If a country is ripe for legislation of abortion and the issue is openly discussed abortion is generally considered a major operation which can only be carried out in a hospital. But in most countries where abortions are legalised most are done in special dedicated clinics. All hospitals and abortion clinics are under legal obligation to report all their cases and the incidence of complications to the Ministry of Health.
Many hospitals actually refer their second trimester cases to the clinics.
That means that complications occur more than ten times as often in a hospital than in a clinic. The reason for this is in the first place the lack of routine in clinics where gynaecologists do only a few terminations. In the second place the fact that hospitals tend to use general anaesthesia. In a hospital in Amsterdam halothane is used in all cases, although it is a well known fact that this invokes uterine blood loss. Board or superintendent may refuse abortions Staff and board are selected on their positive attitude concerning abortion.