortion in the first trimester is one of the safest procedures you can get.” (Subscribe to Women’s Health’s newsletter So This Happened for the latest news and trending stories)

Although a surgical abortion can be performed as early as a woman’s first missed period, Wysocki says that many doctors like to wait until a woman is five weeks pregnant, and some even prefer to wait up to 12 weeks to do the procedure. This makes it easier for doctors to ensure they’ve removed the entire contents of the uterus. “This involves putting a cannula (tube) through the cervix and suctioning the uterine out contents,” she says.

But women also have another option in the first trimester: a medical abortion, which requires taking two pills to induce a miscarriage within the first 10 weeks of gestation. Unlike with surgical abortions, medical abortions become less effective as time goes on. According to Planned Parenthood, the “abortion pill” is 98 percent effective when taken within the first eight weeks of pregnancy, 96 percent effective between weeks eight and nine, and 93 percent effective from weeks nine to 10. Planned Parenthood also notes that medical abortions are considered extremely safe. Risks associated with taking these pills are very rare, but can include blood clots, bleeding, infection, or an allergic reaction. And unless you have one of these (highly unlikely) complications, there are no long-term side effects.

Related: This Is What a Future Without Legal Abortions Would Look Like

Second Trimester (13-27 weeks)

Here’s where things get a little bit tricky. Many states restrict abortions between 20 and 24 weeks of gestation, with some exceptions if a woman’s life is in danger. (The Guttmacher Institute has compiled state rules here.) Clearly, there are politics involved in these decisions, but medically, it’s worth noting that a fetus likely cannot survive outside the womb until 24 weeks, according to research from The New England Journal of Medicine.

Still, even though an abortion becomes a more complicated procedure around 20 weeks of pregnancy since there’s more that needs to be evacuated, Wysocki says the bottom line is that it is safe to undergo a surgical abortion. It just might be a little more complicated: “Later in pregnancy, medical instruments may be required to fully remove the contents of the uterus,” Wysocki says, as opposed to the cannula used in the first trimester. The CDC’s report states that only 7.1 percent of abortions occur between 14 and 20 weeks, with just 1.3 percent happening after 21 weeks of gestation.

Related: An Oklahoma Lawmaker Thinks Women Should Ask Men For Permission Before Having An Abortion

Third Trimester (28 weeks to birth)

According to Wysocki, even if a woman travels to a state with liberal laws (like Nevada or New York), it will generally be very difficult to terminate a pregnancy after 24 weeks of gestation. But even though it is certainly less common to get an abortion in the third trimester of pregnancy, a woman can safely get one if she has a reason that deems abortion necessary. “One would be that she finds out that there is a serious abnormality with the fetus,” says Wysocki. Another is that there is a health concern for the woman, which could include cardiac issues, uncontrolled diabetes, or uncontrollable hypertension.

A late-term abortion looks very different from one that is performed earlier in the pregnancy because more tissues will have to be removed. In the highly rare case of a 24-week abortion, Wysocki notes that the fetus may be removed in parts to protect the woman’s cervix. Although there are some risks at this point—for example, an infection can occur if tissue is left behind in the uterus—Wysocki notes that, “there are web sites that list complications of abortions that are untrue. For example, an increased risk of breast cancer and difficulty with future pregnancies is not true. Women should be aware of websites that aim to scare women from making the choice that might be right for them.”

According to Wysocki, the most important thing you can do when deciding to have an abortion is to go to an experienced provider. “The more experience they have, the better they are at it.”

Termination of Pregnancy: Is Abortion Legal in Singapore?

Singapore’s laws on abortion are encapsulated in the Termination of Pregnancy Act (TPA).

Who is Eligible for Abortion Procedures in Singapore?

Abortions are legal in Singapore and there is no age limit for an abortion procedure. However, only the following persons may obtain treatment to terminate pregnancies:

  1. Citizens of Singapore, or a wife of a citizen of Singapore
  2. A holder, or the wife of a holder, of a work pass issued under the Employment of Foreign Manpower Act
  3. Residents in Singapore for a period of at least 4 months immediately preceding the date on which the abortion is to be carried out
  4. Persons in exceptional circumstances, such as where an abortion is necessary to save the life of the pregnant woman

If a pregnant woman does not meet any of the above-mentioned criteria and goes through with an abortion procedure, she can be fined of up to S$3,000, and/or up to 3 years’ jail.

The medical professional who handled the abortion procedure for her, could also be subject to the same penalties.

Mandatory Counselling and Cooling-Off Period

Every pregnant woman, especially those under the age of 16, will be required to undergo mandatory counselling prior to the procedure.

If a pregnant woman, after receiving counselling, wishes to proceed with the termination of pregnancy, at least 48 hours must elapse before she consents to the abortion. She can only undergo the abortion procedure once this 48-hour window has passed.

Circumstances under which Abortion Procedures are Not to be Carried Out

Abortion procedures are prohibited if the pregnancy is over 16 weeks, unless the treatment is carried out by an authorised medical practitioner with the necessary qualifications. Procedures on pregnancies over 24 weeks are prohibited unless necessary to preserve the life or health of the pregnant woman.

Under the section 4 of the TPA, the duration of the pregnancy may be determined:

  • By clinical examination; or
  • By way of calculation from the first day of the last normal menstruation of the pregnant woman to the end of the 24th week, or to the end of any week between the 16th and the 24th week, whichever is applicable.

Additionally, any person (such as a scumbag husband) who uses coercion or intimidation to compel a pregnant woman to undergo an abortion, or to induce her to do so against her will, is guilty of a criminal offence and can be fined up to $3,000 and/or jailed up to 3 years.

Can Medical Professionals Refuse to Perform an Abortion?

Medical professionals are allowed to refuse to perform the abortion procedure if it goes against their beliefs. They are not bound by contract or any legal or statutory duty to perform the procedure, should they have a “conscientious objection” to doing so.

The only situations in which medical professionals must carry out their duty to perform the abortion procedure would be ones where it is necessary to save the life of the pregnant woman, or if performing the procedure would prevent grave or permanent injury to the pregnant woman’s physical or mental health.

Confidentiality of Abortion Procedures

Medical professionals and institutions are legally obliged to keep details of the abortion procedure confidential to protect the privacy of the woman undergoing the abortion. They may only disclose the details of the abortion procedure if she expressly consents to such disclosure.

Persons who breach this confidentiality requirement can be fined up to $2,000 and/or jailed up to 12 months.

Early Abortion Options

In the United States, abortion is a safe and legal way to end a pregnancy. There are two methods of abortion available to women in the first trimester of pregnancy. A medication abortion (also called medical abortion or abortion with pills) involves taking medicines to end a pregnancy. An aspiration abortion (also called surgical or suction abortion) is a procedure that uses medical instruments in the vagina and uterus to remove the pregnancy. The information below compares the two methods.

How far along in the pregnancy can I be?

Medication Abortion: Up to ten weeks from the first day of your last period.

Aspiration Abortion: Up to 12 weeks from the first day of your last period.

What will happen?

Medication Abortion: Generally, the abortion pill (mifepristone) is taken in person at the clinic or at a doctor’s office. Most women feel fine after taking mifepristone, though some experience nausea. At home, 6 to 72 hours later, a second pill, misoprostol, is taken bucally (placed in your cheek to dissolve) or vaginally, as instructed by your healthcare provider.

The abortion starts one to four hours after taking the misoprostol. Heavy bleeding and cramps last for a couple of hours. You will have a follow-up appointment about a week later to be sure the abortion is complete.

Aspiration Abortion: The abortion takes place in the clinic or office. The actual abortion procedure takes five to 10 minutes. A physician uses medical instruments in your vagina and uterus to remove the pregnancy. A return visit is required only if you experience problems, or if you would like to see a healthcare provider.

How painful is it?

Medication Abortion and Aspiration Abortion: Expect mild to very strong cramps on and off during the abortion, which may be managed (or helped) with pain medication.

How much will I bleed?

Medication Abortion: Heavy bleeding with clots is common when you are passing the pregnancy. After that, lighter bleeding may continue off and on for one to two weeks or more.

Aspiration Abortion: Light bleeding generally lasts for one to seven days. Bleeding may continue off and on for a few weeks.

How much does it cost?

For both types of abortion, the exact cost depends on whether you have insurance as well as your location, the facility, and timing. The range is anywhere from $0-$950.

Can the abortion fail?

Medication Abortion: For women 8 weeks pregnant or less, the pills work about 94-98 out of 100 times. They are slightly less effective later at 8- 10 weeks. If the pills fail, you will need to either try them again or have an aspiration abortion.

Aspiration Abortion: It works 99 percent of the time. If it fails, you will need to have a repeat aspiration abortion.

Can I have children afterwards?

Yes. Neither type of abortion reduces your chances of getting or staying pregnant in the future.

Is it safe?

Medication Abortion: Both pills have been used safely since the late 1980s in Europe and since 2000 in the U.S. Major problems are rare. Medication abortion carries at least 10 times less risk of health complications than continuing a pregnancy.

Aspiration Abortion: Aspiration abortion is a safe and common procedure that has been done for more than 40 years. Abortion in the first eight weeks is the safest, and problems with any first trimester abortions are rare. Surgical abortion carries at least 10 times less risk of health complications than continuing a pregnancy.

What are the advantages?

Medication Abortion: No shots, anesthesia or medical instruments are involved. The abortion may feel more natural, like a miscarriage. It can be done earlier in the pregnancy than an aspiration abortion. You have the option to be at home or wherever you feel most comfortable. You can choose to have someone with you, or you can be alone.

Aspiration Abortion: The procedure is over in a few minutes. There is less bleeding than with a medication abortion. Medical staff members are with you during the abortion. It can be done later in the pregnancy than a medication abortion.

What are the disadvantages?

Medication Abortion: It takes one to two days to complete the abortion. Bleeding and cramps can be very heavy and can last longer than with aspiration abortion. It cannot be done as late in the first trimester of pregnancy as aspiration abortion.

Aspiration Abortion: It is more invasive; instruments are inserted through the vagina and into the uterus. Anesthetics and pain medication may cause side effects. You have less control over the procedure and perhaps over who can accompany you into the room. The vacuum aspirator may seem noisy. It cannot be done as early in pregnancy as medication abortion.

For more information, see:

  • Medication Abortion
  • Aspiration Abortion
  • Frequently Asked Questions about Abortion
  • U.S. Abortion Rates & Related Information
  • Abortion Resources & Support
  • Parental Consent and Notification Laws Affecting Teens

The phrase late-term abortion is everywhere lately. It’s not exactly new, but it’s lighting a wildfire of renewed controversy, thanks to comments from politicians that have led to inflammatory comparisons to infanticide. Naturally, people have a lot of questions, so we asked a board-certified ob-gyn to set the record straight.

What is late-term abortion?

The first thing you need to know: There isn’t actually an agreed-upon definition of what counts as “late”—that’s not how doctors talk about abortions. “In medicine we talk about pregnancy in terms of trimesters,” says Jennifer Conti, M.D., a board-certified ob-gyn, fellow with Physicians for Reproductive Health, and host of The V Word podcast.

This is important. Doctors base their decisions on a precise set of factors specific to each situation—the health of the fetus, the health of the woman, and the exact trimester and week of the pregnancy—not an arbitrary idea of what “late” means. “The way that they have crafted this language on the anti-choice side is strategic,” Dr. Conti says. “It’s meant to intentionally cause uncertainty; when we hear , we don’t know if that refers to a fetus that is periviable”—which is the very delicate gray area between 20 and 25 weeks of pregnancy when a fetus may or may not survive outside the womb—”or if you’re referring to the third trimester.”

That’s a massively important distinction, Dr. Conti says. Doctors treating a pregnant woman with serious complications at 30 weeks would likely consider a preterm delivery—not an abortion. “That’s a very different situation than 25 weeks pregnant, which is closer to what we traditionally think of as viability, where the fetus has a lower chance of surviving and an even lower chance of living a life that’s not severely impacted by medical conditions,” she says. The vague idea of “late-term abortion” is meant to “conjure up the image of someone in the throes of labor asking for an abortion and ‘evil’ abortion doctors coming and doing that,” she says. “That would never happen.”

When is it too late to get an abortion?

The answer depends on where you live. Forty-three states prohibit abortions after a specified point in pregnancy (everywhere except Alaska, Colorado, Washington, D.C., New Hampshire, New Jersey, New Mexico, Oregon, and Vermont). But exactly when that point is varies by state.

24–28 Weeks

Twenty-three states ban abortions after viability outside the womb—which providers say falls between 24 and 28 weeks. There are exceptions—endangerment to the woman’s life or health, cases of rape or incest, and fetal abnormality—but these also vary by state.

While most states define the cut off vaguely as viability, five states (Florida, Massachusetts, Nevada, New York, and Pennsylvania) draw the line at 24 weeks. (Virginia bans abortions in the third trimester, which begins at 27 weeks.)

20 Weeks

Nineteen states ban abortion after 20 weeks, which is before what medical experts have deemed the point of “fetal viability.” This is somewhat confusing since 20 weeks isn’t a significant milestone in fetal development, according to the American Congress of Obstetricians and Gynecologists. Instead, many of these laws are based on concerns about “fetal pain,” but experts say pain is not possible at that stage of fetal development.

6 Weeks

Some states are trying to ban abortions even earlier, as soon as a fetal heartbeat can be detected. That’s at about six weeks, and before most women even know they’re pregnant. In 2018, Ohio voted to pass a “heartbeat bill”, but it was ultimately vetoed by Governor John Kasich.

Outright bans aren’t the only way states are restricting abortions. Laws that limit access to abortion care and impose restrictions (like mandatory waiting periods and counseling) pose serious threats to a woman’s right to choose. Keep track of what’s happening through our ongoing abortion rights coverage.

Seventy-six percent of patients were able to access abortion care within 7.6 days of making an appointment, with 7 percent of patients reporting delays of more than two weeks between setting an appointment and having the procedure.

The first nationwide study exploring the average wait time between an abortion care appointment and the procedure found most patients are waiting one week.

Seventy-six percent of patients were able to access abortion care within 7.6 days of making an appointment, with 7 percent of patients reporting delays of more than two weeks between setting an appointment and having the procedure.

In cases where care was delayed more than 14 days, patients cited three main factors: personal challenges, such as losing a job or falling behind on rent; needing a second-trimester procedure, which is less available than earlier abortion services; or living in a state with a mandatory waiting period.

The study, “Time to Appointment and Delays in Accessing Care Among U.S. Abortion Patients,” was published online Thursday by the Guttmacher Institute.

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The national findings come amid state-level research in Texas indicating that its abortion restrictions forced patients to drive farther and spend more to end their pregnancies. A recent Rewire analysis found states bordering Texas had reported a surge in the number of out-of-state patients seeking abortion care.

“What we tend to hear about are the two-week or longer cases, or the women who can’t get in because the wait is long and they’re beyond the gestational stage,” said Rachel K. Jones, lead author and principal research scientist with the Guttmacher Institute.

“So this is a little bit of a reality check,” she told Rewire in a phone interview. “For the women who do make it to a facility, providers are doing a good job of accommodating these women.”

Jones said the survey was the first asking patients about the time lapse between an appointment and procedure, so it’s impossible to gauge whether wait times have risen or fallen. The findings suggest that eliminating state-mandated waiting periods would permit patients to obtain abortion care sooner, Jones said.

Patients in 87 U.S. abortion facilities took the surveys between April 2014 and June 2015. Patients answered various questions, including how far they had traveled, why they chose the facility, and how long ago they’d called to make their appointment.

The study doesn’t capture those who might want abortion care, but didn’t make it to a clinic.

“If women able to get to a facility because there are too few of them or they’re too far way, then they’re not going to be in our study,” Jones said.

Fifty-four percent of respondents came from states without a forced abortion care waiting period. Twenty-two percent were from states with mandatory waits, and 24 percent lived in states with both a mandatory waiting period and forced counseling—common policies pushed by Republican-held state legislatures.

Most respondents lived at or below the poverty level, had experienced at least one personal challenge, such as a job loss in the past year, and had one or more children. Ninety percent were in the first trimester of pregnancy, and 46 percent paid cash for the procedure.

The findings echo research indicating that three quarters of abortion patients live below or around the poverty line, and 53 percent pay out of pocket for abortion care, likely causing further delays.

Jones noted that delays—such as needing to raise money—can push patients later into pregnancy, which further increases the cost and eliminates medication abortion, an early-stage option.

Recent research on Utah’s 72-hour forced waiting period showed the GOP-backed law didn’t dissuade the vast majority of patients, but made abortion care more costly and difficult to obtain.

Topics and Tags:

72-Hour Waiting Period, Abortion Care, Abortion restrictions, Access to abortion, Forced Waiting Periods 2016, Guttmacher Institute, Health Systems, Reproductive rights

Shocking Stats Show Just How Long Women In England Are Forced To Wait For An Abortion

I wasn’t eating badly and I was brushing my teeth for two minutes, twice daily. Yet, my gums were bleeding regularly. I’d recently made a pact with myself to stop turning to the internet to self-diagnose (it was January; every sniffle or cough could escalate to something pretty serious after a few minutes on Google), so I pushed this strange thing to the back of my mind. I bought floss.

Not even a couple of weeks later, when I was waking up to go to the toilet more than once throughout the night, and falling asleep at my desk throughout the day, did I think I might be pregnant. But, after feeling totally wasted after one pint at the pub one Friday night, I decided that it wouldn’t do any harm to do a pregnancy test. Something wasn’t right, and I always made an effort to be extra careful about this stuff.

A week later, I found myself in a sexual health clinic in south London, having just been handed a Family Planning Association (FPA) leaflet with the title: ‘Abortion: Your questions answered.’

According to the NHS website, you can refer yourself for an abortion by directly contacting the UK’s two main abortion providers, BPAS and Marie Stopes or through a referral from an NHS professional at a contraception or GUM clinic. I went with the second option, as I thought it’d be good to talk through my options with someone.

When I found out I was pregnant, I was a bit gutted, but I knew from the start that I didn’t want to continue with the pregnancy. However, I had a lot of questions, and I wanted to make sure I got informed answers on how this was all going to pan out.

Women who don’t want to go through with a pregnancy can have a medical abortion, which involves taking two pills (mifepristone and then misoprostol) 24 to 48 hours apart to induce a miscarriage, or they can have a surgical abortion. I began to read the leaflet further. The FPA say it should take five working days from your referral (in person or on the phone) to get a consultation at an abortion clinic, and another five from your decision date to have the abortion. I’d already made up my mind, but the ‘official’ decision has to happen at the consultation (although some women need more time to think and decide after their consultation). The NHS website also says: ‘waiting times can vary, but you shouldn’t have to wait more than two weeks from your initial appointment to having an abortion.’ Again, there it was, 10 working days.

This calmed my nerves: In a couple of weeks, this would all be over. I later found out that on this day I would have been around six weeks pregnant. I didn’t expect my abortion to take place bang on 10 working days later, perhaps it would happen a day or two after that recommended waiting time but nothing could have prepared me for how long I had to wait. I waited 40 days from then – around six weeks – from my first referral appointment to the date of the procedure. I was 13 weeks pregnant when I had a surgical abortion, which, if waiting times had been shorter, could have (in theory) happened via medical abortion a lot earlier on. So, why did I have to wait so long?

At my first appointment, when I was sat waiting in the sexual health clinic reading through the FPA leaflet, I was told that I’d have to self-refer to BPAS, as the doctor couldn’t get through – ‘the phone lines are too busy,’ she said. I did so as soon as I left.

To get to the next stage of the process, I had to know my NHS number, weight, and height (so they could note my BMI). All things I probably could have had done at my clinic appointment, but anyway. It was another few days before I could call back with my weight (seriously, who has scales in a rented house), and I then had to book a second telephone consultation for a few days later, where a nurse spoke to me about contraception options post-abortion. During this call, I also booked my consultation at the BPAS clinic, which took place 12 days later (the earliest appointment available). At my consultation, the earliest date offered to me for my abortion was 23 days after that date.

‘Crisis Point’: The Best And Worst Abortion Waiting Times In The Country

While the NHS website and FPA guidelines suggest you shouldn’t be waiting more than two weeks in total for an abortion, it also says that waiting times can vary depending on where you live. So, during a four month-investigation, The Debrief sent Freedom of Information (FoI) requests to NHS Clinical Commissioning Groups (CCGs) across England (the bodies which manage local NHS services) to find out the average waiting times for accessing surgical and medical abortions. If I had to wait – without requesting extra time to consider my decision – surely lots of other people were having to wait too?

Here’s what The Debrief found out:

Increasing waiting times are just one of the obstacles for women trying to access early abortion, a situation which is now ‘at crisis point’, according to one of the UK’s leading experts on women’s healthcare. Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists recently told The Guardian: ‘There are a lot of women now who are finding that there are big barriers to them accessing swift response to their request . Many women and girls are finding it difficult to access.’

The longest waiting time for a surgical abortion in 2016 was in Leicester, with an average wait of 22.7 calendar days. This is an improvement to its 2012 waiting time (29.1 days), but the figures have been consistently high – more than 20 days – for both medical and surgical abortion since 2012.

The shortest waiting times in 2016 were in Essex (Basildon, Brentwood and the North East area of the region all recorded an average waiting time of fewer than 10 days). Scarborough and Ryedale (9.3 days) and South Devon and Torbay (7.3 days) also fell under the 10-day guideline. The data suggests that you can access early abortion in these places quickly, and their waiting times have stayed at a pretty constant rate since 2012 when I first requested data from them.

Here’s a rundown of the longest average waiting times from 2012-16 (in calendar days) across England, which all exceed the 10-day working day (14-day calendar day) guideline:

The results of The Debrief’s FOI requests showed that between 2015-16, the highest increase in waiting times for a surgical abortion was in Telford and Wrekin in the West Midlands, where women had to wait 12.4 days longer to access a termination than the year previous. Hull has also seen a stark jump in waiting times in the year from 2015-16, despite the number of abortions going down. The number of days taken to access abortion in Hull in 2016 was 11.7 days (not making the top 10), but this was 6.7 days longer than it had previously been (four days).

The next highest increase in waiting times from 2015-16 was in Doncaster, where women had to wait almost a week longer to access abortion in 2016 than the year previous – an extra 6.8 days. Wokingham has seen waiting times increase by 6.3 days in the same amount of time, and women in Lambeth, south London, had to wait an extra 5.9 days in 2016 than they did in 2015.

In the case of Lambeth, where I had my abortion, the numbers definitely don’t match up to my own experience. Lambeth CCG said its average wait in 2016 was 15.7 days, but mine – from my first contact with BPAS to my termination – was 40 days in 2017.

One in three women will get an abortion at some point in their lives, and in England, Wales and Scotland you can get them legally, and safely, up to 24 weeks into your pregnancy (except for Guernsey and Jersey, where it must take place on or before 12 weeks). The 1967 Abortion Act does not apply to Northern Ireland or the Republic of Ireland.

As well as the Abortion Act stating an abortion has to take place before its 24th week, it also says that it must be authorised by two doctors before it is performed by a registered medical practitioner (aka a doctor). This clause of the Act makes the process unnecessarily time-consuming – in a situation where time is really valuable – and experts have recently called for nurses to be able to administer medical abortion pills to reduce waiting times.

It’s too easy to forget that women aren’t booking referral appointments on the first day of their pregnancy, especially if the pregnancy is unplanned, which half of all pregnancies are. If you’re not trying to get pregnant, you might not even realise that you are until your first missed period. I was six weeks pregnant before I realised (constant fatigue wasn’t unusual for me). And, after all, half the number of women who had abortions in 2016 were using contraception. If you take a test two weeks after a missed period, decide to proceed with an abortion, but can’t get a termination for another six or seven weeks, you’re walking around with an unwanted pregnancy for three months.

I spoke to Clare Murphy, head of public policy at BPAS. She said: ‘Once a woman is sure of her decision, she needs to be able to access care as soon as possible. No woman wants to be pregnant for any longer than necessary once that decision has been made.’

High waiting times are even drawing women to access illegal abortion pills online. ‘Even though abortion is legal, one you’ve got hurdles, women can take things into their own hands’, Clare told me. Indeed, as this study published in September’s Contraception Journal showed that more than 500 woman ‎had tried to obtain abortion pills online over a four-month period alone. One key problem is the current law can require women to attend multiple appointments for early medical abortion, which can be near-impossible for women with work or childcare commitments. Other women may be in abusive and coercive relationships, which mean they would find to hard to access abortion services in confidence, and services may be a long distance from where they live.

Why Are Abortion Waiting Times Rising?

So, why is it taking so long? The most recent NHS figures for abortions in England and Wales show that the number of abortions taking place has been fairly constant in recent years, indeed if anything they’ve fallen slightly since the mid-2000s according to NHS figures. Clare told The Debrief ‘there are problems in the sector at the moment which are largely related to the provision of Marie Stopes’ services, which were suspended last year. Bpas does everything it possibly can to see women as fast as possible in what has been a challenging environment, and waiting times are decreasing all the time.’

What Clare is referring to is the fact that Marie Stopes had some of its services temporarily suspended last year due to concern over the quality of care from the Care Quality Commission (CQC), which had a small knock-on effect on service delivery*. On waiting times specifically, one CQC report, conducted in Merseyside found that ‘patients were not always seen within RCOG recommended timeframes’. Another, conducted in London East recorded that ‘there was no formal monitoring of waiting times or the reasons for any delays’.

Matters are complicated ever so slightly by the fact that local abortion services providers differ slightly, depending on where in the country you live: Marie Stopes, Bpas and the NHS. So which bodies are responsible? Of the worst ten revealed by The Debrief’s FOI requests Leicester NHS trust’s services were NHS operated, Sheffield CCG’s were ‘carried out under NHS contracts’, United Lincolnshire CCG’s were ‘NHS-funded’, South East Staffordshire CCG’s were Bpas, East Staffordshire’s were Bpas, Barnsley CCG said they ‘could not distinguish’ between their figures, Derby Teaching Hospitals Trust and Sutton CCG’s were ‘NHS-funded’ and Cannock Chase CCG fell under Bpas.

‘You are never going to see 100% of women treated within a specific timeframe, as waiting times will also be affected by a woman’s choice – some women may take longer to make up their mind about proceeding, and cancel or not show up for appointments – which is absolutely their right,’ Clare added.

Of course, some women are offered appointments that they don’t want to take at first, as they want some time to consider their decision. But if you know your pregnancy is an unwanted one, the whole process is made much more difficult by what is essentially an outdated Act that expects women to take time off work to see two different doctors, unnecessarily drawing out the time it takes to have an abortion. Indeed, the woman must also attend a specified location to take the pill as it is not currently legal for her to do so at home.

The Debrief also asked Laura Russell, the Policy and Public Affairs Officer of the Family Planning Associaton (FPA) why waiting times could be growing? She explained that it’s exactly for this reason that the FPA is ‘in favour of decriminalising abortion’. Laura explained that ‘abortion should not sit within criminal law. It doesn’t reflect women’s needs or allow for a women-centered service because the way abortion is provided today is not the same as it was 50 years ago. A change in the law would allow for abortion to be regulated like any other medical procedure, and allow the creation of a more women-centered service.’ As she sees it ‘stuff like two doctors signing off and women having to go to specific premises for an abortion, i.e. not being able to take the pill at home does put barriers between women and accessing abortion. The law is not allowing for the best abortion care that we could be providing. It is not flexible enough.’

Professor Lesley Regan, is in agreement. She told The Debrief that the RCOG ‘believes that the current need for two doctors’ signatures to certify that a woman is approved to undergo an abortion causes unnecessary delays in women’s access to abortion services’. Indeed, she emphasised that there are ‘no other situations where either competent men or women require permission from two third parties to make a personal healthcare decision’. Professor Regan firmly believes that doctors should be allowed to ‘provide the assessment in the same way as when they treat their patients without the need to consult another doctor’.

As things stand, if a woman did end her pregnancy without the permission of two doctors, she could technically be sentenced to life in prison under the 1861 Offences Against the Person Act. However, the increasing availability of abortion pills online means that this scenario is far more likely than in the past. Professor Regan says ‘no other medical procedure in the UK is so out-of-step with clinical and technological developments.’

Indeed, as the aforementioned study in September’s Contraception Journal30435-3/fulltext]) pointed out, increasing waiting times are actually a reason that women who have chosen to order pills online and carry out an abortion home cite as a key reason for doing so.

There is another factor at play here, as mentioned above the way abortion care is commissioned and delivered has changed. Professor Regan says this is ‘having an impact on doctors’ access to training and women’s access to services’. She added there is ‘low prestige and stigma which may be associated with abortion care’ and this is ‘affecting the morale within the profession’. In England and Wales, Professor Regan said, ‘two-thirds of abortions are performed in the independent sector, meaning junior doctors find it difficult to access training, as there are fewer NHS consultants working in abortion care to train and mentor them’. To address these issues, the RCOG has established an Abortion Task Force, which Professor Regan will be leading.

The Impact Of Rising Waiting Times On Women

Tash*, 25, faced a few obstacles that impacted her waiting time, waiting six weeks from the first time she’d got in contact, to the point of procedure.

‘The waiting time was the most harrowing part of my experience. I was in the middle of my final major project for my MA when I found out I was pregnant,’ she told me. ‘My first point of contact was to go to a free clinic where I had another test. From where I was in my cycle, we worked out I was around five weeks pregnant; I was 11 weeks pregnant by the time I had my termination. I was booked in for an ultrasound – I think it was around 10 days after my appointment at the clinic, and I remember being frustrated that that would be the next contact I would have. I started to get morning sickness symptoms and a deadening lethargy, especially frustrating seeing as I had my MA looming over me still. I remember the ultrasound technician telling me ‘whatever you decide to do will be with you for the rest of your life’.

‘I was unto the mercy of the appointment system at that point. I think I did a fair bit of crying on the phone in order to get my next appointment, which was with a doctor to say I really wanted to go ahead with the termination. Then, because I am rhesus negative, I needed to have blood tests taken at another appointment. I had to have an injection after my termination so that my body didn’t reject my next foetus, should I decide to keep it. By the time I had done that and an appointment space was free, I was 11 weeks pregnant. I remember spending long weeks drifting in and out of sleep, eating a lot, toying with the decision of keeping the baby, crying and being sick.’

As I’ve said, I was 13 weeks pregnant before I could book in for an abortion. It is safe to say that during this long process I was beginning to feel quite pregnant. In the first trimester of pregnancy (the first 12 weeks), pregnancy symptoms include: morning sickness (which can happen throughout the day and night), severe fatigue, bleeding gums, food cravings, tender breasts, headaches, heightened sense of smell (this could often be the worst), frequent urination and acne. This was the hardest thing about having to wait – the constant, physical reminder that you were playing a waiting game you don’t want to play.

An abortion is safer the earlier you can have it. The sooner it can be dealt with also decreases the impact it can have on your mental health, no woman should be forced to walk around carrying an unwanted or problematic pregnancy for any longer than necessary because of external factors.

I got in touch with BPAS to request counseling, as I began to really struggle with my mental health to a point where I needed to talk to someone about it. It felt like a dark cloud that followed me everywhere. It wasn’t guilt about going through with it – I don’t and have never regretted my decision – it was guilt about not being totally OK with it. I’m pro-choice! I’m pro-women. I’m pro-abortion! Why couldn’t I handle this better than I was?

I had a contraceptive coil put in after the termination, and the emotional turmoil I was going through made sex so uncomfortable, that I was sure it had been put in the wrong place. Six weeks after the abortion, I booked an appointment with my GP for a check-up. I wanted to talk about my concern that the coil was in the wrong place. As soon as I sat down in the chair, I burst into tears.

My GP suggested I phoned BPAS to book a counselling appointment with them. She also suggested I go to a sexual health clinic to get a second opinion on the position of the coil. I phoned the counselling number to book an appointment as soon as I got home. It was the 8th of June. I was told the next face-to-face appointment available in London would be on the 11th of August. She then suggested I call the Samaritans: ‘They’re not just for people who are thinking about committing suicide,’ she said. I saw that her intentions were good, but it’s not exactly the kind of thing you want to hear when you’ve already reached a point where you’re seeking counselling. (It is worth saying that BPAS do have a 24-hour aftercare support line for physical after effects).

Feeling pretty disheartened, I took a day off work the week after and went to the sexual health clinic to see if they could tell me if my coil was in the right place. If someone could tell me that everything was physically alright, I’d be able to start moving on, I thought. The first doctor I saw was unsure, even doing an ultrasound, but said they were quite busy and asked if I could come back another day when another doctor was in, for a second – or, in my case, third – opinion. The third doctor I saw confirmed everything was OK with the coil, but suggested I get some counselling. Yes please, I said. She explained that my body and hormones had been preparing for pregnancy, and now that it had gone away, it was natural for my body to be craving it again. I was led into another room where I was told I’d see a counsellor. ‘Oh no, I’m just a support worker,’ he said. ‘I’ll take your mobile number, and when we have a free slot to book you in, I’ll give you a call.’ That was on the 20th of June. It’s now October and I haven’t had a phone call.

Now, with the support of my boyfriend, best friends, and, well, time, I am having more good days than bad. I’m quite certain that if I was able to access the abortion earlier, the emotional effects wouldn’t have been so heavy. Carrying around an unwanted or problematic pregnancy for several weeks is really difficult, especially when you are told at the start that you shouldn’t have had to wait longer than 10 days and that’s what you mentally prepare for. There was also the added strain of feeling like I couldn’t talk to anyone about it because, even today, in 2017, we still don’t really talk openly about abortion.

This week marks 50 years of the Abortion Act. We’ve had 50 years of safe and legal abortion in most parts of the UK, with the shameful exception of Northern Ireland. However, with waiting times increasing, early abortion and aftercare support are increasingly hard to access. Its stigma indicates that shame is still being felt by many – and with one in three women getting an abortion at some point in their lives – campaigning for a better quality of care is something all women should be concerned about.

*Names have been changed

The Debrief contacted NHS England for a comment

This article originally appeared on The Debrief.

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Re: Waiting For An Abortion Law, editorial, Feb. 2.
On Twitter, Jonathan Kay (the Post’s Managing Editor Comment) stated: “If you can find an incorrect sentence in this editorial, identify it.” The misleading sentence is: “It is perfectly legal in Canada to have or perform an abortion — for any reason, or no reason at all — at 20, 25, 30 or 35 weeks gestation.”

I am totally fed up with “lawyered” assertions that totally misrepresent the facts. While in Canada we do not have a law, we do have very strict professional guidelines. No physician in Canada can terminate a pregnancy over 24 weeks without serious indications that the life of the mother is at risk or that the fetus has very serious malformations. I have sat with these women as they received the terrible news and sat with them throughout the terrible long, tear-drenched process. The assertion that late-term abortions can be performed “for any reason, or no reason at all” is just not true.
I challenge Mr. Kay to find one late-term abortion performed in Canada to a healthy mother with a healthy fetus. I am one of many politicians “willing to tackle” this subject. He needs to be one of many journalists who are prepared to admit when their fine prose may have misled Canadians … in this case that late-trimester abortions are not happening in Canada without “reason.”
Dr. Carolyn Bennett, MP for St. Paul’s, Toronto.

How to avoid live fetuses

Re: Treat Late-Term Abortions As Homicide, Backbench MPs Say, Feb. 1.
As physicians, we are trained to assist as best we can people facing various medical challenges. One of the challenges a pregnant woman may face is a miscarriage. If a woman miscarries before her fetus is viable (i.e., during the first 20 weeks of her pregnancy), our role is to support her in her grief. If she miscarries in or after the 21st week, our duty is to provide her newborn child with the care it requires to survive. As a result of this training, it has always been clear for me where the limit on elective abortion should be set: At 20 weeks of gestation.
This was reinforced this week in a document I received from The Quebec College of Physicians, titled “Guidelines in performing abortions.” When performing an abortion on a woman who is 21 weeks pregnant or more, in addition and prior to following general procedures, we are instructed to inject digoxin or potassium chloride into the fetus or the amniotic sac. This effectively kills the fetus, thereby avoiding having to deal with a live, aborted infant.
Dr. Christiane Dauphinais, Toronto.

Abortion is a travesty …

Alberta MP Leon Benoit says that in late-term abortions some babies are born alive and then killed. Of course this is homicide or, more appropriately, infanticide, just as killing a baby in the womb is feticide. Canadian law permits feticide if the procedure is a “medical abortion,” but not the killing of a child that is born, whether or not as the result of an unsuccessful abortion. That is the law, regardless of practice. Yet, what is the difference between feticide or infanticide? A baby dies in either case, even although one procedure is “legal” and the other is not. The problem lies in Canadian law’s definition of “person,” which is a travesty of justice, crying out for revision.
Moira McQueen, executive director, Canadian Catholic Bioethics Institute, Toronto.

Regarding abortion, MP Rona Ambrose states: “This is an issue that women are not interested in debating.” I must correct Ms. Ambrose — I am one of tens of thousands of Canadian women who are very much interested in debating this issue. As minister of the Status of Women, Ms. Ambrose should be listening to all women, not just those who agree with her values on abortion.
Liz Rybka, Brampton, Ont.

The letter the three MPs sent to the RCMP is not speaking to late-term abortions in general, which are legal in Canada, one of the few countries world-wide with no restrictions at all on abortion. What the letter is decrying are the 491 late-term abortions documented by Statistics Canada in which the baby was born alive, but then was left to die. The MPs are simply requesting an investigation. Is that too much to ask? Are we really comfortable as a society sweeping this under the rug?
Ruth Meerveld, Beamsville, Ont.

… or is the status quo OK?

The abortion issue was settled years ago. Until it is born, a fetus is part of its mother’s body and is subject to her wishes — and no one else’s.
Leave this subject; let it die.
Charles Hooker East Garafraxa, Ont.

Re: Anti-abortion display ‘private property’, B.C. town says, Feb 1.
Regarding the mock cemetery for aborted fetuses in Abbotsford, Joyce Arthur, spokesperson for the Vancouver based Abortion Rights Coalition of Canada, states that abortion is a “private experience that is absolutely no one’s business” (beyond that of the woman herself, obviously). How very wrong she is. That that aborted fetus will not be supporting me in my dotage makes it very much my business. That it is a human being, not an orange or an apple, and I my brother’s keeper, makes it much, much more so.

Jeff Willerton, Airdrie, Alta.

Re: Treat late-term abortions as homicide, backbench MPs say, Feb. 1; Re: Waiting for an abortion law, editorial Feb. 2.
The three Tory MPs named in this editorial are to be praised for raising the issue of “homicide” when a baby who has already exited the womb live is killed or left to die.
The Post, while allowing that an abortion law is long overdue, takes exception to the use of the term “homicide,” calling it “lurid.” But technically, as laws now stand, there may indeed be cases of “homicide,” at least where there is a chance that the baby may survive with some quality of life if proper care is given.
The term “lurid” reminds me of the rhetoric hauled out by pro-abortionists whenever photographs are shown of aborted fetuses. Their delicate sensibilities are supposedly offended by such photographs. But aren’t they rather more worried that the general public, confronted graphically with the consequences of abortion to living beings (the fetuses), will rise up in repugnance against the hateful practice, which for thousands of years was dismissed out of hand as intrinsically evil?
Yes indeed, some kind of law, any law, is needed to curb the killing of fetuses. How about defining as a “human person” the human egg as soon as it is fertilized? Scientists tell us unequivocally that it is a human being with potential, not merely a potential human being.
Lars Troide, Apple Hill, Ont.

Canada’s justice system is the most important tool in providing protection for the weak and vulnerable. That these live-birth abortions have not been investigated shows the system is failing those members of the human family who are the weakest and most defenceless and that we are on a slippery slope to legalized infanticide. Canada needs to act now to address this gross violation of human rights by enforcing existing Criminal Code protections for newly born children. Thus I applaud the three MP’s who brought this to the attention of the RCMP Commissioner.
It’s time that as a collective nation we ask if “choice” is enough reason for law enforcement to be silent, even after a child is born? For truly, how is this choice any different than the choice to kill an infant or any other born human?
Either human rights apply to all humans or we may as well throw the notion out the window all-together.
Mike Schouten, Campaign Director,, Surrey, BC

Thank you, National Post for reminding us of the fact that Canada “is the only nation in the Western world without an abortion law.”
God Bless Messers, Vellacot, Benoit and Lizon for being men of fortitude in their pursuit of the truth. I pray that the MP’s supporting you silently will find the courage to stand with you publicly in the House of Commons.
Rhonda Wood, Brampton, Ont.

Kudos to the three federal backbenchers, MPs Maurice Vellacott, Leon Benoit and Wladyslaw Lizon, for fighting to keep the atrocities from being swept under the rug by their brave efforts. This should uncover the truly insidious evil of abortion and all its ugly realities. It has progressed from originally attempting to protect women from harming themselves to women and babies being harmed by doctors, to expanding and extending the term limit to no limit, without regard to consequences for any kind of moral or ethical responsibility by doctors to babies, (who also become their patients in reality). How can we ignore the 491 babies left to die and not cry out for some kind of retribution or justice? What would it take to at least admit that it is nothing short of premeditated first degree murder and it has to stop?
Anne Smyth, Toronto.

I am horrified to see the effects of the crown jewel of the feminist movement: abortion on demand, that requires that for later term abortions the baby be killed in the womb “perhaps using lethal injection” to “avoid legal complications and psychological trauma for the staff” and that live-born babies are “likely due to professional failure” of not killing the baby prior to that abortion so that the staff is not traumatized by receiving an alive baby.
I think every one involved should feel the psychological trauma of killing the baby in the womb: the mother, the father, the family, the doctor’s performing the killings despite taking the Hippocratic Oath of “First Do No Harm”, the nurses, the politicians who have legalized such killings and the complicit voters who support the abortion legislation, so that they can weigh the blood that is on their heads for freeing women and men from the natural consequences of sexual behaviour.
Also, let us not hide behind the euphemism ‘fetus’, considered to be a non-human being. Call abortion the killing of the baby growing in the womb of the mother, who is in the family way because of a union between a man and a woman.
Jiti Khanna, Vancouver,

I read with rapt attention Saturday’s front page article concerning late term abortions in Canada. Thank you for giving it the coverage it deserved even though it was not an emotionally easy read . So interesting how language effects how we think and act. A mother who plans to take her pregnancy to full term will refer to the unborn as “her baby.” One who plans not to carry the unborn to full term and those who will assist her refer to the unborn as “a fetus.”
Patrick Stewart, Combermere, Ont.

World shaken by penny’s demise

Re: Royal Mint Stops Distributing Penny, Transactions To Be Rounded, Feb. 4.
I can’t believe the penny is going out of circulation. I can’t believe we’re all going to become slightly poorer. I can’t believe we get to be around to experience this historical change. I kind of like pennies, and I will miss them. I like that artists are using them as a medium. I like that my mother suggested our family gather all of our pennies and make a Keystone art piece.
I like that 99¢ sales will be gone — I have always loathed $14.99 and $22.99 and have a particular distaste for $36.99. Thank goodness that will all be over. I can’t wait for the first time I have to wait a little longer for a cashier to do the rounding math in their head. It’s sad, “penny for your thoughts” will need to be explained to our grandchildren. Or that the value of those “lucky pennies” you find on the ground will be purely luck — which in a very real way, makes them more meaningful. And what to do about those little plastic “Leave a penny, take a penny” things.
I feel like our world is being shaken ever so slightly — I love this stuff.
David Keystone, Toronto.

The irony is that now that the penny is out of circulation it has become a collector’s item and instead of leaving pennies on the ground or failing to pick one up people are now hoarding them. The penny is now suddenly “in” — even though it’s out.
Douglas Cornish, Ottawa.

Are you going to miss the penny? Or are you glad to see it go? Let us know in 75 words or fewer by Feb. 8 at 2 p.m. EST at [email protected] with responses to be published on Feb. 11.

Liberal oysters

Re: Ontario Could Become Next Greece, Jan. 31.
The leadership of the Ontario Liberal party is like an oyster; it changes gender (Kathleen McGunity = Dalton Wynne) without altering anything else, it is incapable of producing a bright idea, and when pressed to explain endemic corruption and malfeasance, it simply clams up, prorogues and sticks its head deeper into the sand.
Peter Strachan, Oshawa, Ont.

Not a true picture of Detroit

Re: Tale Of Two Cities, Feb. 2.
I have to mention an interesting inference that comes from the data included in the infographic regarding Detroit. The data seem to suggest something like the following:
— Detroit then (starting in 1960): mostly white
— Detroit now: mostly black
— Detroit then: high density
— Detroit now: houses in bad condition/many abandoned
— Detroit then: lesser murder rate
— Detroit now: high murder rate/lots of shootings
The inference that an uneducated reader could possibly make from the presentation of the data is that black people in Detroit have caused lower home prices, their houses are in poor conditions and they have created a higher murder rate/shootings. As more black people moved into Detroit, the worse the crime got and worse the housing conditions got. To put it bluntly: the reader may conclude that black people are bad.
I know this wasn’t the intention and correct me if I am wrong, but to me, this graphic invites a racist inference. I think the better question to ask is: “Why did the whites leave Detroit and why couldn’t the majority black population keep the city streets safe and the housing conditions up/unabandoned?”
Ryan Solcz, Victoria.

‘One does what one can’

Re: Idle No More: The View From The (Far, Far) North, Terry Audla, Jan. 29.
Inuit Leader Terry Audla speaks of the critical issues of housing and hunger, stating there have been “submissions to the government to address these issues.”
Sadly, poverty like this is not restricted to native and Inuit communities. Deep poverty is endemic across Canada. Those who are in the helping agencies in towns and cities across this nation know this all too well. The greater problems are with those who are on disability pensions, as well as the working poor. They must pay the same bills everyone else does, but on minimal incomes. People live in darkened, chilly, cramped conditions across this nation. They rely on food banks and helping agencies to keep food on the table and the landlord/bank/mortgage company at bay. Too often there is not enough money for basic bus transportation, and their children may arrive at school with little in their lunch boxes.
What is always heartening is to view those who are seeking ways to improve their lot. They will (if they are able) upgrade education, take second (and third) jobs, or move to areas with better opportunities.
As the old saying goes, “One does what one can.”
Donna Procher, Innisfil, Ont.

‘Thank you, Mr. Black … I think’

Re: Attack Of The Lady Premiers, Conrad Black, Feb. 2.
Conrad Black’s reference to Ontario Premier-designate Kathleen Wynne as a lesbian, his back-hand across Quebec Premier Pauline Marois’s face of political self-serving intent and his seeming acceptance of Toronto Mayor Rob Ford’s disrespectful comedy show left me conflicted over my respect for your columnist.
I wondered, has his trial, his conviction, his imprisonment and his attempt to return home (as he now sees fit to refer to Canada), caused a deep blemish on his otherwise analytical, clarity of thought? Or has he left me questioning my own commitment to my own political and personal beliefs?
As I read this column, I found my temperature rising and my respectful opinion of Mr. Black ebbing. I found myself disliking the man, agreeing with him, disagreeing with him, liking him and shaking my head in disbelief and wonder. I discussed his column with my well-educated wife and teenage daughter and realized that this was but another masterful oration (albeit in print) by Mr. Black to foster deep personal thought and controversy in our otherwise tepid, at best, Canadian societal opinion.
There is no right or wrong, there is no good or bad, just differing opinions and if that isn’t truly Canadian, I don’t know what is.
Thank you Mr. Black … I think.
Wayne Proulx, Toronto.

Good to see that Conrad Black attempts to remain a gentleman. Having suggested that Kathleen Wynne, the “self-identified lesbian” that is “steeped to the eyeballs in the brackish waters of the McGuinty regime” was selected as leader of the Liberal party for no other reason than political fashion, he wishes her well! In another time, however, a gentleman such as Mr. Black would know that he would have to accept the inevitable challenge to a duel to settle what most would understand to be a real insult to a lady of character and substance. Ms. Wynne’s choice of weapons at dawn!
John Hague, Mississauga, Ont.

Saturday humour

Re: Putting Up With The Man, Dear Diary by Tristin Hopper, Feb. 2.
The story this week about domestic cats and their effect on the ecology included a reference to Stanley, the Prime Minister’s feline. While reading the story I thought to myself: “I bet we get to read Stanley’s diary on Saturday.” Sure enough, when I turned the page on Saturday morning, there was Stanley! What a great way to start the day; Stanley’s insights into the PM’s interests were most illuminating.
Give the person writing the Dear Diary piece a raise.
Chris Askin, Ottawa.

Re: Wrong Insemination “Worst Nightmare,” Feb. 1.
The caption under the photo with this story (in the print edition) states: “Dr. Norman Barwin of Ottawa pleads guilty to inseminating three women with the wrong sperm at a Toronto disciplinary hearing on Thursday.”
Really? Is this what goes on at disciplinary hearings? Maybe if the three women would have stayed home and watched TV this would not have happened.
Robert Birnbaum, Montreal.

Re: Court Rules IKEA Monkey Will Stay In Sanctuary; Audit Finds Ford Campaign Violations, both Feb. 2.
A human going to court so that she may cohabit with a primate. To a group of primates (Toronto councillors) that cannot cohabit with a human (Rob Ford). From the ridiculous to the sublime. And the saga continues.
Arthur Rubinoff, Toronto.

My favourite part of the Weekend Post is always the City Life spread — it is always fun to see how many Mulroneys one can count on seeing there. This weekend’s issue was particularly hilarious (there were three) and lent some comic relief to what has been a very dismal, dull week.
Barbara Morrison, Niagara on the Lake, Ont.

How Late In Pregnancy Can You *Actually* Have an Abortion?

Even though the U.S. Supreme Court ruled abortions legal back in 1973, the topic is as relevant as ever. There was that whole “rip the baby out of the womb” thing during one of the 2016 presidential debates-not to mention a slew of changes to abortion legislation in the U.S. Here’s what you need to know about when it’s legal (and safe) to get an abortion in the U.S.

Abortion During the First and Second Trimester

For the record, you can’t abort a pregnancy one day before the due date. There are two main types of abortions, medical and surgical/in-clinic. Medical abortions (think: the abortion pill) can be used during the first 10 weeks of pregnancy, according to Planned Parenthood.

Surgical abortions can be done during the first or second trimester, and include procedures like aspiration (used up to 16 weeks after the last period) and dilation and evacuation (used after 16 weeks), according to Planned Parenthood. Aspiration involves a gentle suction (either manually or by machine) through a tube that goes through the cervix and empties the uterus. Dilation and evacuation involve entering the uterus through the cervix and removing tissue from the uterine lining with a scoop-like surgical instrument. While they’re called “surgical” there’s not actually any surgery required; there are no incisions involved and it takes about 10 minutes to do, as Debra Stulberg, M.D., assistant professor in the Department of Family Medicine at the University of Chicago told us in How Risky Are Abortions Anyway?.

Abortion During the Third Trimester

So, yes, you have several options during the first and second trimester, but late-term abortions-those done towards the end of the second trimester and beginning of the third trimester-are illegal in most states. Three states currently ban abortions in the third trimester and 15 states ban it about 20 weeks post-fertilization (or about 22 weeks after the last period), according to the Guttmacher Institute. For 19 other states, the guideline for considering an abortion to be “late term” and illegal is if the fetus is considered “viable,” or that it could survive outside the womb. Most medical communities consider that to be about 24 weeks, according to the American Pregnancy Association. The exception for performing a late-term abortion after these dates, however, is when it’s deemed medically necessary (ex: if the pregnancy is putting the mother’s life at risk).

Know Your Abortion Risks

This all might sound super scary, but there’s good news; when done in the first trimester, abortions are one of the safest medical procedures-the risk of major complications is less than 0.05 percent, according to research from the Guttmacher Institute. That being said, the earlier the better when it comes to terminating a pregnancy; the risk of death from childbirth is 11 times greater than the risk of death from an abortion procedure during the first 20 weeks of pregnancy. After 20 weeks, the risk of death is about the same as childbirth, according to Planned Parenthood.

  • By Lauren Mazzo @lauren_mazzo

The medical abortion works — so why aren’t more women using it?

I found out I was pregnant during a routine gynecological exam after I mentioned my period was a few days late. My doctor told me she’d need to collect a urine sample anyway, so they’d test it just to be sure. I wasn’t worried. I’d only been off hormonal birth control for a little over a month after staying on it for many years, and I’d read it sometimes takes months to resume regular ovulation. My boyfriend and I had one slip up, but that single incident seemed like a long shot. So when the doctor came back into the room with a upbeat “yup, you’re pregnant,” I was (perhaps stupidly) shocked.

“Yup, you’re pregnant.”I immediately asked if her office performed abortions. I was 26, working in the sex industry, and involved with a man I knew wasn’t right for me in the long term. I was pretty sure I didn’t want to have children at all — but particularly not now, not like this.

The doctor recoiled as if I’d struck her. “We don’t do that here,” she said. “You’re not even going to think about keeping it?” I affirmed with complete certainty that I was not, and asked if she could recommend a facility that would help. “You can Google it,” she said as she opened the door to the examination room, indicating very clearly that I should leave.

My best friend, a nurse, urged me to get an abortion shot. (A what? I thought.) She swore it would be the easiest and quickest option, and told me where I could find it. She even accompanied me on the visit — though I wasn’t required to bring a second party for the procedure, which was a simple injection in the hip.

The subsequent abortion felt mercifully easyThe subsequent abortion felt mercifully easy. It was quick and entailed almost no pain. Giddy with relief, I hugged the doctor on my follow-up visit, when successful termination was confirmed.

I’ve been passionate about reproductive health for the entirety of my adult life, and surrounded myself with similarly engaged and educated women — how had I not heard of an abortion shot? Even today, when I talk to other women about terminating with an injection, they’re entirely unfamiliar with this option. I wanted to know why it wasn’t available and known to more women.

Why wasn’t this available and known to more women?Well, it was; in Canada, anyway. Methotrexate, the chemotherapy drug used for my abortion, is one of three approved drug-based methods to end pregnancy, and an important one in environments without better alternatives; namely, countries with extremely restrictive abortion laws in which mifepristone (“the abortion pill”) is difficult to obtain. Methotrexate works by stopping fetal cell duplication as well as the ongoing implantation process. Though my experience was mild and physically undemanding — I had no downtime, nausea, or heavy bleeding — the drug itself is regarded as extremely toxic and can have a host of ugly side effects.

So the current preference among health experts around the world is for the superior abortifacient mifepristone, often called RU486 or the abortion pill, which was approved by the FDA in 2000. (Misoprostol, the third abortion medication, causes contractions of the uterus and is effective in inducing abortion 90 percent of the time. Though it can be taken alone, it’s more commonly used in combination with either methotrexate or mifepristone.) Some American clinics still offer methotrexate abortions — and methotrexate can be taken orally instead of administered by injection — but since the FDA approved mifepristone in 2000, most provide that instead. Mifepristone has a higher rate of success and carries less risk of side effects.

Medical abortion constitutes the majority of cases in many parts of EuropeMedical abortion — meaning any abortion induced by drugs as opposed to achieved through surgery — constitutes the majority of abortions in many parts of Europe: 70 percent in Switzerland, 83 percent in Sweden, and 94 percent in Finland. And for the majority of human history, ingestibles and herbs have been a highly common method for inducing abortion. The ancient equivalent of medical abortion even receives mention in the Bible. When the abortion pill became available in the States, the public response anticipated an abortion revolution. Time put the pill on their print issue’s cover, and The New York Times’ headline suggested it would “reshape debate.” Gloria Feldt, president of Planned Parenthood at the time, called it “the most significant technological advance in women’s reproductive health care since the birth control pill.”

An anti-choice protester (Daveynin)

But the abortion pill amounts to only 36 percent of domestic abortions within the first nine weeks of pregnancy, at least in 2011, the most recent statistic available. That same year brought a slew of restrictive regulation which impacted medical abortion availability — and, consequently, its use. “The dream of Mifeprex was that all doctors are going to prescribe it, and that would greatly reduce stigma because it’s going to be available everywhere,” says Tammi Kromenaker, MS, of Red River Women’s Clinic in North Dakota. But it proved to be a technological advancement that didn’t fulfill the invested parties’ anticipations of widespread change — at least, not here in the US.

Theoretically, medical practitioners could dispense a pill in private without calling attention to themselves Reproductive rights activists hoped that abortion medications would appeal to doctors who didn’t want anti-abortion protesters at their clinic doors, but who did want to help patients obtain abortions. Theoretically, medical practitioners could now dispense a pill in private without calling attention to themselves and inviting the inevitable cascade of protest, harassment, and threats. But stigma is not so easily sidestepped. As the Guttmacher Institute’s Rachel Jones points out, “if you’re in a fundamentalist, born-again community and you offer a patient an abortion option, it could be the death of your practice.” That fear among practitioners places an onus on patients to ask for options they might not even know exist — and from someone who may not be sympathetic to the idea at that. As Jones says, “If you’re not advertising , how do patients know?” There’s always the possibility that if you venture a request for help, you might be told to “Google it,” and shown the door.

Furthermore, the abortion pill is not available in pharmacies; doctors willing to provide it must work with the manufacturer directly to be personally approved. If a woman approaches her general practitioner with a request for medication and the doctor agrees, it’s possible too much time may pass before she can actually obtain the drugs. (Danco Laboratories, maker of Mifeprex, the only FDA abortion pill, did not reply to a request regarding how long the average application process takes.)

A medical abortion is a process, not an instant fix And then there are the side effects. A medical abortion is a process, not an instant fix, and it can entail heavy bleeding, intense cramping, and the passage of large clots. According to Kromenaker, pregnant women who intend to request abortion medications are sometimes dissuaded after finding out what the side effects entail.

This last point is crucial for understanding why abortion by pill didn’t sweep the nation in the way some media coverage suggested it would. Enthusiasm about abortion medication has less to do with its intrinsic advantages, which are highly subjective, and more to do with its ability to work around circumstantial limitations that make surgical abortions challenging to obtain. Its rise in popularity on the international stage, for instance, is the result of increasing abortion access for rural women with scant other options, rather than women with ready access to surgical options choosing medication instead. And while some European countries have policies favoring abortion through medication and may subsidize the cost entirely, the Hyde Amendment prevents US federal funding from playing a role in citizens’ abortions in any aspect. Twenty-five states have even passed laws prohibiting or inhibiting privately purchased insurance plans from covering it.

Here in the States, where many people are left to cover the cost themselves, surgical abortion can be the cheaper option — another mark in its favor. The Guttmacher Institute averages the cost of surgical abortion to be about $450, while medication is $483. Thirty dollars is not an insignificant amount to those for whom the procedure is already a considerable expense.

Rates of medical abortion have consistently risen every year since the pill’s approval — even as abortion rates have dropped

Still, rates of medical abortion have consistently risen every year since the abortion pill’s approval 15 years ago, even as abortion rates themselves have gone down, and Dr. Beverly Winikoff of Gynuity, an organization that promotes expanding affordable reproductive options worldwide, expects that trend to continue. “I think is amazingly popular here given how hard the government has made it to get,” she says. Since awareness of and comfort with choosing the abortion pill rests largely on word of mouth — women telling friends what their personal experience with the drugs was like — any frustrations about its popularity are a reflection of “inflated expectations about how transitions between medical technologies happen without commercial involvement,” as opposed to an accurate indication of the method’s appeal and usefulness.

(Anthony Easton)

As Dr. Winikoff observes, state laws ultimately play such a large role in women’s ability to obtain abortions, medical or surgical, attempting to describe them as popular or unpopular indicates a level of personal preference most women simply can’t exercise. The same women who struggle to obtain a surgical abortion will most likely struggle to obtain a medical one as well, thanks to purposefully restrictive regulations.

17 states have banned telemedicine for medical abortion For instance, telemedicine, which allows physicians to consult with nurses and patients through video conferencing, keeps patients from driving long distances to obtain mifepristone and misoprostol. That time saved can mean the difference between choosing an early, medical abortion, or being left with no choice but surgical after the window for early action has closed. But 17 states have banned telemedicine for medical abortion — and only medical abortion — which effectively means those who’d benefit most from access to the pill (rural women without the time or financial resources for travel to the nearest surgical abortion clinic) are denied.

Other recent anti-choice legislation seized upon enforcing an outdated FDA-approved regimen for administering mifepristone, which requires patients make three or more office visits instead of only two. (Under the evidence-based alternative regimen, women can bring home the misoprostol they’re supposed to take two days after the mifepristone, while the FDA regimen requires an additional trip be made to take that misoprostol in front of a doctor.) In North Dakota, home to Kromenaker’s clinic, this law is in effect. “We had to switch back to the FDA regimen, and our medication abortion numbers plummeted,” says Kromenaker. “Even for the most privileged of women, making four trips to a doctor’s office to terminate one pregnancy is a huge burden.” Guttmacher Policy Review described this legal maneuver as “threaten(ing) US trend toward early abortion.”

Women prefer surgical abortion to medicalDr. Winikoff is quick to point out that while only four states have passed laws requiring providers adhere to the FDA regimen, two of those states are Ohio and Texas. “Those are big states with a lot of people — and they’re almost entirely unable to provide medical abortion because conforming to the FDA approval document makes provision so cumbersome. Medical abortion is very popular in California and New York, which are also states with a lot of people, but with more supportive regulation.”

In 2014, the American College of Obstetricians and Gynecologists found that while women are usually satisfied with whatever abortion method they choose, they prefer surgical abortion to medical. When presented with the breakdown of what each entails, it’s easy to understand why: surgical abortion is quicker, more effective, and often entails only light bleeding, so it may remain the more popular choice in the US for the foreseeable future even if restrictive laws are overturned. And that’s not a bad thing. In fact, it’s a testament to how tenaciously activists have fought to ensure access and options to the pregnant people who need them.

For supporters of reproductive rights and comprehensive health care, the goal is for everyone to have the option of both methods: no more instances in which women can’t obtain medication in time to avoid surgery, and no more instances in which women have to go with medical abortion (or else no abortion at all) because surgery is too costly an investment in terms of travel and time.

A reproductive rights rally in Minnesota (Fibonacci Blue)

I’m not sure I would go with medication again if I needed an abortion and were given the option of surgery

Now that I know my medical abortion experience was somewhat anomalous, I’m not sure I would go with medication again if I needed an abortion and were given the option of surgery. I admit I’m daunted by the thought of intense cramps and heavy bleeding. But any number of circumstances could mean medical abortion would be the better method for me in the future, even if it isn’t right now. In a perfect world, I — and all of us — would always have the choice.

The reasons behind these bans differ from state to state, though. That’s what this legislation mostly seems to be about: the principles, rather than the practicalities, of abortion. Most of the newer limits on gestational age have to do with fetal pain—legislators claim they’re prohibiting the abortion of fetuses that can feel physical distress. But confusingly, these legislators often count the number of weeks in a pregnancy differently than doctors do. Although states like South Carolina claim to have passed a 20-week abortion ban, in medical terms, that’s actually 22 weeks.

Here’s why: Doctors measure gestational age by a standard called LMP, which dates a pregnancy from the woman’s last menstrual cycle. But starting with a 2010 Nebraska bill, some legislators started using the number of weeks “post-fertilization” as the standard for gestational age—equivalent to two weeks after a woman’s period, the average time when most women ovulate. Some states have tried to pass bans that would apply even earlier in a pregnancy, like Arizona’s 2012 law that tried to set the limit at 18 weeks post-fertilization or 20 weeks after a woman’s last period. That measure was struck down by the courts, though. For now, bans that apply 20 weeks post-fertilization and 22 weeks LMP are about as low as states can go. More than a dozen have these limits in place.

This linguistic sleight-of-hand might be one way legislators are trying to create a sense of fetal personhood, said Elizabeth Nash, a staffer at the Guttmacher Institute, a pro-choice research organization. “There’s been an effort by conservative lawmakers to peg the beginning of pregnancy to fertilization,” she said. “They’ve talked about personhood starting at fertilization for a long time, and this is a way to codify that and get it into law.”

Although laws like South Carolina’s aren’t effectively that different than those in other states, Nash said, they shift the standard set by the Supreme Court in Roe v. Wade and the 1992 case Planned Parenthood v. Casey. If measures of fetal pain were to become the standard, “that would really upend the underpinnings of abortion rights: a state cannot ban abortion before viability,” she said.

The standard of viability presents its own challenges, though. “I don’t find the concept of viability to be a particularly helpful one for physicians,” said Edward Bell, a doctor at the University of Iowa who studies premature infants. “In a practical sense, when doctors talk about viability, they mean, ‘At what point in pregnancy is it reasonable to try and resuscitate a baby and try and offer treatment?’” That calculation might depend on a number of factors, from the gender of the fetus to the kind of neonatal care the mother has received, Bell said. “It’s rather simplistic to reduce the conversation to the number of completed weeks in pregnancy.”

How many weeks do you have to be to get an abortion?

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