Intended for healthcare professionals

Clinical Review


BMJ 2014; 348 doi: (Published 06 January 2014) Cite this as: BMJ 2014;348:f7553
  1. Patricia A Lohr, medical director1,
  2. Mary Fjerstad, director of medical affairs and pharmacovigilance2,
  3. Upeka DeSilva, independent consultant3,
  4. Richard Lyus, surgeon1
  1. 1British Pregnancy Advisory Service, Stratford upon Avon CV37 9BF, UK
  2. 2Womancare Global, London, UK
  3. 3London, UK
  1. Correspondence to: P A Lohr patricia.lohr{at}

Summary points

  • Abortion is a common feature in the reproductive lives of women around the world

  • Most women seeking an abortion have made their decision before consulting with a healthcare provider and require unbiased information and prompt referral for services

  • Medical and surgical abortions are both highly effective, with low rates of complications; a choice of procedures should be offered

  • Uncomplicated abortions are not associated with long term psychological or physical sequelae

  • Women who wish to use a contraceptive method after abortion should start as soon as possible after the abortion and preferably on the day of the procedure

Every year, millions of women around the world decide to end a pregnancy through abortion (defined as removal of a fetus or embryo from the uterus before the stage of viability1). The global abortion rate is estimated at 28 per 1000 women of childbearing age but varies by and within regions.2 For example, western Europe has the lowest subregional rate at 12 abortions per 1000 women but eastern Europe has the highest at 43 per 1000.2 About 185 000 abortions are performed for residents of England and Wales annually—16.5 per 1000 women aged 15-44 years.3

Worldwide, just under half of all pregnancies are unintended and half of these end in abortion.4 The reasons women give for choosing abortion over adoption or parenthood are complex. Common themes include an understanding of the responsibilities of parenthood, financial constraints, and lack of partner support.4 Teenagers, economically disadvantaged women, and those who did not suspect they were pregnant or who face barriers to services are more likely to undergo abortion in the second trimester.5 6

A small but important proportion of abortions are performed for serious maternal medical conditions or fetal indications. Most terminations for fetal anomaly occur during the second …

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