Legal abortion in the United States is one of the safest medical procedures available. The national case-fatality rate for legal induced abortion from 2013 to 2021 was 0.46 deaths per 100,000 procedures, according to CDC surveillance data. To put that in perspective, carrying a pregnancy to term is substantially riskier: the pregnancy-related mortality rate in 2021 was 23.5 to 43.9 per 100,000 births, depending on how deaths are classified. That means childbirth carries roughly 40 to 80 times the mortality risk of legal abortion.
How Common Are Serious Complications?
Most abortions, whether done with medication or a procedure, end without any significant medical event. In a large study of more than 233,000 medication abortions, serious adverse events occurred in 0.16% of cases. Hospital admission was needed in 0.06%, and blood transfusion in 0.05%. Those are extremely low rates for any medical intervention.
The most common complications across all types of abortion include heavy bleeding, infection, and incomplete abortion (where some pregnancy tissue remains). For procedural abortions, the rate of significant bleeding ranges from about 0.03% to 1%. Uterine perforation, where a surgical instrument passes through the uterine wall, is rare and occurs primarily with second-trimester procedures. These complications are treatable and rarely lead to lasting harm when managed in a clinical setting.
Timing Matters
The vast majority of abortions in the U.S. happen early in pregnancy, and earlier procedures carry lower risk. The risk of death increases by about 38% for each additional week of pregnancy beyond eight weeks. This is one reason most clinical guidelines emphasize timely access: delays in obtaining care push procedures later into pregnancy, when both the complexity and the risk go up. Still, even later abortions remain far safer than continuing a pregnancy to term.
Medication vs. Procedural Abortion
Medication abortion uses two drugs taken in sequence to end an early pregnancy, typically up to 10 or 11 weeks. It causes cramping and bleeding similar to a heavy period or early miscarriage. Serious complications requiring hospitalization affect fewer than 1 in 1,500 patients. The main reason people seek follow-up care is incomplete expulsion of tissue, which can usually be resolved with a brief in-office procedure.
Procedural abortion (sometimes called surgical abortion) involves a clinician using gentle suction to empty the uterus. It’s typically done in a single visit and takes only a few minutes. Complication rates are comparable to or lower than medication abortion, and recovery is usually quick. Most people return to normal activities within a day or two.
Effects on Future Fertility
Some states require that patients be told abortion harms future fertility. The evidence does not support this claim. Multiple literature reviews have found no increased risk of ectopic pregnancy, and no clear link to later miscarriage or stillbirth. A safe, uncomplicated abortion performed with modern methods does not damage the uterus or reduce your ability to become pregnant later. Complications like uterine perforation or severe infection could theoretically affect fertility, but these events are exceptionally rare in legal, clinical settings.
Mental Health After Abortion
The question of whether abortion causes lasting psychological harm has been studied extensively. When researchers account for a person’s mental health before the pregnancy, abortion does not predict higher rates of anxiety, depression, eating disorders, or suicidal thoughts. A major analysis using national survey data found that the apparent link between abortion and mental health problems disappeared entirely once pre-existing conditions were factored in. The one exception was a small, persistent association with substance use disorders, though the direction of that relationship is difficult to untangle.
Relief is the most commonly reported emotion after an abortion. Some people do experience sadness, guilt, or grief, and those feelings are valid. But the clinical evidence is clear that abortion itself does not cause mental illness. Policies requiring providers to warn patients about depression or suicide risk from abortion lack a scientific basis.
Why “Unsafe Abortion” Is a Different Category
Globally, about 45% of all abortions are classified as unsafe by the World Health Organization, meaning they’re performed by people without proper training, outside clinical settings, or using dangerous methods. The contrast in outcomes is stark. While deaths from safe abortions are negligible (fewer than 1 per 100,000), unsafe abortions in some regions carry death rates above 200 per 100,000. An estimated 7 million women per year in developing countries are hospitalized for complications of unsafe abortion, including severe bleeding, infection, and internal organ damage.
This distinction matters because restricting legal access to abortion does not eliminate it. It shifts procedures from safe clinical environments to unsafe ones. The safety profile of abortion depends almost entirely on the conditions under which it is performed: trained providers, appropriate methods, and timely access.