Ending a pregnancy before 12 weeks

Research in the US suggests that up to one in four pregnancies end in abortion, with the vast majority being ended before 13 weeks.

“They are mothers, daughters, sisters, nieces, wives, aunties and grandmothers. They are politicians, lawyers, students, teenagers, nurses, police officers, women who ‘don’t believe in abortion’, waitresses, doctors, journalists, and dancers.

They come from many different religious and cultural backgrounds. They can be wealthy, getting by, or struggling financially. They are married, in long term relationships, single, divorced, having casual sex, or victims of sexual assualt. They usually share the belief that while the decision may have been difficult, they made the best choice at the time.” Source: https://www.childrenbychoice.org.au

Photo by Rich Smith on Unsplash

In Belgium, abortion is possible provided certain conditions are met, notably in terms of timing and respect of a 6-day ‘reflection period’.

The Fédération des Centres de Planning familial des Femmes Prévoyantes Socialistes kindly allowed us to take some of the information below from their website.

What is the time limit for an abortion in Belgium?

If you wish to end a pregnancy, you should contact your doctor, gynaecologist or family planning centre as soon as possible so that the stage of pregnancy can be determined and you can begin to discuss how to proceed.

Note that an abortion can never be carried out at the first medical appointment – a ‘reflection period’ of six days is imposed, unless there is a medical urgency.

In Belgium, an abortion can be carried out until the end of the 12th week after conception (i.e. 14th week of amenorrhea / since the first day of the last period) for any reason.

Note that an abortion can never be carried out at the first medical appointment – a ‘reflection period’ of six days is imposed between the first appointment and the procedure, unless there is a medical urgency. Therefore, you need to factor this in to your timing.

If the first appointment takes place less than six days before the 12-week time limit, the time limit is extended by the number of unused days of the reflection period, e.g. the first appointment is two days before the end of the 12th week, the abortion can take place on the fourth day of the 13th week.

If the last day of the extension is a non-working day, the abortion can be carried out the following working day.

What happens if the 12-week time limit has passed?

In Belgium, abortion after the 12-week limit is possible in two cases:

  • if the pregnancy endangers the health of the mother; or
  • where the baby has been diagnosed with a terminal condition.

If the above criteria are not met, and a woman still wishes to end a pregnancy after 12 weeks, she can go to another EU country where abortion is still possible at her stage of pregnancy.

Travel to another EU country

If the 12-week limit has passed and a woman still wishes to end the pregnancy, she can go to another EU country, where abortion is still possible at her stage of pregnancy. The time limits for abortion vary per country.

In this situation, women in Belgium most often go to the Netherlands, where abortion is possible until the end of the 22nd week after conception (24th week of amennorhea).

For the woman, the initial steps to take remain the same:

  • You make an appointment with a family planning centre in Belgium to express the wish to have an abortion and tell the care provider how far the pregnancy is.
  • The family planning centre arranges the necessary psycho-social and medical examinations.
  • They then make contact with the foreign clinic and explain to you the steps to take.

An abortion after 12 weeks (after conception/14 weeks of ammennorhea) is usually carried out under general anaesthetic, and after 17 weeks, this is mandatory. After the procedure, the women can return home the same day.

A follow-up appointment will be offered in the original family planning clinic the woman visited for her first appointment.

Who can have an abortion?

If you wish to end a pregnancy, you should contact your doctor, gynaecologist or family planning centre as soon as possible so that the stage of pregnancy can be determined and you can begin to discuss how to proceed.

Note that an abortion can never be carried out at the first medical appointment – a ‘reflection period’ of six days is imposed, unless there is a medical urgency.

Any woman can choose to end a pregnancy, including minors, irrespective of their background, nationality, social security status etc.

It is entirely the choice of the pregnant women to end the pregnancy, even if she is married. Only the woman’s consent is needed, and no information about the procedure would be provided to anyone else without her consent.

Minors

Most minors bring a parent or trusted adult with them to an appointment to discuss an abortion.

In cases where a minor attends alone, the care providers evaluate the maturity of the individual and invite her to bring someone to support them. But they will always respect the girl’s final choice.

Confidentiality

As with any medical relationship, a doctor cannot provide information about you to anyone, without your agreement. This is also the case for minors.

If not covered by Belgian social security

For women covered by Belgian social security, the cost of an abortion is covered by the mutuelle. If you do not have a mutuelle, you may have to pay the costs yourself.

For women in precarious circumstances, it may be possible to request ‘urgent medical help‘ via the public social services centres CPAS / OCMW.

Where are abortion procedures carried out?

In Belgium, abortions before the end of the 12th week since conception (14th week of amenorrhea) can take place either:

  • in a hospital; or
  • in a non-hospital environment, such as a family planning centre (‘Centres de Planning familial’) in Brussels and Wallonia or in an ‘abortus centra’ in Flanders

In Belgium, 75% of abortions are carried out in non-hospital centres, where women benefit from comprehensive medical and psychological support.

Where a pregnancy is beyond 12 weeks, and is being ended because of risk to the mother or because of an incurable medical condition, the procedure is only carried out in a hospital.

Where can I find a family planning centre?

Any family planning centre in Belgium can welcome you if you find yourself pregnant and wish to end the pregnancy. They will be able to advise you on the next steps.

You can find a list of family planning centres in Brussels and Wallonia on the website www.loveattitude.be.

For details of other non-hospital centres that carry out abortions in the Brussels-Wallonia region, see the website of Gacehpa (Groupe d’Action des Centres Extra-Hospitaliers Pratiquant l’Avortement): www.gacehpa.be.

For details of ‘abortus centrum’ in Flanders that carry out abortions, see the website of LUNA (Unie van Nederlandstalige Abortuscentra): www.abortus.be.

Where can I find a hospital that carries out abortions?

Not all hospitals carry out abortions. To know if your local hospital carries out such procedures, you will need to contact them as there is currently no list of hospitals performing abortions.

What happens when?

Whether in hospital or in a family planning clinic, there are three main stages:

  • an initial appointment;
  • the procedure itself (minimum six days after the initial appointment); and
  • a follow-up appointment.

How do I choose between a hospital or non-hospital environment?

In Belgium, 75% of abortions are carried out in non-hospital centres. The main differences between a hospital or non-hospital environment lie in:

  • the continuity of care in a family planning clinic – you will be accompanied by the same professionals at all stages;
  • additional psychosocial support in a family planning clinic;
  • the possibility to have a general anaesthetic in a hospital.

The initial appointment

At the initial appointment in a family planning clinic, you will be welcomed by a psychologist / social worker who will listen, non-judgementally and in the strictest confidence, to your story. He/she will provide you with general information about abortion (your rights, what happens, methods etc.) and alternatives to abortion.

During this initial appointment you will also meet a doctor from the family planning clinic.

In a hospital, the initial appointment will only be with a doctor.

What happens during the visit with the doctor?

The doctor focuses on three aspects:

Gynecological exam

The doctor uses ultrasound to determine the state and advancement of the pregnancy, with a view to recommending an abortion method. He/she also: takes a cervical swab (to check for STDs); may take a blood sample to determine your blood group; foresees any other medical exams needed.

Evaluation of your state of mind

The doctor and psychologist / social worker confirm your wish to end the pregnancy and ensure that you are acting of your own free will, with no external pressure.

Information about the procedure

The doctor provides you with all the relevant information about the procedure itself (what happens when, possible risks, what you may experience, possible discomfort etc.), and can answer any questions you may have.

The abortion procedure itself

Until the end of the 7th week after conception (9th week since the start of the last period), most abortions are ‘medical’, i.e. taking medication to end the pregnancy by provoking a miscarriage.

A surgical termination – a procedure to remove the foetus using vacuum or suction aspiration, carried out under local anaesthetic – is also possible, and after the 7th week, this is the only possibility.

On the day of the procedure (minimum six days after the initial appointment) you are asked to confirm your wish to end the pregnancy in writing. It is a legal obligation that this confirmation be annexed to your medical file.

If the procedure is carried out in a family planning clinic, the psychologist / social worker who you have been dealing with will be there to support you. You can also bring along someone else to support you if you wish (partner, parent, sibling, friend etc.)

The two methods

Medical abortion – using medication to end the pregnancy

This method can be used until the end of the 7th week after conception (9th week since the start of the last period), and it involves taking medication to end the pregnancy by provoking a miscarriage. It doesn’t require surgery or an anaesthetic.

It involves the following steps:

  • at the hospital or family planning clinic, you take a medicine called mifepristone – this stops the hormone that allows the pregnancy to continue working; after this, you will be able to go home and continue your normal activities.
  • around 36 to 48 hours later, you will come back to the hospital / clinic, where you will be given a second medicine called misoprostol, which provokes uterine contractions. You will stay around four hours, during which time you will be monitored. It may be that the contractions provoke the expulsion of the foetus while you are in the hospital / clinic, or this may happen later that evening, or even the next day. Your doctor will be able to answer any questions you might have about what to expect.

Surgical abortion – vacuum or suction aspiration

This method is typically used for abortions between the end of the 7th week after conception (9th week since the start of the last period) and the 14th week after conception. It involves inserting small instrument through the entrance to the womb (the cervix). The foetus is then removed using suction.

You may be given medication earlier in the day to soften and dilate the cervix. At the beginning of the procedure, a local anaesthetic is applied to the cervix. The doctor will then gently widen the cervix a few centimetres.

A small, soft-tipped instrument called a cannula is then inserted through the cervix and gentle suction is used to remove the contents of the uterus. A curette (spoon shaped instrument) is then used to check that the uterus is empty.

The whole procedure takes around 15 to 20 minutes and most women go home a few hours later.

Does it hurt?

The perception of pain differs between women. Most women feel discomfort towards the end of the procedure, when the uterus contracts. This discomfort can be compared to heavy period pain, or like that experienced during a miscarriage, and though it can be intense, it should not last long.

Follow-up

A follow-up appointment will be proposed two to three weeks after the procedure. The doctor will look at not only your physical health, but also your emotional and psychological wellbeing in relation to the abortion. The doctor and psyshologist social worker are there to listen, if you need them.

The doctor will also discuss contraception options with you.

Costs

If you are covered by Belgian social security, the mutuelle covers almost all the costs related to the procedure, leaving only a small amount to pay out-of pocket. To ensure confidentiality, it is possible to ask that communications, bills etc. are sent to a different address.

If you are not covered by Belgian social security, you will have to pay for the procedure and visits yourself. An abortion costs around €450 – if you go to a family planning centre, this amount is limited to around €200.

For women in precarious circumstances, it may be possible to request ‘urgent medical help‘ via the public social services centres CPAS / OCMW.

Emotional and psychological support

The decision to end a pregnancy often brings strong emotions, whether around the time of the procedure itself, or even later. In fear of judgement, or of making others feel uncomfortable, many women suffer in silence.

Local support

  • An independent midwife is a good point of contact for holistic support before and after making the choice to end a pregnancy. This is also covered by the mutuelle.
  • Some doulas offer support before, during and after abortion.
  • Community Help Services offer a helpline (+32 (0)2 648 40 14) as well as English-speaking psychologists, psychotherapists, bereavement counselors.

Online resources

This website provides a wealth of information for women who choose to end a pregnancy.

In particular, this page may be of use for women who are struggling emotionally: https://www.childrenbychoice.org.au/forwomen/afteranabortion