How to Have an Abortion: Types, Costs and Access

Abortion in the United States falls into two broad categories: medication abortion, which uses pills to end a pregnancy (typically up to about 10–11 weeks), and procedural (surgical) abortion, which is performed in a clinic. Both are safe and highly effective when done under proper medical guidance, with success rates above 95 percent. How you access either one, what you pay, and how long the process takes depend heavily on where you live, your insurance coverage, and how far along the pregnancy is. Since the 2022 Dobbs decision removed the federal right to abortion, the landscape has shifted dramatically in parts of the country, making questions about types, costs, and access more urgent and more complicated than ever.

Medication Abortion

Medication abortion is the most common method in the first trimester and accounts for the majority of all abortions in the U.S. The standard protocol uses two drugs: mifepristone, which blocks the hormone progesterone needed to sustain a pregnancy, and misoprostol, which causes the uterus to contract and expel its contents. You take mifepristone first, then misoprostol 24 to 48 hours later (placed between the cheek and gum, under the tongue, or vaginally). A systematic review covering more than 45,000 cases found that the overall failure rate with this combination was about 5 percent, with ongoing pregnancy occurring in roughly 1 percent of cases.¹ Success rates climb even higher when the pregnancy is earlier: one large study found the mifepristone-plus-buccal-misoprostol regimen was about 98 percent effective below 60 days of gestation.²

Failure risk goes up when the pregnancy is further along, when the interval between the two drugs is shorter than 24 hours, or when misoprostol is swallowed rather than administered through the cheek, under the tongue, or vaginally.¹ In practical terms, this means following the timing instructions matters, and that medication abortion is best suited for earlier pregnancies.

Misoprostol Alone

In situations where mifepristone is unavailable or restricted, misoprostol by itself can be used for first-trimester abortion. This approach is less well-known in the U.S. but is used widely around the world. A 2023 meta-analysis confirmed that misoprostol-only regimens are safe and effective, though they work best when mifepristone simply cannot be obtained.³ A separate study of over 600 people using misoprostol alone found that about 98 percent had a complete abortion without needing a procedure, though common side effects included nausea (about half of participants), fever (about a third), and diarrhea (roughly a quarter).⁴ Misoprostol alone tends to cause more cramping and side effects than the two-drug combination, but it remains a reasonable backup option.

Surgical Abortion

The term “surgical abortion” makes the procedure sound more invasive than it usually is. In the first trimester, the most common method is vacuum aspiration (sometimes called suction aspiration), which involves dilating the cervix and using gentle suction to empty the uterus. The whole thing typically takes about 5 to 10 minutes in the procedure room, though preparation and recovery extend the clinic visit. For pregnancies in the second trimester, dilation and evacuation (D&E) is the standard approach. A large comparative analysis found that D&E had significantly lower complication rates than alternative second-trimester methods, with major complications occurring in under 1 percent of cases.⁵

Surgical abortion has some practical advantages: it is completed in a single visit, you know the abortion is done before you leave, and it works reliably across a wider range of gestational ages. Some people prefer it for the certainty. Others prefer medication abortion because it can feel more private and happens at home. Neither is inherently better; the right choice depends on how far along you are, your medical history, and your personal preferences.

What to Expect During Recovery

After a medication abortion, cramping and bleeding are the main experiences, and they can be intense. The bleeding typically starts after the misoprostol dose and often includes heavy flow and clots for several hours, then tapers over the following days. Most people in one study experienced bleeding for a median of about four days.⁴ The longer you wait between taking mifepristone and misoprostol, the more likely you are to start having cramps and spotting before the misoprostol dose, though once misoprostol is taken, the pattern of cramping and bleeding is similar regardless of the timing interval.⁶

After a surgical abortion, cramping is usually milder and shorter-lived since the procedure itself removes the pregnancy. Some bleeding is normal for a week or two, but it tends to be lighter than with medication abortion. A multicountry trial comparing the two approaches found that medication abortion produced more side effects, especially more bleeding and more pain, but that overall satisfaction was similar between the two groups.⁷

Serious complications from either type of safe, legal abortion are rare. A narrative review for emergency clinicians found that mortality rates for safe abortions are below 0.2 percent, and the major variables affecting complication risk are gestational age, the type of procedure, and whether the abortion was performed safely in the first place.⁸ Warning signs to watch for include soaking more than two thick pads an hour for two or more hours, a fever lasting more than 24 hours, foul-smelling discharge, or severe abdominal pain that does not respond to over-the-counter painkillers. Any of these warrant a call to your provider or a trip to the emergency room.

Costs and Who Pays

What you pay depends enormously on where you live and how you are insured. Under the federal Hyde Amendment, Medicaid does not cover abortion except in cases of rape, incest, or danger to the pregnant person’s life. However, about 16 states and Washington, D.C. use their own funds to cover abortion through Medicaid. The difference this makes is stark: a survey of abortion patients in 2021–2022 found that 71 percent of respondents in states where Medicaid covers abortion paid nothing out of pocket, compared to just 10 percent of those in states that follow the Hyde Amendment restrictions. In those restricted states, 82 percent paid entirely out of pocket, and two-thirds reported having to raise money by delaying bills or borrowing.⁹

Out-of-pocket costs for a first-trimester medication abortion generally range from roughly $300 to $800, depending on the clinic, the state, and whether ultrasound or lab work is included. First-trimester surgical abortion costs are often comparable or somewhat higher. Second-trimester procedures are significantly more expensive, easily running $1,000 to $3,000 or more, and can require additional days for cervical preparation. If you need to travel to another state, lodging, gas or flights, meals, and childcare add up quickly. Private insurance coverage for abortion varies widely by plan and by state; some states mandate coverage while others allow or require insurers to exclude it.

Abortion Funds and Practical Support

For people who cannot afford the procedure on their own, abortion funds are nonprofit organizations that help cover costs and logistics. These funds exist in most states and can be found through the National Abortion Federation hotline or the National Network of Abortion Funds. Some cover part or all of the procedure cost, while others help with travel, lodging, childcare, or time off work.

The role of these organizations has grown since the Dobbs decision. Research on practical support funds found that after Dobbs, clients were more likely to be traveling from states with restrictions, needed more financial assistance, and waited longer for care.¹⁰ Qualitative research on people who traveled for later abortions found that well-resourced funds could meaningfully reduce the stress of the experience by arranging travel in advance, covering costs for a companion, and offering emotional support along the way.¹¹ Prompt referrals and coordinated financial support were consistently identified as the factors that most reduced the burden of forced travel.¹²

Telehealth and Self-Managed Abortion

Telehealth has become one of the most significant changes in abortion access in recent years. In states where it is legal, you can have a video or even asynchronous (message-based) consultation with a clinician, receive a prescription, and have the pills mailed to your home. A large study of over 6,000 telehealth medication abortions found that nearly 98 percent were complete without any further intervention, and serious adverse events occurred in only about 0.25 percent of cases, rates comparable to in-person care.¹³

Self-managed abortion, where someone obtains and uses medications without direct clinician supervision, is a separate category. People may turn to it because of cost, distance, legal barriers, or a desire for privacy. A study of over 4,500 people in the U.S. who received medications by mail from an online telemedicine service found that about 96 percent of first-trimester users successfully ended their pregnancy without surgical intervention, and about 1 percent reported a serious adverse event.¹⁴ A smaller pilot study found similar results, with 95 percent reporting a complete abortion and no major adverse events.¹⁵

There is an important distinction between obtaining medications through a legitimate telehealth service (even one based outside the country) and buying them from unregulated online pharmacies. Unregulated sellers often provide incomplete information about dosing and side effects, and purchasing from illegal online sources has been linked to a higher rate of serious or fatal events.¹⁶ A study of online sellers in Indonesia found that 87 percent provided incomplete information about physical effects, and none warned about possible complications.¹⁷ If you are considering self-managed abortion, using a vetted telehealth service with proper medical guidance makes a meaningful safety difference compared to buying pills from an anonymous website.

The Post-Dobbs Access Landscape

Before the Dobbs decision in June 2022, the median travel time to an abortion facility in the U.S. was about 11 minutes, and the average was about 28 minutes. After the ruling, when facilities in states with total or six-week bans are considered inactive, the median jumped to 17 minutes and the average shot up to over 100 minutes. About a third of women of reproductive age now live more than 60 minutes from an abortion facility, up from roughly 15 percent before Dobbs.¹⁸ The averages are pulled upward by people in ban states who now face drives of several hours or more to reach the nearest legal clinic.

The legal landscape shifts frequently, with state legislatures and courts changing rules on gestational limits, telehealth prescribing, and who can provide abortions. Before making plans, check the current law in both your state and the state where you would seek care. Several organizations maintain up-to-date maps and legal trackers, including the Guttmacher Institute and the Center for Reproductive Rights.

Mandatory Waiting Periods and Other Regulatory Barriers

Several states require a mandatory waiting period, typically 24 to 72 hours, between an initial counseling appointment and the abortion itself. The practical effect is often that you need two separate clinic visits, which means more time off work, additional travel, and extra childcare. A synthesis of evidence from eight studies found that mandatory waiting periods contribute to delays by increasing the time between counseling and the procedure and by creating logistical difficulties in obtaining care, an effect that is magnified when two in-person visits are required.¹⁹ These delays push some people into the second trimester, when the procedure becomes more complex, more expensive, and harder to access. One study estimated that introducing a mandatory waiting period caused a 53 to 69 percent increase in the share of abortions obtained during the second trimester.²⁰ Some people end up past the gestational limit entirely and are forced to carry the pregnancy to term.²¹

Crisis pregnancy centers are another barrier that catches people off guard. These are nonprofit facilities that present themselves as reproductive health clinics but exist to discourage abortion. Research has found that they engage in deceptive practices, spread misinformation about sexual health and abortion, and can delay access to legitimate medical care.²² They often show up prominently in online search results and may offer free pregnancy tests or ultrasounds as a draw. If you are looking for an actual abortion provider, verify that the clinic you contact provides or refers for abortion services before booking an appointment.

Minors and Parental Involvement Laws

Many states require minors to notify or obtain consent from a parent before having an abortion. Most of these states offer a judicial bypass process, in which a minor can petition a court for permission, but navigating that process takes time and can be intimidating. A systematic review of parental involvement laws found that decreases in in-state abortion rates among minors were often offset by increases in minors traveling out of state for care. That travel creates financial and emotional burdens and widens disparities, since minors with money and family support can still access care while those without may have no alternative but to continue the pregnancy.²³

Contraception After an Abortion

If you want to prevent future unintended pregnancies, you can start most forms of contraception immediately after an abortion. A systematic review found that starting hormonal contraception right after a medical or surgical abortion generally does not reduce the effectiveness of the abortion or create safety concerns related to bleeding.²⁴ One exception to note: one study found a small increase in ongoing pregnancy rates when injectable contraception (DMPA) was given immediately after a medication abortion compared to a delayed start, so your provider may discuss timing depending on the method you choose.²⁴

Long-acting methods like IUDs and implants can be placed during the same visit as a surgical abortion, which is convenient for people who have traveled a long distance. A study of first-trimester abortion patients found that about 65 percent chose an immediate long-acting method, and those who lived more than 70 miles from the clinic were more likely to make that choice, probably because a return visit would be difficult.²⁵ Fertility returns quickly after an abortion, so if you want contraception, the sooner you start, the better.

Emotional Responses and Mental Health

The psychological experience of abortion varies. Many people feel relief. Some feel sadness, guilt, or a mix of emotions. Large studies have consistently found that being denied a wanted abortion is more psychologically harmful than having one. A Swedish cohort study that followed people before and after abortion found that the rate of post-traumatic stress symptoms actually dropped from about 24 percent before the procedure to under 5 percent at three months afterward, and the rate of diagnosable post-traumatic stress disorder fell from about 4 percent to 2 percent.²⁶ In other words, much of the distress people experience around an abortion is present before the procedure and reflects the circumstances leading to it, not a consequence of the procedure itself.

The Economic Stakes of Access

Researchers in the landmark Turnaway Study tracked women who received a wanted abortion alongside women who were turned away because they were just past a clinic’s gestational limit. The results were striking. Women who were denied abortions and gave birth had nearly four times the odds of being in poverty six months later, were significantly less likely to be employed full time, and were more than six times as likely to be receiving public assistance, differences that persisted for four years.²⁷ An analysis using credit report data linked to the same study found that being denied an abortion led to a large, sustained increase in financial distress lasting several years.²⁸ These findings came from comparing women whose pregnancies were only a few days apart on either side of a gestational cutoff, which makes the groups almost identical except for whether they received the abortion. The implication is clear: barriers that delay or prevent access to abortion have measurable, lasting economic consequences for the people affected.

Unsafe Abortion and the Global Picture

The safety statistics discussed throughout this article apply to legal, medically supervised abortions. Unsafe abortions, defined by the World Health Organization as procedures carried out by unqualified people or in inadequate settings, are a different story entirely. A narrative review found that mortality rates for unsafe abortions range from about 5 to 13 percent, compared to below 0.2 percent for safe procedures.⁸ Globally, maternal mortality from abortion complications is higher in regions with more restrictive abortion laws than in those with fewer restrictions.²⁹ Restricting legal access does not eliminate abortion; it shifts it toward less safe methods. That pattern is one of the most consistent findings in reproductive health research, and it is worth keeping in mind as laws continue to change across the United States.