Termination of pregnancy
What is a termination of pregnancy?
A termination of pregnancy (TOP) is to intentionally end a pregnancy so that it does not result in the birth of a child. It refers to the medical or surgical TOP. It is estimated that up to 1 in 3 women in Australia have at least one abortion in their lifetime. Most of these abortions occur in early pregnancy and over 92% occur in the first 14 weeks of pregnancy.
The best TOP method depends on how pregnancy gestation, which option is most suitable and preferable.
Seeking a termination of pregnancy TOP is a difficult choice but is a valid choice. Women access TOP services for many reasons including:
- Being too young
- Being a single parent struggling with caring for children
- Not ready
- Being a parent who has already completed her family with older children
- Currently in a violent and abusive relationship
- Experienced a rape
- Pregnancy is not viable, or the baby will be born with little chance of living past a few days
- Going through pregnancy would be physically and/or psychologically harmful for the woman
- Contraceptive method failed
- Not wanting to be pregnant.
Whether or not you’re in need of a TOP, everyone has the right to know about options and be enabled to access safe and effective TOP in the ACT.
Two types of termination of pregnancy
In the ACT, women can access up to two types of TOP depending on gestation (number of weeks pregnant):
- Medical TOP is available in Australia for pregnancies under 9 weeks. This is a non-surgical method of terminating a pregnancy using medication (mifepristone and misoprostol) to induce an abortion. Medication TOP is available through TOP clinics and through some GPs who have received training in providing medication TOP. There is no available list of GPs who provide this service in NSW or the ACT so you will need to ask your GP if they do this. For women who are unable to access abortion services in their area Marie Stopes Australia has a telehealth option for medication TOP or call 1300 867 104. For more information on the medication see NPS Medicinewise.
- Surgical TOP is available for pregnancies under 14 weeks at Gynaecological Centres Australia and under 16 weeks at Marie Stopes Clinic. It is a simple surgical procedure that is carried out as a day procedure. While surgical abortion can be done under local anaesthetic (which is injected into the cervix) or general anaesthetic, it is most often performed under twilight sedation, where you are effectively asleep during the procedure. Twilight sedation has few health risks and is considered safer than a general anaesthetic.
- Later term surgical TOP are also available in public hospitals but access can be difficult and may require interstate travel. For more information see here.
Process of medical termination of pregnancy
Medical TOP is a safe and effective method for up to 9 weeks (63 days) gestation. It is non-surgical and is available at a TOP clinic or by telehealth (over the phone) if under 8 weeks (56 days) gestation.
- Visit a clinic or phone a telehealth service where there will be free counselling.
- Consultation with doctor to discuss medical history, question time and provide informed consent.
- Confirmation of gestation via ultrasound or blood test.
- Doctor provides first medication to take in the clinic, or pick up or receive in mail. This medication blocks the hormone progesterone which is maintaining the pregnancy.
- Second medication taken at home roughly 24-48 hours after first medication and causes the uterus to expel the pregnancy tissue (bringing on a miscarriage). This process usually takes 4 hours but can take up to a few days. It can cause period-like pain and bleeding. The bleeding should ease within the first week, but lighter bleeding can continue for up to a month afterwards.
- Follow up care with the doctor to check that the termination is complete and whether follow up is required. This is also the opportunity to discuss about effective and appropriate contraception with the doctor.
Success rates for medical termination are up to 98%. While still very low, the complication rate is slightly higher than for surgical abortion.
For more detailed information see Children by Choice: Medical abortion.
Process of surgical termination of pregnancy
Surgical TOP is a safe and effective method available in an approved medical facility. Most surgical TOPs are performed using “suction (vacuum curettage) aspiration” within 14 weeks of gestation and the procedure itself takes less than ten minutes.
- Visit a clinic where there will be free counselling.
- While procedures vary with individual clinics this will usually include admission, consultations with a nurse, an anaesthetist, and the doctor to discuss medical history, question time and provide informed consent.
- Confirmation of gestation via ultrasound and/or blood test.
- Preparation for surgery at an appointed time includes fasting beforehand and things to bring with you.
- You will then be taken to the theatre where the procedure is performed. The actual surgery itself takes only 10 to 15 minutes to perform and is done by putting a small tube through the cervix and gently removing the pregnancy tissue from the uterus using suction.
- You will then spend some time in recovery and may spend from two hours to half a day at the clinic.
- Most clinics require that you have someone to drive you home because you have had sedation.
- Post-operation can have some cramping and bleeding.
- Follow up care with the doctor or your regular doctor.
Surgical TOPs after 12 to 14 weeks (second trimester) usually require a different procedure, sometimes involving two separate visits to the clinic, one for the cervix to be prepared and one for the procedure itself, altogether called “dilation and evacuation”. Second trimester abortions are more expensive, with cost increasing with the length of the pregnancy.
For more information see Children by Choice: Surgical abortion.
How safe is termination of pregnancy?
Termination of pregnancy in Australia is performed by highly trained medical professionals, and in the case of surgical TOPs are performed in accredited health facilities and are one of the safest procedures available.
The complication rate for early surgical TOP is very low at around 1%. This rate rises to around 5% after 15 weeks gestation. The complication rate for medication abortion is between 2% and 5%.
If complications do occur the most common are retained products (where a small bit of pregnancy tissue remains in the uterus after the termination usually requiring a second procedure) and infection, which is dealt with by using antibiotics.
How might you feel following a termination of pregnancy
The majority of women cope very well after having a TOP, and the most common feeling expressed is relief.
How you feel afterwards will depend on many factors, including your individual circumstances, how you felt about the decision, your individual beliefs and values, if you had good support and someone to talk to, and importantly if the decision was yours. Studies show that the vast majority of women who have abortions (around 98 per cent) feel that they made the right decision.
The very small number of women who do experience emotional problems tend to be those who were very ambivalent at the time of the TOP, or were persuaded or coerced into having a TOP by someone else.
Some women are pressured by partners, family or others to have a TOP. If a woman wants to continue the pregnancy, a coerced TOP can result in emotional problems for her afterwards.
If a woman has had problems with anxiety or depression in the past and has found the decision to have a TOP a very difficult one then she may have more difficulty and need more support during this time. This support may be from family or friends or through professional counselling.
Myths about termination of pregnancy
As with a lot of issues, there are many myths about TOPs. These are often put forward by individuals or groups who are anti-choice and run scare campaigns about TOPs, or by people who are simply misinformed. As a result there is a lot of biased and inaccurate information out there, particularly online.
In reality we know that legal, safe TOP has very low rate of complications and is a common procedure in Australia that forms part of women’s reproductive health care.
Research has shown that there is no link between safe, legal TOPs and future problems such as infertility, breast cancer, or long-term mental health problems.
Termination of pregnancy laws in the ACT
Accessing a safe TOP has been legal in the ACT since 2002, as long as it is provided by a registered medical practitioner.
TOPs in the ACT is governed by the Health Act 1993, which requires that:
- Only a registered medical practitioner may carry out abortion (maximum penalty: 5 years imprisonment);
As of July 2019 the Health (Improving Abortion Access) Amendment Act 2018 allows women in ACT to access the medical TOP pills from registered general practitioners and pharmacists in Canberra.
For the safety of people accessing TOP services and the staff working in TOP services, the Health (Patient Privacy) Amendment 2015 put exclusion zones in place 50 meters around clinics that provide TOP services. This means those seeking medical advice and treatment can do so in privacy without harassing, obstructing, threatening, humiliating or intimidating behaviour.
Availability of termination of pregnancy services
All states & territories in Australia have some abortion services however, the availability of these services and the limits of how far pregnant you can be when you can have a TOP vary.
There are two clinics which provide termination services in the ACT region:
- Marie Stopes Australia has a clinic in Canberra city which provides medication abortion up to 9 weeks gestation and surgical abortion up to 15 weeks and 6 days gestation at time of publication. Phone 1300 867 104 or enquire and book online via their website.
- Gynaecology Centres Australia has a clinic in Queanbeyan which provides medication abortion up to 9 weeks gestation and surgical abortion up to 14 weeks gestation at the time of publication. Phone 65859559 or enquire and book online via their website.
In NSW there are clinics which provide abortion up until 20 weeks gestation, in Queensland there are clinics that provide abortion to 22 weeks gestation, and in Victoria there are clinics that provide abortion up to 24 weeks gestation. If you need further information and contact numbers for these services, please contact SHFPACT on 62473077.
Costs of termination of pregnancy in the ACT and surrounding areas
Prices start to rise at most clinics once the pregnancy reaches 11 weeks gestation, with steep increases from 14 weeks onwards. Therefore, it is vital to recognise that TOP is a time-sensitive decision.
Costs vary according to gestational stage, the clinic, and whether the woman has a Medicare card/Health care card/Pension card and the additional costs incurred to getting to the clinic. Medical & surgical TOP at Marie Stopes Canberra Clinic start from $440 in the clinic or via telehealth (as of publication) Medical & surgical TOP at Gynaecological Centres Australia start from $410 (as of publication).
Questions you may want to ask yourself when considering a termination of pregnancy.
- How do I feel about the issue of TOPs generally?
- How do I feel about TOP for myself?
- What are the pros and cons of TOP for me? (write these down)
- How do I think I may feel 6 months from now?
- How do I think I may feel 2 years from now?
- Do I know anyone who has had a TOP?
- What are my main fears and uncertainties about having a TOP?
- What strategies can I use to deal with those fears and uncertainties?
What to do next if you decide to have a termination of pregnancy?
You can call one of the TOP services directly to make an appointment, you do not need a doctor’s referral for this. If you would like further information before booking then make an appointment with SHFPACT ’s free unplanned pregnancy counselling service for more information or call 62473077.
For more information see Unplanned pregnancy counselling.
Adapted from Know4sure.