Is an abortion with pills safe?

A medical abortions performed in the first 10 weeks of pregnancy have a very low risk of complications. This risk is the same as when a woman has a natural miscarriage. These problems can easily be treated by a doctor. 
Out of every 100 women that do medical abortions, 2 or 3 women have to go to a doctor, first aid center, or hospital to receive further medical care.
In countries where childbirth is safe, 1 in every 15.000 women dies during childbirth. Less than 1 in every 200,000 women who use a medical abortion die, making medical abortions safer than childbirth and about as safe as naturally occurring miscarriages. This means that a safe abortion with Mifepristone and Misoprostol is always lifesaving.

In Europe, more than 1.5 million women have terminated their pregnancies with mifepristone and misoprostol. Medical TOP is proven to be safe and effective, with few serious complications and success rates of 95–98%.2Mifepristone and misoprostol have been on the list of essential medicines of the World Health Organization since 2005. 

Medical abortion is safer than the use of antbiotics. The risk of fatal anaphylaxis with penicillin has previously been estimated as about 1 in 100 000[1]. Mortality of medical abortion is less than 1 per 200.000 women who do a medical abortion.

“Abortion care can be safely provided by any properly trained health-care provider, including midlevel (i.e.non-physician) providers (35, 6). The term “midlevel providers” in the context of this document refers to a range of non-physician clinicians (e.g. midwives, nurse practitioners, clinical officers, physician assistants, family welfare visitors, and others)”

 “Abortion care provided at the primary-care level and through outpatient services in higher-level settings is safe, and minimizes costs while maximizing the convenience and timeliness of care for the woman (7).”

“Allowing home use of misoprostol following provision of mifepristone at the health-care facility can further improve the privacy, convenience and acceptability of services, without compromising on safety (810). Inpatient abortion care should be reserved for the management of medical abortion for pregnancies of gestational age over 9 weeks (63 days) and management of severe abortion complications (see Chapter 2).”[2]

Of  every 100 women that have medical abortions , 2 or 3 will need to go to a local doctor, first aid center, or hospital to receive further medical care such as vacuum aspiration. This risk is equal to that of requiring medical care for an allergic reaction after using penicillin. 56 57(Further medical care consists of vacuum aspiration for a continuing pregnancy or an incomplete abortion.)

Medical abortion with Mifepristone and Misoprostol is used in most European countries. In France alone more than 2.000.000 abortions have been done with Mifepristone and Misoprostol since 1992 and no deaths have occurred.

Compare this mortality rate with that of Viagra, a drug that treats erectile dysfunction. As of early 2000, approximately 11 million prescriptions had been written for Viagra. 18 564 men had died as a result of using the drug, according to an article in the Journal of the American Medical Association. Based on the number of prescriptions written, that mortality rate is approximately 1 in every 20,000 prescriptions! As most men get more than 1 prescription, this means that the death rate is even higher than 1 in every 20,000 users. Apparently, the mortalities associated with Viagra have not been reason to remove this drug from the market.

Compare medical abortion's mortality rate with that of penicillin. Fatal reactions to penicillin occur in 1 case per 50,000-100,000 courses. 58 This means that a medical abortion is safer than a treatment with penicillin.

The risks associated with miscarriage and with safe and legal abortion “are substantially less than the risk of continuing the pregnancy." 9

In many countries, there are more deaths associated with childbirth than with induced abortion. The actual number of deaths from induced abortion are even fewer than what is shown in the following chart, since deaths related to induced abortion, miscarriage, and ectopic pregnancy are grouped in the same category. 41


Country Deaths caused by miscarriage, ectopic pregnancy, safe abortion Death caused by miscarriage, ectopic pregnancy, abortion per live birth Pregnancy-related deaths, excluding abortion Pregnancy-related deaths per live births
France 2 1 in 387,000 48 1 in 16,000
Australia 0 0 per 246,000 12 1 in 21,000
Canada 1 1 in 328,000 10 1 in 33,000

Source: WHO Mortality Database, 2001


Updated References:

2 Significant adverse events and outcomes after medical abortion. Cleland K, at all Obstet Gynecol. 2013 Jan;121(1):166-71. doi: http://10.1097/AOG.0b013e3182755763.

3 WHO report: Safe abortion: technical and policy guidance for health systems, 2012. page 65