Questions and Answers

A medical abortion or abortion with pills uses medicines to cause the non-surgical termination of an early pregnancy. These medicines, called mifepristone and misoprostol, cause the expulsion of the pregnancy from the uterus.
The most effective type of medical abortion involves the combined use of both types of pills. Misoprostol alone is also commonly used to cause an abortion but is slightly less effective.
Mifepristone blocks the hormone progesterone, which is required to sustain a pregnancy. Without this hormone, the attachment of a fertilised egg to the uterine wall is disrupted, and the uterus contracts. Misoprostol enhances contractions and helps to expel the pregnancy from the uterus.
Medical abortion with mifepristone and misoprostol or misoprsotol alone are safe and effective. These medicines are listed on the Core Model List of Essential Medicines of the World Health Organization.

The World Health Organization recommends that individuals in the first trimester (up to 12 weeks pregnant) can self-administer mifepristone and misoprostol medication for an abortion without direct supervision of a health-care provider.
Abortions are safe if they are done with a World Health Organization-recommended method that is appropriate to the pregnancy duration, and if the person supporting the abortion is trained.

If you prefer a surgical abortion, visiting a clinic or are more than 10 weeks, you can read more about clinics here.

According to the law, all pregnant people have the right to a free abortion at a government hospital or clinic during the first 12 weeks of pregnancy.
You can also have an abortion from week 13 up to week 20 of the pregnancy if your healthcare provider believes that:

• the continued pregnancy would significantly affect your social or economic circumstances
• the continued pregnancy poses a risk of injury to your physical or mental health
• there is a substantial risk that the foetus would suffer from a severe physical or mental abnormality
• the pregnancy resulted from rape or incest.

After week 20 of pregnancy, you can have an abortion if the pregnancy:

• would endanger the your life
• would result in a severe malformation of the foetus
• would pose a risk of injury to the foetus.

People of all ages have the right to terminate a pregnancy and should never be denied the service because of their age. We suggest that if you are under 16 talk to trusted adult for support.

Ultrasound and pregnancy test are the only ways to be sure if you are pregnant. If you are sexually active and have missed a period, you may be pregnant. Common symptoms of early pregnancy are nausea, breast soreness, tiredness and frequent need to urinate.

A pee-on-a-stick pregnancy test can be bought from a pharmacy for R30. You can do a test from the first day of your missed period. Before that the level of hormones produced by the pregnancy is too low to show on the test and the test might give you a false negative.

An ultrasound will show a pregnancy from a week after you missed your expected period, before that the pregnancy is too small to detect.

You can estimate how long you have been pregnant by calculating the number of days since the first day of your last menstrual period (LMP). You can also use our pregnancy calculator here.

Calculating pregnancy length (from LMP) is less accurate if you had irregular menstruation in the 3 months prior to pregnancy, during breastfeeding, and while using hormonal contraceptives (e.g. oral contraceptive pill, patch, ring, injection, implant or hormonal IUD). In this case we advise that you have an ultrasound. An ultrasound can tell you how long you have been pregnant. In most cases, you do not need an ultrasound to have an abortion. You can get an ultrasound at a clinic or gynaecologist.

According to the World Health Organisation, abortion with pills is safe at home until 12 weeks of pregnancy. If you are above 12 weeks, we strongly advise you to visit a clinic. Abortion is legal in South Africa up to 20 weeks. According to South African policy, people with pregnancies up to 10 weeks can do an abortion at home.

If you are more than 12 weeks and choose to self-manage your abortion, the medicines will still work to cause an abortion but the risk of complications increases. The further along the pregnancy is, the more likely that you will need to visit a doctor afterwards.

An ectopic pregnancy is a pregnancy that grows outside the womb, usually in a fallopian tube. An ectopic pregnancy can be life-threatening because if the pregnancy grows too large it can cause the tube to burst. This must always be treated with an operation or medicines. A medical abortion does not affect a pregnancy outside the womb! You can make sure that your pregnancy is inside the womb by having an ultrasound.

• If you use mifepristone and misoprostol to end a pregnancy and you do not do an ultrasound first, there is always a chance that you could have an undetected ectopic pregnancy.
• If you do not pass tissue and blood after taking the Misoprostol, you might have an ectopic pregnancy.
• If you have sudden severe pain in your belly or back (mostly on one side), if you feel you might faint or if you do faint, or if you feel pain in the shoulder area, you might have an ectopic pregnancy that has burst and you should go to a hospital immediately.

You are strongly advised to use the medicines in the presence of someone you trust.  If you experience abnormally severe side effects (prolonged or extreme pain, bleeding, cramping, fever, nausea, vomiting, diarrhea), it is good to be with someone who can go get medical help.

If you choose to do the medical abortion alone, it is not necessarily hazardous. Make sure you are near a phone or some way of contacting medical professionals.

You should consider telling someone (a neighbor, a family member, or someone who is nearby) that you are not feeling well and you are going to rest. You can ask them to check on you later in the day after you use the misoprostol. This way someone will know if you are experiencing complications and can help you, but they do not have to know that you have done a medical abortion. You can say that you think you have had a miscarriage.

It is absolutely necessary to be within one hour of help in case you lose too much blood. This is also advised when a person has a miscarriage or gives birth. Hospitals and clinics have basic medical equipment and staff. This equipment and expertise is sufficient to care for individuals who have complications related to miscarriage, abortion or birth.

To end a pregnancy up to 12 weeks using misoprostol (Cytotec), the medicines should be taken as follows:

1. Put 4 misoprostol pills under your tongue and keep them there until they dissolve. You can swallow your saliva. After 30 minutes, you can spit out any remains of the tablets.
2. 3 hours later, put 4 more misoprostol pills under your tongue and keep them there until they dissolve or for at least 30 minutes.
3. 3 hours later, put 4 more misoprostol pills under your tongue and keep them there until they dissolve or for at least 30 minutes.

There are 2 ways to do an abortion with pills. Both options are scientifically proven to be safe and effective.
Option 1: Misoprostol alone is 94% effective (6 out of 100 abortions will not succeed) and costs R180 at a pharmacy.
Option 2: The combination of misoprostol and mifepristone is 98% effective (2 in 100 abortions will not be successful) and costs R800 at a pharmacy.

The doctors we work with provide misoprostol alone as it is more affordable but you can email to let them know if you prefer mifepristone. It's important to ask your pharmacist for Mediprist (this is the brandname for mifepristone) as it is cheaper than other brands but just as effective

To end a pregnancy up to 12 weeks using mifepristone (Mediprist) and misoprostol (Cytotec), the medicines should be taken as follows:

1. Swallow one tablet of mifepristone (200 mg).
2. 24 hours later, put 4 tablets of misoprostol (200 mcg each) under your tongue and keep them there until they are dissolved. You can swallow your saliva. After 30 minutes, you can spit out any remains of the tablets

• If you have less bleeding than expected and are concerned the medication has not worked, 3 hours after using the misoprostol, put 2 tablets of misoprostol (200 mcg each) under your tongue. Keep them there for 30 minutes, until the tablets are dissolved. After 30 minutes, you can spit out any remains of the tablets.
• If you still have not started bleeding and you have more misoprostol, you can continue taking 2 more tablets of misoprostol (200 mcg each) under your tongue, keep them there for 30 minutes, until the tablets are dissolved. After 30 minutes, you can spit out any remains of the tablets.

Mifepristone and misoprostol pass into breast milk but the amounts are very small and should not cause adverse effects to the breastfed infant. You can continue to breastfeed without interruption following mifepristone and misoprostol, there is no need to discard any breast milk.

As a precaution, infants exposed to mifepristone or misoprostol via breastmilk should be monitored for nausea, vomiting and poor feeding.

You can eat and drink as you normally would after taking the abortion pill. However, as some women experience nausea from the misoprostol, you may want to eat lightly. You should not drink alcohol or use drugs during the abortion, as it could affect your judgment.

The heaviest bleeding typically occurs 2-5 hours after using misoprostol and usually slows down within 24 hours. The most intense cramping and bleeding generally lasts 3-5 hours, but it can last for less or more time. It is normal for your body to take time to empty the uterus completely. Some women bleed heavily for up to 48 hours and may pass clots days or even weeks after taking the misoprostol. This is common and is not dangerous, unless you soak through more than two maxi pads per hour for 2 hours or more, or if you lose heavy clots bigger than an orange. Every woman’s body and experience is different.
Light bleeding can continue for 1-3 weeks after using abortion pills, but times may vary. Normal menstrual period usually returns after 4-6 weeks after the abortion.

If you do not start bleeding within 4 hours of taking misoprostol, you can take another dose of misoprostol.
If you experience complications such as fever, faintness, or extreme abdominal pain, then you should seek medical help immediately, because you could have a ruptured ectopic pregnancy.
If you have an ectopic pregnancy, the medical practitioner will treat it. If the ultrasound shows a continuing pregnancy, you can do the medical abortion again.

In most cases you can see blood and tissue in your pad or in the toilet. The (very small) embryo is usually passed within this blood and tissue unnoticed. However, it is possible that you might see the (very small) embryo. Depending on the length of the pregnancy, a small pregnancy sac with some tissue around it may be visible. For instance, if you are five to six weeks pregnant, a sac might be visible. At nine weeks, you might see a sac in the blood and/or an embryo. Please be warned that with a pregnancy of 8 or 9 weeks you will pass an embryo that is approximately 2.5 cm. This can be distressing. Our helpdesk can offer resources and support if you’re concerned about this.
At 6 or 7 weeks gestation, the embryo measures approximately 1/4 to 1/2 inches, and at 9 weeks it measures about 1 inch.

The medical abortion normally causes side effects such as pain and cramping, as well as bleeding accompanied by the passage of blood clots and tissue. Nausea, vomiting, diarrhea, headache, dizziness, and hot flashes or fever may also occur.
A fever that starts soon after Misoprostol administration and lasts less than 24 hours and is less than 100.4 F/ 38,5 C is a common side effect. If the fever lasts longer than 24 hours or is higher than 100.4 F/38,5 C, you should seek medical attention.
An allergic reaction to the medication can cause hives (itchy welts or bumps on the skin.) Please refer to the question “What are the symptoms of allergic reaction?”
If your side effects are extreme, you may have a complication. Please refer to the question "How do you know if you have a complication and what should you do?" if you think you might be experiencing abnormal side effects.
Most women will experience pain and cramping during the medical abortion after using the Misoprostol. In the majority of the scientific studies on the topic, most women describe the pain as only a little bit worse than the pain they experience during a menstrual period.
Some women will experience nausea, vomiting, or diarrhea, but it is thought that this is an effect of early pregnancy as much as it is due to Mifepristone or Misoprostol. Usually these side effects go away by themselves and do not require medical attention. Headache, mild dizziness, fever and hot flashes are symptoms that also should go away by themselves

Many people know if the abortion was successful because they feel the symptoms of pregnancy (nausea, tender breasts, need to urinate) going away or they see the embryo come out.

Within a few days of the abortion, you can learn if your pregnancy has ended by having an ultrasound. An early ultrasound will tell you if the pregnancy has ended, but it is best wait for 10 days after using Mifepristone before having an ultrasound because only 23% of abortions are totally complete after 7 days. [1]

Three weeks after taking the abortion pill, you can use a pee-on-a stick home pregnancy test to learn if the abortion pill worked. You must wait for the three weeks because the pregnancy hormones are still in your body and the test might show an unreliable, falsely positive result.

If the pregnancy test is still positive after 3 weeks, it is important to get a medical evaluation right away as you may have an ectopic pregnancy, which can be dangerous.

If performed in the first 12 weeks, a medical abortion carries a very small risk of complications. This risk is the same as when a woman has a miscarriage and can be easily treated by a trained healthcare provider. Out of every 100 women who do a medical abortion, 2 to 3 women will seek further medical care.

Please see the list below for possible complications, symptoms, and treatment:

Heavy bleeding (occurs in less than 1% of medical abortions)

• Symptom: Bleeding that lasts for more than 2 hours and soaks more than 2 maxi sanitary pads per hour. Feeling dizzy or light-headed can be a sign of too much blood loss. This is a serious health risk and requires medical attention.
• Treatment: Misoprostol and/or a vacuum aspiration (curettage.) When available, a woman should start taking 2 misoprostol under the tongue immediately at home before going to the hospital. Very rarely (less than 0.2%) a blood transfusion is needed.

Incomplete abortion

• Symptoms: heavy or persistent bleeding and/or persistent severe pain.
• Treatment: 2 tablets of misoprostol or/ and vacuum aspiration

Infection

• Symptom: If you have a fever (more than 38 °C) for more than 24 hours, or you have a fever of more than 39 °C, you might have an infection.
• Treatment: antibiotics and/or vacuum aspiration.

If you think you might have a complication you should seek medical attention immediately. You do not have to tell the medical staff that you tried to induce an abortion. If you prefer you can tell them that you had a spontaneous miscarriage.

The symptoms of a miscarriage and an abortion with pills are exactly the same and the healthcare provider will not be able to see or test for any evidence of an abortion, as long as the pills have completely dissolved. If you took the misoprostol under the tongue, as our protocol recommends, the pills should be spit out after 30 minutes, if not dissolved completely. If you took the pills vaginally, you must check with your finger to make sure that they are dissolved. Traces of the pills may be found in the vagina up to four days after inserting them.

Less than 1% of women experience ongoing pregnancy. This can be determined by a pregnancy test after 3 weeks or an ultrasound within a week. If the medical abortion treatment failed, there is a slight increase in the risk of birth defects such as deformities of the hands or feet,and/or problems with the nerves of the fetus. To

Infections following medical abortions are very rare. If you feel weakness, nausea, vomiting, diarrhoea, fever that lasts more than 24 hours or is higher than 38 °C, pain in your belly, if your belly feels sore or tender, if the bleeding increases or takes longer than expected or if you have vaginal discharge that smells bad, you might have an infection and you should seek medical care or assistance immediately. The infection should be treated with antibiotics.

A fever that starts soon after taking misoprostol, lasts less than 24 hours and is less than 38 °C is a common side effect of the medicines. If the fever lasts longer than 24 hours or is more than 38 °C, you should seek medical attention.

The risk of infection is greater when a woman gives birth than when she has a medical abortion.

An incomplete abortion is an abortion that has been only partially successful. The pregnancy has ended, no fetus will develop, but your body has expelled only part of the tissue and products of pregnancy. If you have prolonged bleeding, too much bleeding (much more than a regular menstrual period), pain in your belly that does not go away a few days after taking misoprostol, unbearable pain, fever, continued bleeding after three weeks, or pain when pushing on your belly, you may have an incomplete abortion. It is important to go to a hospital or clinic to have an ultrasound if you have any of these symptoms. If the tissue and blood remain in the body, they can cause complications like heavy bleeding or an infection, which need to be treated. If there are no complication signs, often treatment with 2 extra tablets of misoprostol is enough.

Abortion is legal and you have acted within your rights. However, if you visit a health facility, it is not necessary to tell the doctor or nurse that you tried to induce an abortion. If you prefer, you can say that you think you are having a miscarriage. There are no tests that can show that a woman has done a medical abortion. It is extremely important to treat the complications of incomplete abortion. The treatment consists of evacuating residual tissue by vacuum aspiration, and antibiotics, in case of infection. Any clinic that can deal with complications of miscarriage can also help women with incomplete abortions because the symptoms are the same.

How common are incomplete abortions after a medical abortion?

If you still have symptoms of pregnancy such as sore breasts or nausea, you may have a continuing pregnancy.

Bleeding does not mean that you have had a successful abortion. Even if you bleed, you can still have a continuing pregnancy. A continuing pregnancy is a pregnancy that continues to develop even after the use of mifepristone and misoprostol. In this case, the abortion has failed completely and the woman remains pregnant.

You should have an ultrasound a week after your abortion or do a pregnancy test 3 weeks after your abortion to confirm that the pregnancy has ended. It is necessary to wait 3 weeks after the abortion because pregnancy hormones can remain in the body and can make the pregnancy test falsely positive.

If you have an ongoing pregnancy after you did a medical abortion, you can try to do a medical abortion again or have a surgical abortion.

If you do not have symptoms of a complication, nor doubts whether the pregnancy was terminated, it is not necessary to have an ultrasound after a medical abortion.

An ultrasound 3-10 days after the abortion can determine if the pregnancy has ended. This may be useful if you are unsure whether the abortion was successful. Alternatively, you can do a home urine pregnancy test 3-4 weeks after taking the medicines. If you use the home urine pregnancy test before waiting for 3 weeks, the result may show up as false positive, as there are still pregnancy hormones in your body.

Medical abortion, like miscarriage, is a process and the body might take several weeks to fully expel all the tissue from the uterus. This is completely normal. Even if the pregnancy has ended, many women will still have tissue and blood inside the uterus for several weeks after a medical abortion. If you do not have symptoms of complication (i.e. intense pain in the belly, ongoing fever, heavy bleeding or foul-smelling vaginal discharge) there is no need for a surgical intervention, like vacuum aspiration. One can wait until after the next menstruation or take 2 tablets of misoprostol under the tongue.

If you want to avoid becoming pregnant right away, it is important to start using contraceptives immediately. Although it may be several weeks after your abortion before you menstruate again, you could ovulate (be fertile) in the first week after your abortion. This means you can get pregnant right away, even if you are still bleeding.

You can use condoms right away. You can start hormonal contraceptive methods (pills, patch, ring, injection, implant) 1 to 3 days after using misoprostol. If you start birth control pills more than 3 days after using misoprostol, it is recommended that you use a barrier method (condoms) during the first 9 days, until the pills reach their full level of protection. An IUD can be put in place 4-14 days after using misoprostol, even if there is still light bleeding. You can also wait until your next period to insert an IUD , but you will need to use another contraceptive method in the meantime if you do not want to risk becoming pregnant.

If you are sexually active and do not want to get pregnant, always use contraception. Some contraceptives are more effective but none are 100% effective. https://findmymethod.org/birth-control-options

Right after the abortion, the cervix might be slightly open so there is a greater risk of infection if you have sexual during this time. To prevent infection, it is best to wait 4-7 days to have sex again after taking abortion pills. If you want to avoid becoming pregnant right away, it is important to start using contraceptives immediately.

Most people do not need any psychological help before or after an abortion.

Feelings of regret after abortion are rare. In fact, the most common emotional response after abortion is relief. Transient feelings of guilt, sadness, or loss are common, but most women can overcome negative feelings that might affect them. It is normal to feel emotional after an abortion. While you may experience sadness or grief, these feelings usually go away after a few days. However, in countries where social stigma is prevalent, it is more common for women to suffer feelings of guilt and shame.

If you are not sure if abortion is right for you, we encourage you to discuss it with a trusted friend.