244 Abor tion
A pregnancy can be removed from the womb by a trained health
worker in the following ways:
Abortion by suction (vacuum aspiration, MVA)
The pregnancy is removed by suction using a special tube
(cannula) that is put into the womb through the vagina and cervix.
This can be done without putting the woman to sleep, though
sometimes medicine is injected into the cervix to help with the
pain. When vacuum aspiration is done by hand (manual vacuum
aspiration or MVA), the pregnancy is removed using a special
syringe. Otherwise, a small electric machine is used.
MVA is simple and safe, and takes only about 5 to 10 minutes. It
is usually done in a clinic or health post, or doctor’s office. This kind
of abortion is safe to do during the first 12 weeks (3 months) of
pregnancy. After 12 weeks, only use MVA if the woman is in serious
danger and you have no other way to help her. MVA causes fewer
complications than dilation and curettage (described below).
In some places MVA is used to bring on late monthly bleeding.
The woman may not even know if she is pregnant—just that her
monthly bleeding has not come. This is called menstrual regulation.
MVA is also used to treat bleeding from an incomplete abortion
or a miscarriage. (For more information about MVA see A Book For
Midwives, published by Hesperian.)
Abortion by scraping (dilation and curettage,
or D and C)
The pregnancy is scraped out with a curette, a small spoon-
shaped instrument that is made especially to go into the womb. A
curette is larger than a cannula and because it is sharp, the cervix
must first be stretched open. This stretching can cause some pain.
The D and C takes more time to do (about 15 to 20 minutes),
is more painful, and costs more than vacuum aspiration. It is
usually done in an operating room, and the woman is often given
medicine to make her sleep.
Abortion by medicine (medical abortion)
Certain modern medicines are now used by doctors and
health workers all over the world to cause abortion. This
is called medical abortion. These medicines make the womb
contract and push out the pregnancy. The medicines are either
swallowed or dissolved in the mouth. When the right medicines
are used correctly, medical abortion is very effective and safe.
Since nothing is put inside the womb, there is less danger of
infection that kills many women who have unsafe abortions.
Where Women Have No Doctor 2012