Baby fetus abortion
Abortion | Pregnancy Birth and Baby
What is an abortion?
An abortion (or termination) is the medical process of ending a pregnancy so it does not result in the birth of a baby. Depending on how many weeks you have been pregnant, the pregnancy can be ended by taking medication or by having a surgical procedure.
An abortion is not the same as a miscarriage, where the pregnancy ends without medical intervention (although medical treatment may be needed after a miscarriage).
Why do women have abortions?
There are many reasons why a woman might choose to have an abortion. Deciding to have an abortion is a deeply personal choice and in many cases, a very difficult decision to make.
For example, the pregnancy may be unplanned and the woman’s personal circumstances might make it difficult or impossible to raise a child. These reasons could include financial considerations, being in an abusive relationship, where assault is involved, not being the right time, or the woman may not want to have a baby.
Some women may discover there is something wrong with their baby or that continuing with the pregnancy may put their own health at risk.
Whatever the reason a woman decides to terminate a pregnancy, the choice is hers to make.
When can I have an abortion?
There are 2 different types of abortion that you could have based on your stage of pregnancy. The earlier you talk to your doctor or clinic about having an abortion, the more choices you will have.
Surgical abortion
The most common type of abortion is a surgical procedure called a ‘suction curette’. This involves removing of the lining and the contents of the uterus by applying gentle suction to the inside of the uterus with a small plastic tube. Surgical abortion is a safe and straightforward day-surgery procedure most often performed in the first trimester (up to 14 weeks’ gestation). The procedure takes about 15 minutes, but you will need to be at the clinic or hospital for about 4 hours.
Medical abortion
A low-risk alternative to surgery used for terminating pregnancies earlier than 9 weeks (depending on the clinic) is a medication called mifepristone (RU486).
It is sometimes called ‘the abortion pill’ and is the most widely known medication used for this procedure. Medical abortion is a 2-stage process. The first stage involves taking a tablet that blocks the hormone necessary for the pregnancy to continue. This is followed 36 to 48 hours later by a second medication that causes the contents of the uterus to be expelled.
What is a 'late-term' abortion?
A late-term or second trimester abortion is when a pregnancy is terminated after 14 weeks. The process is similar to a surgical abortion, but instead of suction, instruments are used to remove the fetus.
You may need to travel interstate to have a late-term abortion since states and territories have different laws on how late an abortion can be performed.
Is abortion legal in Australia?
Abortion law in Australia varies across states and territories. Abortion is legal in all states and territories under certain circumstances and when it is done by a registered medical professional.
In most states and territories, it is illegal to protest within 150m of a clinic or service that provides abortions.
ACT
Abortion is legal and must be performed by a medical professional including a nurse.
New South Wales
Abortions can be performed at up to 22 weeks' gestation. After that, 2 doctors must approve the procedure.
Northern Territory
One doctor can approve and perform an abortion at up to 14 weeks. Between 14 and 23 weeks, a second doctor also needs to approve. After 23 weeks, an abortion can only be performed if the life of the woman is at risk.
Queensland
Abortions can be performed at up to 22 weeks. After 22 weeks, 2 doctors must approve the procedure.
South Australia
Abortions can be performed at up to 22 weeks and 6 days. Abortions performed after this time, must be approved by 2 doctors and only if they agree that the health or mental wellbeing of the woman is at risk, to save another fetus (multiple pregnancy) or the fetus has a serious abnormality.
Tasmania
Abortions can be performed at up to 16 weeks. After 16 weeks, 2 doctors must approve the procedure.
Victoria
Abortions can be performed at up to 24 weeks. After 24 weeks, 2 doctors must approve the procedure.
Western Australia
Abortions can be performed at up to 20 weeks. Termination after 20 weeks is very restricted.
How much does an abortion cost?
The cost of an abortion will depend on whether it is a medical or surgical abortion, how far along you are and whether you are using a public service or a private clinic.
Not all GPs can prescribe a medical abortion and not all chemists stock the medication required. Depending on where you live, you may need to go to an approved clinic or a hospital.
Hospitals and GPs may offer bulk billing or they may be partially covered by Medicare. For a private clinic, the consultation can cost several hundred dollars. The medication costs around $50, less if you have a healthcare card.
Surgical abortions cost around the same as a medical abortion, but this cost can vary depending on how many weeks along you are and whether you are a public or private patient.
Apart from the cost of the actual procedure, many women may need to travel to get an abortion. Termination services are not easily accessible in rural and remote areas and depending on the law in your state or territory, you may need to travel interstate to have an abortion.
Some clinics can offer medical abortion consultations via telehealth video call. Speak to your GP or clinic to find out if this option is available to you.
Can I get counselling before an abortion?
Yes, you can. Counselling is an important part of the decision making process when you are considering whether to have an abortion. You should understand all of your options and make the decision that is right for you.
Your doctor or clinic will talk to you about your choices and offer support services so you can talk to someone.
If you can, talk to family and friends, but you shouldn’t allow anyone else to pressure you. You should also make sure you seek advice and support from counselling services that will give you unbiased information and won’t try to talk you into making a decision that is not right for you.
When can I start contraception after an abortion?
After you’ve had an abortion, your normal menstrual cycle will resume. This means it’s possible for you to fall pregnant again. You should talk to your doctor or clinic about the best type of contraception to use.
How do I find an abortion clinic?
You can contact the Family Planning clinic in your state or territory. You can also use the Find a Health service or call Pregnancy, Birth and Baby on 1800 882 436 to get help finding a service near you.
How is the 'morning after' pill different from an abortion?
Emergency contraception, sometimes called the ‘morning after pill’, can be taken up to 5 days after having unprotected sex.
Unlike an abortion which ends a pregnancy, emergency contraception prevents a pregnancy from happening.
There are 2 types of medication available to prevent pregnancy in Australia. The levonorgestrel pill can be taken up to 72 hours (3 days) after unprotected sex. Ulipristal acetate (UPA) can be taken up to 120 hours (5 days) after unprotected sex. Both are available over the counter from a pharmacist without a prescription.
Australia has safe and supportive abortion and family planning clinics that can provide reliable advice.
To find these clinics, and for reliable, unbiased information about abortion in your state or territory, contact:
- Family Planning Alliance Australia
- MSI Australia
- Children by Choice (Queensland)
- 1800MyOptions (Victoria)
- NSW Pregnancy Options Helpline (1800 131 231)
You can also discuss your options with your doctor, or call Pregnancy, Birth and Baby on 1800 882 436 to speak with a maternal child health nurse for information and support.
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Abortion | The Embryo Project Encyclopedia
AbortionAbortion is the removal of the embryo or fetus from the womb, before birth can occur—either naturally or by induced labor. Prenatal development occurs in three stages: the zygote, or fertilized egg; the embryo, from post-conception to eight weeks; and the fetus, from eight weeks after conception until the baby is born. After abortion, the infant does not and cannot live. Spontaneous abortion is the loss of the infant naturally or accidentally, without the will of the mother. It is more commonly referred to as miscarriage. Induced abortion is the deliberate removal of a developing infant to end a pregnancy.
Induced abortion, known hereafter as simply abortion, has been practiced since before written history. Various ancient methods relied upon a number of different herbs to induce menstruation and expel the fetus.
Soranus, a child-bearing expert of the second century BC, recommended exercises such as horseback riding and carrying heavy loads, which would make a woman more likely to miscarry. If the pregnancy was not terminated after one treatment, others would be recommended. Today, in countries where abortion is legalized, there are several simple and standard medical procedures which end the pregnancy without extensive regimens.
Abortion was not illegal in the US until the 1880s, when a number of states passed stringent anti-abortion laws. These laws are often linked to the Comstock Laws of 1873, which made it illegal to distribute materials used for contraception or for abortion. Abortion remained illegal until the controversial but landmark Supreme Court case Roe v. Wade of 1973. This case legalized abortion under the premise that the decision to have an abortion was a protected right to privacy between a woman and her doctor. It also extended the circumstances in which abortion is permissible.
However the Roe v. Wade case gave the government continued permission to restrict or preclude abortion in certain situations.
Several techniques existed for performing an abortion at the time of Roe v. Wade. The dilation and curettage method, or the D&C, has been practiced since even before abortion was legalized in the US, and is now called the D&E, or dilation and evacuation. At one time a physician gradually enlarged the woman’s cervix by inserting a series of increasingly thicker rods, but now the cervix is dilated by administering medication. The physician then gently scrapes out the contents of the uterus using a spoon-like instrument called a curette. If performed early enough in the pregnancy, the woman is said to suffer little to no discomfort, but if performed later the procedure can result in menstrual-like cramps. The suction method is a similar procedure, and uses what is called a suction curette. The curette has an opening at the end attached to a drainage tube that leads to a collecting container.
The device works by vacuum pump and enables physicians to remove only the fertilized ovum and placenta, eliminating the possibility of pushing through the wall of the uterus—a risk of the D&C. It also results in less tissue being removed from the uterine wall, making it a safer procedure with less chance of affecting the woman’s future ability to conceive.
After the fourteenth week of pregnancy, scraping methods can no longer be used; instead the uterus must be induced to expel the fetus, resulting in premature labor. In the saltwater method, formerly used for this purpose, a needle is inserted through the abdominal and uterine walls and into the amniotic sac, the fluid-filled sac that supports the embryo in the womb. A portion of this amniotic fluid is removed; a saline solution is then injected between the uterine wall and the amnion, forcing their separation. After a day or so, contractions begin. The woman goes through labor and delivery to expel the fetus. This method can also be termed salt-poisoning, because the actual mechanism of death is theorized to be acute hypernatremia, or acute salt poisoning.
It may be that the death of the fetus is due to the high concentrations of salt injected into the womb, instead of the forced separation of the amnion from the uterus.
Today a woman can obtain a medication abortion or an in-clinic abortion. If a woman chooses to have an abortion at the clinic, a physician performs a D&E. The medication abortion can be administered up to sixty-three days (nine weeks) after a woman’s last period. At her first visit to the clinic, the woman is given the drug mifepristone, which blocks the hormone progesterone, causing the lining of the uterus to break down. Up to three days later, a second drug known as misoprostol is administered. Misoprostol causes cramping and bleeding as the contents of the uterus are expelled. Bleeding or spotting can last up to four weeks after a medication abortion. Follow-up appointments occur two weeks after the misoprostol is given to ensure that the pregnancy is terminated and that the woman is healthy.
Under the administration of George W.
Bush as US President, a federal ban was placed on late-term abortions. The Partial-Birth Abortion Ban Act of 2003 made it illegal to perform or obtain partial-birth abortions, or intact D&E. A partial-birth abortion involves partially extracting the fetus, until only the head remains in the uterus. The physician then punctures the skull, collapsing the fetal head. This is typically followed by suctioning out the contents of the fetal head, which results in the death of the fetus, and allows for an easier extraction through the cervix. This procedure was typically used after the second trimester of pregnancy, when other techniques could no longer be used. Congress passed bills banning partial-birth abortion twice during the Clinton Administration, but the president vetoed both bills. After the 2003 ban was signed by George W. Bush, several noteworthy cases went before the Supreme Court challenging the legality of the ban, but each time the court has narrowly (often 5-4) voted that the ban is constitutional.
There is a great amount of controversy over abortion in the US and elsewhere. Those who oppose abortion, known as pro-life or right-to-life advocates in the US, contend that life begins at conception, and that to deliberately end a pregnancy is murder and violates the rights of the unborn. Advocates for abortion have several different arguments. Some claim that abortion was banned as an attempt to control women’s reproductive rights, or that women ultimately have the right to make decisions about their own health, their bodies, and whether or not they wish to carry a pregnancy to term. Others base their opinions on the fact that abortions will occur whether or not it is legal; by legalizing abortion, the practices can be regulated and performed by knowledgeable, trained professionals, instead of by untrained practitioners—or even the women themselves.
- Baehr, Ninia. Abortion Without Apology. Boston: South End Press, 1990.
- Henderson, Meredith R. “Stenberg v.
Carhart: Partial-Birth Abortion Bans and the Supreme Court’s Rejection of the Methodical Erasure of the Right to Abortion.” North Carolina Law Review 79 (2000–2001): 1127–1154. - Kessler, Bruce. “Recent Development in Health Law: Select Recent Court Decisions: Abortion: Supreme Court Upholds Partial-Birth Abortion Ban Act Against Facial Challenge–Gonzales v. Carhart.” American Journal of Law and Medicine 33 (2007): 523.
- Law Library–American Law and Legal Information. “Comstock Law of (1873).” http://law.jrank.org/pages/5508/Comstock-Law-1873.html (Accessed December 6, 2009).
- Medical Encyclopedia. “Abortion: Partial Birth.” http://www.answers.com/topic/abortion-partial-birth (Accessed December 7, 2009).
- Planned Parenthood. “The Abortion Pill.” http://www.plannedparenthood.org/health-topics/abortion/abortion-pill-medication-abortion-4354.htm (Accessed September 23, 2009).
- Riddle, John M. Contraception and Abortion from the Ancient World to the Renaissance.
Cambridge, MA: Harvard University Press, 1992. - Saltman, Jules, and Stanley Zimering. Abortion Today. Springfield, MA: Charles C. Thomas, 1973.
- Silverthorn, Dee U. Human Physiology: An Integrated Approach, 4th ed. San Francisco: Pearson Education, 2007.
- Willke, John C., and Barbara H.Willke. Handbook on Abortion. Cincinnati, OH: Hayes, 1979.
Raup, Christina, "Abortion". Embryo Project Encyclopedia (2010-06-10). ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/1669.
Arizona State University. School of Life Sciences. Center for Biology and Society. Embryo Project Encyclopedia.
© Arizona Board of Regents Licensed as Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported (CC BY-NC-SA 3.0) http://creativecommons.org/licenses/by-nc-sa/3.0/
Abortion and its consequences
Home / Articles / Consequences of abortion
Every woman knows what an abortion is, but not everyone knows how to have an abortion, what are the indications and contraindications, the consequences.
An abortion is an abortion that occurs spontaneously or artificially for a period of up to 22 weeks with a fetus weighing up to 500 g. Why abortion is justified? Why create poverty? The pregnancy was the result of rape. Parents against the child or the husband says he will leave. If the mother can die in childbirth? If it is known that a sick child will be born? Parents are alcoholics. Other Reasons for Abortion... Pro-Abortion Slogans Every child should be wanted. Every woman has the right to control her own body. No one should impose his religious morality on others. Legalized abortion is safe. Abortion is not murder. the fetus is not human...
In the course of the process, abortions are distinguished:
· Spontaneous.
Artificial.
Spontaneous abortion is subdivided according to the period at which the pregnancy was terminated for various reasons:
1. Early spontaneous abortion - spontaneous abortion for up to 12 weeks.
2. Late - spontaneous interruption between 14 and 22 weeks.
3. Habitual - this is the name given to spontaneous interruption, repeated more than twice.
Artificial termination of pregnancy is also classified according to the conditions in which the manipulation was performed:
Safe abortion - performed in a specialized institution under the supervision of specialized specialists.
· Unsafe - performed under improper conditions, often by non-specialists. It is the manipulation in unsafe conditions that is the cause of postoperative complications, leading to sad consequences and ending in the death of a woman.
Interruption can be:
Medical.
Instrumental.
The instrumental solution, depending on the period and the chosen method of extraction, can be of the following types:
· Vacuum extraction - used in the early stages up to 12 weeks.
· Dilation, curettage - in its essence resembles the gynecological procedure of separate curettage performed quite often.
· Artificially induced labor - used later.
According to the peculiarities of the clinical course, abortions are divided:
Complete.
Incomplete.
· Failed.
· Launched, in progress.
Safe and unsafe abortions
Performing unsafe abortions is a rather complex and urgent problem of modern gynecology. Worldwide abortion statistics, according to WHO, show that despite the rapid development of modern medicine, the improvement and increase in the availability of medical care even in poor countries with low living standards, the annual number of unsafe abortions performed is more than 20 million cases. Of these, approximately 5 million end in bleeding, perforation of the uterus, septic complications, leading to the death of about 50 thousand women.
Even in developed countries, the mortality rate for women who have had unsafe abortions is 30 per 100,000 unsafe abortions. And for African countries, the rate reaches more than 500 deaths per 100,000 unsafe abortions.
The risk of complications from unsafe abortion increases progressively with increasing gestational age.
As a rule, the likelihood of such an abortion is higher with limited availability of safe abortion, the lack of proper educational activities and promotion of contraceptives as an alternative to artificial termination of pregnancy.
Indications
In order to perform a safe abortion in a specialized medical institution, as well as for any medical intervention, there are indications:
1. Conscious choice of a woman. Within a period of up to 12 weeks, the woman's right to choose whether or not to terminate a pregnancy is legally enshrined.
2. Statement as a result of the performed examination of intrauterine death of the fetus, pathological conditions of the fetus.
3. Unforeseen complications arising during pregnancy that endanger the woman's life.
4. Examination confirmed ectopic pregnancy.
5. Critical changes in a woman's health that require immediate intervention, not directly related to the course of pregnancy: the need for organ transplantation, chemotherapy, radiation treatment in connection with an oncological disease detected during pregnancy.
It should be noted that the described clinical situation is not an absolute indication for abortion. In all the cases described, the desire and the right are taken into account
women to continue their pregnancy, despite the high risk of fatal outcomes for both mother and child.
6. Legal aspect, which consists in the right to terminate a pregnancy resulting from rape for up to 22 weeks.
Contraindications
General relative contraindications are:
Acute inflammatory, infectious diseases of the genital tract.
Diagnosed ectopic pregnancy.
· More than 12 weeks. The exception is the need to perform manipulations for medical reasons.
· The presence of Rhesus conflict during the first pregnancy.
Before an abortion is done, there is a mandatory mandatory list of examinations.
Medical termination of pregnancy
WHO recommends the use of medical termination of pregnancy up to 9 weeks of pregnancy, but not more than 49 days after the last menstrual bleeding.
The indications for this type of abortion are:
The desire of the woman. (provided that the term allows the use of this method).
· Presence of medical indications identified before the specified date.
Contraindications are:
Intolerance to drugs.
Ectopic pregnancy.
Serious concomitant pathology in the acute phase, violation of the rheological properties of the blood.
Manipulation is carried out in a specialized institution, under the supervision of a specialist. As a rule, it does not require a woman's inpatient stay; medication can be taken on an outpatient basis.
Hospitalization is required in case of complications:
1. In the event of bleeding requiring urgent attention.
2. Incomplete abortion.
3. With the appearance of severe adverse reactions in the form of manifestations of allergies, dyspeptic disorders, uncontrollable vomiting, diarrhea, fever.
The effectiveness of medical interruption is from 92 to 98%.
When prescribing this method of terminating an unwanted pregnancy, an important psycho-emotional factor should be taken into account: the drug effect is psychologically much easier for women than the use of instrumental methods.
Vacuum suction
Applies to instrumental methods. It is the WHO recommended way to safely terminate a pregnancy up to 12 weeks.
The effectiveness of this method is almost 100%, and the probability of complications according to statistical data does not exceed 0.1%.
Indications for vacuum aspiration are:
The patient wishes to terminate the pregnancy up to 12 weeks.
Incomplete abortion after a previous medical abortion.
Medical indication for termination before 12 weeks of pregnancy.
The procedure is performed in a specialized gynecological facility. Most often outpatient. Local anesthetics are used to relieve pain during the procedure.
Complications are:
· Uterine bleeding requiring surgical intervention if it is impossible to stop conservatively.
· Incomplete abortion - when it is impossible to perform ultrasound control after incision.
· Dizziness, nausea, vomiting, signs of severe weakness - are temporary, do not significantly affect long-term effects.
It is important to remember that after vacuum aspiration it is necessary to maintain sexual rest for at least 2-3 weeks.
Instrumental abortion (curettage)
Until recently, this was the only way to terminate an unwanted pregnancy.
Indication:
· To date, this method of interruption is used for periods of more than 12 weeks, solely taking into account medical indications.
In case of incomplete aspiration after minimally invasive manipulation, when visualizing the residual tissue of the fetal egg during ultrasound examination of the uterine cavity.
Requires a gynecological hospital for operating conditions. It is performed under general intravenous anesthesia.
The mechanism of abortion (curettage) is similar to separate curettage performed for diagnostic purposes: through the open external os and cervical canal, the entire functional layer of the uterus with the fetal egg is scraped out with a special tool (curette).
Complications are:
Uterine bleeding.
Injury to the walls of the uterus, perforation of the uterus, damage to the mucous membrane of the cervix with subsequent development of erosions.
· Occurrence of inflammatory processes in the organs of the reproductive system.
Artificial induction of labor
Performed at a later date. In essence, it is an abortion, but with significant differences:
· The presence of exclusively medical indications: a statement of the fact of intrauterine death of the fetus, the identification of severe anomalies in the development of the child incompatible with life.
· Pregnancy complications, identified severe pathology in the mother, requiring immediate treatment, entailing the possibility of fatal consequences for the mother.
Long-term consequences of abortion
The consequences of abortion are divided into:
· Early. These are early postoperative complications.
Remote.
It must be understood that termination of pregnancy in the absence of early complications does not mean at all that abortion is a harmless procedure that does not affect the body.
Long-term effects are:
1. Disturbances in the hormonal balance of the body, manifested by cycle disorders.
2. Occurrence of tumor formations of mammary glands.
3. Tumor and pre-tumor background diseases of the female reproductive organs.
4. Chronic inflammatory diseases of the pelvic organs.
5. Occurrence of adhesive process in the small pelvis.
6. Infertility.
7. Psycho-emotional trauma, experiences. 8. Psychological consequences of abortion
Abortion leaves a mark not only on the body, but also on the soul of the mother. Women who have had an abortion are haunted by painful experiences that can lead to suicide. The psychological consequences of abortion are called "Post-abortion syndrome"...
9. Memories of women who have had an abortion If you want to have an abortion, listen to women who have already had it.
Perhaps you are not fully aware and do not know what you can expect after an abortion...
Of course, the right of every woman to decide whether to continue or terminate a pregnancy. Making a decision should involve a calm and balanced analysis of all the pros and cons.
Abortion and its consequences
Abortion and its consequences.
The issue of termination of pregnancy at the request of a woman remains relevant for modern Russia. In the Komi Republic, only 60% of pregnancies end in childbirth, while the birth rate in the republic is declining.
Unwanted pregnancy is always a high risk of unsafe abortion and maternal death. Unfortunately, pregnancy does not always occur at the moment when it is realized and desired.
In some cases, the measure of abortion is forced. For example, if the health of the mother does not allow a healthy fetus to be born; there are fetal malformations that are incompatible with life; had a spontaneous abortion ("miscarriage").
According to the Federal Law of the Russian Federation No. 323 - FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", a woman is given a waiting time to make a decision to terminate a pregnancy: weeks, but no later than the end of the twelfth week of pregnancy;
2) not earlier than 7 days from the date of application for a period of 8-10 weeks of pregnancy.
There are currently three types of artificial termination of pregnancy.
1. Medical abortion.
Medical abortion is the safest abortion technology available today. It does not imply surgical intervention, which women are so afraid of. With medical abortion, patients take drugs orally according to a certain scheme.
Terms of termination of pregnancy in medical abortion up to 9 weeks of pregnancy.
2. Vacuum abortion.
This type of abortion is often referred to as a "mini-abortion". It is believed that after a vacuum abortion, the female body recovers faster than after a surgical one.
With a “mini-abortion”, medical intervention is carried out in the uterine cavity using special equipment (vacuum aspirator).
Terms - up to 20 days of delayed menstruation (5-6 weeks).
3. Surgical abortion.
Is the so-called "classic" abortion, which is also popularly called "curettage". It is considered the most dangerous of all, as it can lead to catastrophic consequences. This type of abortion is especially dangerous for primigravida, young girls - there is a risk that after such an abortion they will not be able to have children in the future.
Possible complications during abortion:
- Heavy bleeding requiring surgery.
- Major haemorrhage requiring a blood transfusion.
- Injury to the cervix.
- Uterine perforation.
If these complications occur, surgical treatment may be suggested.
Possible complications after abortion:
- Infection.
Taking antibiotics can reduce the risk of this complication. If left untreated, women at risk may develop a severe infection (acute pelvic inflammatory disease). - Having a chlamydial infection before an abortion increases the risk of salpingitis (“inflammation of the uterus”).
- Secondary infertility.
- Incomplete abortion requiring additional emptying of the uterine cavity by vacuum aspiration.
- Increased future risk of preterm birth.
Any abortion leads to a change in the hormonal background in the female body. This leads to the development of gynecological diseases, weight gain, metabolic disorders.
Finally, one cannot ignore the psychological consequences of abortion. This is especially true for young girls, for whom an abortion can be a real shock. In this case, psychologists talk about the "post-abortion syndrome", which is characterized by severe depression and stress.
Timing of starting contraception after an abortion.
