In early pregnancy, the procedure used most commonly in the US is vacuum aspiration (suction). The procedure itself takes about 10 minutes and is usually done with a local anesthetic, although sedation or general anesthetic may be requested. The cervix (opening to the uterus) has to be opened (dilated) enough for a small tube to fit in. The plastic tube is attached to a machine that creates a mild suction. With this suction, the doctor removes the endometrial lining of the uterus, the embryo, and the placenta. Vacuum aspiration abortions may be done from 5 to 16 weeks after the last menstrual period. (Abortion is not performed before 5 weeks because the embryo is too small to ensure that all fetal material has been removed. Lab examination of the removed uterine contents helps to prevent incomplete abortions.)

For pregnancies beyond 16 weeks, which represent about 1/10 of the total abortions performed, other methods are used.  Surgical abortions in Rhode Island can go up to 18 weeks 6 days at Planned Parenthood of Southern New England and sometimes above 18 weeks 6 days at other locations, such as hospitals. Surgical abortions can go up to 20 weeks 6 days at Planned Parenthood League of Massachusetts, while some clinics in Massachusetts may perform abortions up to 24 weeks. Oftentimes, if a clinic cannot perform an abortion based on your gestational age, they will help you find another location. 

Second Trimester Pregnancy

Second trimester pregnancies often require a two-day process of laminaria insertion (on day 1) and then an in-clinic surgical abortion (on day 2). Laminaria are small seaweed sticks that are inserted by a clinician into the cervix for dilation. The laminaria are left in place overnight and then removed the next day before the procedure. The laminaria expand, similar to a tampon, to prepare and dilate the cervix to make the procedure quicker and more comfortable. The clinician will numb the area before insertion of the laminaria and often prescribe pain medication to help with any associated cramping while the dilation process occurs. (Once the laminaria are placed, it is essential that they be removed the next day since leaving them inserted can cause serious health issues, such as sepsis. It is also important to note that once laminaria is inserted, there is an increased risk of miscarriage if a person did not have the abortion procedure and continued the pregnancy.)

After Procedure

After any surgical abortion procedure, patients remain at the clinic for at least 30 minutes so that their vaginal bleeding and health status can be monitored. Antibiotics are often given to guard against infection. Also routine is a discussion about contraceptive methods and giving the patient contraceptive supplies before the end of the visit. This can include the placement of an IUD or implant while in the procedure room if one is desired. The involvement of a friend, partner or family member throughout the abortion process, from the diagnosis of pregnancy through follow up after the procedure, is often very helpful and is usually encouraged by clinics. 

A medical abortion, often referred to as the “abortion pill,” is an alternative to surgical abortion that was approved in the US by the FDA in September 2000. These medications are not the same thing as emergency contraception, also known as the “morning after pill.” After a pregnancy is confirmed, a medical abortion is performed by administering prescription medications that will induce an expulsion of the uterine lining and the implanted fertilized egg.

These medications (a combination of mifepristone and misoprostol) are collectively called RU-486 and require a prescription. The use of mifepristone and misoprostol is the standard of care for most medical abortions and are both safe and effective. Mifepristone is taken orally, while misoprostol can be placed buccally (between the cheek and gums) to dissolve or inserted vaginally. As an abortion method, RU-486 can be used up to 11 weeks after the first day of your last menstrual period. 

A medical abortion can take anywhere from 4-5 hours to a few days after after taking the medication, and requires a minimum of 2 visits to the clinic or medical office. Return visits are scheduled the week after taking the medication. At the return visit an ultrasound is done to be sure that the abortion has been completed. In the vast majority of cases, the expulsion will complete within a few days and most patients return to normal activities the day after a medical abortion. In the small percentage of cases (3-4%) where the medications do not result in a full abortion, a surgical abortion is needed to complete the process.

Abortion is legal in Rhode Island, but there are restrictions if you are under 18. In Rhode Island, people under 18 are required to have the consent of one parent or legal guardian to have an abortion. If this is not possible, the state provides an alternative called "judicial bypass" which means you go to court to have a judge determine that you are mature enough to make this decision without a parent or guardian's consent. (Local abortion clinics can link you to counselors trained to help with this process and to accompany you to court.) In neighboring Massachusetts, parental consent or judicial bypass is required if you are under 16.

Call the clinic ahead of time to discuss insurance and payment. If you have the Student Health Insurance Plan (SHIP), you do not have to get a referral from Student Health Services in order to receive services. Voluntary pregnancy termination is covered the same way as any other medical condition. For more information visit the SHIP website or email studenthealthinsuranceplan@brown.edu.

If you have another health insurance plan, you should check to determine what is covered and how to maximize your coverage. You might also want to ask what the insurance company's procedures are regarding notification of the plan subscriber (the person who pays for the insurance plan, whether it's you or your parents) about services covered. 

If you pay out of pocket, most abortion costs in Rhode Island and nearby Massachusetts will fall in the range of $600-$1400, depending on pregnancy gestation, medical or surgical care, and, for surgical abortions, sedation options. (Costs last updated July 2024.) 

Some people may opt-out of using insurance. If this is the case, or if your health insurance plan does not cover abortion care, there are opportunities for funding assistance for medical and surgical abortion services. Listed below are some local and national funds. When considering an abortion fund, it is important to check your health insurance coverage and schedule an appointment with a provider before reaching out to coordinate funding. 

Physical complications are rare. The most common complications are heavy blood flow and infection. Danger signs include excessive bleeding (which is defined as saturating one pad top to bottom per hour), fever, nausea, severe cramps that don’t improve with over the counter pain relief, such as ibuprofen or Tylenol and heat or cold, or foul-smelling vaginal discharge. Additionally, passing blood clots is common after a surgical abortion. Golf-ball size clots are normal, however if you are passing clots that are lemon-size, you should follow-up with your provider. The clinic will give you instructions about what to do if any complications occur.

Recovery time varies after an abortion. If you receive moderate sedation, you are monitored for a minimum of 30 minutes post-procedure in recovery to ensure that you are feeling okay and to check your vaginal bleeding and are then required to have an escort drive you home. An antibiotic to prevent infection and a medication to help the uterus contract to its normal size are sometimes prescribed. Additional care, such as pain or nausea medication, may be offered while you are in the recovery room if you are feeling unwell.  

Avoid strenuous activities for a few days and then resume normal activities when you feel well. You can also ask the clinic or provider for a school or work note to excuse you for a few days while you recover.

There is often a bloody discharge like a menstrual period for several days and even up to 4-6 weeks after an abortion. Some individuals do not bleed at all. Both of these situations are considered normal. Normal periods should start within 4 to 8 weeks following an abortion.

To prevent infection, avoid douching, baths, tampons, and sexual intercourse for about 1-2 weeks after an abortion. Pads are useful to monitor bleeding over the first couple of weeks post-abortion.

Nausea is one of the first pregnancy symptoms to resolve after an abortion, taking up to a few days, while other symptoms such as breast tenderness may take several days. 

It is possible to become pregnant in the time after an abortion and before your next menstrual period, so it is recommended that you use a contraceptive method or abstain from sex. It is ok to begin a birth control method immediately. (Note that if you do start birth control, this can also change your bleeding pattern.) If you are not ready to discuss contraceptive methods at the time of your visit, you can schedule an appointment at another time with the clinic or at Student Health Services.

A post-abortion checkup is generally not needed unless a patient reports complications such as excessive bleeding or infection symptoms. 

For medical abortions, physical complications are rare. If you experience any chills, fever, or nausea, these symptoms should subside quickly. However, if you experience any of these symptoms for more than 24 hours following taking the second set of pills, call your provider. While uncommon, these symptoms may indicate an infection.

How patients feel following a medical abortion varies with each individual. When the second set of medication is taken, prepare to have a day of rest in a comfortable setting. It typically takes 1 to 2 days for patients to return to their baseline of health. Heavy bleeding, cramping, and large blood clots are common once the process begins.

You can return to normal activities the day following the medical abortion if you feel capable. However, do not do any strenuous activities for several days.

It may take hours to days before bleeding and cramping is totally complete for medical abortions. For medical abortions, it is okay to use tampons or menstrual cups to help with this bleeding. Often it is recommended to use pads in order to track bleeding for the few days following an abortion.

Expect a regular period after 6-8 weeks following the medical abortion (if you don’t start a birth control method which affects your menstrual cycle). Birth control can be used immediately following a medical abortion, as it is possible to get pregnant very soon after. After a medical abortion, you can have sex whenever you feel ready.

There are many myths regarding the long-term consequences of abortion, such as abortion is linked to breast cancer, however, there is no scientific evidence to support claims like these.

Only in the rare cases of serious complications that go untreated are there long-term effects of an abortion.

In the vast majority of cases, abortions do not affect future pregnancies, fertility, or overall health.

Additionally, long-term emotional problems following an abortion are uncommon. They are about as common as they are after giving birth. That being said, there are many hotlines and resources for additional emotional support, including this Exhale PDF.