# Abortion on our ship

When the Women on Waves ship visits your country, you can make an appointment with us by telephone, email or by visiting the ship. We will inform you about when and where to board the ship. You will be treated according to Dutch professional medical standards, which include full confidentiality about counseling and/or treatment. Here you can read more about counseling, the treatment and what to expect afterwards. 

### Services offered by Women on Waves are

  * Information about and provision of contraceptives
  * Information about and provision of emergency contraceptives
  * Pregnancy testing
  * Non-directive pregnancy counseling, aimed at making an optimal informed personal decision
  * Ultrasounds to determine your kind of pregnancy
  * Medical abortions if your period is no more than 16 days too late
  * Counseling on sexually transmitted diseases



Although abortion is illegal in your country, Women on Waves can help you in a legal and safe way. Dutch law applies on board a Dutch ship once it is outside territorial waters. We have permission to give you the abortion pill if you have missed your period for 16 days.

#### Unwanted pregnancy

If you are pregnant you have three choices: 

  * Continue the pregnancy and keep the baby
  * Continue the pregnancy and place the baby up for adoption
  * End the pregnancy by having an abortion



Whatever you decide, Women on Waves will support you and help you make your personal choice in this situation.

#### Counseling

Your decision has to be made free of coercion, and you have to be well-informed about all the alternatives. Every woman with an unplanned pregnancy faces different and sometimes conflicting emotions: feelings such as insecurity, desperation, anxiety, depression, shame or guilt may compete with happiness. Our counseling service will help you cope with these feelings now and in the future, providing information about all your options and supporting you in making your personal choice.

#### Procedure

You can make an appointment with us by telephone, email or by visiting the ship. In a personal consultation we will provide counseling. You can be accompanied by your partner, friend or family. No pregnancy termination will be carried out at this first visit. We will ask you to talk with us about your situation. Feel free to tell us voluntarily and confidentially about violent acts, if they occurred. We will discuss your medical history, examine you and make a sonogram, preferably vaginally.

#### If you decide to have an abortion

We will give you information about the procedure and the small risk of complications. We will also discuss future contraception. Don't hesitate to ask as many questions as you want. You will be asked to sign a patient agreement and informed consent form.  
We will inform you about when and where to board the ship. A telephone number where we can contact you discretely is very helpful. If you decide to cancel the appointment, feel free to do so even without mentioning the reason, but please let us know by phone or email.

#### Abortion services

The pregnancy termination will involve a trip with a ship to international waters therefor you need to take your passport with you. You will get a seasickness tablet before departure. If you use any prescribed medicines, pills or inhalers, use them normally and take them with you.  
Wear comfortable clothes and shoes, no high heels.   
During the sea travel you can talk with staff and other clients and have something to drink and eat. After about two hours we will arrive in international waters.

#### Medical abortion

Medical abortion is safe and effective. Medical abortion usually requires two medicines at two different times. The drug Mifepristone is responsible for ending the pregnancy and is provided in the international waters. You can decide at any moment that you do not want to proceed with the treatment and that you do not want to take the pill. After returning to the harbour you will go home. If you took the Mifepristone there is a small chance (3%) that a spontaneous abortion may have already started. After 6-24 hours most women need a second drug, Misoprostol, that should be administered vaginally or under your tongue. This drug causes contractions of the uterus. You will take this drug at home. Bleeding usually occurs within 4 hours after taking it. Be prepared to experience quite severe pain (similar to menstrual cramps) for which we will prescribe analgesics. Nausea and vomiting are normal side-effects of the Misoprostol.

#### What to expect after an abortion?

Especially after a medical abortion, it is hard to predict how long the bleeding will last. Generally, a period of about two weeks is normal, but shorter or longer periods are possible as well. Blood loss is often heavy with clots and in some cases (<1%) vacuum aspiration is needed to treat persisting heavy bleeding (incomplete abortion) and very rarely (0,2%) a blood transfusion is needed.   
In order to prevent an infection, do not have unprotected vaginal sex until the bleeding has stopped.   
Pregnancy symptoms, such as breast tenderness, will gradually disappear as your hormone levels normalize.

#### When to contact us

Don’t hesitate to contact us in case of fever lasting more than 6 hours (more than 100 ∞F or 38 ∞C) or in case heavy bleeding soaks through two full-size thick sanitary pads per hour for two consecutive hours.

#### Antibiotics

Prophylactic use of antibiotics is advised by some doctors to prevent an infection after a medical or surgical abortion. The doctor will discuss with you whether it is useful in your situation.

#### Check-up to confirm that the abortion is complete

Bleeding after using Mifespristone and Misoprostol does not necessarily signify that the abortion has occurred. A check-up is essential, preferably with a sonogram. The Women on Waves doctors can provide this service shortly after the abortion, or will advise you to contact a Family Planning service providing legal post-abortion care about two weeks later.   
As will be discussed with you, about 3% of the women do not abort spontaneously after using the medicines. In this case we strongly recommend a surgical evacuation (vacuum aspiration), since otherwise there is a slight risk of congenital abnormalities.

#### Vacuum aspiration treatment

In case of heavy bleeding or continuing pregnancy you might need a vacuum aspiration about which you will   
receive additional information and counseling.  
The doctor will insert a speculum in your vagina, disinfect the cervix and give local anaesthesia. This is usually not painful. After dilating the cervix the doctor inserts a thin plastic tube into the uterus which is then emptied with a pump. The procedure only takes a few minutes. Some women feel painful cramps, as during heavy menstruation, usually for a minute at the end of the treatment when the uterus is emptied and contracts. Afterward the nurse will bring you to a private space where you can lay down. If you feel well you can put on your clothes and the nurse will guide you back to the mess room. After about half an hour the nurse will check your blood loss.

#### Contraception

Women on Waves will provide you with information on contraceptives in order to help you prevent unwanted pregnancies in the future.  
\- Pill: you can start on the evening of the day of the abortion and they are available on board.  
\- Intra-Uterine Device (IUD): it is available on board and can be inserted immediately after the abortion procedure.   
\- Condoms: they are available on board.   
\- Information about alternatives such as diaphragms, hormone injections, implants and sterilisation