Termination of Pregnancy (Abortion)

The legal framework in Türkiye

Elective termination of pregnancy (commonly called abortion) is governed in Türkiye by Law no. 2827 on Population Planning. The law sets out two things: a time limit and consent requirements.

Time limit: 10 weeks

Under the law the womb may be evacuated on request, until the 10th week of pregnancy is complete, provided there is no medical objection in terms of the mother's health.

After 10 weeks

If the pregnancy is past 10 weeks, termination on request is not possible. After that point the law allows evacuation in only two situations:

• The pregnancy threatens, or would threaten, the mother's life
• It would cause severe disability for the child to be born and for the generations that follow

In these situations reports from two separate specialists are required: an obstetrician and gynaecologist and a specialist in the relevant field. The law requires those reports to be reasoned and based on objective findings — the decision is not made at the patient's request.

Emergencies

In emergencies where a failure to intervene immediately threatens life or one of the vital organs, the authorised doctor who establishes the situation carries out the necessary intervention and evacuates the womb. Here the law also places a duty to notify on the doctor: notification must be given to the relevant provincial health directorate before the intervention or, where that is not possible, within 24 hours at the latest.

Whose consent is required?

The consent rules are set out in article 6 of the law:

• An adult: the pregnant woman's own consent is required.
• Minors: both the minor's own consent and the guardian's permission are required. The guardian's permission alone is not enough.
• People under guardianship who are not adults or not of sound judgement: the consent of the person and of the guardian is required together with the permission of the magistrate.
• For a pregnant woman who does not have freedom of consciousness because of mental disability, her own consent is not sought.

Where, and by whom

The law states that termination of pregnancy is carried out under the supervision and inspection of the State, and adds that a pregnancy may not be terminated other than in the circumstances the law provides for. The places where the procedure may be performed, the health conditions those places must meet and their inspection are set out in a separate regulation.

Emptying the womb after a pregnancy loss

The section that follows describes a different subject: the emptying of the womb once a pregnancy loss has been confirmed. This is not an elective termination but the management of a pregnancy that has already ended.

The three options

When a pregnancy loss is confirmed there are three ways for the womb to empty: waiting, medical treatment and surgery. Guidelines require that all three be discussed and that the choice be made, on an informed basis, by the person themselves.

1. Waiting (expectant management)

In a confirmed pregnancy loss, the approach recommended first is to wait 7–14 days. The guideline also states that most women need no other treatment.

But waiting is not appropriate in every situation. In the following situations the other options should be considered:

• A high risk of bleeding — for example being towards the end of the first trimester
• A previous negative or traumatic experience relating to pregnancy — such as stillbirth, miscarriage or bleeding before birth
• Being vulnerable to the effects of bleeding — such as having a clotting disorder or not being able to receive a blood transfusion
• Signs of infection

If waiting does not feel right for you, medical treatment is recommended — you do not have to wait simply because it comes first.

What happens while waiting?

• You should be given verbal and written information about how the process will unfold, the use of painkillers and where and when to seek help in an emergency.
• If the bleeding and pain settling suggests that the process is complete, you are given a urine pregnancy test to do at home 3 weeks later. If the test is positive you are asked to be seen for individual assessment.
• If at the end of the period the bleeding and pain have not started at all (the process may not have begun) or are continuing or increasing (it may be an incomplete miscarriage), the ultrasound is repeated and the three options are discussed again.
• If you choose to go on waiting, your situation is reassessed at least 14 days after the first check.

2. Medical treatment

If waiting is not appropriate or acceptable, medical treatment is recommended. The approach differs according to the type of pregnancy loss:

• Where the pregnancy has stopped but the miscarriage has not started: two medicines are used — the second is given 48 hours after the first. If the pregnancy sac has already passed, this treatment is not needed.
• In an incomplete miscarriage: a single medicine is used as a single dose. The guideline states plainly that in this situation the first medicine (used in the other situation) should not be given.

What you need to know about medical treatment

• Painkillers and anti-sickness medicines are given as needed.
• You should be told how long the process will take, how much and how heavy the bleeding will be, the possible side effects such as pain, diarrhoea and vomiting, and when and how to ask for help.
• If bleeding does not start within 48 hours of the second medicine, you need to tell your health service.
• A urine pregnancy test is done at home 3 weeks later. If it is positive, assessment is needed to rule out pregnancy tissue remaining in the womb, a molar pregnancy or an ectopic pregnancy.
• If the test is negative but heavy bleeding continues, or there are other symptoms such as pelvic pain or fever, assessment is again needed.

3. Surgery

Where surgery is appropriate, the guideline requires that the person be offered a choice between two options:

• Manual vacuum aspiration carried out under local anaesthesia, in outpatient or clinic conditions
• A surgical procedure carried out under general anaesthesia in an operating theatre

In both cases verbal and written information should be given about the treatment options and what to expect during and after the procedure.

If there is bleeding but the pregnancy is continuing

Bleeding in a pregnancy inside the womb in which a heartbeat is seen does not always mean a miscarriage. The guideline's recommendations:

• In those who have not had a miscarriage before: if the bleeding increases or lasts more than 14 days, they should be seen for reassessment; if the bleeding stops, routine antenatal care continues.
• In those who have had a miscarriage before: micronised progesterone by the vaginal route is recommended. If a heartbeat is confirmed it is continued until week 16 of pregnancy is completed.