General · EdgepediaOctober 21, 20268 min read

Induced Abortion (procedure)

Induced abortion is the deliberate interruption of an ongoing pregnancy by medical or surgical means, resulting in the complete expulsion or extraction of an embryo or fetus regardless of pregnancy duration, and not intended to result in a live birth.¹ In the International Classification of Diseases, 11th Revision (ICD-11), it is coded JA00.1 under the category JA00 (Abortion), where it is distinguished from spontaneous abortion (miscarriage), unspecified abortion, and failed attempted abortion.¹^•² The World Health Organization (WHO) treats induced abortion as a common health intervention that is very safe when performed with a recommended method, appropriate to pregnancy duration, by someone with the necessary skills.³

Key fact	Detail
Definition	Complete expulsion or extraction of an embryo or fetus following deliberate interruption of an ongoing pregnancy by medical or surgical means, not intended to result in a live birth; ICD-11 code JA00.1¹
Global frequency	Around 73 million induced abortions per year; 61% of unintended pregnancies and 29% of all pregnancies end in induced abortion³
Safety	Very safe when performed with a WHO-recommended method by a skilled provider; deaths from safe abortion are negligible, <1 per 100,000 procedures³
Unsafe abortion	About 45% of all induced abortions (2010–2014 estimates) are unsafe; one third of these occur under the least safe conditions³
Mortality contrast	In regions where unsafe abortion is common, death rates exceed 200 per 100,000 abortions³
Clinical methods	Combined mifepristone and misoprostol for medical abortion; vacuum aspiration recommended for surgical abortion below 14 weeks of gestation⁴^•⁵
WHO guidance	Consolidated abortion care guideline first published in 2022, second edition in 2025, with 54 recommendations and best practice statements across law and policy, clinical services, and service delivery⁶^•⁷

Definition and classification

ICD-11 places induced abortion (also called artificial termination of pregnancy) in chapter 18, Pregnancy, childbirth or the puerperium, as code JA00.1 within the JA00 Abortion category.¹^•² The category includes therapeutic abortion as an inclusion, and its subordinate codes capture incomplete induced abortion complicated by genital tract or pelvic infection (JA00.10), delayed or excessive hemorrhage (JA00.11), or embolism (JA00.12).¹ Index terms mapped to JA00.1 include legal abortion, abortion induced for medical indications, and illegal abortion.⁸ ICD-11 reporting guidance requires that artificial termination of pregnancy be clearly distinguished from spontaneous abortion and stillbirth in mortality statistics.⁹

Clinical methods

Medical abortion uses medicines to end a pregnancy. The most widely researched agents are prostaglandins such as misoprostol, the antiprogesterone mifepristone, and combinations of the two; methotrexate and, more recently, the aromatase inhibitor letrozole have also been studied.¹⁰ A systematic review of 33 randomized trials with 22,275 participants at 63 days of gestation or earlier found that combined mifepristone and misoprostol regimens produced lower rates of ongoing pregnancy and higher rates of successful abortion and satisfaction than misoprostol alone, and that 800 µg of misoprostol was more effective than 400 µg within combined regimens; serious adverse events were generally low.⁴ A Cochrane review of 99 studies similarly concluded that combined regimens are probably more effective than single agents and that vaginal misoprostol is probably more effective than oral administration, with fewer side effects than sublingual or buccal routes.¹⁰

Surgical abortion in the first trimester is performed by vacuum aspiration. WHO's clinical guidance recommends vacuum aspiration for induced abortion at gestational ages below 14 weeks, notes that health workers able to perform a bimanual pelvic examination and transcervical procedures such as IUD insertion can be trained to provide it, and states that no evidence supports sharp curette checks after vacuum aspiration.⁵ An earlier WHO guideline characterized dilation and sharp curettage (D&C) as an obsolete method of surgical abortion that should be replaced by vacuum aspiration.¹¹

Second-trimester abortion (at or after 13 weeks of gestation) can be performed by either surgical or medical methods. A 2025 Cochrane review found that both may be safe and effective, while noting that incomplete abortion requiring an additional procedure may occur less often with surgical abortion, with very uncertain evidence (RR 0.19, 95% CI 0.07 to 0.53; 3 trials, 269 participants).¹² A systematic review informing NICE guidance concluded that women should be offered the choice of medical or surgical methods between 13+0 and 23+6 weeks of gestation unless not clinically appropriate, since hemorrhage requiring transfusion, uterine injury, cervical injury, and infection did not differ significantly between methods.¹³

Self-managed and home-based care

In the first 12 weeks of pregnancy, a medical abortion can be safely self-managed by the pregnant person outside a health care facility, in whole or in part, provided she has access to accurate information, quality medicines, and support from a trained health worker if needed.³ A systematic review of nine studies (4,522 participants) using mifepristone and misoprostol found complete abortion in 86–97% of home-based cases and 80–99% of clinic-based cases, with no difference in complete abortion rates between groups (odds ratio 0.8, 95% CI 0.5–1.5).¹⁴ Self-assessment of the outcome of first-trimester medical abortion at home, including urine testing, is not inferior to routine clinic follow-up for effectiveness and safety, and is preferred by more women.¹⁵ A review of abortion safety measurement notes that earlier three-tier classifications labeled self-managed medical abortion as "less safe" despite substantial evidence across multiple settings that it does not correspond with higher biomedical health risks.¹⁶

Unsafe abortion and its consequences

The World Health Organization considers an abortion unsafe when the pregnancy is ended by someone without adequate training or knowledge, or in a setting that fails to meet basic medical standards, or both.³ Global estimates for 2010–2014 indicate that 45% of all induced abortions are unsafe; one third of unsafe abortions were performed under the least safe conditions, by untrained persons using dangerous and invasive methods. More than half of unsafe abortions occurred in Asia, mostly in south and central Asia; in Latin America and Africa approximately 3 out of 4 abortions were unsafe, and in Africa nearly half occurred under the least safe circumstances.³

The health consequences are quantified. A review covering 2009–20 found that 8% of maternal deaths were linked to abortion, a figure subject to misclassification and underreporting due to stigma.³ According to 2012 figures, developing countries alone saw roughly 7 million women annually receive hospital care for problems arising from unsafe abortion.³ Physical risks include incomplete abortion, hemorrhage, infection, uterine perforation, and damage to the genital tract and internal organs.³ An earlier WHO report estimated 22 million unsafe abortions annually and approximately 47,000 associated pregnancy-related deaths, with 5 million women suffering disability from complications.¹⁷ In Kenya, an average of seven women die every day from complications of unsafe abortions, according to the African Population and Health Research Center.¹⁸

Economic burden. Complications of unsafe abortions cost health systems in developing countries an estimated US$ 553 million per year for post-abortion treatment (2006 estimates), and households lost US$ 922 million in income due to long-term disability related to unsafe abortion.³

Law, access, and WHO guidance

Evidence shows that restricting access to abortion does not reduce the number of abortions, but it does affect whether the abortions women obtain are safe and dignified; the proportion of unsafe abortions is significantly higher in countries with highly restrictive laws than in countries with less restrictive laws.³ A WHO publication states that a woman's likelihood of having an unintended pregnancy and seeking induced abortion is about the same whether abortion is legally restricted or available on request, while legal status dramatically affects her access to safe abortion.¹⁷ Barriers include high costs, stigma, conscientious refusal by health workers, criminalization, mandatory waiting periods, biased counseling, third-party authorization, and restrictions on provider or facility type.³ In Kenya, the 2010 Constitution permits abortion when a woman's health or life is threatened, yet the colonial-era penal code criminalizes providers and women seeking the procedure, with penalties of up to 14 years in prison, and most public hospitals do not perform abortions.¹⁸

WHO's consolidated abortion care guideline, first published in March 2022, presents the complete set of WHO recommendations and best practice statements across three domains: law and policy, clinical services, and service delivery; it replaced the 2012 safe abortion guidance, the 2015 task-sharing guidance, and the 2018 medical management of abortion guidance.¹⁹ A second edition released in August 2025 contains 54 recommendations and best practice statements and updates the remarks for Recommendation 22, with no other changes to the recommendations.⁶^•⁷ WHO also maintains the Global Abortion Policies Database covering abortion laws, policies, health standards, and guidelines for all countries, and co-sponsors the HRP research program, which monitors the global burden of unsafe abortion.³

References

Topic: Encyclopedia › Life and health › Human health and medicine › Diseases and injuries › Urinary, reproductive, and developmental conditions › Female reproductive conditions › Abortion and early pregnancy loss

Initially written Oct 21, 2026

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