Reproductive Health

Abortion

This page describes the medical process involved with an abortion so that people can make fully-informed decisions. Local clinics that provide abortion services are also listed.

What is a surgical abortion?

Legal abortion, carried out by trained medical practitioners, is one of the most common and safest surgical procedures. About 600,000 million Americans have induced abortions each year. Fewer than a quarter of a percent of all abortion patients experience a major complication associated with the procedure.

In an abortion, the contents of the uterus (uterine lining and implanted fertilized egg) are extracted, which ends the pregnancy. In Rhode Island, surgical abortion procedures are performed in medical clinics rather than in a physician's office. Each clinic is inspected and regulated by the Rhode Island Department of Health in the same manner as hospitals and individual medical providers. In other states, abortion procedures may be performed in clinics or by an individual physician in their office.

In early pregnancy, the procedure used most commonly in the US is vacuum aspiration (suction). The procedure itself takes about 10 minutes and is usually done with a local anesthetic, although sedation or general anesthetic may be requested. The cervix (opening to the uterus) has to be opened (dilated) enough for a small tube to fit in. The plastic tube is attached to a machine that creates a mild suction. With this suction, the doctor removes the endometrial lining of the uterus, the embryo, and the placenta. Vacuum aspiration abortions may be done from 5 to 16 weeks after the last menstrual period. (Abortion is not performed before 5 weeks because the embryo is too small to ensure that all fetal material has been removed. Lab examination of the removed uterine contents helps to prevent incomplete abortions.)

For pregnancies beyond 16 weeks, which represent about 1/10 of the total abortions performed, other methods are used.  Surgical abortions in Rhode Island can go up to 18 weeks 6 days at Planned Parenthood of Southern New England and sometimes above 18 weeks 6 days at other locations, such as hospitals. Surgical abortions can go up to 20 weeks 6 days at Planned Parenthood League of Massachusetts, while some clinics in Massachusetts may perform abortions up to 24 weeks. Oftentimes, if a clinic cannot perform an abortion based on your gestational age, they will help you find another location. 

Second trimester pregnancies often require a two-day process of laminaria insertion (on day 1) and then an in-clinic surgical abortion (on day 2). Laminaria are small seaweed sticks that are inserted by a clinician into the cervix for dilation. The laminaria are left in place overnight and then removed the next day before the procedure. The laminaria expand, similar to a tampon, to prepare and dilate the cervix to make the procedure quicker and more comfortable. The clinician will numb the area before insertion of the laminaria and often prescribe pain medication to help with any associated cramping while the dilation process occurs. (Once the laminaria are placed, it is essential that they be removed the next day since leaving them inserted can cause serious health issues, such as sepsis. It is also important to note that once laminaria is inserted, there is an increased risk of miscarriage if a person did not have the abortion procedure and continued the pregnancy.)

After any surgical abortion procedure, patients remain at the clinic for at least 30 minutes so that their vaginal bleeding and health status can be monitored. Antibiotics are often given to guard against infection. Also routine is a discussion about contraceptive methods and giving the patient contraceptive supplies before the end of the visit. This can include the placement of an IUD or implant while in the procedure room if one is desired. The involvement of a friend, partner or family member throughout the abortion process, from the diagnosis of pregnancy through follow up after the procedure, is often very helpful and is usually encouraged by clinics.  

What is a medical abortion?

A medical abortion, often referred to as the "abortion pill," is an alternative to surgical abortion that was approved in the US by the FDA in September 2000. These medications are not the same thing as emergency contraception, also known as the "morning after pill." After a pregnancy is confirmed, a medical abortion is performed by administering prescription medications that will induce an expulsion of the uterine lining and the implanted fertilized egg.

These medications (a combination of mifepristone and misoprostol) are collectively called RU-486 and require a prescription. The use of mifepristone and misoprostol is the standard of care for most medical abortions and are both safe and effective. Mifepristone is taken orally, while misoprostol can be placed buccally (between the cheek and gums) to dissolve or inserted vaginally. As an abortion method, RU-486 can be used up to 11 weeks after the first day of your last menstrual period. 

A medical abortion can take anywhere from 4-5 hours to a few days after after taking the medication, and requires a minimum of 2 visits to the clinic or medical office. Return visits are scheduled the week after taking the medication. At the return visit an ultrasound is done to be sure that the abortion has been completed. In the vast majority of cases, the expulsion will complete within a few days and most patients return to normal activities the day after a medical abortion. In the small percentage of cases (3-4%) where the medications do not result in a full abortion, a surgical abortion is needed to complete the process. 

Is abortion legal in Rhode Island?

Yes. Abortion is legal, but there are restrictions if you are under 18. In Rhode Island, people under 18 are required to have the consent of one parent or legal guardian to have an abortion. If this is not possible, the state provides an alternative called "judicial bypass" which means you go to court to have a judge determine that you are mature enough to make this decision without a parent or guardian's consent. (Local abortion clinics can link you to counselors trained to help with this process and to accompany you to court.) In neighboring Massachusetts, parental consent or judicial bypass is required if you are under 16.
 

 

Does my health insurance cover the abortion procedure?

Call the clinic ahead of time to discuss insurance and payment. If you have the University-sponsored health insurance plan, you do not have to get a referral from Health Services in order to have the insurance cover your abortion services. Voluntary pregnancy termination is covered the same way as any other medical condition. Specific questions about the University-sponsored plan should be directed to the Office of Insurance and Risk at 401.863-1703.

If you have another health insurance plan, you should check to determine if it will pay for part or all of your abortion services and to determine how to maximize your coverage. You might also want to ask what the insurance company's procedures are regarding notification of the plan subscriber (the person who pays for the insurance plan, whether it's you or your parents) about services covered. If you don't know the name of your health insurance company, call Health Services at 401.863-3953 to find out. 

What happens after a surgical abortion?

Physical complications are rare. The most common complications are heavy blood flow and infection. Danger signs include excessive bleeding (which is defined as saturating one pad top to bottom per hour), fever, nausea, severe cramps that don’t improve with over the counter pain relief, such as ibuprofen or Tylenol and heat or cold, or foul-smelling vaginal discharge. Additionally, passing blood clots is common after a surgical abortion. Golf-ball size clots are normal, however if you are passing clots that are lemon-size, you should follow-up with your provider. The clinic will give you instructions about what to do if any complications occur.

Recovery time varies after an abortion. If you receive moderate sedation, you are monitored for a minimum of 30 minutes post-procedure in recovery to ensure that you are feeling okay and to check your vaginal bleeding and are then required to have an escort drive you home. An antibiotic to prevent infection and a medication to help the uterus contract to its normal size are sometimes prescribed. Additional care, such as pain or nausea medication, may be offered while you are in the recovery room if you are feeling unwell.  

Avoid strenuous activities for a few days and then resume normal activities when you feel well. You can also ask the clinic or provider for a school or work note to excuse you for a few days while you recover.

There is often a bloody discharge like a menstrual period for several days and even up to 4-6 weeks after an abortion. Some individuals do not bleed at all. Both of these situations are considered normal. Normal periods should start within 4 to 8 weeks following an abortion.

To prevent infection, avoid douching, baths, tampons, and sexual intercourse for about 1-2 weeks after an abortion. Pads are useful to monitor bleeding over the first couple of weeks post-abortion.

Nausea is one of the first pregnancy symptoms to resolve after an abortion, taking up to a few days, while other symptoms such as breast tenderness may take several days. 

It is possible to become pregnant in the time after an abortion and before your next menstrual period, so it is recommended that you use a contraceptive method or abstain from sex. It is ok to begin a birth control method immediately. (Note that if you do start birth control, this can also change your bleeding pattern.) If you are not ready to discuss contraceptive methods at the time of your visit, you can schedule an appointment at another time with the clinic or at Health Services

A post-abortion checkup is generally not needed unless a patient reports complications such as excessive bleeding or infection symptoms. 

What happens after a medical abortion?

For medical abortions, physical complications are rare. If you experience any chills, fever, or nausea, these symptoms should subside quickly. However, if you experience any of these symptoms for more than 24 hours following taking the second set of pills, call your provider. While uncommon, these symptoms may indicate an infection.

How patients feel following a medical abortion varies with each individual. When the second set of medication is taken, prepare to have a day of rest in a comfortable setting. It typically takes 1 to 2 days for patients to return to their baseline of health. Heavy bleeding, cramping, and large blood clots are common once the process begins.

You can return to normal activities the day following the medical abortion if you feel capable. However, do not do any strenuous activities for several days.

It may take hours to days before bleeding and cramping is totally complete for medical abortions. For medical abortions, it is okay to use tampons or menstrual cups to help with this bleeding. Often it is recommended to use pads in order to track bleeding for the few days following an abortion.

Expect a regular period after 6-8 weeks following the medical abortion (if you don’t start a birth control method which affects your menstrual cycle). Birth control can be used immediately following a medical abortion, as it is possible to get pregnant very soon after. After a medical abortion, you can have sex whenever you feel ready.

Are there any long term side effects?

There are many myths regarding the long-term consequences of abortion, such as abortion is linked to breast cancer, however, there is no scientific evidence to support claims like these.

Only in the rare cases of serious complications that go untreated are there long-term effects of an abortion.

In the vast majority of cases, abortions do not affect future pregnancies, fertility, or overall health.

Additionally, long-term emotional problems following an abortion are uncommon. They are about as common as they are after giving birth. That being said, there are many hotlines and resources for additional emotional support, including Exhale.

Where can I go to have an abortion?

This list is intended to provide information on the various agencies in and around Rhode Island that offer quality and reputable health and abortion care. It is not intended as a recommendation or endorsement of specific agencies.

When searching for a clinic or provider, you can learn more about the specific services offered by reviewing their website and/or calling and inquiring about the offered services. In deciding if a provider or clinic is right for you, know that you have the right to get accurate information and support you need from people who will give you the facts without judgment or pressure about what to do about a pregnancy. (There are some organizations which advertise themselves as Crisis Pregnancy Centers and as places to go if you are seeking an abortion, but which do not provide abortion care or referrals and have the goal of discouraging people from getting abortions. We do not list any of those organization below as they are not abortion providers.) 

Planned Parenthood of Southern New England 401.421-9620 
175 Broad Street, Providence, RI

Appointments

  • Surgical abortion procedures are provided Tuesday and Friday. Medical abortion (the pill form) are provided Monday thru Saturday. Call or schedule an appointment online.

  • Surgical abortion procedures are done up to 20 weeks of pregnancy. Medical abortion procedures are done up to 11 weeks.

Fees (out-of-pocket)

  • Medical abortion: up to 11 weeks, $600

  • Surgical abortion:

    • Up to 12 weeks: $600 for local anesthesia, $710 for sedation

    • 12 to 13.6 weeks: $680 for local anesthesia, $790 for sedation

    • 14 to 15.6 weeks: $780 for local anesthesia, $890 for sedation

    • 16-19.6 weeks: $885 for local anesthesia, $995 for sedation                

Payment Method

Cash and card are accepted. Personal checks and money orders are not accepted. Most major insurances are accepted. If you have the University-sponsored insurance plan, you may call the Office of Insurance and Risk at 401.863-1703 to discuss your coverage anonymously. If you have other insurance coverage, call the insurance company ahead of time to determine the amount of coverage and procedures for payment.

There is an opportunity to receive funding from Planned Parenthood if you cannot afford the procedure or pill, but you must ask for this financial assistance during your appointment and consultation. If you don’t have insurance, a sliding scale fee system is in place based on reported income and household size. Based on this information you will get an estimated price of the services. If you are 19 or under, you have access to Planned Parenthood abortion funds to help you pay for any of the care that you receive. 

Additional Information

If you are receiving sedation, you must have an escort to drive you home. A partner, friend, or family member may accompany the patient through counseling, but they are not allowed in the room during the procedure. Group counseling is also offered for partners, friends, and family members. Anti-abortion protesters may be outside the facility and it is encouraged not to engage with them. Escorts are always available through Planned Parenthood to accompany patients into the clinic.

Early Options Clinic, Obstetrics and Gynecology Care Center, 401.274-1122 x42797
2 Dudley Street, 5th Floor, Providence, RI

Appointments
Call for an appointment. Procedures are done from 5 weeks up to 22 weeks, 6 days gestation.

Fees
Surgical abortion: Depends on whether abortion done in outpatient clinic (<10 weeks gestation only) or operating room. Call for more information.
Medical abortion: $750

Payment Method
Most insurance plans are accepted and on-site individual financial counseling is provided. Cash, money orders, MasterCard and VISA are accepted. Personal checks are not accepted. If you have the University-sponsored insurance plan, you may call the Office of Insurance and Risk at 401.863-1703 to discuss your coverage anonymously. If you have other insurance coverage, call your insurance company ahead of time to determine the amount of coverage and procedures for payment.

Additional Information
Pregnancy options counseling available for people seeking termination of pregnancy.  In the Early Options Clinic Friday afternoons, staff provide medication abortion ("the abortion pill") and surgical abortion under local anesthesia up to 10 weeks gestation.  They can also make arrangements for surgical abortion up to 22 weeks 6 days gestation in the operating room with full anesthesia if desired.  A full range of contraceptive options is available including IUDs and implants.

Four Women, Inc. 508-222-7555
152 Emory Street Unit 2, Attleboro Massachusetts

Appointments
Abortion procedures are scheduled Thursdays and Saturdays. Procedures are done up to 20 weeks 6 days, according to doctor’s discretion. Surgical abortions performed from 16 weeks 1 day to 20 weeks 6 days is a two-day process. Medical abortions (the abortion pill) appointments are scheduled on Wednesdays, and can be used as an abortion method up to 11 weeks.

Fees
Updated fee information not currently available. Call for more information.

Payment Method
Money orders, cash, Mastercard and VISA are accepted. Personal checks are not accepted. If you have the University-sponsored insurance plan, you may call the Office of Insurance and Risk at 401.863-1703 to discuss your coverage anonymously. If you have other insurance coverage, call the insurance company ahead of time to determine the amount of coverage and procedures for payment.

Additional Information
Partners, friends, and family members are not allowed in the procedure room. Antiabortion protesters may be outside facility. Call ahead if you need an escort to accompany you into the clinic. There is also a security guard outside the building that can serve as an escort. It is important to note that Four Women does not have any employees at the end of the driveway. 

Planned Parenthood League of Massachusetts (PPLM) 1(800) 258-4448

PPLM clinics that offer surgical & medication abortions:

  • Worcester: 470 Pleasant St, Worcester, MA 
  • Boston: 1055 Commonwealth Avenue, Boston, MA 
  • Springfield: 3550 Main St Suite 201 Suite 201, Springfield, MA 

Appointments 
Surgical abortion procedures are done up to 20 weeks 6 days of pregnancy. Medical abortion procedures are done up to 11 weeks.
Medication abortions at all three of these sites are offered every day of the week that they are open. Surgical abortion schedules vary by site.

Fees (out-of-pocket)

  • Medical abortion: up to 11 weeks, $700
  • Surgical abortion:
    • Up to 11 weeks 6 days: $700
    • 12 weeks - 13 weeks 6 days: $750
    • 14 weeks - 15 weeks 6 days: $1,000
    • 16 weeks - 18 weeks 6 days (2-visit abortion):
      • 16 weeks - 16 weeks 6 days: $1,350
      • 17 weeks - 17 weeks 6 days: $1,385
      • 19 weeks - 20 weeks 6 days: $1,400 

Prices depend on whether you are receiving moderate anesthesia or not and other factors, such as how far along the pregnancy is. These prices include IV sedation, all required testing, Rhogam shot if needed, and a post-abortion visit for the medical abortion.

Payment Method
Cash and card are accepted. Personal checks and money orders are not accepted. Note that if you plan to pay with a credit card that is not your own, you must bring a letter from the cardholder with you. You will also need to fill out this form and bring it to your appointment. Most major insurances are accepted at PPLM. If you have the University-sponsored insurance plan, you may call the Office of Insurance and Risk at 401.863-1703 to discuss your coverage anonymously. If you have other insurance coverage, call the insurance company ahead of time to determine the amount of coverage and procedures for payment.

Additional Information
Anti-abortion protesters may be outside the facility, however they are not permitted on the property. It is recommended to not engage with them. The Boston location has volunteer escorts to accompany you into the clinic from the sidewalk. There is also a security guard at all three of the clinics that can serve as an escort. 

 

Related Links

Planned Parenthood
In addition to information about abortion, pregnancy, and contraception, you can link to reproductive health advocacy sites and you can enter your local zip code to find the Planned Parenthood health center nearest you.

National Abortion Federation
This site has information about all pregnancy options, the legal issues around abortion, advocacy links, and an electronic database to assist you in finding a provider in your area who is a member of the National Abortion Federation and upholds their standards for quality care. 

Backline 888.493-0092
A Talk Line that offers a safe and confidential space to talk openly about pregnancy, abortion, adoption and parenting. Call toll free from anywhere in the U.S.

Abortion Conversation Project
This site helps prepare teens for talking to parents about their pregnancy. It offers conversational tips, pregnancy resources, and real stories from both parents and teens.

PHONE NUMBERS
  • 401.863-2794
    Health Promotion
  • 401.863-3953
    Health Services
  • 401.863-6000
    Sexual Assault Response Line
  • 401.863-4111
    EMS
  • 401.863-3476
    Counseling & Psychological Services
  • 401.863-4111
    DPS