'Abortion is like a 'silent secret' but people are less judgemental than one might expect' 

Abortion is a divisive issue, and a topic that women can feel reluctant being open about. 

And what surprises gynaecologists most about public perceptions of abortions is the misunderstanding of how common it is. Research recently carried out the US shows that one in three women have an abortion at some point in their lives - and 95 per cent don’t regret it.

“Termination of pregnancy is more common than most women think,” Dr Josephine Senior, who is six years into training to specialise in obstetrics and gynaecology, told The Independent, adding: “but it will always be a difficult topic to talk about.”

“It is almost a 'silent secret' which women may only find out about if it is brought up openly with friends and colleagues,” says Dr Anne Henderson, a Consultant Obstetrician and Gynaecologist based at Nuada Medical in Harley Street. “The other issue is that most people are much less judgemental towards women who have had an abortion than might be expected, and there is some evidence that the procedure is much more accepted within society than it has been in the past.”

Vanessa Avlontis, the UK's chief nurse at contraception and abortion organisation Marie Stopes, chimes: “Having a mature discussion can only benefit women who face pressures or personal circumstances that make it difficult for them to have a child at a particular time. Such discussion can demystify the process."

So, if there isn’t an adequate conversation happening about what the realities of an abortion are like, what would the healthcare professionals want their would-be patients to know? 

Dr Senior starts with the basics. Firstly, terminations are in one of two ways: medical or surgical. “The medical involves taking one tablet then going home for 48 hours," she says. "In that time women may experience cramps and bleeding. After 48 hours they come back to hospital and have either a single tablet, usually given as a vaginal pessary, or a course of tablets, depending on how many weeks pregnant they are. 

“In many units, women under nine weeks are given a single tablet and are welcome to go home as long as they have someone with them who knows what is happening and can easily return to hospital if they need to. The surgical termination involves having a general anaesthetic then the cervix is dilated and any pregnancy tissue is removed using suction.”

Both have similar side effects, she goes on, with the most common being bleeding and cramping pain. Infections in the womb are also common because the cervix is artificially opened during the procedure. 

Bleeding can last up to three weeks after the procedure, but a woman should visit a doctor if bleeding or pain worsens, or they release a smelly discharge. 

“Less common problems include the procedure leaving some tissue behind," she adds. "This would present itself as ongoing heavy bleeding and pain usually. There is also a small risk of preterm labour in future pregnancies because we artificially open the cervix and it can become incompetent in the future but this is a small risk, especially for women who have only one termination. Surgical procedures also carry a risk of making a small hole in the wall of the womb. These heal quickly and rarely cause long term problems.” 

“Whilst bleeding is common, it should not be very heavy," stresses Dr Senior. "If women are soaking through a thick sanitary pad more than once an hour they need to be seen by gynaecology."

However, she is also surprised by how little understood the different reasons for terminations are, and how women from all socioeconomic backgrounds seek such procedures out. Financial hardship, the relationship with the father, and mental health issues can all play a role, as well as the health of the baby.

Recalling the case of a woman who had undergone IVF for her first pregnancy, Dr Senior said: "Half way through that pregnancy her husband left her and she was living in a studio with her one year old son. She had intercourse with a new man who never contacted her again. She found herself pregnant spontaneously with no money and no support and decided to terminate. This was genuinely the most difficult thing she'd ever decided to do but it was the right thing for her and her son."

Dr Henderson, highlights the psychological effects of terminations, which are less common than the physical. 

“A significant minority of women will nonetheless experience psychological upset such as mood lability. This can include tearfulness, mood swings, and unpredictability. Some women experience headaches due to the withdrawal of the pregnancy hormone, and these usually settle fairly soon after the procedure."

She stresses that while women can feel ill-informed about abortions until they need to undergo one, friends and loved ones can also feel in the day. But simply getting in touch with a woman and showing support in the run up to and following a termination is an important gesture. 

“Practical support such as ensuring medical reviews if there any evidence of concerning symptoms can be helpful, as some women are too embarrassed or ashamed to seek help following an abortion, even when they know something is wrong.

"Checking how they are feeling without prompting can be helpful particularly if they haven’t heard from the person for some time," she says. "Being non-judgemental is also key to minimise any feelings of blame or guilt."