Overview
Abortion (termination of pregnancy) services in Wales are provided by Local Health Boards. Clinics offer a range of methods and services depending on gestational period (how many weeks pregnant you are). Each Health Board may differ in process so it is important to check with the clinic to find out what method is available, how to go about accessing the service and whether or not there are any exclusions.
The Law:
The law states that a doctor can refuse to certify a woman for an abortion if they have a moral objection to abortion. If this is the case, they must recommend another doctor who will be willing to help.
Before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled;
- Abortions must be carried out in a hospital or specialised licenced clinic
- Women who are normally resident in Wales and meet certain requirements may be offered the option of taking the second medication in an early medical abortion at home.
- Two doctors must agree that an abortion would cause less damage to a women’s physical or mental health than continuing with the pregnancy
Under UK law, an abortion can usually only be carried out during the first 24 weeks of pregnancy. After 24 weeks, abortion can be carried out if;
- It is necessary to the woman’s life
- It is to prevent permanent injury, physically or mentally, to the woman
- There is a substantial risk that the child would have serious medical/physical disabilities
Accessing abortion services:
If you have a pre-existing medical condition, it is important that you discuss this with clinic staff in advance of any treatment..
Please contact the clinics below for information on abortion services in Wales, based on the Health Board area. Sexual Health Clinics will be able to signpost you effectively to the most appropriate service. There may be the need for patients to visit a Sexual Health Clinic initially to be referred into the abortion service.
Health Boards, contact information and clinic information:
Frequently Asked Questions (FAQs)
Do I need someone to come with me?
You can bring someone with you to make you feel comfortable but this is your decision. If you are under 16, it is advised that a parent or guardian accompanies you however, if the doctors believe it is in your best interest and you fully understand what is involved, you can attend alone if you wish to do so.
What kind of treatment is available?
Late abortion is not available in Wales (20 to 24 weeks), however the medical and surgical method are available. Your clinician will discuss the most appropriate method, and alternative methods if applicable, with you to help you decide the best option for you.
What is a medical abortion?
A medical abortion does not involve surgery or anaesthetic. It is the process of taking medication to induce contractions and thins the lining of the uterus. This process involves two doses of medication. The first does will block the hormone that allows pregnancy to continue, also thinning the lining of the uterus. This medication is called Mifepristone and is taken orally. The second dose is taken between 24 to 48 hours after the first dose and is called Misoprostol. This will induce the contractions, and is taken either orally, allowed to dissolve under the tongue or in the cheek, or is put inside the vagina. Within 4 to 6 hours, the lining of the womb breaks down causing bleeding, and the loss of the pregnancy. You will have to stay at the clinic while this happens to determine whether it is best for you to go home. The dosage depends on the duration of the pregnancy, and there may be a need for a small surgical procedure to be performed if the pregnancy does not pass. This method procedure differs depending on the length of pregnancy – it is important to discuss with the clinician the options and methods.
What is a surgical method?
This procedure involves local anaesthetic (where the area is numbed), conscious sedation (you will be awake but relaxed), or general anaesthetic (where you will be asleep). The surgical method can be performed by vacuum or suction aspiration or by dilation and evacuation.
The vacuum or suction aspiration method can be used up to 15 weeks of pregnancy. This involves inserting a tube through the cervix into the womb. The cervix will be gently widened first, and a tablet may be placed inside the vagina or taken orally a few hours before the surgery to make it easier to open. This method usually involves local anaesthetic or common sedation so there is little pain. This method usually takes between 5 to 10 minutes.
The dilation and evacuation method is usually used around 15 weeks of pregnancy and involves inserting forceps (a surgical instrument used to grasping) into the cervix and womb to remove the pregnancy. The cervix is dilated several hours or up to a day before the procedure. This is usually carried out with conscious sedation or general anaesthetic and normally takes between 10 to 20 minutes.
Do you offer 1 day abortion in Wales?
No, the surgical method will be scheduled after a referral from the Sexual Health Clinic, which may be a few days after the assessment. The medical method involves taking oral medication on different days. For Welsh residents, if certain criteria is met, women may be offered the option to take the second medication, in a medical abortion, at home. This will be agreed by your clinician.
How do I make an appointment?
Most Health Boards will need you to be referred by a Sexual Health Clinic, you can search for these here. Please see the table to understand the different processes for each Health Board.
What is the maximum gestation period (number of weeks pregnant) that I can be seen in Wales for an abortion?
In Wales, the longest gestation period that will be seen is up to 18 weeks. Women who are over 18 weeks pregnant will be referred onto the British Pregnancy Advisory Service (BPAS) for alternative services in England.
What can I expect?
You will contact the appropriate service, depending on where you would like to go. You can either contact the appointment line, or access the service through a Sexual Health Clinic depending on where you live. An initial assessment will be arranged for you to attend. In this assessment appointment, you will have the opportunity to ask the clinician any questions you may have. The clinician will assess your need and situation to determine what they can do – this will include discussions around methods, procedures, and risks. Here is the opportunity to provide any information about existing medical conditions. This is very important. Typically, the assessment appointment will include;
- An ultrasound scan (abdominally or internally/vaginal) to check how many weeks you are pregnant
- A blood test to check your blood group or for anaemia
- An STI (Sexually Transmitted Infection) test
- A chance to discuss any concerns or questions – where information will be given to support you and forms of contraception discussions
Is the service confidential?
The service is confidential and communication is not made with any person that you do not consent to being sent information or contacted. This applies if you are under 16. If you are under 16, understand the process, and doctors believe it is within your best interest, it is fully confidential. Doctors will encourage under 16 year olds to involve a parent or guardian as they will provide a level of support for you.
How is it performed?
Abortions can only be carried out in hospital or licensed clinics.
You won't usually need to stay in the clinic or hospital overnight, but you may need to attend several appointments on different days.
Before the abortion
Before having an abortion, you'll need to attend an assessment appointment at the hospital or clinic.
During this assessment, you may:
- discuss your reasons for considering an abortion and whether you're sure about your decision
- be offered the chance to talk things over with a trained counsellor if you think it might help
- talk to a nurse or doctor about the abortion methods available, including any associated risks and complications
- do a pregnancy test to confirm you're pregnant – an ultrasound scan may be done to check how many weeks pregnant you are
- be tested for sexually transmitted infections (STIs), your blood type and low iron levels (anaemia)
- be given antibiotics to reduce the risk of an infection developing after the abortion
When you're sure you want to go ahead with the abortion, you'll be asked to sign a consent form and a date for the abortion will be arranged. You can change your mind at any point up to the start of the procedure.
Methods of abortion
There are two main types of abortion:
- medical abortion (the "abortion pill") - taking medication to end the pregnancy
- surgical abortion - a minor procedure to remove the pregnancy.
Medical and surgical abortions can generally only be carried out up to 24 weeks of pregnancy.
But in exceptional circumstances an abortion can take place after 24 weeks – for example, if there's a risk to life or there are problems with the baby's development.
You will be offered a choice of which method you would prefer whenever possible.
Medical abortion
A medical abortion involves taking medication to end the pregnancy. It doesn't require surgery or an anaesthetic, and can be used at any stage of pregnancy.
It involves the following steps:
- you first take a medicine called mifepristone – this stops the hormone that allows the pregnancy to continue working; you'll be able to go home afterwards and continue your normal activities
- usually 24 to 48 hours later, you have another appointment where you take a second medicine called misoprostol – this will either be a tablet that you may swallow, let dissolve under your tongue or between your cheek and gum, or put inside your vagina
- within about four to six hours, the lining of the womb breaks down, causing bleeding and loss of the pregnancy – you may have to stay at the clinic while this happens or you may be able to go home
If a medical abortion is carried out after nine weeks, you may need more doses of misoprostol and you're more likely to need to stay in the clinic or hospital. Occasionally, the pregnancy doesn't pass and a small operation is needed to remove it.
Surgical abortion
Surgical abortion involves having a procedure with local anaesthetic (where the area is numbed), conscious sedation (where you're relaxed but awake), or general anaesthetic (where you're asleep).
There are two methods.
Vacuum or suction aspiration
Can be used up to 15 weeks of pregnancy. It involves inserting a tube through the entrance to the womb (the cervix) and into your womb. The pregnancy is then removed using suction.
Your cervix will be gently widened (dilated) first. A tablet may be placed inside your vagina or taken by mouth a few hours beforehand to soften your cervix and make it easier to open.
Pain relief is usually given using medicines that you take by mouth, and local anaesthetic, which is numbing medicine injected into the cervix. You may also be offered some sedation, which is given by injection. A general anaesthetic isn't usually needed.
Vacuum aspiration takes about 5 to 10 minutes and most women go home a few hours later.
Dilation and evacuation (D&E)
Used from around 15 weeks of pregnancy. It involves inserting special instruments called forceps through the cervix and into the womb to remove the pregnancy.
The cervix is gently dilated for several hours or up to a day before the surgery to allow the forceps to be inserted.
D&E is carried out with conscious sedation or general anaesthetic. It normally takes between 10-20 minutes and you may be able to return home the same day.
Afterwards
If you have a medical abortion, you may experience shortlived side effects from the medications, such as nausea and diarrhoea. General anaesthetic and conscious sedation medication can also have side effects.
For all types of abortion, it's likely you will experience some stomach cramps and vaginal bleeding, too. These usually last a week or two. Sometimes light vaginal bleeding after a medical abortion can last up to a month.
After an abortion, you can:
- take ibuprofen to help with any pain or discomfort
- use sanitary towels or pads rather than tampons until the bleeding has stopped
- have sex as soon as you feel ready, but use contraception if you want to avoid getting pregnant again as you'll usually be fertile immediately after an abortion
Get advice if you experience heavy bleeding, severe pain, smelly vaginal discharge, a fever or ongoing signs of pregnancy, such as nausea and sore breasts. The clinic will give you the number of a 24-hour helpline to call if you have concerns.
You may experience a range of emotions after an abortion. If you need to discuss how you're feeling, contact the abortion service or ask your GP about post-abortion counselling.
Buying abortion pills online
It's against the law to try to cause your own abortion. It is possible to buy abortion pills online, but you will not know if these are genuine and they could be harmful.
Before doing anything, contact an abortion advice service such as the British Pregnancy Advisory Service (BPAS), who can help you find appropriate care for free and in confidence.
Risks
Abortions are generally very safe and most women will not experience any problems.
But like any medical treatment, there's a small risk that something could go wrong. The risk of complications increases the later in pregnancy an abortion is carried out.
Possible complications
The risks are different depending on whether you have a medical abortion or surgical abortion, and how many weeks pregnant you are.
Medical abortion
Before 14 weeks of pregnancy the main risks of medical abortion are:
- needing another procedure to remove parts of the pregnancy that have stayed in the womb: this happens to about 70 out of 1,000 women
- serious complications such as heavy bleeding, damage to the womb, or sepsis: this happens to about 1 out of 1,000 women
From 14 weeks of pregnancy, the main risks of medical abortion are:
- needing another procedure to remove parts of the pregnancy that have stayed in the womb: about 13 out of 100 women
- infection or injury to the womb: this happens to a small number of women
Surgical abortion
Before 14 weeks of pregnancy, the main risks of surgical abortion are:
- needing another procedure to remove parts of the pregnancy that have stayed in the womb: this happens to about 35 out of 1,000 women
- serious complications such as heavy bleeding, damage to the womb, or sepsis: this happens to about 1 out of 1,000 women
After 14 weeks of pregnancy, the main risks of surgical abortion are:
- needing another procedure to remove parts of the pregnancy that have stayed in the womb: about 3 out of 100 women
- very heavy bleeding: between about 1 and 10 out of 100 women
- infection: this happens to a small number of women
- injury to the womb or entrance to the womb (cervix): this happens to a small number of women
The clinic will provide you with the number of a 24-hour helpline to call if you have any problems after an abortion.
Effect on fertility, health and future pregnancies
Having an abortion does not increase the risk of breast cancer or mental health issues.
Having an abortion will not affect your chances of becoming pregnant and having normal pregnancies in the future.
Many women are able to get pregnant immediately afterwards, so you should start using contraception right away if you do not want to get pregnant.
You should be offered the chance to talk about contraception at the time you have the abortion. If you choose a method of contraception, you should be able to get it from the hospital or clinic that provides your abortion.
There's a very small risk to your fertility and future pregnancies if you develop a womb infection that is not treated quickly. The infection could spread to your fallopian tubes and ovaries – known as pelvic inflammatory disease (PID).
PID can increase the risk of infertility or ectopic pregnancy, where an egg implants itself outside of the womb.
But most infections are treated before they reach this stage.
Talk to your doctor or an abortion advice service for more information if you're concerned about the possible risks of an abortion.
The information on this page has been adapted by NHS Wales from original content supplied by 
NHS website nhs.uk
Last Updated:
07/11/2024 10:23:20