This is sometimes a difficult issue to deal with, but its important to think about it and be clear of the facts. Sometimes a contraceptive method can fail and you might find yourself having to face the prospect of abortion. An unplanned pregnancy for any girl or woman can be a turbulent and emotionally trying time. You're all clear in the head about having an abortion, and then suddenly the uterus jumps for joy and screams out "keep the baby". Now of course you can't always have the space to do that! It can be a tough haul, so make sure you have friends around who can help you through it. And the right information about abortion.

In India abortions are legalized and about 7 million induced abortions are carried out every year, but many of them in unsafe and unsanitary conditions putting women at a serious reproductive health risk. Because abortion is a taboo and secretive issue, it has led to the flourishing of unsafe and unqualified medical personnel. Many unscrupulous quacks and unregistered practitioners are on the prowl for uninformed and scared girls, and can put your life at serious risk if you are not careful. Here are some tips on choosing a legally qualified practitioner:

• You must look for a licensed clinic with a registered practitioner. The government provides a certification and you must look for it. Ask the doctor to see a copy of it yourself; it might be awkward to ask for it but remember what the stakes are
• Check the general cleanliness of the clinic
• The staff should be supportive and provide full and detailed information and counseling
• Make sure the doctor takes a record of your full family medical history
• Make sure the clinic has all the necessary equipment, not just for an abortion but also if complications arise

D & C (Dilation and Curettage): This is the most widely used method in India. It requires the dilation (expansion and widening) of the cervix and the scraping of the uterus with a metal instrument called a curette, to remove the embryo. This procedure is performed under general anesthesia, but can also be done under local anesthesia with pain medications as an outpatient procedure

Vacuum Aspiration: A vacuum source and suction is used to clear out the uterus. The vacuum source can be an electric pump or a hand-operated syringe. It is generally performed under local anesthesia coupled with pain medication, but general anesthesia might sometimes be recommended.

RU 486: These are pills taken orally followed two days later by a prostaglandin (a substance causing uterine contractions) as an oral tablet or a vaginal suppository (inserted into the vagina). The drug combination induces uterine bleeding and contractions to terminate the pregnancy. This is useful only in the very early stages of pregnancy and is a form of emergency contraception.

Dilation and Evacuation: This is considered the safest method for pregnancies in the second trimester (a trimester is three months) and uses a combination of dilation procedures vacuum aspiration and special forceps to evacuate the uterus. The procedure may be done over two or three days but an overnight hospital stay is rarely required. It can be performed under local anesthesia with a pain medication.

Late Term Procedures (Beyond 20 weeks): These are more complicated and are restricted in their usage under the law (Medical Termination of Pregnancy Act). It requires overnight hospitalization and uses a combination of different methods.

Some precautionary tips following an abortion:

• There may be some spotting or occasional bleeding following an abortion. This is completely normal, so carry a pad with you. If there is excessive bleeding speak to your physician.
• Take it easy for a few days after an abortion, to give your self-some emotional healing time, and also because you might feel weak or dizzy.
• Do not use a tampon immediately after an abortion. The cervix needs some time to heal so you can use tampons at your next period.
• Your next menstrual period should begin 30-40 days after the abortion. If it is delayed, speak to your doctor. In a very small percentage of cases the abortion might have failed so you might need to go in for another procedure.
• Most physicians recommend against sexual activity right after an abortion because conception might occur again and there is a risk of infection. More so, the body needs time to heal
• Finally, be informed about the risks of an abortion. You might experience some emotional trauma because of the circumstances of the unwanted pregnancy and its termination, the roles of family and your partner and your relationship with him. Also, in some cases, further pregnancies and possibilities of conception might be affected.

Adapted from Single in the City, The Independent Woman’s Guide, Penguin, New Delhi 2000.
www.plannedparenthood.org

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