A likely illegal<unk>  flyer in South Africa The health risks of<unk>  depend principally upon whether the procedure is performed safely or unsafely. The World Health Organization (WHO) defines unsafe<unk> s as those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities. Legal<unk> s performed in the developed world are among the safest procedures in medicine. In the United States as of 2012,<unk>  was estimated to be about 14 times safer for women than childbirth. CDC estimated in 2019 that US pregnancy-related mortality was 17.2 maternal deaths per 100,000 live births, while the US<unk>  mortality rate is 0.7 maternal deaths per 100,000 procedures. In the UK, guidelines of the Royal College of Obstetricians and Gynaecologists state that "Women should be advised that<unk>  is generally safer than continuing a pregnancy to term." Worldwide, on average,<unk>  is safer than carrying a pregnancy to term. A 2007 study reported that "26% of all pregnancies worldwide are terminated by induced<unk> ," whereas "deaths from improperly performed<unk>  procedures constitute 13% of maternal mortality globally." In Indonesia in 2000 it was estimated that 2 million pregnancies ended in<unk> , 4.5 million pregnancies were carried to term, and 14-16 percent of maternal deaths resulted from<unk> . In the US from 2000 to 2009,<unk>  had a mortality rate lower than plastic surgery, lower or similar to running a marathon, and about equivalent to traveling 760 miles in a passenger car. Five years after seeking<unk>  services, women who gave birth after being denied an<unk>  reported worse health than women who had either first or second trimester<unk> s. The risk of<unk> -related mortality increases with gestational age, but remains lower than that of childbirth. Outpatient<unk>  is as safe from 64 to 70 days' gestation as it before 63 days. There is little difference in terms of safety and efficacy between medical<unk>  using a combined regimen of mifepristone and misoprostol and surgical<unk>  (vacuum aspiration) in early first trimester<unk> s up to 10 weeks gestation. Medical<unk>  using the prostaglandin analog misoprostol alone is less effective and more painful than medical<unk>  using a combined regimen of mifepristone and misoprostol or surgical<unk> . Vacuum aspiration in the first trimester is the safest method of surgical<unk> , and can be performed in a primary care office,<unk>  clinic, or hospital. Complications, which are rare, can include uterine perforation, pelvic infection, and retained products of conception requiring a second procedure to evacuate. Infections account for one-third of<unk> -related deaths in the United States. The rate of complications of vacuum aspiration<unk>  in the first trimester is similar regardless of whether the procedure is performed in a hospital, surgical center, or office. Preventive antibiotics (such as doxycycline or metronidazole) are typically given before<unk>  procedures, as they are believed to substantially reduce the risk of postoperative uterine infection; however, antibiotics are not routinely given with<unk>  pills. The rate of failed procedures does not appear to vary significantly depending on whether the<unk>  is performed by a doctor or a mid-level practitioner. Complications after second-trimester<unk>  are similar to those after first-trimester<unk> , and depend somewhat on the method chosen. The risk of death from<unk>  approaches roughly half the risk of death from childbirth the farther along a woman is in pregnancy; from one in a million before 9 weeks gestation to nearly one in ten thousand at 21 weeks or more (as measured from the last menstrual period). It appears that having had a prior surgical uterine evacuation (whether because of induced<unk>  or treatment of miscarriage) correlates with a small increase in the risk of preterm birth in future pregnancies. The studies supporting this did not control for factors not related to<unk>  or miscarriage, and hence the causes of this correlation have not been determined, although multiple possibilities have been suggested. Some purported risks of<unk>  are promoted primarily by anti-abortion groups, but lack scientific support. For example, the question of a link between induced<unk>  and breast cancer has been investigated extensively. Major medical and scientific bodies (including the WHO, National Cancer Institute, American Cancer Society, Royal College of OBGYN and American Congress of OBGYN) have concluded that<unk>  does not cause breast cancer. In the past even illegality has not automatically meant that the<unk> s were unsafe. Referring to the U.S., historian Linda Gordon states: "In fact, illegal<unk> s in this country have an impressive safety record." According to Rickie Solinger, Authors Jerome Bates and Edward Zawadzki describe the case of an illegal<unk> ist in the eastern U.S. in the early 20th century who was proud of having successfully completed 13,844<unk> s without any fatality. In 1870s New York City the famous<unk> ist/midwife Madame Restell (Anna Trow Lohman) appears to have lost very few women among her more than 100,000 patients—a lower mortality rate than the childbirth mortality rate at the time. In 1936, the prominent professor of obstetrics and gynecology Frederick J. Taussig wrote that a cause of increasing mortality during the years of illegality in the U.S. was that Mental health Current evidence finds no relationship between most induced<unk> s and mental health problems other than those expected for any unwanted pregnancy. A report by the American Psychological Association concluded that a woman's first<unk>  is not a threat to mental health when carried out in the first trimester, with such women no more likely to have mental-health problems than those carrying an unwanted pregnancy to term; the mental-health outcome of a woman's second or greater<unk>  is less certain. Some older reviews concluded that<unk>  was associated with an increased risk of psychological problems; however, they did not use an appropriate control group. Although some studies show negative mental-health outcomes in women who choose<unk> s after the first trimester because of fetal abnormalities, more rigorous research would be needed to show this conclusively. Some proposed negative psychological effects of<unk>  have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome", but this is not recognized by medical or psychological professionals in the United States. A long term-study among US women found that about 99% of women felt that they made the right decision five years after they had an<unk> . Relief was the primary emotion with few women feeling sadness or guilt. Social stigma was a main factor predicting negative emotions and regret years later. Unsafe<unk>  Soviet poster circa 1925, warning against midwives performing<unk> s. Title translation: "Miscarriages induced by either grandma or self-taught midwives not only maim the woman, they also often lead to death." Women seeking an<unk>  may use unsafe methods, especially when it is legally restricted. They may attempt self-induced<unk>  or seek the help of a person without proper medical training or facilities. This can lead to severe complications, such as incomplete<unk> , sepsis, hemorrhage, and damage to internal organs. Unsafe<unk> s are a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe<unk> s are performed annually, with 97% taking place in developing countries. Unsafe<unk> s are believed to result in millions of injuries. Estimates of deaths vary according to methodology, and have ranged from 37,000 to 70,000 in the past decade; deaths from unsafe<unk>  account for around 13% of all maternal deaths. The World Health Organization believes that mortality has fallen since the 1990s. To reduce the number of unsafe<unk> s, public health organizations have generally advocated emphasizing the legalization of<unk> , training of medical personnel, and ensuring access to reproductive-health services. In response, opponents of<unk>  point out that<unk>  bans in no way affect prenatal care for women who choose to carry their fetus to term. The Dublin Declaration on Maternal Health, signed in 2012, notes, "the prohibition of<unk>  does not affect, in any way, the availability of optimal care to pregnant women." A major factor in whether<unk> s are performed safely or not is the legal standing of<unk> . Countries with restrictive<unk>  laws have higher rates of unsafe<unk>  and similar overall<unk>  rates compared to those where<unk>  is legal and available. For example, the 1996 legalization of<unk>  in South Africa had an immediate positive impact on the frequency of<unk> -related complications, with<unk> -related deaths dropping by more than 90%. Similar reductions in maternal mortality have been observed after other countries have liberalized their<unk>  laws, such as Romania and Nepal. A 2011 study concluded that in the United States, some state-level anti-abortion laws are correlated with lower rates of<unk>  in that state. The analysis, however, did not take into account travel to other states without such laws to obtain an<unk> . In addition, a lack of access to effective contraception contributes to unsafe<unk> . It has been estimated that the incidence of unsafe<unk>  could be reduced by up to 75% (from 20 million to 5 million annually) if modern family planning and maternal health services were readily available
Abortion
Hysterotomy abortion
Instillation abortion
Superfecundation
Postpartum confinement
Hormonal IUDs
Intrauterine device
Natural childbirth