Medical abortions--also known as "the pill abortion" now represent 50% of abortions performed before 11 weeks of pregnancy. The other 50% are still procedural abortions--also known as a suction D&C or surgical abortion. Terminations after 11 weeks especially those in the second trimester cannot be achieved with the Medical abortion--it doesn't work or is too dangerous. The abortion underground and self-managed abortions are Medical abortions. There are excellent reasons to use these pills in states where abortion is illegal--patients can access and use these pills without the expense of taking time off from work, arranging childcare and traveling to a state where abortion is legal. Women in states where abortion is still legal may prefer the Medical abortion also because it offers more privacy and avoids a surgical procedure.
What are the problems with Medical abortions? There are two basic issues: 1. There is a significant failure rate with the pill abortion of 5-8% even if used before 11 weeks. I have seen many patients who thought their Medical abortions were completed but who had continuing pregnancies and were faced with obtaining a second trimester abortion. 2. Medical abortions actually mean inducing a miscarriage which a patient manages at home with heavy bleeding and cramping over several hours. There can be complications such as retained tissue requiring a D&C or hemorrhage requiring blood transfusion--complications that would force a woman to seek medical care--not ideal in states where abortion is illegal.
The advantages of the Procedural abortion--typically a suction D&C--are the very low rate of complications--less than 2%--much lower than the Medical abortion--and that failure to complete the abortion practically never happens. There are so few failures because the uterus is completely emptied by the suction procedure rather than relying on medication to induce the uterus to expel the entire pregnancy. The only real disadvantage of the Procedural abortion is the need to travel to a facility that offers it.
Often lost in discussion of type of abortion is the large number of patients whose pregnancies are too advanced for a Medical abortion--those past 10 weeks of pregnancy. For these clients we must always have facilities that offer first and second trimester procedural abortions!