Abortion, i.e. medical termination of pregnancy, is ending a pregnancy either with tablets or surgically.
Surgical abortion is the termination of pregnancy during a surgical procedure. The procedure is performed under anaesthesia. During the procedure, the cervical canal is dilated and the pregnancy tissue is removed from the uterus with a special vacuum aspirator. Surgical abortion is possible upon request for up to 12 weeks of pregnancy (11 weeks + six days from the first day of the last menstruation). Surgical abortion is a safe and effective method to terminate a pregnancy.
Medical abortion, i.e. non-surgical abortion is the termination of pregnancy with tablets. Two medications are used for medical abortion: mifepristone and misoprostol. Medical abortion is possible for up to 11 weeks and six days of pregnancy, counting from the first day of the last menstruation. (Medical abortion used to be allowed for up to 63 days of pregnancy, but this restriction no longer applies.) Medical abortion is a safe and effective method to terminate a pregnancy.
A pregnancy can only be terminated with the consent of the woman. In Estonia, a pregnancy can be terminated upon request if the pregnancy has lasted less than 12 weeks (i.e. up to 11 weeks and six days, counting from the first day of the last menstruation). In the case of certain indications, pregnancy can also be terminated later if the pregnancy has lasted less than 22 weeks (i.e. 21 weeks and six days).
Such indications are:
- the pregnancy poses a risk to the woman’s health
- the foetus may have a severe mental or physical disorder
- the woman’s illness prevents them from raising a child
- the person pregnant is under 15 or over 45 years of age
Whether these indications are present is decided by a council of at least three doctors.
Why should anyone have an abortion?
There are several reasons why someone may decide to have an abortion. It is a personal decision and people can decide for themselves whether termination of pregnancy is right for them.
Unplanned pregnancy
Generally, people do not want to become pregnant before they are ready to have a child. There are a variety of reasons why many people can experience an unplanned pregnancy. Some of them decide not to continue the pregnancy and to have an abortion. Others decide to continue their pregnancy and choose becoming a parent or adoption.
Termination of pregnancy upon request is a paid procedure in Estonia. The person seeking an abortion, provided that they have insurance from the Health Insurance Fund (HIF), have to pay 50% of the HIF price for a medical abortion and 30% of the HIF price for a surgical abortion. In the absence of insurance, they have to pay full price. The price of abortion may change slightly every year (depending on the current HIF price list).
Fatal foetal anomaly
Fatal foetal anomaly, sometimes referred to as fatal foetal abnormality, is a condition that can develop when the foetus is still in utero. If a pregnant woman is diagnosed with a fatal foetal anomaly, it means that their child is unlikely to survive the term of the pregnancy or is likely to die shortly after birth.
Some people may decide to carry their pregnancy to term in spite of this diagnosis. Others decide to terminate the pregnancy before full term instead of continuing a pregnancy knowing that their child will not survive.
Danger to life
For some people, pregnancy may cause severe complications to their physical or mental health or even endanger their life. For example, a person who has been diagnosed with cancer may not be able to continue treatment if they become pregnant.
If you have decided to terminate
If you have decided to terminate your pregnancy, you have to see a gynaecologist either at a women’s clinic or a youth counselling centre for pre-abortion counselling and to get a referral for abortion. When making the appointment, make sure to let them know that you want to terminate a pregnancy, as this will get you an appointment sooner.
At the appointment, the gynaecologist will diagnose the pregnancy and determine the gestational age. The gestational age is calculated by counting the days from the first day of the last menstruation. If menstruation is very irregular or if the date of the last menstruation is unknown, the gestational age is assessed with an ultrasound scan. The doctor will take samples for sexually transmitted diseases from both the cervix and blood. They will also perform a standard blood test and determine your blood type and rhesus factor. If necessary, they will collect a sample from your cervix for a Pap smear. Afterwards, your doctor will advise you on the possibilities and methods of terminating a pregnancy and you will have to decide whether you want a medical or surgical abortion. Your decision and consent have to be in writing and you will have to sign the consent sheet. The doctor will then book you an appointment for an abortion at a hospital or women’s clinic and will have a follow-up appointment with you after 2-3 weeks to assess whether the abortion was successful.
At the referral appointment, it is important to have a discussion with your doctor and decide how to protect yourself from unwanted pregnancies in the future. If you have decided to terminate your pregnancy, be sure to use an effective contraceptive (e.g. an implant, IUD, pill, patch, vaginal ring) in order to prevent unwanted pregnancies. Most contraceptives should be used as early as the day of abortion or the day after at the latest. This will give you immediate protection against pregnancy because you can become pregnant again before the next menstruation.
The article is based on the sexual health website www.seksuaaltervis.ee of the Estonian Sexual Health Association and www.spunout.ie.
The Estonian Sexual Health Association is an advocacy organisation for sexual and reproductive health and rights.
Spunout is Ireland’s youth information website.
