Editing Abortion (section)

==Methods==

===Medical===
{{Main|Medical abortion}}
{{Distinguish|text= [[emergency contraception]]}}
{{Image frame|width=300|innerstyle=font-size:88%;|link=:File:Abortionmethods.png|caption=[[Gestational age (obstetrics)|Gestational age]] may determine which abortion methods are practiced.|content={{#invoke:Block diagram|main|width=300|height=190|<border-color #cccccc><border-width 0px 0px 0px 1px><left 30><right 30>&nbsp;<vcentertext><left 70><right 70>&nbsp;<border-width 0px><top 0><bottom 12><left 0><right 100><background-color #ffbcd8>Practice of Induced Abortion Methods<background-color #bdc9df><top 19><bottom 29><left 7.5><right 20>[[manual vacuum aspiration|MVA]]<left 40><right 65>[[dilation and evacuation|D&E]]<top 38><bottom 48><left 15><right 30>[[electric vacuum aspiration|EVA]]<left 50><right 75>[[Hysterotomy abortion|Hyst.]]<left 15><right 37.5><top 56><bottom 66>[[Dilation and curettage|D&C]]<left 50><right 75>[[Intact dilation and extraction|Intact D&X]]<left 7.5><right 30><top 74><bottom 84>[[Mifepristone|Mifepr.]]<left 40><right 75>Induced Miscarr.<left 0><right 30><background-color #b7e690><top 90><bottom 100>[[First trimester|0–12&nbsp;wks]]<left 30><right 70><background-color #dfe988>[[Second trimester|12–28&nbsp;weeks]]<left 70><right 100><background-color #e9c788>[[Third trimester|28–40&nbsp;wks]]}}}}
Medical abortions are those induced by [[abortifacient]] pharmaceuticals. Medical abortion became an alternative method of abortion with the availability of [[prostaglandin]] [[prostaglandin analogue|analogs]] in the 1970s and the [[antiprogestin|antiprogestogen]] [[mifepristone]] (also known as RU-486) in the 1980s.<ref name=Kapp2013/><ref name=":0" /><ref name="Creinin 2009">{{cite book|vauthors=Creinin MD, Gemzell-Danielsson K |year=2009| chapter=Medical abortion in early pregnancy|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell|pages=111–134| isbn=978-1-4051-7696-5}}</ref><ref name="Kapp 2009">{{cite book| vauthors=Kapp N, von Hertzen H |year=2009| chapter=Medical methods to induce abortion in the second trimester| veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD |title=Management of unintended and abnormal pregnancy: comprehensive abortion care| location=Oxford|publisher=Wiley-Blackwell| pages=178–192| isbn=978-1-4051-7696-5}}</ref>

The most common early first trimester medical abortion regimens use mifepristone in combination with [[misoprostol]] (or sometimes another prostaglandin analog, [[gemeprost]]) up to 10 weeks (70 days) gestational age,<ref name=":2"/><ref name=":1">{{cite web |author=Center for Drug Evaluation and Research |title=Mifeprex (mifepristone) Information |url=https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/mifeprex-mifepristone-information |website=FDA |access-date=2 July 2019 |date=8 February 2019 |archive-date=23 April 2019 |archive-url=https://web.archive.org/web/20190423032409/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111323.htm |url-status=live }}</ref> [[methotrexate]] in combination with a prostaglandin analog up to 7 weeks gestation, or a prostaglandin analog alone.<ref name=":0" /> Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens, and combination regimens are more effective than misoprostol alone, particularly in the second trimester.<ref name="Creinin 2009"/><ref>{{cite journal | vauthors = Wildschut H, Both MI, Medema S, Thomee E, Wildhagen MF, Kapp N | title = Medical methods for mid-trimester termination of pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 1 | pages = CD005216 | date = January 2011 | pmid = 21249669 | pmc = 8557267 | doi = 10.1002/14651858.CD005216.pub2 }}</ref> Medical abortion regimens involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 70 days' gestation.<ref name=":1" /><ref name=":2">{{cite journal | vauthors = Chen MJ, Creinin MD | title = Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review | journal = Obstetrics and Gynecology | volume = 126 | issue = 1 | pages = 12–21 | date = July 2015 | pmid = 26241251 | doi = 10.1097/AOG.0000000000000897 | url = http://www.escholarship.org/uc/item/2pw521h5 | access-date = 30 July 2019 | url-status = live | s2cid = 20800109 | archive-url = https://web.archive.org/web/20200726105924/https://escholarship.org/uc/item/2pw521h5 | archive-date = 26 July 2020 }}</ref>

[[File:Abortion pill.jpg|thumb|right|Shown here is the typical regimen for early medical abortions (200&nbsp;mg [[mifepristone]] and 800&nbsp;μg [[misoprostol]]).]]

In very early abortions, up to 7 weeks [[gestation]], medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion ([[vacuum aspiration]]), especially when clinical practice does not include detailed inspection of aspirated tissue.<ref name="WHO FAQs 2006">{{cite book |author=WHO Department of Reproductive Health and Research |url=http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |title=Frequently asked clinical questions about medical abortion |publisher=World Health Organization |year=2006 |isbn=92-4-159484-5 |location=Geneva |access-date=22 November 2011 |url-access=subscription |archive-url=https://web.archive.org/web/20111226115043/http://whqlibdoc.who.int/publications/2006/9241594845_eng.pdf |archive-date=26 December 2011 |url-status=dead}}</ref> Early medical abortion regimens using mifepristone, followed 24–48 hours later by [[Buccal administration|buccal]] or vaginal misoprostol are 98% effective up to 9 weeks gestational age; from 9 to 10 weeks efficacy decreases modestly to 94%.<ref name=":2" /><ref name="Fjerstad 2009b">{{cite journal | vauthors = Fjerstad M, Sivin I, Lichtenberg ES, Trussell J, Cleland K, Cullins V | title = Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days | journal = Contraception | volume = 80 | issue = 3 | pages = 282–286 | date = September 2009 | pmid = 19698822 | pmc = 3766037 | doi = 10.1016/j.contraception.2009.03.010 }} The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''vaginal'' misoprostol) ''previously'' used by [[Planned Parenthood]] clinics in the United States from 2001 to March 2006 was 98.5% effective through 63 days gestation—with an ongoing pregnancy rate of about 0.5%, and an additional 1% of women having uterine evacuation for various reasons, including problematic bleeding, persistent gestational sac, clinician judgment or a woman's request. The regimen (200&nbsp;mg of mifepristone, followed 24–48 hours later by 800 mcg of ''[[wikt:buccal|buccal]]'' misoprostol) ''currently'' used by Planned Parenthood clinics in the United States since April 2006 is 98% effective through 59 days gestation.</ref> If medical abortion fails, surgical abortion must be used to complete the procedure.<ref>{{cite book| vauthors=Holmquist S, Gilliam M |year=2008| chapter=Induced abortion| veditors=Gibbs RS, Karlan BY, Haney AF, Nygaard I |title=Danforth's obstetrics and gynecology| edition=10th| location=Philadelphia|publisher=Lippincott Williams & Wilkins| pages=586–603| isbn=978-0-7817-6937-2}}</ref>

Early medical abortions account for the majority of abortions before 9 weeks gestation in [[Abortion in Great Britain|Britain]],<ref>{{Cite report |title=Abortion statistics, England and Wales: 2022 |url=https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2022 |publisher= [[Office for Health Improvement and Disparities]] |date=2023| access-date=2024-07-23 |language=en|section = Table 5: Legal abortions: gestation weeks by purchaser and method of abortion, residents of England and Wales, numbers, percentages, 2022 |section-url = https://assets.publishing.service.gov.uk/media/664dcb9d4f29e1d07fadcc7b/Abortion-statistics-2022-data-tables.ods}}</ref> [[Abortion in France|France]],<ref>{{cite web| vauthors=Vilain A, Mouquet MC |date=22 June 2011 |title=Voluntary terminations of pregnancies in 2008 and 2009 |location=Paris |publisher=DREES, Ministry of Health, France |url=http://www.sante.gouv.fr/IMG/pdf/er765.pdf |access-date=22 November 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110926235733/http://www.sante.gouv.fr/IMG/pdf/er765.pdf |archive-date=26 September 2011 }}</ref> [[Abortion in Switzerland|Switzerland]],<ref>{{cite web| date=5 July 2011|title=Abortions in Switzerland 2010| location=Neuchâtel| publisher=Office of Federal Statistics, Switzerland| url=http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|access-date=22 November 2011| url-status=dead| archive-url=https://web.archive.org/web/20111003203103/http://www.bfs.admin.ch/bfs/portal/fr/index/themen/14/02/03/key/03.html|archive-date=3 October 2011}}</ref> [[Abortion in the United States|United States]],<ref>{{cite report | vauthors = Jones RK, Witwer E, Jerman J |title=Abortion Incidence and Service Availability in the United States, 2017 |year=2019 |publisher=Guttmacher Institute |doi=10.1363/2019.30760 |doi-access=free |pmc=5487028 }}</ref> and the [[Nordic countries]].<ref>{{cite web| vauthors=Gissler M, Heino A|date=21 February 2011| title=Induced abortions in the Nordic countries 2009| location=Helsinki| publisher=National Institute for Health and Welfare, Finland| url=http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf| access-date=22 November 2011| url-status=dead|archive-url=https://web.archive.org/web/20120118094034/http://www.stakes.fi/tilastot/tilastotiedotteet/2011/Tr09_11.pdf|archive-date=18 January 2012}}</ref>

Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second trimester abortions in [[Abortion in Canada|Canada]], most of Europe, [[Abortion in China|China]] and [[Abortion in India|India]],<ref name="Kapp 2009"/> in contrast to the United States where 96% of second trimester abortions are performed surgically by [[dilation and evacuation]].<ref name=":3">{{cite book|title=Management of unintended and abnormal pregnancy: comprehensive abortion care| vauthors=Meckstroth K, Paul M|publisher=Wiley-Blackwell| year=2009|isbn=978-1-4051-7696-5|veditors=Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD| location=Oxford|pages=135–156|chapter=First-trimester aspiration abortion}}</ref>

A 2020 [[Cochrane review|Cochrane Systematic Review]] concluded that providing women with medications to take home to complete the second stage of the procedure for an early medical abortion results in an effective abortion.<ref name=":4">{{cite journal | vauthors = Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD | title = Self-administered versus provider-administered medical abortion | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD013181 | date = March 2020 | issue = 3 | pmid = 32150279 | pmc = 7062143 | doi = 10.1002/14651858.CD013181.pub2 }}</ref> Further research is required to determine if self-administered medical abortion is as safe as provider-administered medical abortion, where a health care professional is present to help manage the medical abortion.<ref name=":4" /> Safely permitting women to self-administer abortion medication has the potential to improve access to abortion.<ref name=":4" /> The review also noted a research gap concerning methods to support women who take medication at home for a self-administered abortion.<ref name=":4" />

===Surgical===
[[File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).<br />'''1:''' [[Amniotic sac]]<br />'''2:''' [[Embryo]]<br />'''3:''' [[Endometrium|Uterine lining]]<br />'''4:''' [[Speculum (medical)|Speculum]]<br />'''5:''' Vacurette<br />'''6:''' Attached to a [[Vacuum pump|suction pump]]]]

Up to 15 weeks' gestation, [[suction-aspiration abortion|suction-aspiration]] or vacuum aspiration are the most common surgical methods of induced abortion.<ref>{{cite web| author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |website=WebMD |access-date=5 December 2008| archive-url= https://web.archive.org/web/20070211155626/http://www.webmd.com/hw/womens_conditions/tw1078.asp| archive-date=11 February 2007| url-status= live}}</ref> ''Manual vacuum aspiration'' (MVA) consists of removing the [[fetus]] or [[embryo]], [[placenta]], and membranes by suction using a manual syringe, while ''electric vacuum aspiration'' (EVA) uses an electric pump. Both techniques can be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.<ref name=":3" />

MVA, also known as "mini-suction" and "[[menstrual extraction]]", or EVA can be used in very early pregnancy when cervical dilation may not be required. [[Dilation and curettage]] (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The [[World Health Organization]] recommends ''sharp curettage'' only when suction aspiration is unavailable.<ref>{{cite book|title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors| author=World Health Organization| publisher=World Health Organization| year=2017| isbn=978-92-4-154587-7| location=Geneva|  chapter=Dilatation and curettage| oclc=181845530| access-date=30 July 2019|chapter-url=https://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html|archive-date=19 May 2009|archive-url=https://web.archive.org/web/20090519162903/http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html| url-status=live}}</ref>

[[Dilation and evacuation]] (D&E), used after 12 to 16 weeks, consists of opening the [[cervix]] and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. [[Intact dilation and extraction]] (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.<ref>{{cite book| title=Dilation and evacuation. In Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds)Management of unintended and abnormal pregnancy: comprehensive abortion care.| vauthors = Hammond C, Chasen S |publisher=Oxford: Wiley-Blackwell|year=2009|isbn=978-1-4051-7696-5|pages=178–192}}</ref>

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. [[Hysterotomy abortion]] is a procedure similar to a [[caesarean section]] and is performed under [[general anesthesia]]. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.<ref>{{cite journal | vauthors =  | title = ACOG Practice Bulletin No. 135: Second-trimester abortion | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1394–1406 | date = June 2013 | pmid = 23812485 | doi = 10.1097/01.AOG.0000431056.79334.cc | s2cid = 205384119 }}</ref>

First trimester procedures can generally be performed using [[local anesthesia]], while second trimester methods may require [[Sedation#Levels of sedation|deep sedation]] or [[general anesthesia]].<ref name="NEJMDec2011">{{cite journal | vauthors = Templeton A, Grimes DA | title = Clinical practice. A request for abortion | journal = The New England Journal of Medicine | volume = 365 | issue = 23 | pages = 2198–2204 | date = December 2011 | pmid = 22150038 | doi = 10.1056/NEJMcp1103639 | doi-access =  }}</ref><ref>{{cite journal | vauthors = Allen RH, Singh R | title = Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation | language = English | journal = Contraception | volume = 97 | issue = 6 | pages = 471–477 | date = June 2018 | pmid = 29407363 | doi = 10.1016/j.contraception.2018.01.014 | url = https://www.contraceptionjournal.org/article/S0010-7824(18)30036-2/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 3777869 | archive-url = https://web.archive.org/web/20220303075142/https://www.contraceptionjournal.org/article/S0010-7824%2818%2930036-2/fulltext | archive-date = 3 March 2022 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Cansino C, Denny C, Carlisle AS, Stubblefield P | title = Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia | language = English | journal = Contraception | volume = 104 | issue = 6 | pages = 583–592 | date = December 2021 | pmid = 34425082 | doi = 10.1016/j.contraception.2021.08.007 | url = https://www.contraceptionjournal.org/article/S0010-7824(21)00351-6/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 237279946 | archive-url = https://web.archive.org/web/20220303075141/https://www.contraceptionjournal.org/article/S0010-7824%2821%2900351-6/fulltext | archive-date = 3 March 2022 | doi-access = free }}</ref>

===Labor induction abortion===
In places lacking the necessary medical skill for dilation and extraction, or when preferred by practitioners, an abortion can be induced by first [[Labor induction|inducing labor]] and then [[Late termination of pregnancy#Methods|inducing fetal demise]] if necessary.<ref name=GLOWM_Late>{{cite journal| last = Borgatta | first= Lynn |journal=Global Library of Women's Medicine| date=December 2014 |volume=GLOWM.10444| doi=10.3843/GLOWM.10444| url=http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443| access-date=25 September 2015| title=Labor Induction Termination of Pregnancy| url-status=live| archive-url=https://web.archive.org/web/20150924082507/http://www.glowm.com/section_view/heading/Labor%20Induction%20Termination%20of%20Pregnancy/item/443| archive-date=24 September 2015| url-access=subscription}}</ref> This is sometimes called "induced miscarriage". This procedure may be performed from 13 weeks gestation to the third trimester. Although it is very uncommon in the United States, more than 80% of induced abortions throughout the second trimester are labor-induced abortions in Sweden and other nearby countries.<ref name=Labor_Induced_Abortion>{{cite journal | last1 = Borgatta | first1= Lynn  |first2 =Nathalie |last2 =Kapp| title = Clinical guidelines. Labor induction abortion in the second trimester | journal = Contraception | volume = 84 | issue = 1 | pages = 4–18 | date = July 2011 | pmid = 21664506 | doi = 10.1016/j.contraception.2011.02.005 | url = http://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf | access-date = 25 September 2015 | url-status = live | quote = 10. What is the effect of feticide on labor induction abortion outcome? Deliberately causing demise of the fetus before labor induction abortion is performed primarily to avoid transient fetal survival after expulsion; this approach may be for the comfort of both the woman and the staff, to avoid futile resuscitation efforts. Some providers allege that feticide also facilitates delivery, although little data support this claim. Transient fetal survival is very unlikely after intraamniotic installation of saline or urea, which are directly feticidal. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin. Factors associated with a higher likelihood of transient fetal survival with labor induction abortion include increasing gestational age, decreasing abortion interval and the use of nonfeticidal inductive agents such as the PGE1 analogues. | archive-url = https://web.archive.org/web/20200606205318/https://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf | archive-date = 6 June 2020 | doi-access = free }}</ref>

Only limited data are available comparing labor-induced abortion with the dilation and extraction method.<ref name=Labor_Induced_Abortion/> Unlike D&E, labor-induced abortions after 18 weeks may be complicated by the occurrence of brief fetal survival, which may be legally characterized as live birth. For this reason, labor-induced abortion is legally risky in the United States.<ref name=Labor_Induced_Abortion/><ref name=NAF_2015_Policy>{{cite book| title=2015 Clinical Policy Guidelines| publisher=National Abortion Federation| date=2015| url=http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf| access-date=30 October 2015| quote=Policy Statement: Medical induction abortion is a safe and effective method for termination of pregnancies beyond the first trimester when performed by trained clinicians in medical offices, freestanding clinics, ambulatory surgery centers, and hospitals. Feticidal agents may be particularly important when issues of viability arise.| url-status=live| archive-url=https://web.archive.org/web/20150812220053/http://prochoice.org/wp-content/uploads/2015_NAF_CPGs.pdf| archive-date=12 August 2015}}</ref>

===Other methods===
Historically, a number of herbs reputed to possess abortifacient properties have been used in [[folk medicine]]. Such herbs include [[tansy]], [[Mentha pulegium|pennyroyal]], [[black cohosh]], and the now-extinct [[Silphium (antiquity)|silphium]].<ref name="riddle2">{{cite book |last=Riddle |first=John M |url=https://archive.org/details/evesherbshistory0000ridd |title=Eve's herbs: a history of contraception and abortion in the West |publisher=Harvard University Press |year=1997 |isbn=978-0-674-27024-4 |location=Cambridge, MA |oclc=36126503 |author-link=John M. Riddle |url-access=registration}}</ref>{{rp|44–47, 62–63, 154–155, 230–231}}

In 1978, one woman in Colorado died and another developed organ damage when they attempted to terminate their pregnancies by taking pennyroyal oil.<ref>{{cite journal | vauthors = Sullivan JB, Rumack BH, Thomas H, Peterson RG, Bryson P | title = Pennyroyal oil poisoning and hepatotoxicity | journal = JAMA | volume = 242 | issue = 26 | pages = 2873–2874 | date = December 1979 | pmid = 513258 | doi = 10.1001/jama.1979.03300260043027 | s2cid = 26198529 }}</ref>
Because the indiscriminant use of herbs as abortifacients can cause serious—even lethal—side effects, such as [[multiple organ dysfunction syndrome|multiple organ failure]],<ref>{{cite journal | vauthors = Ciganda C, Laborde A | title = Herbal infusions used for induced abortion | journal = Journal of Toxicology. Clinical Toxicology | volume = 41 | issue = 3 | pages = 235–239 | year = 2003 | pmid = 12807304 | doi = 10.1081/CLT-120021104 | s2cid = 44851492 }}</ref> such use is not recommended by physicians.

Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing [[miscarriage]].<ref>{{cite journal | vauthors = Smith JP | title = Risky choices: the dangers of teens using self-induced abortion attempts | journal = Journal of Pediatric Health Care | volume = 12 | issue = 3 | pages = 147–151 | year = 1998 | pmid = 9652283 | doi = 10.1016/S0891-5245(98)90245-0 }}</ref> In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.<ref name="potts">{{cite journal | vauthors = Potts M, Graff M, Taing J | title = Thousand-year-old depictions of massage abortion | journal = The Journal of Family Planning and Reproductive Health Care | volume = 33 | issue = 4 | pages = 233–234 | date = October 2007 | pmid = 17925100 | doi = 10.1783/147118907782101904 | doi-access = free | author-link1 = Malcolm Potts }}</ref> One of the [[bas relief]]s decorating the temple of [[Angkor Wat]] in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the [[underworld]].<ref name="potts" />

Reported methods of unsafe, [[self-induced abortion]] include misuse of [[misoprostol]] and insertion of non-surgical implements such as knitting needles and [[clothes hanger]]s into the uterus. These and other methods to terminate pregnancy may be called "induced miscarriage".  Such methods are rarely used in countries where surgical abortion is legal and available.<ref>{{cite journal | vauthors = Thapa SR, Rimal D, Preston J | title = Self induction of abortion with instrumentation | journal = Australian Family Physician | volume = 35 | issue = 9 | pages = 697–698 | date = September 2006 | pmid = 16969439 | url = http://www.racgp.org.au/afp/200609/11015 | url-status = live | archive-url = https://web.archive.org/web/20090108181951/http://www.racgp.org.au/afp/200609/11015 | archive-date = 8 January 2009 }}</ref>
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